Method of treating metabolic syndrom
SUBSTANCE: invention refers to medicine, namely therapy and surgery, and can be used for treating metabolic syndrome, including in patients suffering cardiovascular and respiratory insufficiency, and also obstructive sleep apnea. That is ensured by brief noninvasive continuous positive pressure assisted ventilation for 3 days (CPAP-therapy). The compensation is followed by inserting an intragastric cylinder and continuing the long-term CPAP-therapy to eliminate sleep apnea completely.
EFFECT: method provides compensating metabolic syndrome by manifested body weight reduction ensured by enabled insertion of the intragastric cylinder together with a reduced risk of developing complications accompanying the insertion due to the advance compensation of the detected disorders.
1 ex, 4 dwg
The present invention relates to medicine, in particular to abdominal surgery, gastroenterology, endocrinology, sleep, and may be used to treat metabolic syndrome.
Metabolic syndrome is a combination of various disorders and/or diseases that are risk factors for the early development of atherosclerosis and its cardiovascular complications. (Ivan Dedov, Gasolinetm "Obesity". - Medical news Agency, Moscow 2004. P.44-77, 272-311). Main symptoms and signs of metabolic syndrome are:
- abdominal-visceral obesity
- insulin resistance and hyperinsulinemia
- arterial hypertension
- impaired glucose tolerance / diabetes mellitus type 2
- early atherosclerosis / TBS
- hyperuricemia and gout
- liver steatosis
- obstructive sleep apnea.
There are medical methods of treating obesity using, for example, preparations of sibutramine (meridia firm Abbott Laboratories, USA) and orlistat (xenical companies F.Hoffman-La Roche Ltd., Switzerland). (Ivan Dedov, Gasolinetm "Obesity". - Medical news Agency, Moscow, 2004. S-406). In patients with severe obesity effectiveness of conservative treatment does not exceed 5-10%. (Wiesco "the surgical treatment of obesity". - Air Art, Moscow, 2004, P.9).
The known method of non-drug treatment of metabolic syndrome, namely, that patients spend 10-12 holistic treatments lasting 40-50 minutes. Treatments include simultaneous effects dosage systemic hyperthermia body mode dry sauna with a gradual increase in temperature up to 50-80°C, with subsequent reduction to 35°C by the end of the procedure, hardware vibrating massage of the back and lower extremities, aromatherapy and hypoxic-gipertoksicheskaya inhalation through the mask. Each inhalation consists of 5-7 cycles, consisting of a period of breathing a hypoxic mixture with 11% O2changing breathing gipertoksicheskaya mixture with 30% O2, the length of which is adjusted individually. Inhalation of hypoxic gas mixture continues until the individual minimum level of blood oxygen saturation or individual maximum heart rate and 1 minute after that hypoxic mixture replace gipertoksicheskaya to restore the original settings (patent RU 2391121, 2010).
There is a method of treatment of metabolic syndrome, characterized by the fact that the conduct of hypoxic-gipertoksicheskaya inhalation exposure to oxygen at a concentration of 10-14 and 87-93%, with the duration with the NGOs, 3-4 and 1-2 minutes while conducting vibration impacts from 20-200 Hz frequency and temperature effects in the mode of dry saunas from 35 to 82°C for 30-45 minutes Also conduct local aeroionotherapy with the concentration of positively charged ions (O3+WITH+750 units/cm3and more and negative ions (O2-N2-) 650 units/cm3and more music and effects in the range of 4-12 cycles/minute (patent RU 2398562, 2010).
There is a method of treatment and/or prevention of overweight and/or obesity and/or metabolic disorders, which is that elaborate on the causes of excess weight through the study of polymorphism of genes selected from the range: LPL, GREL, INS, FABP2, ADRb3, the choice of diet, exercise and pharmacotherapy, depending on the options identified polymorphism (patent RU 2403038,2010 year).
The least invasive intervention even if morbid obesity is the introduction into the stomach of a silicone container, the method was developed F.C.Gau in 1986 (SCI Sedlec "Modern methods of treatment of obesity". - ALBI-Petersburg, Saint-Petersburg 2007, S-250). Installation of intragastric balloons can be used as an independent treatment, and as a preparatory step to more complex interventions (Ihateyou, Eueka Endoscopic interventions in the treatment of the AI alimentary constitutional obesity". - VITA Press, Moscow, 2003, ñ.38-45). Loss of excessive body weight with this method of treatment may vary from 3-4 up to several tens of kilograms, and on average, patients lose about one-third of overweight (Wiesco "About surgical methods for the treatment of obesity". - Air Art, Moscow, 2004, p.12-16). However, this method has several disadvantages: first, it largely does not eliminate the symptoms associated diseases immediately after installation, in particular obstructive sleep apnea (OSA). Secondly, you need some time to compensate for associated syndromes and diseases that it is not always possible to achieve. Thirdly, after this method, the part of the patients are not satisfied with the treatment results. Fourth, when unsatisfactory results requires the use of more complex methods of treatment (operative methods - banding, gastroenterologie, biliopancreatic bypass). Fifthly, in severe condition of the patient with heart failure on the background of many comorbidities, the risk of installation intragastric balloon dangerous and necessary preliminary preparation.
