Method of topical treatment of hyperfibrinolytic hemorrhages in cardiosurgery
SUBSTANCE: invention relates to field of medicine and is intended for treatment of hyperfibrinolytic hemorrhages in cardio surgery. Method includes irrigation of pericardium cavity and/or pleural cavity with solution of antifibrinolytic. Solution is introduced during hemorrhage against the background of hyperfibrinolysis after suturing postoperative wound.
EFFECT: method application makes it possible to reduce postoperative hemorrhage, need of transfusion of blood components and necessity of additional surgical hemostasis, ensures maximal concentration of active substance in area of maximal activity of fibrinolysis and in immediate proximity from source of hemorrhage, excluding risk of thrombosis.
The invention relates to medicine, namely, cardiovascular surgery, and can be used to reduce postoperative blood loss and need for blood transfusions, reducing the need for additional surgical hemostasis.
Known methods of therapy hyperfibrinolytic bleeding in cardiac surgery (Dementieva I.I. the hemostatic System during operations on the heart and great vessels. Disorders, prevention, correction / I.I. Dementieva, M.A. Charney, Y.A. Morozov): GEOTAR-Media, 2009. - 432 S.; Varela Crespo C.A. Effect of tranexamic acid on postoperative bleeding in pediatric heart surgery / C.A. Varela, P. Sanabria, M.A Palomero Rodriguez et al // Rev. Esp.Anestesiol. Reanim. - 2007. - Vol.54. - P.155-161.; McCIure P.O. The use of epsilon-aminocaproic acid to reduce bleeding during cardiac bypass in children with congenital heart disease / P.D. McCIure, 1 Izsak // Ancsthcsiology. - 1974. - Vol.40. - P.604-608.), assuming the systemic use of Antifibrinolytics, such as ε-aminocaproic acid and tranexamic acid.
The disadvantage of these methods is that they do not provide optimal concentration of active substance in the areas of greatest activity of fibrinolysis, i.e. in the wound, the activity of fibrinolysis in which surpass those in the systemic blood. The use of higher doses of these drugs threatens the development of thrombosis in different locations. In fact, the systemic use of antifibrinolytic which inhibits systemic fibrinolysis, the activation of which is often small, but does not have a decisive impact on the local, dominant in the clinic, defines as the process of lysis of clots in the wound, and the persistence of bleeding.
There is a method of topical application of Antifibrinolytics surgery (De Bonis M. Topical use of tranexamic acid in coronary artery bypass operations: a double-blind, prospective, randomized, placebocontrolled study / M. De Bonis, F. Cavaliere, F. Alessandrini // J. Thorac. Cardiovasc. Surg. - 2000. - Vol.119. - P.575-580), including irrigation pericardium cavity with a solution of 1 g tranexamic acid in 100 ml of isotonic sodium chloride solution before closure of the surgical wound with subsequent removal of the solution through the drainage tube, and the presence of postoperative bleeding, therapy with the use of hemostatic drugs and blood transfusion.
The disadvantage of this method is that it does not have a prolonged effect and does not exclude the risk of postoperative bleeding on the background of activation of systemic or local fibrinolysis. It is known that the activity of fibrinolysis after operation for some time increases and the preventive application of Antifibrinolytics not able to exert influence on it, which limits the effectiveness of such method and does not preclude therapy with the use of hemostatic drugs and blood transfusion.>
The technical result of the claimed method is the enhanced activity of Antifibrinolytics in the areas of greatest activity of fibrinolysis.
The method is as follows. In postoperative blood loss in excess of 3 ml/kg/h, and under normal laboratory indicators of blood coagulation (indicating bleeding, caused by the activation of local fibrinolysis), or when continuing after normalization of these parameters, the rate of bleeding through the drainage tube to the cavity of the pericardium or the potential of finding the source of bleeding in the pleural cavity pleural cavity is irrigated with a solution of antifibrinolytic with the subsequent removal of the solution through the drain tube. The volume of solution is calculated from the anthropometric characteristics. In the case of intact pleural cavities it should not exceed 5 ml/kg Before the introduction of the solution antifibrinolytic heated to body temperature. To prevent tamponade cardiac irrigation produced under continuous monitoring of heart rate, arterial and Central venous pressure.
For irrigation use official recipe solutions Antifibrinolytics. The volume of injected solution is limited by the volume of the cavity of the pericardium, and the risk of arrhythmias and coronary the perfusion determines the necessity of warming the solution.
