Method of treating baker's cyst

FIELD: medicine.

SUBSTANCE: invention refers to orthopaedics, namely rheumatology, and concerns treating Baker's cyst. That is ensured by cyst puncture, aspiration of its content, and introduction of the non-steroid anti-inflammatory preparation xefocam in its cavity; and then the enzymatic preparation longidaza is introduced in a paraarticular space.

EFFECT: method provides effective conservative treatment of Baker's cyst with no recurrences and side effects.

11 cl, 2 dwg, 3 ex

 

The invention relates to orthopedics, namely, rheumatology, and can be used in medical practice for the treatment of cysts Baker when synovitis.

The knee joint is the largest synovial joint. The synovial membrane covering the inside of the joint capsule forms numerous folds, which juts into the joint cavity. A Baker cyst is a hollow saccular education that develops from the tissues lining the bag knee joint. The typical localization of the cyst Baker - rear surface of the joint. For Baker cyst is characteristically affected or aseptic fluid accumulation in the popliteal fossa of the knee joint, it is often accompanied by synovitis in patients with osteoarthritis, rheumatoid arthritis [lugoves YEAR Popliteal cysts in rheumatic diseases. Discard. the honey. Sciences. - M., 1998. - 95 S.]. In the treatment of synovial cysts are used for both surgical and conservative methods.

Surgical treatment of cysts Baker are surgical excision its walls. The procedure can be performed under local anesthesia and does not require a hospital stay longer than a day. After removal of the cyst in the region of the knee imposed a special adhesive bandage or a plaster bandage for a few days, usually up to a week, limited to the load on operirovanne the leg.

Conservative treatment cyst Baker is to puncture the cavity of the cyst, removal of contents and the introduction of anti-inflammatory drugs (predominantly use steroid hormones). Unfortunately, the frequency of relapse (re-education of cysts) after treatment is quite high, which is one of the main reasons is much more frequent use of surgical methods.

Conservative therapy includes the following methods: unloading joints, physiotherapy, puncture of cysts by aspiration and the subsequent introduction (or not) of drugs.

As a Baker cyst in the knee joint, usually associated with synovitis, then it is logical treatment involving the use of one or another anti-inflammatory drug.

There is a method of treatment of a cyst Baker by intraarticular injection of corticosteroids persons with rheumatoid arthritis, accompanied by Baker cyst, which as a result of treatment is reduced in size [Danilov IM Ultrasonographic diagnosis of cyst Baker in gonarthrosis: Dis...Kida. the honey. Sciences. - Barrow, 2000. - 115 C.]. However, corticosteroids are not only not always have a positive effect, but in some cases, their introduction may lead to loss of proteoglycan of cartilage [Zagorodniy, NV Within the statutory and periarticular therapy of diseases of the musculoskeletal system. - M.: Publishing house of the Russian peoples friendship University, 2001. - 48 S.].

There is a method of treatment of a Baker cyst, which after makuchi the contents of the cyst into it enter the cytostatic drug cyclophosphamide [Babich I.I. non-indigenous GI, I.V. Babich Treatment of Wagram in children // Surgery. - 1989. No. 11. - S-82]. This method is the closest analogue of the method proposed and adopted for the prototype of the invention. However, the drug cyclophosphamide [Cyclophosphamide // Vidal-99: Handbook of drugs in Russia. - 5th ed. - M., 1999. - SE.] - alkylating cytostatic, has a number of undesirable side effects. Thus, it can cause nausea, vomiting, alopecia, aseptic hemorrhagic cystitis, sometimes toxic hepatitis, headache and pain in the muscles and bones; has myelotoxicity, i.e. it can lead to leukopenia and thrombocytopenia. Given the development of possible side effects, the use of such drug in the treatment of cyst Baker's insecure and has a lot of contraindications. For example, it is contraindicated in persons with anemia, leukopenia and thrombocytopenia.

The invention solves the problem of creating an effective treatment for cyst Baker, do not produce any side negative effects, therefore, it is safe for the health of patients.

The problem is solved in that a method for the treatment of cyst Baker, including PU is the Ktsia cysts, the aspiration of its contents and introduction in its cavity therapeutic drug xefocam, then in juxta-articular space of the injected drug logidata.

The treatment can be supplemented by the fact that within two to three weeks spend 2-5 injections xefocam in the joint and 2-5 injections longitute intramuscularly, alternating them every other day.

It is advisable to perform diagnostic ultrasound of the knee joint, verification of diagnosis, clarification of the size, shape and position of the cyst

Diagnostic ultrasound of the knee joint can be performed biopsy probe with standard sterile disposable nozzle for holding the punctures.

Puncture of the cyst can be performed with the patient lying on his stomach.

