Method of treating chronic cystitis

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely urology, is applicable for treating chronic cystitis. That is ensured by drug instillations into a bladder. In addition, the instillation is preceded by endovesical mucosal exposure to laser light of wave length 0.62 mcm. The instillation is followed by pubic exposure to laser light of wave length 0.86 mcm within a projection of the bladder. The duration of each procedure is 7 minutes; the therapeutic course is 10-12 procedures.

EFFECT: method provides higher clinical effectiveness ensured by pain pulse interruption and improved microcirculation and consequently prolonged drug staying in the bladder cavity as a result of the exposure to laser light before the instillation, and also by deeper drug penetration in bladder tissue as a result the epicutaneous exposure to laser light after the instillation.

1 dwg, 2 tbl, 2 ex

 

The invention relates to medicine, namely to urology.

Chronic cystitis is one of the most common diseases in women, reaching 1,000 per 100,000 population [1]. As a rule, cystitis is an infectious disease, although up to 30% of patients may not have the growth of flora in the urine [2]. Extensive and sometimes haphazard and uncontrolled use of antibiotics has led to increasing resistance of pathogenic microorganisms, which makes it difficult, and sometimes makes it impossible to eradication of the pathogen. The usual treatment involves the assignment or other antibiotic, herbal medicine, pathogenic drugs; in some cases instillation of medicines. However, the inflamed mucosa of the bladder or deformed due to recurrent cystitis bladder wall may not adequately respond to the impact.

Closest to the claimed is a method of treatment of tuberculosis of the bladder helium-neon laser, in which the chemotherapy mucous membrane of the bladder is irradiated with light helium-neon laser for 10-15 minutes daily; 5-12 procedures course (A.S. USSR 1392699), seeking relief of dysuria.

However, the known method is directed to treating only patients with tuberculosis, for which a specific inflammation of the special characteristics; promotes healing by own forces of the body. In patients with chronic cystitis, especially resistant to standard therapy, these reserves are often exhausted or even exhausted.

The proposed method for the treatment of chronic cystitis by instillation of drugs, characterized in that it further before instillation spend endovesical effect on the mucous radiation with a wavelength of 0.62 μm, and after instillation above the fold in place of the projection of the bladder with a wavelength of 0.86 micron, the duration of each procedure for 7 minutes, at the rate of 10-12 procedures, increases the efficiency of treatment of patients with chronic cystitis, because at the first stage, when exposed endovesical laser radiation wavelength of 0.62 μm, contributes to the interruption of pain impulses and improve microcirculation. Instillation of drugs into the thus prepared the bladder tolerated by the patient easier, as there is no spastic contractions of the detrusor and bowel emptying of the bladder, which contributes to more long-term presence of the drug in the cavity of the bladder and, accordingly, more prolonged therapeutic effect. To ensure deeper penetration of the drug into the tissue of the bladder spend cutaneous exposure laserna the radiation wavelength 0.86 micron, which, with greater depth of penetration, it appears externally.

The method is as follows. After spontaneous urination and toilet vulva, the patient is placed in the urology chair with diluted feet. The outer opening of the urethra treated with an aqueous solution of chlorhexidine and dry sterile gauze ball. The urethra instilliruut katedralen for local anesthesia; exposure time of 7 minutes. Then entering the bladder emitter in a sterile urethral catheter to a depth of 10-12 cm, fixed with adhesive tape to the inner thigh of the patient. Influence of laser radiation with a wavelength of 0.62 μm for 7 minutes, after which the emitter is removed and the bladder instilliruut drug. The catheter is removed. Then place above the fold in place of the projection of the bladder emitter of infrared laser and conducted the influence of the laser radiation with a wavelength of 0.86 micron, also for 7 minutes. During testing of the proposed method, it was found that the reduction of exposure time reduces the effectiveness of treatment, and the increase - not increase it. Thus, 7 minutes is the optimal time set empirically. The number of treatments is determined by the condition of the patient and ranges from 10 to 12.