The technical result is achieved in that in the method of topical treatment hyperfibrinolytic bleeding in cardiac surgery, including irrigation of the cavity of the pericardium solution antifibrinolytic, the solution is injected during bleeding amid hyperfibrinolysis after the suturing surgical wound into cavity pericardial and/or pleural cavity.
The irrigation cavity pericardial and/or pleural cavity with a solution of Antifibrinolytics during bleeding amid hyperfibrinolysis provides the maximum concentration of the active ingredient in the areas of greatest activity of fibrinolysis and in the immediate vicinity of the source of bleeding while eliminating the risk of thrombosis due to the lack of systemic effects of the drug.
Example. Patient D., 1st, 9 mo., the weight of 11.7 kg Clinical diagnosis: ventricular septal defect. The child performed plastic ventricular septal defect in an artificial hypothermic circulatory and pharmachological cardioplegia. In the early postoperative period marked blood flow to drains with an intensity of 5 ml/kg/h have been reported violations of the coagulation phase of blood coagulation, mainly caused by excess heparin: MPE (international normalized ratio) - 1,15, APTT (activated justiceemployee time) - 150 C, CTin(coagulation time of thromboelastogram (TAG) when you activate the internal path) - 587, CTex(coagulation time TAG when you activate the external path) - 61, FTin(formation of a blood clot TAG when you activate the internal path) - 233, CFTex(formation of a blood clot TAG when you activate the external path) - 131, with a secondary violations phase stabilization of the blood clot: fibrinogen 2 g/l, platelets 238×109/l, αin51°, αex65°, MCF;n (the maximum strength of the clot on the TAG when you activate the internal path) - 44 mm, MCFex(the maximum strength of the clot on the TAG when you activate the external path) - 48 mm and normal activity of fibrinolysis: D-dimer 314 ng/ml, Lys30ex(the percentage of clot lysis TAG after 30 minutes when you activate the external path) - 0%, Lys30in(the percentage of clot lysis TAG after 30 minutes when you activate your inner path) - 9%. Therapy, including Protamine sulfate, Aprotinin, fresh frozen plasma. During therapy marked stabilization of the main parameters thromboelastogram (CTin- 126 C STex- 66, CF0Tin- 78, FTex- 93 s, αin- 75°, αex- 72°, MCFin53 mm, MCFex-55 mm) when the increase in the activity of systemic fibrinolysis (Lys30ex- 18%, Lys30in- 14%), despite the systemic use of Antifibrinolytics. The rate of blood loss decreased, noosaville excess, accounting for 3.6 ml/kg/h Through the drainage tube into the cavity of the pericardium introduced 50 ml of 5% solution of ε-aminocaproic acid. The hemodynamic changes are not marked. Drainage periact 10 min residual solution of antifibrinolytic aspirated through the drainage tube. The intensity of blood loss decreased to 0.7 ml/kg/h, the potential need for red cell transfusions and additional surgical hemostasis has been corrected. Patient exuberan after 10 h, transferred to the clinical Department on the 2nd day. The wound healed by first intention. The child was discharged from the hospital on the 7th day.
The proposed method provided the cessation of bleeding, reduction of postoperative blood loss, need for transfusion of blood components and the need for additional surgical hemostasis due to the impact of antifibrinolytic solution of ε-aminocaproic acid, is introduced through the drainage tube into the cavity of the pericardium, while bleeding on the background hyperfibrinolysis, that is, the maximum impact of Antifibrinolytics in the areas of greatest activity of fibrinolysis.
The method of topical treatment hyperfibrinolytic bleeding in cardiac surgery, including irrigation of the cavity of the pericardium solution antifibrinolytic, wherein the solution is injected during bleeding on the background of hyperfibrinolysis is and after suturing surgical wound into cavity pericardial and/or pleural cavity.
SUBSTANCE: invention refers to medicine. What is described is a solution for preparing a chitosan material, methods for preparing the haemostatic material of the solution and a medical device with using chitosan fibres. The solution consists of the following ingredients in ratio of total amount of the solution, wt %: dry chitosan with a degree of deacetylation - not less than 80%: 4-8 at dry basis, an aqueous solution of a polymer or a mixture of polymers: 1-10 at dry basis, an aqueous solution of an organic acid or a mixture of organic acids in the concentration of 50 - 80% - the rest. The method for preparing the haemostatic material of the aqueous-acidic solution containing a polyelectrolyte complex of chitosan and a water-soluble polymer comprising the electrochemical treatment of the chitosan solution in an electric field with a conductive substrate. The electrospun fibres have the following characteristics: viscosity - 1.4-2.5 Pa·s, surface tension - 31-35 mN/m and electrical conductivity no more than 2.3 mSm/cm due to the use of a viscoelastic solution.
