Method of treating cavernous hemangioma of airways

FIELD: medicine.

SUBSTANCE: invention refers to medicine and may be used to treat a benign growth of cavernous hemangioma of the upper airways. The new growth is extracted in a coagulation mode by Nd:YAG laser exposure at wave length 1.064 nm. A quartz light guide of the diameter of 400 mcm is used. The output laser power is 15 Wt. The exposure time is 6 to 10 minutes. The distance of the light guide end to the tumour is 3 to 10 mm. The power density is 850 to 50 Wt/cm2. The pulse length is 0.5 to 1 s.

EFFECT: method enables achieving deep coagulation of cavernous vascular tissue without causing thermal damage to the mucous membrane covering the hemangioma followed by sclerosing of the cavernous component of the hemangioma tissue and replacing it by scar tissue due to thermal ablation of the abnormal blood vessels.

2 ex

 

The invention relates to medicine, namely to methods of treatment using laser radiation, and can be used to treat benign tumors, cavernous hemangioma of the respiratory tract.

Currently in medical practice for the treatment of cavernous hemangiomas oropharyngeal area is widely used by the impact of CO2-lasers. However, when using the CO2laser patients was often marked by the development of various complications.

Known work (Chereskin became popular, Dunaevskaya A.M., Time HE endoscopic Laser surgery of the upper respiratory tract. - Moscow: Medicine, 1990). The authors of well-known techniques used CO2laser for the treatment of cavernous hemangiomas oropharyngeal area 5 patients. In 3 cases, patients had marked the development of complications such as bleeding, which required tamponade or surgical intervention. The cause of the complications in this case was the use of radiation CO2-high power laser and surface evaporation vascular tissue neoplasms. In fact, there was formation of erosions on the surface of the hemangioma.

Known also study "Treatment of congenital hemangiomas poslodavaca Department of the larynx: trends and success over the past 17 years", which provides information about treatment 81-th pale is the CO 2laser (Bitar M.A., Moukarbel R.V., Zilzal GH Management of congenital subglottic I: trends and success over the past 17 years. Otolaryngol Head Neck Surg. 2005; 132(2): 226-231). The positive effect of treatment was achieved in 88.9% of cases. Various complications were observed 12.1%, with 5.5% of patients had cicatricial stenosis podskladochny Department of the larynx. The development of this serious complication was associated with the mode of processing large surface CO2-laser high power (40-60 watts). thermal effects on a large area in podskladochny Department, usually develop stricture formation.

Thus, despite the number of advantages of laser surgery results obtained when it is used for removal of vascular tumors of the oral cavity and pharynx, require new technical solutions.

The claimed invention is directed to solving the problem of complete conservative treatment in the presence of vascular lesions of the respiratory tract.

Use in clinical practice, the proposed method allows to achieve several technical (medical) results:

- reducing the size exophytic component hemangioma;

- restoration of the airway;

- the possibility of reaching deep coagulation cavernous vascular tissue without thermal damage of the mucous membrane covering the hemangioma, after the existing hardening cavernous component tissue hemangioma and its replacement by scar tissue due to thermal ablation of abnormal blood vessels.

These technical (medical) results in the implementation of the invention are achieved due to the fact that just as in the known method, the treatment of single or multiple cavernous hemangiomas of the upper respiratory tract is performed with the use of laser radiation.

The feature of the proposed method lies in the fact that the removal of the tumor is performed in the coagulation mode by summing the radiation of the Nd:YAG laser with a wavelength of 1,064 nm on a quartz fiber with a diameter of 400 μm under the following exposure parameters: laser power output from 10 to 15 watts, time from 6 minutes to 10 minutes, the distance from the end of the fiber to tumors from 3 mm to 10 mm, the power density of the radiation from 850 to 50 W/cm2the duration of pulses from 0.5 to 1 C.

The invention consists in the following.

The authors of the claimed invention designed for the optimal mode to remove vascular lesions in as much as possible sparing mode without opening the tissue hemangioma. To remove a cavernous hemangioma authors used Nd:YAG lasers. Exposure is carried out using a quartz fiber with a diameter of 400 microns with the following parameters: laser power output from 10 to 15 watts, time from 6 minutes to 10 minutes, the distance from the end of the fiber to the surface of the tumor from 3 mm to 10 mm, the power density of irradiation the Oia from 850 to 50 W/cm 2the duration of pulses from 0.5 to 1C. The technical result of the use of the selected mode laser exposure is the possibility of achieving deep coagulation cavernous vascular tissue without thermal damage of the mucous membrane covering the hemangioma. Determinant of exposure to achieve the technical result is the value of the laser power. The laser power less than 10 watts gives the effect of a slight heating of the tissues without therapeutic effect. Modes power density of more than 850 watts/cm2and the energy density of 1000-1500 j/cm2that's the equivalent of the laser power output over 25 watts, leads to the formation of deep tissue defect with a high risk of developing complications such as bleeding.