Example 1. Patient B., 24 the em. Chronic cystitis is suffering 7 years, exacerbation of 3-5 times per year. First time in urine was determined by the growth of E. coli in diagnostically significant titer sensitive to fluoroquinolones; then developed a resistance of the pathogen. When handling complaints about frequent urination (14-16 times a day and 3-4 times a night), discomfort in the bladder, pain while it is being filled and during urination. Uroflowmetric indicators: the volume of the bladder 129 ml, maximum speed urination Qmaxand 11.6 ml/sec, average Qavean 8.4 ml/sec. Started the treatment by instillation of 1% dioksidina to 20 ml with prior exposure to the mucous radiation with a wavelength of 0.62 μm to 7 minutes daily and the final impact on cutaneous region of the bladder laser radiation with a wavelength of 0.86 micron.

Starting from the 6th of procedure the patient noted significant improvement to the 10th procedure dysuria almost completely stopped. However, given the long history of the disease, as well as the continuing feeling some discomfort when urinating, decided to extend the course to 12 sessions. Upon completion of treatment: no complaints, urination free, painless. The volume of the bladder is increased to 316 ml, Qmax- to 18.7 ml/sec, Qaveto 10.3 ml/sec. At the control examination after 6 and 9 months, no complaints, the disease had anticipated.

Example 2. Patient L., 49 years. Chronic cystitis suffers 5 years, exacerbation of 1-3 times per year. In the urine was determined by the growth of E. coli - SOME 105/ml) and Enterococcus faecalis - SOME

103/ml sensitive nitrofurans and fosfomicin and resistant to other groups of antibiotics and chemotherapeutic agents. When handling complaints about frequent urination (16-18 times a day and 3-4 times a night), pain during urination, discomfort in the bladder, pain while it is being filled and during urination, feeling of incomplete emptying of the bladder. Uroflowmetric indicators: the volume of the bladder 86 ml, maximum speed urination Qmaxonly 9.4 ml/sec, average Qaveto 6.2 ml/sec. Treated with fosfomicin and monural within 10 days, which resulted in the decrease of dysuria, stop stranguria, eradication of the pathogen, the normalization of urine. However, continued discomfort in the bladder, pain while it is being filled and during urination, feeling of incomplete emptying of the bladder, which was largely due to the involutive processes of urothelia. Started treatment with instillation of Akola to 40 ml with prior exposure to the mucous radiation with a wavelength of 0.62 μm to 7 minutes daily and the final effect is akono on the area of the bladder laser radiation with a wavelength of 0.86 micron.

Starting with the 3rd procedure, the patient noted significant improvement to the 8th procedure dysuria almost completely stopped. Given the good effect, the treatment is limited to 10 sessions. Upon completion of treatment: no complaints, urination free, painless. The volume of the bladder is increased to 424 ml, Qmax- to 21.9 ml/sec, Qaveup to 14.7 ml/sec. At the control examination after 6 and 9 months - no complaints, the disease had anticipated.

The method was tested in urogenital clinic Novosibirsk TB research Institute in 24 patients. Along with the existing criteria of treatment efficacy we used the total scale of symptoms. Patients were asked to assess the severity of one or another symptom on a 5-point scale, the scores were aggregated and analyzed when evaluating the results of therapy. The original data are presented in table 1.

Table 1
The severity of clinical manifestations of the source (abs./%), n=24
Symptom/score0 no symptom1 weak2 Unsharp3 moderate4 strong 5 very strong
Pain during filling of the bladder0008/33,3%4/16,7%12/50,0%
Imperative urge00013/54,2%4/16,7%7/29,2%
Burning at the end of urination0008/33,3%5/20,8%11/45,8%
Discomfort after urination002/8,3%5/20,8%12/50,0%5/20,8%

The average score of clinical manifestations original was 15.9 per patient. The change in the treatment process point of expression of the symptoms presented in the diagram (Fig.).

Patients also reported an improvement of the microcirculation of the mucosa of the urethra using laser dopplerflowmetry that shown in table 2.