One of the components of the metabolic syndrome is a syndrome of obstructive sleep apnea (OSA), which often depends on the severity of condition of patients with meta is aliceson syndrome. In severe forms of OSA may be up to 400-500 stops breathing during the night for up to minutes or more (for a total of up to 3-4 hours per night!), which leads to acute and chronic lack of oxygen during sleep. And this, in turn, significantly increases the risk of developing hypertension, cardiac arrhythmias, myocardial infarction, stroke and sudden death during sleep (Rvenues, Ivehad "Snoring and obstructive sleep apnea", Moscow, 2010, p.76).
The prototype of the invention is a method of treatment of obesity in patients with severe OSAS, including the use of non-invasive assisted ventilation continuous positive pressure (in English literature method is called CPAP - abbreviation of words Continues Positive Airway Pressure) and xenical (buzunov RV Doctoral dissertation: "the Syndrome of obstructive sleep apnea in combination with obesity: pathogenesis, diagnosis and treatment", 2003).
However, this method has the following disadvantages. Firstly, it is not possible to considerably reduce the weight, as it is proved that all conservative methods lead to weight loss not more than 5-10%. Secondly, there are side effects of xenical, in the form of laxative in violation of the diet, flatulence and bloating. Thirdly, there is a need constantly the first dose. Fourthly, is not observed more significant compensation components of the metabolic syndrome.
The technical result of the invention is the compensation components of the metabolic syndrome, due to the short 3-day initiation and subsequent combination of long-term CPAP therapy and intragastric ballinrobe.
The proposed method is as follows. Produce patient survey, survey, survey for the presence of metabolic syndrome and its components, as well as their severity and gravity. Sick set at night in home diagnostic equipment, respiratory diagnostic apparatus (for example, ApneaLink, Australia). The next day, decode the data and make a conclusion. When detecting moderate and severe OSAS, obesity 2-3 degrees and decompensation of cardiac and respiratory failure, which does not allow the procedure gastroduodenoscopy due to the severity of the condition, conduct initiation (short-term) CPAP therapy for the preliminary preparation of the patient for gastroduodenoscopy and installing intragastric balloon (for example, a device with automatic adjustment of therapeutic pressure in real-time Auto-CPAP SOMNOBalance e company Weinmann, Germany). After 3 days of th the short term eliminate sleep apnea compensate for cardiac and respiratory failure, improve the General condition, which allows the procedure gastroduodenoscopy, installs intragastric balloon, for example, firms Gamed, Russia (Ihateyou, Eueka Endoscopic interventions in the treatment of alimentary constitutional obesity". - VITA Press, Moscow, 2003, ñ.38-45) and continue long-term Auto-CPAP therapy to completely eliminate sleep apnea.
The advantages of this method are:
1. Effective elimination of components of the metabolic syndrome.
2. Identify the steps in the treatment of metabolic syndrome.
3. Pre-preparation of the patient for Auto-CPAP-machine before installing intragastric balloon for eliminating chronic oxygen and heart failure.
4. Set the container in a more favorable time, with less risk of complications.
5. There is long-term Auto-CPAP therapy apparatus for the treatment of obesity gastric balloon. The invention is illustrated by the following figures: figure 1 shows the photo of the patient before treatment; figure 2 - photo of the patient after 6 months of starting treatment; figure 3 - the conclusion of respiratory diagnostic apparatus ApneaLink (Australia); figure 4 - 3 minute scan night's sleep, graphic pre is the submission of the results of respiratory diagnostic apparatus ApneaLink (Australia).
Below is an example of the clinical use of the proposed method.
Patient Century. 53 years, Volik I. 52 years, the case history No. 8022, enrolled in a planned manner with complaints of weight gain, increased blood pressure, restless sleep because of breathing during sleep, snoring, shortness of breath with minimal exertion, pain in the cervical and lumbar spine, a feeling of inferiority due to limitation of physical activity, swelling in the legs and lower abdomen, daytime sleepiness and drowsiness in the management of transport (fell asleep standing, sitting and driving, 4 times was in an accident), disabled. From the anamnesis: Excess weight about 15 years. There have been attempts to weight loss diets, method of Parmentola, Badami, xenicalcom, meridia, weight decreased a maximum of 31 kg 6 years ago on the background of physical activity and diet, and in the subsequent rebound was observed weight gain. Maximum weight of 151 kg currently. Physical activity currently minimal. Patient notes: increased appetite, intake of food 5-6 times, the main meal in the evening, frequent snacking, consume fatty and high-calorie foods, which confirms the nutritional nature of obesity. In the history of diabetes about 3 years with micro macroangioapthy, hypertension 2 tbsp., 2 tbsp., risk 3, CHD angina, syndrome Pickwick is, metabolic syndrome, fatty infiltration of the liver to increase its size, osteochondrosis of the cervical and lumbar spine. The patient is incapacitated.