EFFECT: method enables the chitosan fibre of a thinner diameter.
45 cl, 20 dwg, 6 tbl, 16 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to medical pharmacology and represents a method for preparing a hemostatic product, involving treatment of gelatin in distilled water, incubation, cooling, addition of blood plasma and an antibiotic to gelatin, mixing, cooling, hardening, washing of an end product in water at least twice, grinding, drying at temperature 90°-200°C, additional grinding and sterilisation of the target product; cooling preceding hardening is conducted in a cold room at temperature -3°--5°C for 2.5 hours; the hard mass is carved 2.0×2.0×2.0 cm. The hemostatic may be used to arrest parenchymal and capillary hemorrhages in surgical practice.
EFFECT: invention provides reducing power consumption and enhancing work capacity with keeping the production process continuous.
SUBSTANCE: invention refers to medicine and aims at the prevention of early postpartum excessive blood loss and coagulopathic haemorrhage accompanying vaginal birth. The method involves intravenous drop-by-drop single administration of tranexamic acid 0.75 g dissolved in 0.9% saline 200 ml for 20-30 minutes 1 hour before the expected termination of delivery.
EFFECT: method enables effectively reducing blood loss, preventing the development of coagulopathic haemorrhage, quickly restoring the general condition of an obstetric patient.
2 tbl, 3 ex
SUBSTANCE: invention relates to medicine, particularly to paediatrics, X-ray surgery, paediatric surgery, and concerns the hemostatic disorder correction in the children with hepatic hemangiomas. For this purpose, three days before the endovascular embolisation of the hepatic hemangioma, Protromplex 600 - a preparation of plasma factors II, VII, IX, X is administered intravenously in a dose of 20 IU/kg at max. 2 ml/min; on the first postoperative day, Protromplex is administered in the same dose, and further Fraxiparine is administered subcutaneously in a dose of 158 IU/kg of body weight for 3 days.
EFFECT: presented dose schedule of the preparations provides the effective and safe correction of hemostatic disorders in the children with hepatic hemangiomas due to normalising the internal and external mechanisms of blood coagulation and fibrinolysis.
SUBSTANCE: present invention refers to immunology, namely to an immunostimulating drug containing nano-diamond powder and additionally gold-modified nano-diamonds in the following proportions, wt %: nano-diamond powder - 55; gold-modified nano-diamond powder - 45.
EFFECT: invention provides higher immunobiological activity with low toxicity of the drug.
1 dwg, 1 tbl, 1 ex
SUBSTANCE: invention relates to medicine, namely to phthisiology and can be used with the purpose to increase efficiency of treatment of patients with destructive forms of pulmonary tuberculosis. For this purpose after relief of intoxication manifestations and absence of side effects thymaline in dose 40 mg is introduced to patient in paravasal way 5 days running. After that, 6 days after finishing its introduction, 3% solution of drug glutoxime is introduced in dose 2.0 ml for 10 days. Then, introduced is cycloferon in dose 0.25 g, two times per week until intensive stage of main course is over.
EFFECT: invention makes it possible to reduce terms of elimination of destructive changes in lungs and achieve cessation of mycobacteria release in patients with expressed secondary immunodeficiency.
FIELD: medicine, pharmaceutics.
SUBSTANCE: claimed invention relates to field of pharmacy and represents gel composition for treatment of nosebleed, containing (a) carboxypolymethylene polymer; (b) glycine; (c) source of calcium ions; and (d) water, where concentration of carboxypolymethylene polymer constitutes from 30 to 40 g of dry substance for 1 litre of gel, concentration of glycine constitutes from 110 to 120 g of dry substance per 1 litre of gel, concentration of calcium ions constitutes from 40 to 70 mg per 1 litre of gel.
EFFECT: invention ensures creation of gel composition, efficient for nosebleed treatment.
12 cl, 1 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: stable fat emulsion contains prostaglandin as an active ingredient and phospholipids containing phosphatidylcholine and phosphatidyl glycerol in mass ratio 85:15 to 99.7:0.3. The fat emulsion under the invention and its active ingredient (prostaglandin) possess physical and chemical stability thereby increasing shelf life to approximately two years, and/or extended range of storage temperature to 10°C as compared with a commercially available fat prostaglandin emulsion.