After puncture of the cyst, aspiration of its contents and the introduction of the skin it is advisable to treat with antiseptic and apply aseptic adhesive bandage.

The aspiration of cyst it is advisable to carry out under ultrasound control.

Longido you can enter with the patient lying on his back.

Longido can be used to position the patient lying on his stomach.

The most effective type longido at the position in the periarticular area to the side.

After drug treatment, it is advisable to carry out sclerotiniaceae cysts 96% of what percom.

The inventive method of treatment of a cyst Baker is as follows.

First perform a diagnostic ultrasound examination of the knee joint, verification of diagnosis, clarification of the size, shape, position of the cyst. After that start the treatment, which is carried out in three stages.

Manipulation of the punctured cysts is performed from the position of the patient lying on his stomach. Ultrasonic navigation performed using a biopsy probe with standard sterile disposable nozzle for holding punctures. For this process antiseptic skin, be intra-articular manipulation, and cause them sterile gel for the ultrasound.

At the first stage of treatment the cyst puncture and aspiration. To do this, select the optimal route of a needle into the cyst cavity, evacuating the contents, controlling for ultrasound completeness of extraction.

In the second stage of treatment, leaving the needle in the cavity of the cyst, replace the syringe with the remote content on the syringe with the drug xefocam and implement its introduction into the cavity of the cyst. After removing the contents of the cyst and the introduction in its cavity preparation xefocam treat the skin with antiseptic and put aseptic adhesive bandage. The process of drug xefocam after aspiration of the cyst shown in figure 1. Drug xefocam OK which shows a pronounced analgesic and anti-inflammatory effect.

At the third stage of treatment carry out the introduction side in the juxta-articular space of the drug logidata, which increases the bioavailability of anti-inflammatory drug xefocam. Preparation logidata can be entered either from the position of the patient lying on his back, and the position of the patient lying on his stomach.

Within two to three weeks, depending on the initial condition of the patient, to consolidate anti-inflammatory treatment, alternating every other day, 2-5 injection drug xefocam in the joint and 2-5 injection drug logidata intramuscularly.

Control over the joint state after aspiration of the cyst and the treatment is carried out by ultrasound in a week. If the cyst is not filled with liquid content, conduct fine-needle sclerosing therapy 96%ethyl alcohol.

In case of recurrence of the cyst and filling her cavity content, although this usually does not happen in full, aspiration of the cyst with the introduction of drug xefocam repeat. Exercise and injections longitute, and then sclerosing therapy.

The inventive method of treatment is illustrated by the following examples.

Example 1. Patient B., aged 47. Diagnosis: gonarthrosis stage I, the pain syndrome. When U3-study diagnosed with synovitis, defined by the presence of cysts Baker, located in Duramed the real part of the right knee joint. When ultrasound determined the contents of the cyst - anechoic mass with the cyst oval, without partitions and inclusions. Despite the small volume (~ 6 ml) Baker cyst caused pain when bending the leg at the knee. Held aspiration of the cyst under U3-control with the introduction of the cavity 8 mg xefocam in 2 ml of water for injection and the introduction of longitute 3000 ME in 2 ml of 2% lidocaine in the periarticular area to the side. Additionally, within two weeks, through day three injections xefocam in the joint and longitute intramuscularly. Pain in the joint stopped. After treatment couch cysts sklerozirovana the introduction of 1 ml of ethanol under ULTRASOUND control. Monitoring the state of the joint is carried out by ultrasound in a month. The dynamics of the treatment under ULTRASOUND control shown in Fig.2, where: a) the cyst Baker oval shape of the right knee joint;

b) Baker cyst after aspiration of the content and the introduction of xefocam;) cyst Baker after sclerotherapy, ultrasound in a month after treatment.

Example 2. Patient P., 66 years. Diagnosis: metabolic-dystrophic gonarthrosis stage II. Turned with severe pain in left knee joint, the knee is swollen, has come to accept, using a cane. When U3-examination of the left knee diagnosed with synovitis, defined by the presence of cysts Baker, located in dorsomedial of the left knee the Charter at the level of the joint space, the sizes of a cyst 21×22×22. Held aspiration of the cyst under U3-control with the introduction of the cavity 8 mg xefocam in 2 ml of water for injection and the introduction of longitute 3000 ME in 2 ml of 2% lidocaine. Additionally, through day two injections xefocam in the joint and longitute in juxta-articular space. After treatment there was a partial filling of the cyst liquid. Was repeated aspiration of the cyst with the introduction of xefocam on the above scheme and the introduction of longitute. After re-treatment cyst Baker declined. Conducted cyst sclerotherapy with alcohol under ULTRASOUND control. Additional control condition of the knee joint after 1, 3, 6 months. Recurrence of the cyst Baker was not observed and one year after treatment.

