Method of treating necrotic ulcers of oral mucosa in patients with multiple myeloma considering free radical oxidation in oral fluid

FIELD: medicine.

SUBSTANCE: invention refers to medicine and aims at treating necrotic ulcers of oral mucosa in patients with multiple myeloma. Luminal-dependent chemiluminescence of oral fluid is conducted to determine fluorescence light sum and maximum flash. If the light sum value is within the range of 1.02 to 6.6 standard units, and the maximum flash value is 0.7 to 2.5 standard units, the toothpaste Lacalut fluor is used 2 times a day and solcoseryl dental adhesive paste 4 times a day after meals and before bedtime to relieve symptoms completely. The light sum value 8.3 to 13.5 standard units and the maximum flash value 3.4 to 4.2 standard units, the toothpaste Colgate total propolis is used 2 times a day and the film preparation Oblecol three times a day to relieve symptoms completely.

EFFECT: use of the invention reduces a length of epithelisation of necrotic ulcers of oral mucosa.

2 ex

 

The invention relates to medicine, namely to the dentist, and is intended for treating ulcerative-necrotic lesions of the oral mucosa (SOR) in patients with multiple myeloma (MM) in the context of chemotherapy.

There is currently no clear idea about how the treatment and prevention of ulcer-necrotic lesions in oncohematological patients, due to their atipichnoi manifestations in terms of specific gravity nosology and cytostatic therapy. According to medical records and interviews of patients with MM average period of epithelialization of the ulcer-necrotic lesions SOR is 15-20 days. Manifestations of ulcerative-necrotic lesions SOR in patients with MM in terms of chemotherapy leads to the necessity of searching for optimal methods of treatment taking into account the pathogenetic mechanisms of development of this disease. The study of free radical mechanisms in the pathogenesis of ulcerative-necrotic elements contributes to the development of highly efficient methods of correction of free radical oxidation (CPO) in this disease.

Reliably role violations of SRO in the pathogenesis of many dental diseases that causes the application in their treatment of drugs that affect the formation of free radicals. Carrying out correction of a free radical status of the oral cavity is mainly associated with the treatment of inflammatory diseases of the periodontium. However, the study of mechanisms of development of ulcerative-necrotic lesions SOR MM patients indicate a significant role in their breaches occur volatile stage of phagocytosis, such as the imbalance of oxidant-antioxidant balance.

In some clinical work established that the degree of violation of the oxidant-antioxidant equilibrium depends on the stage of disease, tumor size (Kirsi GV, Belenkov O.Y, Sharipov F.K., Juraev PPM Dependence of lipid peroxidation in cancer of the stomach from the size of the tumor // Clinical laboratory diagnostics, 2004; Aliasova AV, Kontorshikova PHD, Bach BA, 2006), and the activity of chemotherapeutic programs (Bogush T.A. Reduce the toxicity of anticancer drugs is a way to increase the effectiveness of treatment of malignant tumors / Taugus // Matters. Oncology. 1995. No. 2. - P.52-53). Violations antioxidant balance, in turn, enhance the cytotoxic effect of chemotherapeutic agents against healthy tissue weighting thus adverse effects of therapy.

In recent years, more and more researchers are realizing the necessity of antioxidants together with chemotherapy to improve treatment efficacy and reduce side effects of cytostatics (Welser SL Application medicinalplants "deplin" with Galavit and lincomycin for the local treatment of stomatitis, induced by chemotherapy of cancer: Dis. Kida. the honey. Sciences. Moscow, 2005. - 101 C.). The most studied application of antioxidants such as tocopherol acetate, ascorbic acid, selenium, β-carotene, vitamin a and aevit, qudesan (Prasad K.N. Multiple dietary antioxidants enhance the efficacy of standard and experimental cancer therapies and decrease their toxicity / K.N.Prasad // Integr. Cancer Ther. - 2004. - Vol.3, No. 4. - P.310-322; Petrova this YEAR Features the development of chronic inflammation in the oral cavity in lymphoproliferative diseases: Dis. Prof. the honey. Sciences. Novosibirsk, 2009. - 266 S.).