Objectively: the State of moderate severity, clear consciousness. Skin normal color. In the lungs breathing weakened, holding, harsh, wheezing no. BH - 18 minutes muffled heart sounds, rhythmic. AD-140/90 mm Hg, heart rate of 68 beats per min. Language damp, clean, damp. Abdomen enlarged, rounded, palpation of soft, painless swelling of the anterior abdominal wall to the level of the navel. Waist 145 see Peritoneal signs. Liver, spleen not enlarged. Symptom tapping negative on both sides. Chair regular. Diuresis in normal. There is swelling on the lower limbs and lower abdomen to the navel, due to heart failure. The examination of the physician: the Metabolic syndrome. Alimentary-constitutional obesity 3 tbsp. CEH. Hypertension 2 tbsp., 2 tbsp., risk 3, Hsnb-3, FC, HDN. Diabetes mellitus type 2, subcompensated. The Syndrome Piquia. Obstructive apnea during sleep, severe form.
Inspection of endocrinology: diabetes mellitus, cf. gravity, subcompensated. Metabolic syndrome.
The ECHO-KG: Seal the walls of the aorta. Moderate symmetrical hypertrophy of the LV walls. Asynergia annuals. Reduce reduce the Inoi ability LV. Fibrogastroduodenoscopy: Atrophic hypertrophic gastritis.
Ultrasound: Diffuse changes of a parenchyma of the liver, pancreas, increasing its size. Nephroptosis on the right. Chronic acalculous cholecystitis. The tendency to splenomegaly.
R-gram skull: diseases of the bones of the skull are not detected.
R-gram AGR: Pathology was not detected.
Immunoreactive insulin: 15,95 ng/ml Rate of 1.9-23
The glycosylated hemoglobin: 6,0 from 19.02.10 and 7.8 from 3.03.10
Blood sugar capillary 7.7 mmol/l from 3.03.10
B/X: Glucose: 8.1 mmol/l, protein 78 g/l, Ob/b 13,0, MCOL/l, creatinine 109 µmol/L.
Lipid profile: Total cholesterol: 6.6 mmol/l (3,3-5,2). About. Triglycerides 2.7 mmol/l (0.5 to 1.7 norm), Gepvp to 0.92 mmol/l (1,03-1.55V), Allpop of 1.23 mmol/l (0.1 to 0.4), LPNP 4.2 mmol/l (0,0-3,9), atherogenic Index of 5.9.
Triglycerides: fibrinogen 2.4 g/l, PETIT 98%, thrombin time is 12 sec, APTT 32 sec.
OAK: HB-161 g/l, er. - 5,15×1012the hematocrit of 51.7%, lake. and 8.6×109; ESR - 14 mm/h, blood clotting in min Sukhov 3.15 min, platelet - 194×103/L.
OAM: VC., pet., 1025, sour., protein to 0.055 g/l, epit. Lane 1-4-3 7-10-9 in p/C, lake. 5-5-7 and p/C, ACS++.
The HIV antibodies were not detected. Blood on HBS Ag and AHCV - negative. Blood for syphilis - negative.
The somnologist: obstructive sleep apnea, a severe form. The risk of developing cardio-vascular disorders and sudden death in dream high. (Registered with the 451 episode of apnea and 73 episode of obstructive hypopnea Genesis. Index apnea+hypopnea=97 per hour at the rate not exceeding 5 per hour. The duration of apnea and hypopnea from 11 seconds to 64 seconds. During the study were recorded intermittent snoring - 885 episodes).
Weight: 151 kg Height: 181 see BMI: 46,1. Excess body weight: 78 kg In a given patient has the following components of the metabolic syndrome:
- abdominal-visceral obesity
- arterial hypertension
- diabetes mellitus type 2
- obstructive sleep apnea
- steatosis of the liver.
On the basis of complaints, anamnesis, objective data diagnosed with Metabolic syndrome. Alimentary-constitutional obesity 3 tbsp. Sugar type 2 diabetes, subcompensated. Hypertension 2 tbsp., 2 tbsp., risk 3, Hsnb-3, FC, HDN. The Syndrome Piquia. The syndrome of obstructive sleep apnea, a severe form. Microalbuminuria. Due to the severity of the condition, the presence of severe comorbidities, decompensated heart and respiratory failure, which does not allow you to produce the procedure of gastroduodenoscopy at this time, the patient is recommended: initiate Auto-CPAP therapy followed by long-term treatment apparatus with automatic tuning of therapeutic pressure in real time SOMNOBalance e company Weinmann, Germany. After a short, 3-day, the mouth is anemia sleep apnea, compensate for cardiac and respiratory failure, improve the General condition, which allows the procedure gastroduodenoscopy, installed intragastric balloon company Gamed, Russia. Made diagnosis of obstructive sleep apnea with respiratory diagnostic apparatus ApneaLink, Australia. Revealed severe OSAS index, apnea-hypoapnea - 97. Configured and installed Auto-CPAP machine with automatic tuning of therapeutic pressure in real time SOMNOBalance e company Weinmann, Germany. After 3 days the index, apnea-hypoapnea 1,6, withdrew a wheeze. On the 4th day after normalization of the total state compensation cardiac and respiratory failure were gastroduodenoscopy and installation of the intragastric balloon company Gamed (Russia) according to a typical method. 3 day training allows you to compensate for cardiac and respiratory failure and without threats to the life of the patient to perform the procedure gastroduodenoscopy and beyond, keeping time to start the treatment of obesity using intragastric ballinrobe and to achieve a greater reduction of body weight, in contrast to monotherapy by any of the existing conservative methods of treatment of obesity.