EFFECT: fat emulsion under the invention enables satisfactory effectiveness even in the introduction of a low amount.
25 cl, 10 tbl, 12 ex
SUBSTANCE: invention refers to biotechnology, namely plasmid DNA pCID-PROC for expression of recombinant human protein C, cell lines of Chinese hamster ovary DG-CID-PROC-1 and a method for producing recombinant human protein C. The presented invention may be used for producing recombinant human protein C. Plasmid DNA pCID-PROC for expression of recombinant human protein C contains a sequence of full-length complementary DNA of a human protein C gene presented in List of Sequences as the sequence SEQ ID NO: 1. Plasmid DNA pCID-PROC is characterised by a physical map presented on dwg. 1. A cell line of Chinese hamster ovary DG-CID-PROC-1 is produced by transformation of the cell line of Chinese hamster ovary DG-44 by said expression plasmid DNA pCID-PROC. The method for producing recombinant human protein C involves culture of said cell line DG-CID-PROC-1 in a nutrient medium and recovery of produced target protein from a culture fluid.
EFFECT: invention provides higher production performance of the protein C expression system and simplified recovery, activation and purification of recombinant activated human protein C.
3 cl, 3 dwg, 2 ex
SUBSTANCE: invention relates to biotechnology and specifically to obtaining factor VII (FVII) and factor Vila (FVIIa) albumin linked polypeptides, and can be used in medicine. A polypeptide, which is a FVII or FVIIa polypeptide is obtained in a recombinant manner, said peptide being linked with albumins through a glycerine-serine peptide linker of a special structure, which separates part associated with FVII or FVIIa from the albumin part, wherein the FVII or FVIIa polypeptide lies on the N-end of the fused protein. The linked polypeptide or vector structure, which contains its coding nucleic acid, is used as a medicinal agent for treating or preventing blood-clotting disorders.
EFFECT: invention enables to obtain a protein with FVII or FVIIa biological activity and longer functional half-time in plasma in vitro compared to non-linked FVII or FVIIa.
12 cl, 4 dwg, 6 tbl, 6 ex
SUBSTANCE: invention relates to medicine, in particular, to herniology. Greater omentum is cut closer to left edge. Flap is cut out on vascular pedicle in left part of greater omentum with two omentum arteries, which are anastomosed with each other. Larger - right part of transected omentum is sutured to wound from bellow, lower - left part with two anastomosing omentum arteries are brought above sutured peritoneum and laid along entire wound length, forming two layers of greater omentum transplants.
EFFECT: method makes it possible to prevent failure of sutures and recurrences of ventral hernias due to improvement of blood supply of tissues for hernia plasty.
1 ex, 3 dwg
SUBSTANCE: invention relates to field of medicine, namely to surgery and oncology, and can be applied in surgical treatment of breast cancer. Method consists in intrapleural argon-plasma haemostatic coagulation in conditions of videothorascopic retrosternal lymphadenectomy. Parietal pleura is separated and fatty tissue with contained in it retrosternal lymphcollector is removed. For separation of retrosternal lymphcollector applied is argon-plasma coagulation by soft probe with canal section 0.1-0.3 cm. Applied parameters of coagulation are the following: argon steam 1.0-1.5 litre per minute and power 50-80 Wt.
EFFECT: application of claimed invention makes it possible to ensure reliable hemostasis, as due to application of soft probe port of access into thoracic cavity is not totally interrupted, therefore is accessible for any other instrument for carrying out hemostasis and sanitation of thoracic cavity, which, in its turn makes it possible to reduce time and facilitate carrying out operation, exclude installation of additional port, source of argon-plasma coagulation is constantly situated in lumen of thoracic cage during operation.
1 tbl, 5 dwg, 3 ex
SUBSTANCE: inventions relate to medicine, namely, to thoracic surgery, and can be applied for control of pneumostasis. For this purpose indicator substance is additionally introduced into breathing mixture in carrying out artificial lung ventilation (ALV). As such means sulfur hexafluoride in ratio 1:5000 is applied. Detection of indicator means and intensity of its leakage flow in real time mode is used to judge about presence and degree of microdefect in the area of sutured tissue.
EFFECT: group of inventions makes it possible to realise effective control of lung tissue, bronchus stump and tracheobronchial sutures impermeability.