There is a method of treating ulcerative-necrotic lesions of the mucous membranes of the oral cavity, including anesthesia, antiseptic and keratolytic treatment, anti-inflammatory and regenerative effect, with anti-inflammatory and regenerative effect is carried out in one stage by application with suspension of alloparental 3-5 times a day for 5-10 minutes, the course of 3-4 days, followed by the application of stabilizing drug (application EN 2004134873 published 10.05.2006,).

The prototype of the invention is a method for correcting free radical oxidation in the oral fluid in inflammatory periodontal diseases, namely, that in the oral fluid, record levels of chemiluminescence, the maximum flash from 0.8 to 5 conventional units is setosum from 1.5 to 25 conventional units, assessed as low activity of free radical oxidation, and in the complex treatment administered prooxidants, maximum flash from 6,55 to 25 and setosum from 26 to 45 conventional units, estimated as high activity of free radical oxidation in the complex treatment administered antioxidants (patent RU 2140633, 1999).

The objective of the invention is to develop an effective method of treating ulcerative-necrotic lesions of the oral mucosa in patients with multiple myeloma.

The technical result - the reduction of the period of epithelialization of the ulcer-necrotic elements of the oral mucosa in 1,5-2 times due to adequate treatment taking into account the activity of oxidative processes in the oral fluid.

The proposed method is as follows. The chemiluminescence (CHL) oral fluid is performed on the device Chemiluminometer-003 (Interuniversity laboratory technical systems biomedical research Bashkir state medical and Ufa state aviation technical University, the Branch register "Medical industry of Russia and CIS countries").

The collection of saliva spend the morning on an empty stomach by Slavyane in a sterile tube for 10 minutes.

In the measuring cuvette add 2.0 ml of working solution lyuminola (0.5 ml stock solution l is minola DMSO in 500 ml of physiological solution) and 0.1 ml of oral fluid (RJ). The cuvette is placed in chemiluminometer and thermostatic at 37°C. Induced luminescence was measured for 5 minutes. The process of measuring PI and processing of the results is carried out in automatic mode with the help of special programs.

Study the following indicators: S - sutasoma glow - square from the contour to the curve chemiluminescence; Andmax- the maximum amplitude of the glow from the contour to the highest point of the curve. All the data is expressed in arbitrary relative units relative to the standard glow SFHM-1, amounting to 5.1·105quantum/sec.

Patients with low values of indicators chemiluminescence: S from 1,02 to 6.6 conventional units, Andmaxfrom 0.7 to 2.5 conventional units for correction of SRO in the mouth use of prophylactic toothpaste, stimulating the generation of radicals reactive oxygen species - Lacalut fluor and solcoseryl dental adhesive paste (SDAP), which, along with keratoplasticheskie action has a prooxidant effect. SDAP applied by a standard method on the area of lesions 4 times a day after meals and before bedtime, to complete epithelialization of the ulcer-necrotic elements.

Patients with elevated values of chemiluminescence: S from 8.3 to 13.5 conventional units, Andmaxfrom 3.4 to 4.2 conventional units use toothpaste with antioxidant AK is ewnetu - Colgate total propolis and film preparation "Oblaka" (based on sea buckthorn oil), stimulating reparative processes, accelerating the healing process and with antioxidant and cytoprotective effect. The film "Oblaka" cut out the required size and immersed in 0.9% saline. Before applying the film to the affected surface is pre-cleaned of fibrinous film chymotrypsin by a standard method. On top of the film put a gauze pad. The film "Oblaka" impose 3 times a day until complete epithelialization of the ulcer-necrotic elements.

In the available scientific and medical and patent literature information about the popularity identical correction method SRO in the oral liquid in treating ulcerative-necrotic lesions SOR in patients with MM is not detected. Thus, the claimed invention meets the criterion of "novelty".

The authors proved that the application of the method shortens the period of epithelialization of the ulcer-necrotic lesions in the mouth due to the correction of the SRO in the oral fluid. Thus, the claimed invention meets the criterion of "inventive step".

The proposed method treated 24 patients with multiple myeloma. In all cases, was achieved this technical result.

Example 1. Patient K., 52 years old. Di is the prognosis Multiple myeloma, Stage III. Diffuse osteoporosis flat bones. Plasmacytoma of the neck. Chemotherapeutic stomatitis.

Complaints about pain when eating, talking.