The postoperative period was uneventful.
After 7 months: decrease of body weight of 48 kg, stopped apnea and snoring, indec the apnea-hypoapnea for the last 42 of the night was 1.8. The patient is satisfied with the comfort and diet. Not observed significant episodes of apnea and snoring. No shortness of breath and swelling in the legs. When instrumental and laboratory examination performance within normal limits. Improved quality of life. The patient works in production. Leads an active lifestyle.
Objectively: the patient is in satisfactory Condition, clear consciousness. Skin normal color. In the lungs vesicular breathing, wheezing no. BH - 18 minutes muffled heart sounds, rhythmic. BP-120/80 mm Hg, pulse rate is 60 beats per minutes Language clean, damp. Abdomen slightly increased in size, palpation of soft, painless. Waist 96 see Peritoneal signs. Liver, spleen not enlarged. Symptom tapping negative on both sides. Chair regular. Diuresis in normal.
Therapist examination: IHD. Angina FC 1. Complete blockade PNPG.
B/S: protein of 71.7 g/l, Ob/b 13,2, MCOL/l, creatine 105 µmol/l, urea of 5.1 mmol/l, was. Phosphatase 78,3 ed, ACT 35,7 u/l, ALT 29,7 u/l uric acid 303 mmol/L.
Blood sugar capillary 3.8 mmol/l, without sugar-lowering drugs. Lipid profile: Total cholesterol: 5,1 (6,6) mmol/l (3,3-5,2). About. Triglycerides 2,1 (there were 2.7) mmol/l (0.5 to 1.7 norm), Gepvp 1,04 (0,92) mmol/l (1,03-1.55V), Allpop 0,96 (1,23) mmol/l (0.1 to 0.4), LPNP 3,1 (4,2) mmol/l (0,0-3,9), atherogenic Index of 3.9 (5,9).
OAK: NV - 128 g/l, er. and 4.4×1012, CP 0,8, lake. of 6.1×109; ESR - 26 mm/h
St. minutes Sukhov 3.40 min, platelet - 245×103 /L.
OAM: VC., pet., 1030, sour., protein neg., epic. Lane 1-4-3 7-10-9 in p/C, lake. 8-7 in p/C, ACS+.
The patient had grade 3 obesity, currently obesity 1 degree, compensated cardiac and respiratory failure, compensated carbohydrate and lipid metabolism, normalized blood pressure, withdrew sleep apnea, when managing transport no drowsiness (fell asleep standing, sitting and driving, 4 times was in an accident), improved quality of life, has recovered capacity, works for a well-paid job, leads an active lifestyle.
Components of the metabolic syndrome in 7 months:
- abdominal-visceral obesity - improvement (waist size was 145 cm, was 96 cm)
- dyslipidemia - improvement to normal
- arterial hypertension - blood pressure lowering, the abolition of anti-hypertensive drugs
- diabetes type 2 - without lowering medications indicator of glucose 3.8 mmol/l
- obstructive sleep apnea - complete elimination of snoring and significant sleep apnea on the background of CPAP therapy, the index of apnea/hypoapnea 1,6 per hour (at a rate of up to 5).
- microalbuminuria - no protein in the urine
- hepatic steatosis - improved ultrasound indications
On the basis of the years of complaints, anamnesis, objective data, diagnosed with Alimentary-constitutional obesity 1 tbsp. Metabolic syndrome. Diabetes mellitus type 2, compensation. Hypertension 2 tbsp., 2 tbsp., risk 3. The syndrome of obstructive sleep apnea, severe, offset against the background Auto-CPAP therapy.
From surgical treatment biliopancreatic bypass patient is refrained.
Intragastric balloon is removed under endotracheal anesthesia in 7 months. The postoperative period was uneventful. One month after removal of the intragastric balloon weight decreased to 100 kg Is dynamic observation of the patient.
Thus, the application of the proposed method for the treatment of metabolic syndrome allows in a short time to prepare the patient for the procedure gastroscopy and installation of intragastric balloon, to carry out comprehensive treatment in severe conditions
to achieve significant results in the reduction of body weight, improve flow and to compensate for components of the metabolic syndrome.