2 cl, 2 ex
SUBSTANCE: invention relates to surgery and can be applied for treatment of cardia achalasia of 2-3 stage. Before operation esophageal manometry is carried out and average pressure value in stenosis zone is measured. During operation after stomach and esophagus mobilisation balloon dilatator is introduced into esophageal lumen and cuff is blown to the value of average pressure, obtained as a result of esophageal manometry. Cuts of muscular membrane are made 5 mm more proximally and distally from boundaries of stenosis and unaltered wall of esophagus.
EFFECT: method makes it possible to improve possibilities of visual evaluation of zone of esophagostenosis.
SUBSTANCE: invention relates to traumatology and orthopedics and can be applied for treatment of patients with recurring instability of shoulder joint in presence of risk factors of development of shoulder joint instability recurrences. Intra-joint tenotomy of long head of biceps muscle of arm is performed. Tendon of long head of biceps muscle of arm is passed under greater pectoral muscle, and then in front and above tendon of subscapular muscle, with its downward displacement. Tendon of long head of biceps muscle of arm is fixed by means of interferential screw in preliminarily formed canal on front surface of joint process of scapula.
EFFECT: method ensures elimination of shoulder joint instability, reduction of operation trauma and risk of development of postoperative complications.
1 ex, 7 dwg
SUBSTANCE: invention relates to medicine, namely to neurosurgery. Selective rhizotomy of spinal cord roots of lumbar enlargement is performed. Additionally carried out is stimulation of terminal filament and if tonic contraction of shin muscles is detected, excision of terminal filament of spinal cord is carried out.
EFFECT: method makes it possible to increase operation effectiveness, which is reached due to detection and transection of radicels, which take part in formation of hyperactive arc of stretch-reflex.
2 dwg, 1 ex
SUBSTANCE: invention relates to medicine, in particular to reconstructive surgery of wrist bones. Essence of method of fixing vascularised bone transplant of wrist bones includes movement of transplant into recipient zone and fastening with glue "sulfacrylate". "Vicryl" mesh is laid above donor transplant in such a way, that edges of mesh from all sides evenly project beyond the perimetre of transplant. "Sulfacrylate" glue is applied on projecting edges of mesh, used to glue transplant to recipient bone around zone of transplant.
EFFECT: claimed is novel method of fixing vascularised bone transplant on wrist bones.
1 ex, 5 dwg
SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Method includes bow-shaped cut above head of first instep bone, exposure of joint capsule and tendon of long extensor of I toe. Tendon of long extensor of I toe is exposed along main phalange of toe and diaphysis of I instep bone. Longitudinal canal is made through head of I instep bone by drill. Tendon of long extensor of I toe is cut, its distal end is passed in formed bone canal, ends of long extensor of I toe are connected by tendon suture, with elimination of valgus deformation of I toe. I toe is fixed in correct position through metatarsophalangeal joint with pins for 1 month term. Wound is sutured. Bandage, plaster base splint are applied until removal of skin sutures for two weeks.
EFFECT: method prevents recurrence of toe deformation.
SUBSTANCE: invention relates to medicine, namely to traumatology and orthopedics. Method includes edge resection of part of injured phalange, or III middle metacarpal bone, with removal of tumour masses. After removal of tumor masses perforation of walls on side surfaces of phalange, or III middle metacarpal bone, with preservation of integrity of joint surfaces and palm cortical plate of phalange, or III middle metacarpal bone is carried out. The remaining side walls are brought together by mechanic pressure on them.
EFFECT: method restores normal anatomical proportions of bone structures, tendons of extensor and functioning of extensor apparatus of finger after operation.
SUBSTANCE: invention relates to field o medicine, namely to traumatology and orthopedics, and can be applied for correction of midfoot deformations. Transosseous supports are applied on shin, calcaneous bone and instep bones. Two consol attachments are fixed to support, fixing calcaneous bone, at the top in frontal plane, half-ring being fixed in the same plane at the bottom. Additional bearing is fixed to support, which fixes instep bones more distally from it. Strata No1 and No5 are fastened to consol attachments of support, fixed on calcaneous bone. Stratum No3 is fastened in the center of additional half-ring of calcaneous support. Strata No2 and No4 are fastened to edges of remote support fixed on instep bones. Stratum No6 is fastened in the center of the same support, No 2, No 4 and No 6 being fixed with Z-shaped pads.
EFFECT: method ensures restoration of support ability of extremity, achievement of maximal reposition possibilities of apparatus with minimal dimensions of construction during fixation period.
1 ex, 16 dwg
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