Developed by the authors mode laser irradiation can achieve the effect of deep penetration into the tissue exposed (up to 2-8 mm) with the ability to coagulate large abnormal blood vessels (diameter up to 5 mm), achieving a good hemostatic effect.

The method is as follows.

To achieve coagulation of the cavernous tissue radiation down on a quartz fiber with a diameter of 400 microns at a distance from the end of the fiber until the tumor is from 3 to 10 mm. Using the laser: the laser power from 10 to 15 watts. The value of capacity can be increased within the specified limits, depending on the distance. The power density of the radiation of the Nd:YAG laser ranges from 850 to 50 W/cm2the duration of pulses from 0.5 to 1 s, the exposure time from 6 minutes to 10 minutes.

Examples

1. Patient B., 72 years old, came in February 2011 G. of Moscow them. PageRank with complaints of feeling of nasal congestion, heaviness in the region of the nasopharynx.

If videolaryngoscopy on the bottom wall of the right hoani with the transition to the front and right side walls of the nasopharynx, on the rear surface of the soft palate was determined exophytic and volumetric lesions of irregular shape, dark red color with bluish (until black) shade, soft-elastic consistency (cavernous hemangioma). The lumen of the naso - and oropharynx narrowed to 1/2. Similar to the lesions observed in the area of the right tubular folds (6×8 mm) on the front and right side of the uvula (10×8 mm). The distal border of the tumor was visualized in the upper third of the right palatal arch. The length of neoplastic lesions 4,5 see

Diagnosed with cavernous hemangioma of the nasopharynx. The Council, with the participation of ENT surgeons decided to endoscopic treatment.

p> The same day the operation was performed using a flexible endoscope: laser sclerosing therapy of vessels of cavernous hemangioma of the nasal septum and of the uvula. For treatment was used Nd:YAG laser, DL. oxen 1,064 nm. Used quartz fiber with end chip with a diameter of 400 μm. The laser power output in the range from 10 to 15 watts. The distance from the end of the fiber to tumors from 3 mm to 10 mm

Under the influence of laser irradiation there was a gradual decrease in the volume of hemangioma with interstitial coagulation cavernous dilated vessels. After laser irradiation, the tumor oposals, its volume was reduced more than 2 times. Complications were noted, there were no signs of thermal damage to the surface of the hemangioma.

When viewed through the day in the area of laser photocoagulation remained whitening and seal sclerotioides tissue, reducing its volume and flattening.

The next day held the second session of coagulation of the tumor. Achieved long-lasting positive effect.

When viewed through 3 months. in the naso - and oropharynx were determined flat barely noticeable Nutrilite scars, signs of residual hemangioma was absent.

2. The patient F. 47 years, was observed about cavernous hemangioma of the soft tissues of the neck to the right from birth. In 1987 was Ipanema surgery: removal of haemangioma. In 1995 came paperchine, recurring attacks of shortness of breath. Diagnosed with a cavernous hemangioma larynx and pharynx. During the next periodic health examination showed increase in hemangioma larynx and pharynx. Directed of Moscow for further evaluation and treatment.

If videolaryngoscope (13.06.08) of Moscow: the nasal cavity is not changed. On the back wall of the nasopharynx is determined by several sections of the mucosa is dark red with a bluish tint, sizes from 2×3 mm to 5×6 mm, These changes are propagated distally on the Oro-, hypopharynx and larynx. The shape and size downstream of the modified sections of the mucous different places they have a drain in nature. Tumors are vascular in nature (multiple sites hemangioma). In hypopharynx right these areas take the form of decorated nodules are spherical shape with a size of 7×8 mm, occupying partially pyriform sinus, entire right charalabidis cartilage, right cabalonline fold and part of the vestibular folds. This education has narrowed the lumen of the vestibular division of the larynx 1/2. Around the endoscope neoplasm was able to walk freely in the Central division of the larynx: voice folds mobile, anatomy them saved, slimy smooth. Podsiadly the Department has not narrowed. In podkladova the Department is in the trachea circular around the perimeter of the upper and middle thirds of its also define multiple drain areas with the presence of the above-described changes in vascular nature. The distal border is above the crest of Karina 3.0 see the Area of bifurcation, bronchi, right and left up to 5 order without pathology.

Thus, was diagnosed with multiple cavernous hemangioma larynx, pharynx, trachea stenosis of the larynx II-III century In connection with the presence of a large extent of the lesion on the Council with the participation of ENT surgeons, it was decided endoscopic laser treatment. This was used by Nd:YAG laser. Radiation was summed up by quartz face diffuser with microlens length of 1 cm and a diameter of 400 microns. Was used following the coagulation mode: laser power output ranged from 10 to 15 watts. The distance from 1 to 3 mm With increasing distance output power was increased to 15 watts.

During laser irradiation, there was a gradual decrease in the volume of hemangioma with interstitial coagulation cavernous dilated vessels. After laser irradiation, the tumor oposals, its volume was reduced more than 2 times. Complications were noted, there were no signs of thermal damage to the surface of the hemangioma.