When inspecting the element lesion was located on the lateral surface of the tongue size 13 mm Ulcer was rounded with fuzzy uneven edges, with a clean surface, sharply painful to palpation, with no signs of inflammation.

The patient in the morning on an empty stomach was spat the saliva into a sterile tube. In the measuring cuvette was added 2.0 ml of working solution lyuminola (0.5 ml stock solution lyuminola DMSO in 500 ml of physiological solution) and 0.1 ml of RJ. The cuvette was placed in chemiluminometer-003. Findings: sutasoma - 2,4 conventional units, the maximum flash - 0,9 conventional units, suggesting a low activity of free radical oxidation. In the complex treatment of traditional dental activities the patient was scheduled preventive Lacalut toothpaste fluor and solcoseryl dental adhesive paste. Toothpaste was used 2 times a day, morning and evening. A strip of paste SDP length of about 0.5 cm was applied in a thin layer on pre-dried gauze swab the affected area of oral mucosa and slightly moistened caused pasta water. The procedure was repeated 4 times a day after meals and before bedtime. The treatment was carried out before the disappearance the Oia symptoms.

On the same day, there was a decrease in pain, on the 2nd day was marked by the appearance of granulations. Ulcer epithelials on the 6th day. Performance chemiluminescence on 6th day: sutasoma - 5,3 conventional units, the maximum flash - 1,4 conventional units.

Example 2. Patient M., aged 57. Diagnosis: Multiple myeloma, stage III. Myeloma destruction of the bones. Nephropathy. Chemotherapeutic stomatitis.

Complaints about pain when eating and talking, the impossibility of wearing complete dentures.

When viewed on the mucosa of the right cheek on the line joining the teeth and the mucous membrane of the hard palate was determined sores round shape with clear smooth edges, covered with fibrinous film, redness and swelling at the periphery. Ulcer dimensions of 1.0 and 1.4, see the Patient in the morning on an empty stomach collected saliva into a sterile tube. In the measuring cuvette was added 2.0 ml of working solution lyuminola (0.5 ml stock solution lyuminola DMSO in 500 ml of physiological solution) and 0.1 ml of RJ. The cuvette was placed in chemiluminometer-003. Findings: sutasoma - 12,6 conventional units, the maximum flash - 4,1 conventional units, testified to the high activity of free radical oxidation. In the complex treatment of traditional dental patient events were assigned toothpaste Colgate total ropolis and film preparation "Oblaka". Toothpaste was used 2 times a day, morning and evening. The film "Oblaka" cut out the required size and immersed in 0.9% saline. Before applying the film, the skin surface was pre-purified from fibrinous film chymotrypsin by a standard method. On top of the film put a gauze pad. The film "Oblaka" were applied 3 times a day until complete epithelialization of the ulcer-necrotic elements.

Complete relief of pain came on 2nd day. On the 2nd day there was a decrease in congestion. Complete epithelialization of the ulcer was achieved on the 7th day. Performance chemiluminescence on the 7th day was: sutasoma - 8,9 conventional units, the maximum flash - 3,5 conventional units.

The application of the proposed method of treating ulcerative-necrotic lesions SOR patients with MM with regard to free-radical oxidation in the oral fluid is adequate pathogenetic treatment to reduce the period of epithelialization of the ulcer-necrotic elements.

The proposed method is easily reproducible and can be used in dental clinics and in the hospital. Thus, the claimed invention meets the criterion of "industrial applicability".

A method of treating ulcerative-necrotic lesions of the mucosa from patients is now with multiple myeloma with regard to free-radical oxidation (CPO) in oral fluid, including Lomonosovskiy chemiluminescence oral fluid, determining the maximum flash and sutasoma glow, holding a Pro-oxidant therapy in low activity SRO or antioxidant therapy in increased activity of SRO, characterized in that when the values of sutasoma from 1,02 to 6.6 units, and the maximum flash from 0.7 to 2.5 conventional units as a Pro-oxidant therapy using Lacalut toothpaste fluor and callserially adhesive paste when the values setosum from 8.3 to 13.5 units, and the maximum flash from 3.4 to 4.2 conventional units as antioxidants use toothpaste Colgate total propolis and film preparation "Oblaka", moreover, the treatment until epithelialization of the ulcer-necrotic elements.



 

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