A method of treating metabolic syndrome, including short-term noninvasive assisted ventilation continuous positive pressure (CPAP-therapy) with subsequent long-term CPAP therapy, characterized in that after 3 days short of eliminating sleep apnea is avodat installation intragastric balloon.
SUBSTANCE: invention refers to medicine, namely to anaesthesiology and resuscitation, and can be used if placing of a flexible reinforced laryngeal mask airway required. That is ensured by preoxygenation through a face mask for two minutes. Then a patient is placed in a "sniffing" position with a head supported by a cotton roll. The laryngeal mask airway is placed with its aperture upwards and arranging a mask tip on the centre of front incisors on an internal surface of a patient's mouth with pressing it to a hard palate with a third finger. After that, the mouth cavity is examined, and the LMA is moved downwards with pressing within a tube and mask junction to enable the mask passing near a tongue and falling in a pharynx. If observing resistance behind the tongue, the mask is turned around 90° with the aperture to the left and placed back into the initial position after passing the obstacle. Mask cuff is inflated with making sure that a black line is directed backwards and found in the middle.
EFFECT: method allows providing easy placing of the laryngeal mask airway with simultaneously reduced risk of hypoxia and laryngopharynx damages during mask placing.
7 tbl, 2 ex
SUBSTANCE: invention relates to medicine, specifically to influenza medicine, and can be used as individual protection of respiratory organs of humans and animals against airborne viral and bacterial infections. Personal protection from viral infection includes the input layer of the filter, the light-emitting diodes located outside inhalation area behind the front surface of the input layer of the filter; the light-emitting diodes light is directed toward the location of the inhalation area. The selected emission spectrum is fatal to the virus. LEDs Housing has a shaped location plate made with the lodgment, the concave shape of which is oriented toward the inhalation area. On the opposite side of the LEDs (opposite to inhalation area) outside the inhalation area there are reflectors each facing their concave surface towards its radiator, LED. The interior surfaces of lodgments and reflectors have high reflectance in the radiation area.
EFFECT: invention provides a high degree of protection from disease-causing viruses that cause influenza, such as swine influenza H1N1, by destroying these viruses.
15 cl, 2 dwg
SUBSTANCE: invention relates to medicine, namely to rehabilitology, and can be applied for non-drug treatment of metabolic syndrome. For this purpose patients are given 10-12 complex procedures with 40-50 minute duration. Procedures include simultaneous impact with dosed systemic body hyperthermia in conditions of dry sauna with gradual temperature increase to 50-80°C with its further decrease to 35°C by the end of procedure, apparatus vibration massage of back and lower extremities, aromatherapy and hypoxic- hyperoxic inhalations through the mask. Each inhalation consists of 5-7 cycles which include period of breathing with hypoxic mixture with 11% O2, followed by breathing with hyperoxic mixture with 30% O2, whose duration is selected individually. Inhalations with hypoxic gas mixture are continued until individual minimal value of level of blood saturation with oxygen or individual maximal value of heart beat rate is reached, 1 minute after it hypoxic mixture is replaced with hyperoxic mixture until initial values of parametres are restored.
EFFECT: said mode of complex physiotherapeutic procedures including individual selection of dosage of hypoxic and hyperoxic inhalations duration ensures increase of treatment efficiency due to synergetic action of therapy components.
SUBSTANCE: for treatment patients with hypogonadism with obstructive sleep apnea syndrome before substitutive therapy with androgens CPAP- therapy is carried out. After that CPAP- therapy is realised simultaneously with therapy with testosterone medications until its normal level is recovered.
EFFECT: method allows to carry out substitutive therapy of hypogonadism in patients with syndrome of obstructive sleep apnea, who have relative contraindications to administering androgens.
3 cl, 3 tbl, 1 ex
SUBSTANCE: invention concerns medicine and can be used in treating the diseases accompanied with chronic tissue hypoxy. That is ensured by breathing of hypercapnic respiratory mixture created by the patient by mixing the proper exhaled and atmospheric inhaled air in a respiratory device representing a mixing chamber mask of capacity 0.8 litres. A mask is put on to the patient's face with embedding nose, mouth and chin and fixing so that to ensure free breathing, and adjusting the gaps the face and mask, herewith preventing air drags. A mask is individually matched for each patient depending on the rest exhalation volume. Its capacity shall be 100-150%, and dimensions shall not impede sight and head movements of the patient. The mask breathing is continuous to enable normal ventilation indicated by improved health state and achieved time of after-exhalation rest breath-holding 40-60 seconds.
EFFECT: method allows for considerable reduction of chronic tissue hypoxy due to continuous inhalation of the hypercapnic mixtures regardless of the environment.
SUBSTANCE: invention concerns medicine, namely anaesthesiology, and can be used as anaesthetic means in laparoscopic gynaecologic operations in women of reproductive age. It is ensured by spinal anaesthesia that is followed by sedation with midazolam and propofol, and laryngeal masking ProSeal. Thereafter carbodioxyperitoneum is formed, while the patient is moved in Trendelenburg's position.