When viewed through the day in the area of laser photocoagulation remained whitening and seal sclerotioides tissue, reducing its volume and flattening.

A total of 11 sessions Nd:YAG laser coagulate the plots and multiple cavernous hemangiomas.

At the control examination after 1 year after treatment: the lumen of the naso-, Oro-, hypopharynx free. In the areas of laser photocoagulation lesions hemangiomas are superficial whitish flat scars, smooth mucosa. The epiglottis normal shape and size. The lumen of the larynx is not narrowed. In the field of laser sclerosing exophytic hemangioma right 1/2 naslednogo Department of the larynx has a smooth kapitalizirovana mucosa with robovie changes. In the field poslodavaca Department of the larynx, the upper and middle 1/3 of the trachea (areas of flat lesions) there are multiple intramural whitish scars. The lumen of the trachea and larynx, not narrowed.

Thus, the patient was noted a marked positive effect of the treatment in the form of complete resorption of all sections of the cavernous hemangioma naso-, Oro-, hypopharynx, larynx and trachea with the full restoration of the lumen of the larynx.

Currently, the patient is observed without recurrence or attacks of shortness of breath.

The inventive method has significant advantages and meets the criteria of patentability.

The method of treatment of single or multiple cavernous hemangiomas of the respiratory tract with the use of laser radiation, characterized in that the removal of the tumor is performed in the mode of coagulation way the sum of the radiation of the Nd:YAG laser with a wavelength of 1,064 nm on a quartz fiber with a diameter of 400 μm under the following exposure parameters: laser power output from 10 to 15 watts, exposure from 6 to 10 min, the distance from the end of the fiber to tumors from 3 mm to 10 mm, the power density of the radiation from 850 to 50 W/cm2the duration of pulses from 0.5 to 1 C.



 

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1 ex

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EFFECT: reduced risk of metastasizing.

4 cl, 13 dwg

FIELD: medicine.

SUBSTANCE: method involves building tunnel to posterior eyeball pole in inferoexterior and superexterior quadrants. The tunnel is used for implanting flexible polymer magnetolaser implant to the place, the subretinal neovascular membrane is localized. The implant has a permanent magnet shaped as a cut ring and is provided with drug delivery system and a short focus scattering lens of laser radiator connected to light guide. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 5-7 mTesla units intensity. It is arranged with its north pole turned towards sclera at the place of the subretinal neovascular membrane projection with extrascleral arrangement of laser radiator lens membrane being provided in the subretinal neovascular membrane projection area. The other implant end is sutured to sclera 5-6 mm far from the limb via holes made in advance. The implant is covered with conjunctiva and retention sutures are placed thereon. Light guide and drug supply system lead is attached to temple with any known method applied. Drugs are supplied via the implant drug supply system in retrobulbary way in any order. Triombrast is given in the amount of 0,4-0,6 ml and dexamethasone or dexone in the amount of 0,4-0,6 ml during 3-4 days every 12 h. 0.1-1% aqueous solution of khlorin is intravenously introduced at the third-fourth day after setting the implant as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, at a bolus dose of 0.8-1.1 mg/kg. Visual control of subretinal neovascular membrane cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the subretinal neovascular membrane with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at general dose of 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the subretinal neovascular membrane via laser light guide and implant lens, repeated laser irradiation of the subretinal neovascular membrane is carried out with radiation dose of 30-60 J/cm2.

EFFECT: accelerated subretinal edema and hemorrhages resorption; regression and obliteration of the subretinal neovascular membrane; prolonged vision function stabilization.

6 cl

FIELD: medicine.

SUBSTANCE: method involves filling vitreous cavity with perfluororganic compound. Two electrodes manufactured from platinum group metal are intravitreally, transretinally introduced into intraocular neoplasm. Electrochemical destruction is carried out with current intensity of 10-100 mA during 1-10 min in changing electrodes polarity and their position in the intraocular neoplasm space, and the electrodes are removed. 0.1-1% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells fluorescence is carried out by applying fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, intravitreous, transretinal laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2 in perfluororganic compound medium. The transformed retina and tumor destruction products are intravitreally removed with perfluororganic compound volume being compensated with its additional introduction. Boundary-making endolasercoagulation of retinotomy area is carried out. The perfluororganic compound is substituted with silicon oil. The operation is ended in placing sutures over sclerotmy areas and over conjunctiva. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity. Platinum, iridium or rhodium are used as the platinum group metals.

EFFECT: complete destruction of neoplasm; reduced dissemination risk.

6 cl, 12 dwg

FIELD: medicine, applicable for stopping of pains of various nature.

SUBSTANCE: the device has a quantum-mechanical oscillator located in a casing, magnet, vessel for medicinal agent and a hollow cylinder. The magnet is installed between the oscillator and the vessel. Positioned in the vessel is a hollow cylinder having through holes on its surface.

EFFECT: quick and absolute anestesia.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

EFFECT: enhanced effectiveness in inhibiting dysbacteriosis; reduced frequency of postoperative complications.

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