Table 2
Dynamics of capillary blood flow (n=24)
Indicator LDFSourceAfter the treatment
THEY (P.E.)9,76±1,8***12,84±1,54***
σ (P.E.)3,33±1,24,28±1,3
Tov (%)25,43±3,227,8±3,2
Amax - α (P.E.)8,5±1,4*14,16±1,2*
Amax - LF (P.E.)of 5.05±0,4***6,12±0,3***
Amax - HF1(P.E.)to 3.73±0,3*2,14±0,8*
Amax - HF2(P.E.)1,42±0,211,18±0,2
Amax - CF1(P.E.)1,88±0,15**2,62±03**
Amax - CF2(P.E.)0,68±0,20,7±0,2
AmaxCF/AmaxLF0,23±,09 0,19±0,5
AmaxHF/AmaxLF0,66±0,32*0,42±0,3*
1,29±0,8*2,1±0,9*
* - the difference is significant with a probability of 95%.
**- the difference is significant with a probability of 99%.
*** - the difference is significant with a probability of 99.9%.
THEM - the index of microcirculation
σ is the standard deviation
Tovthe coefficient of variation
Amax - α is the maximum amplitude of α-waves arising from the rhythmic activity of endothelial cells
Amax - LF - peak amplitude of the low frequency (vasumati)
Amax - HF1- the maximum amplitude of respiratory and predialling oscillations (13-30 min)
Amax - HF2- the maximum amplitude of respiratory and predialling oscillations (31-49 min)
Amax - CF1- maximum amplitude (50-99 min)
Amax - CF2- maximum pulse amplitude of oscillation (100-180 min)

As follows from table 2, due to the claimed method of treatment of chronic cystitis recorded a significant increase of the index of microcirculation, reflecting the improvement in the perfusion of tissues. The increase in the amplitude of cardiorenal evidenced by a decrease in spasm bringing vessels, and a decrease in the amplitude of oscillations in the respiratory range on the elimination of stagnation. Significantly increased the amplitude of the α-rhythms, which is associated with the restoration of active mechanisms of microcirculation.

None of the patient is not noted any significant adverse effects of therapy.

Thus, the claimed method of treatment of chronic cystitis by instillation of drugs, characterized in that before instillation spend endovesical effect on the mucous radiation with a wavelength of 0.62 μm, and after instillation above the fold in place of the projection of the bladder with a wavelength of 0.86 micron, the duration of each procedure for 7 minutes, in the course of 10-12 treatments are simple, available both in hospital and in the clinic, not costly, and highly effective.

Literature

1. Laurent O., Epidemiological and what aspects of urinary tract infections. Proceedings of the International Symposium "urinary tract Infections in outpatients". - M., 1999. - P.5-8.

2. Rafalski CENTURIES, Stratchounski L. C., Kogan M.I. et al. Antibacterial therapy of complicated urinary tract infections in outpatients // Urology. - 2004. No. 5. - S-31.

Method for the treatment of chronic cystitis installations drugs, characterized in that it further before instillation spend endovesical effect on the mucous radiation with a wavelength of 0.62 μm, and after instillation above the fold in place of the projection of the bladder with a wavelength of 0.86 micron, the duration of each procedure for 7 min, in the course of 10-12 treatments.



 

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19 tbl

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1 tbl

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3 tbl, 2 ex

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2 ex, 2 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely ophthalmology. A method involves introducing a photosensitiser (PS) in a patient's body that is followed by retinal exposure to laser light. Chlorine photosensitiser 0.4-0.5 mg/kg is intravenously injected for 10 minutes. Immediately after the PS introduction, ischemic areas and retinal neovascularisation areas are exposed to transpupillary laser light. That is ensured by laser light at wave length matched to maximum PS adsorption of optical emission. Power density makes 50-75 J/cm2.

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1 ex

FIELD: medicine.

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FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to surgery, and can be used for prevention of postoperative enteroparesis. For this purpose, by the end of a technical part of the surgery, a standard sanation procedure is followed by abdominal irrigation with ozonised Perftoran with the ozone concentration 5000 mcg/l. The irrigation volume is measured at 1 ml/kg of weight. Thereafter ozonised Perftoran is intravenously introduced at the same basis.

EFFECT: ensured technical simplicity, effective prevention of postoperative enteroparesis, considerable reduction of length of gastrointestinal motility recovery, antibiotic therapy and hospital stay.

2 ex

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