EFFECT: method allows providing adequate anaesthesia both in ALV and assisted respiration conditions without using muscle relaxants and narcotic analgesic with minimising the negative effect of intraabdominal hypertension owing to carbodioxyperitoneum.
2 tbl, 1 ex
FIELD: medical equipment.
SUBSTANCE: invention is intended for application in drug administration under pressure, e.g. in aerosol drug administration system. In one version, face mask includes at least partially deformed case with surface contacting patient's face, nose bridge zone made in the upper case part, lower bent section where part of case is bent for positioning over face, and two holes in eye area at different sides of nose bridge. When the mask is placed over patient's face, the holes can be positioned over patient's eyes. Case is shaped so as the lower bent part is at least partially creased when mask is placed over face, and eye holes can form gap remaining open between internal edge of the hole and face part below eyes to provide outlet for mask placed over face with at least partial crease of lower bent section.
EFFECT: facial masks in different implementation version reduce aerosol particle inertia in areas close to nose, thus reducing amount of aerosol drug precipitation in eye area in the result of inertial sedimentation impact, while aerosol drug flow in mask cavity is maintained at level required for efficient drug supply to respiratory system of patient.
33 cl, 23 dwg, 1 tbl, 2 ex
SUBSTANCE: method involves applying sedation and setting laryngeal mask after having done combined spinal epidural anesthesia. Next, controlled mechanical lung ventilation is carried out without total myorelaxation being applied in CMV mode selecting respiration volume being equal to 6-8 ml/kg of body weight, peak flow of 50-65 l/min in applying rectangular gas mixture injection mode or 65-85 l/min in applying descending gas mixture injection mode. Inspiration-to-expiration ratio is selected 1:1.3-1:1.7, oxygen fraction FiO2 in inhaling being equal to 0.25-0.3, forced breathes frequency equal to 10-16 per 1 min, basic positive pressure value at the expiration end being equal to 3-4 cm of water column. The operation being over, the laryngeal mask is removed and auxiliary non-invasive lung ventilation with air and oxygen mixture is applied via facial mask in breathing support mode with PSV pressure. The support pressure is equal to 10-15 cm of water column on inhaling, oxygen fraction FiO2 in inhaling being equal to 0.25-0.3, positive pressure value at the expiration end being equal to 3-4 cm of water column, trigger sensitivity being 2-3l/min. Respiration support is continued until respiration volume is not less than 6-7 ml/kg of body weight.
EFFECT: reduced risk of negative consequences; accelerated respiratory rehabilitation.
SUBSTANCE: method involves applying sedation and setting laryngeal mask after having done epidural anesthesia. Next, controlled mechanical lung ventilation is carried out without total myorelaxation being applied in CMV mode selecting respiration volume being equal to 6-8 ml/kg of body weight, peak flow value of 50-65 l/min in applying rectangular gas mixture injection mode or 65-85 l/min in applying descending gas mixture injection mode. Inspiration-to-expiration ratio is selected 1:1.3-1:1.7, oxygen fraction FiO2 in inhaling being equal to 0.25-0.3, forced breathes frequency equal to 10-16 per 1 min, basic positive pressure value at the expiration end being equal to 3-4 cm of water column. The operation being over, the laryngeal mask is removed and auxiliary non-invasive lung ventilation with air and oxygen mixture is applied via facial mask in breathing support mode with PSV pressure. The support pressure is equal to 10-15 cm of water column on inhaling, oxygen fraction FiO2 in inhaling being equal to 0.25-0.3, positive pressure value at the expiration end being equal to 2-3 cm of water column, trigger sensitivity being 2-3 l/min. Respiration support is continued until respiration volume is not less than 6-7 ml/kg of body weight.
EFFECT: reduced risk of negative consequences; accelerated respiratory rehabilitation.
SUBSTANCE: method involves after performance of spinal anesthesia applying sedation with the subsequent installation laryngeal masks. Then controllable mechanical ventilation of lungs is carried out without total myorelaxation in CMV-mode with respiratory volume of 6-8 ml/kg of body weight, peak flow rate of 50-65 l/min when using rectangular pattern of gas mixture supply or 65-85 l/min when using descending pattern of gas mixture supply. Inhalation-to-exhalation ratio is equal to 1:1.3-1:1.7, oxygen fraction on inhaling FiO2 is 0.25-0.3, compulsory breathing frequency is 10-16 breathings per 1 min, positive base pressure at the end of exhalation is equal to 3-4 cm of water column. Laryngeal mask is removed at the end of operation and auxiliary noninvasive ventilation of lungs is applied using air-oxygen mixture through facial mask in pressure breathing support mode of PSV. Thus, breathing support pressure is equal to 10-15 cm of water column. Oxygen fraction on inhaling FiO2 is equal to 0.25-0.3, positive pressure at the end of exhalation is equal to 2 3 cm of water column, trigger sensitivity is 2-3 l/min. Respiratory support is carried out until respiratory volume achieves the level not less than 6-7 ml/kg of body weight.