Example 3. Patient D., 52 years old. Diagnosis: Rheumatoid arthritis, gonarthrosis II-III century left knee. Pain syndrome. Cyst Baker's boat-shaped without inclusions. Using the proposed method treatment: puncturing the cyst, aspiration under U3 control, the introduction of xefocam in the cavity of the cyst and longitute in juxta-articular space. Achieved complete reduction of cysts. Then, as described above, had a course of injections of xefocam periartikulyarno (8 mg xefocam, No. 5) and the injection of longitute intramuscularly (Logidata 3000 ME in 2 ml of 2% lidocaine, No. 5). Under U3-what stralem cyst Baker sclerotic (fibrous) 96% alcohol. The patient has a drug Arcoxia at a dose of 60 mg twice a day. Additional control condition of the knee joint after 1, 3, 6, 12 months. Recurrence of the cyst Baker was not observed.

In the treatment of synovitis of the knee in 42 patients with rheumatoid arthritis cyst Baker diagnosed by ultrasound in 43% of cases; in 36 patients with gonarthrosis in 33% of cases.

The rate of cyst Baker claimed method in rheumatoid arthritis - 78%, and in gonarthrosis - 97%. All patients, in addition to treatment cyst Baker was conducted therapy of the underlying disease in accordance with the diagnosis. Side effects in the form of ill health patients was not observed.

Thus, the proposed method of treatment cyst Baker gives no negative side effects, and therefore safe for the health of patients, this effectively makes it possible to treat these disease without surgical intervention.

1. The way to treat a cyst Baker, involving puncture of the cyst, aspiration of its contents and introduction in its oral drug treatment, characterized in that the cavity of the cyst impose drug xefocam, then in juxta-articular space of the injected drug logidata.

2. The method of treatment according to claim 1, characterized in that it further in the next two or three weeks spend 2-5 injection drug xefocam in the joint and 2-5 injection is Reparata logidata intramuscularly, alternating every other day.

3. The method of treatment according to claim 1, wherein the pre-perform diagnostic ultrasound of the knee joint, verification of diagnosis, clarification of the size, shape and position of the cyst.

4. The method of treatment according to claim 3, characterized in that the diagnostic ultrasound examination of the knee joint perform a biopsy probe with standard sterile disposable nozzle for holding the punctures.

5. The method of treatment according to claim 1, characterized in that the puncture of the cyst was performed at the position of the patient lying on his stomach.

6. The method of treatment according to claim 1, characterized in that after the puncture of the cyst, aspiration of its contents and the introduction of the drug xefocam the skin is treated with antiseptic and put aseptic adhesive bandage.

7. The method of treatment according to claim 1, characterized in that the aspiration of cyst performed under ultrasound control.

8. The method of treatment according to claim 1, characterized in that longido administered during the patient lying on his back.

9. The method of treatment according to claim 1, characterized in that longido being in the position of a patient lying on his stomach.

10. The method of treatment according to claim 1, characterized in that longido injected into the periarticular area to the side.

11. The method of treatment according to claim 1, characterized in that it further out sclerotiniaceae cysts 96%alcohol.



 

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33 cl, 7 tbl, 43 ex

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9 cl, 10 ex, 3 tbl

FIELD: medicine.

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2 ex, 2 tbl

FIELD: medicine, pharmaceutics.

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8 cl, 1 tbl, 210 ex

FIELD: medicine, pharmaceutics.

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EFFECT: obtained and described are novel compounds, which can be useful in treatment of caspase-mediated diseases.

38 cl, 22 ex

FIELD: organic chemistry, medicine.

SUBSTANCE: invention relates to new 2-aminopyridine derivatives of formula I , wherein R1 is cyano, carboxyl or carbamoyl; R2 is hydrogen, hydroxyl, C1-C6-alkoxy or phenyl; R3 and R4 are aromatic hydrocarbon such as phenyl or naphthyl, 5-14-membered 5-14-membered optionally substituted aromatic group, excepted cases, when (1) R1 is cyano, R2 is hydrogen, and R3 and R4 are simultaneously phenyl;(2) R1 is cyano, R2 is hydrogen, R3 is 4-pyridyl, and R4 is 1-pyridyl; (3) R1 is cyano, R2 is 4-methylphenyl, and R3 and R4 are simultaneously phenyl;(4) R1 is cyano, R2, R3 and R4 are simultaneously phenyl, or salts thereof. Derivatives of present invention have adenosine receptor antagonist activity and are useful in medicine for treatment of irritable bowel syndrome, constipation, and defecation stimulation.

EFFECT: 2-aminopyridine derivatives as adenosine receptor antagonists useful in medicine.

34 cl, 2 tbl, 179 ex

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