EFFECT: prevented negative effects accompanying total myorelaxation and trachea intubation anesthesia; fast respiratory rehabilitation of patients after operation.
SUBSTANCE: invention relates to field of medicine, namely to oncology, and can be applied in case of development of failure of intrapleural esophagogastric anastomosis sutures in early post-operation period after surgery of cancer of cardial part of stomach with spread on esophagus, cancer of thoracic part of esophagus. Essence of method lies in installation of self-extending esophageal stent with antireflux valve in the place of defect under endoscopic control. In case of failure of intrapleural esophagogastric anastomosis, suspended enterostoma is additionally applied. Stent is installed on the length, exceeding zone of esophagogastric anastomosis failure on 6-8 cm.
EFFECT: application of claimed invention makes it possible to improve treatment results in early post-operation period in patients with cancer of esophagus and cancer of cardial part of stomach with spread onto esophagus.
SUBSTANCE: invention relates to field of medicine, in particular to reconstructive-plastic and children surgery and can be applied in treatment of cheloid cicatrixes. Essence of method lies in prevention of cheloid cicatrix recurrences. Dermobrasia of superficial layers of skin cicatrixes is performed by means of hydrosurgical system "Versajet".
EFFECT: application of claimed invention makes it possible to prevent recurrences of skin cicatrixes in children.
6 dwg, 3 ex
SUBSTANCE: invention relates to surgery and can be applied for treatment of chronic pancreatitis complicated with portal hypertension. Two purse-string sutures are applied on anterior wall of portal vein and anterior wall of superior mesenteric vein, through which veins are punctured, silicone tubes are introduced into vein lumens. Tubes are fixed to walls of veins. Free ends of tubes are connected via tee-joint, to whose free end syringe with heparin solution is attached. Portal vein below puncture point and superior mesenteric vein above puncture point are compressed, splenic vein and inferior mesenteric vein are compressed as well. Temporal bypass venous shunting of blood is turned on. Subtotal resection of pancreas head with simultaneous resection of affected part of anterior wall of portal vein is performed. Defect of portal vein is covered with autovenous patch. Decannulation is performed. Puncture openings of veins are sutured. Pancreatoenteroanastomosis is formed.
EFFECT: method makes it possible to reduce risk of vessel injury, increase reliability of portal vein hypertension prophilaxis.
1 ex, 4 dwg
SUBSTANCE: invention relates to medicine, namely to herniology. Aponeurosis of external oblique abdominal muscle is cut from external inguinal ring towards the lateral side with its displacement to inguinal ligament in the area of internal inguinal ring. Lateral flap of aponeurosis of external oblique abdominal muscle under spermatic cord is fixed to lower edges of internal oblique and transversal muscles. Spermatic cord is moved upwards. Medial flap of external oblique muscle aponeurosis above cord is fixed to anterior surface of lateral flap of external oblique muscle aponeurosis without tightening. In case of considerable destruction of posterior wall of inguinal canal and weakness of external flap of external oblique muscle aponeurosis between transversal fascia and lateral flap of external oblique muscle aponeurosis placed is prosthesis, cut for placement of cord. From above edge of prosthesis is fixed to transversal and internal oblique abdominal muscle, from below prosthesis is sewn to lower edge of external oblique muscle aponeurosis. From pubic tubercle upwards sheath of rectus is opened on lateral edge. Medial edge of prosthesis is submerged and fixed under its anterior leaf, formed branches of prosthesis, after coverage with them of spermatic cord, are sutured to each other and fixed to both flaps of external oblique muscle aponeurosis.
EFFECT: method prevents hernia recurrence.
3 cl, 1 ex, 7 dwg
SUBSTANCE: invention relates to field of medicine, namely to endosurgery and is intended for application in oncology in case of cancer and achalasia of esophagus. Essence of method lies in mobilisation of esophagus, stomach and formation of tunnel graft. Mobilisation of esophagus is realised without its transaction. Simultaneously lymph nodes of posterior mediastenum are ablated. Affected part of esophagus and cardial part of stomach are cut off. Further mobilisation of part of stomach is performed on its greater curvature, starting with the level of the middle third of transverse colon and up to its bottom. It is brought out onto abdominal wall and 4-5 cm wide isoperistaltic tunnel graft is cut out from the greater curvature of stomach. Muscles of pylorus are cut transversally on the minor curvature. Dissected surfaces are sewn together with displacement along the edges in such a way that their ends do not coincide but only contact with each other with their external edges. On the neck end-to-end anastomosis between esophagus and transplant is formed.
EFFECT: application of claimed invention makes it possible to ensure venous outflow and improve viability of formed tunnel graft, reduce the pressure inside transplant in early post-operation period and ensure fast and strong healing of esophagogastroanastomosis with further recovery of pylorus function.
SUBSTANCE: invention relates to field of medicine, namely to oncology, plastic and reconstructive medicine and can be applied in reconstruction of external nose in case of subtotal defects. Essence of method lies in resection and reconstruction, application of frontal flap, formation of tunnel and further bringing out flap through it. Flap is deepidermised in accordance with post-resection defect. After that it is turned on 180 degrees along nose dorsum. After bringing it out through formed tunnel, formation of epithelial internal lining of neonose with covering tissues of flap is performed. After that, free autodermoplasty is carried out in order to substitute external epithelial lining.
EFFECT: application of claimed invention makes it possible to reduce total term of treatment, reduce time of surgery, improve esthetic result, restore deficit of internal nose lining, as well as protective function of nose.
11 dwg, 1 ex
SUBSTANCE: invention relates to hernioplasty. Needle in form of rod with round section near the base and oval section in distal part with curvature of 30 mm radius in distal third, blunted end and through opening at the distance 3 mm from the end is used. Woven non-absorbable suture material is used. Cut of skin is performed in inguinal area, through which ligature is passed puncturing abdominal wall to parietal leaf, bypassing neck of hernial sac laterally or medially, moving needle under peritoneum to spermatic cord vessels or round ligament. Ligature is introduced into abdominal cavity puncturing peritoneum. End of ligature is removed from needle by means of clap, needle is extracted outside, into its opening auxiliary thread from any suture material is inserted with formation of a loop. Needle is passed under peritoneum again, bypassing neck of hernial sac on the opposite side, brought into abdominal cavity near spermatic cord or round ligament. Free end of main ligature is passed through loop by pulling by ends of auxiliary thread that remained outside in such a way that it is put through needle opening. Needle is removed outside together with main ligature, whose ends are tied, knot is submerged under the skin.
EFFECT: method eliminates injury of spermatic cord or round ligament.
SUBSTANCE: invention relates to medicine, namely to vascular surgery. One fixing suture is applied on both donor and recipient vessels in lateral walls of vessels. After that, on the wall of recipient vessel performed is transversal cut with size 2-3 mm × 0.5-1.0 cm above anastomosis zone. Through said cut catheter provided with strent is introduced into vessel lumen. Stent is guided into lumen of donor vessel in such a way that half of stent is in donor vessel, and half is in recipient vessel. Catheter is removed ensuring stent extension with its opening under the impact of vessel lumen. Vessels in anastomosis zone are fixed with interrupted sutures, 2-3 suturess are applied in area of performed transversal cut.
EFFECT: method makes it possible to ensure contact of vessels with homogeneous layers on anastomosis line; absence of anastomised vessels of muscular envelope or adventitial cover in lumen; smoothness of vessel surface in anastomosis zone and absence of bends; to prevent injuries in anastomosis area and along vessel length due to absence in stent of perforating as well as cutting ability; to avoid contact of blood passing through vessel with threads; to support specified diameter of vessel lumen, which facilitates normal blood flow in place of connection; to provide possibility of applying even both in thickness and in distance from vessel edge, stitches; to ensure reduction of time of anoxia of vessel and fed by it tissues due to reduction of surgery time.
1 dwg, 2 ex
SUBSTANCE: invention relates to medicine and can be applied for treatment of obturative obstruction of large intestine. Intra-operation decompression and washing of adducting parts through one- or two-orifice probe for washing through cecostoma, last sero-serous interrupted suture on the wall of cecum above probe is applied S-shaped, ends of whose threads are passed between cuff, installed at the skin level, and probe and fixed in tightened position. Ozonised crystalloid solution is introduced through probe and colon is washed several times with 3 minutes exposure. Proximal end is sutured and fixed to peritoneum. Laparotomic wound is sutured. In post-operation period adducting part of colon is washed through probe periodically during 7-10 days. When intestinal passage is recovered and inflammatory process subsides, anastomosis is applied.
EFFECT: method makes it possible to improve quality of intestine purification, reduce risk of anastomosis failure.
2 ex, 3 dwg
SUBSTANCE: invention relates to medicine, in particular, to surgery, to methods of plasty of anterior abdominal wall hernias. Method includes plasty of hernia defect with preperitoneal or axillary location of modeled rectangular synthetic mesh endoprosthesis, cut out in form of basic part with two symmetric petals on its long sides. Basic part of endoprosthesis is fixed to posterior leaves of recti sheaths. Muscular-aponeurotic weakening cuts are formed on recti sheaths, through which petal part is passed from inside outside, and tightened. Endoprosthetis petals aree fixed to anterior petals of recti sheaths. Petal part of endoprosthesis is located in subaponeurotic layer of anterior abdominal wall.
EFFECT: method makes it possible to reduce complications: formation of seroma or hematoma, reduction of physiological mobility of abdominal wall, contamination of prosthesis, reduction of its size, rejection, wound suppuration, formation of ligature fistulas, minimal injury of surrounding tissues (catching vessels and nerves into suture); reduced is risk of development of syndrome of abdominal hypertension, crimping and displacement of endoprosthesis.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg