Method for postoperative prevention of colocolonic anastomotic leakage
SUBSTANCE: after a colocolonic anastomosis is created 10-12 cm in a proximal direction from the anastomosis, a double tube is inserted into an intestinal lumen. After a transanal insertion of the tube, an infusion pump is used for dosed introduction of a rifaximin suspension at 0.01 mcg of an active substance per 1 kg of a patient's body weight a minute through one channel and a passive outflow through the second channel. The rifaximin suspension is introduced continuously for the first days, then 3 times a day for 3 hours until observing active intestinal peristalsis.
EFFECT: method provides effective prevention of colocolonic anastomotic leakage, reduces a probability of postoperative complications ensured by avoiding microbial contamination, infection and development of anastomositis, as well as promotes reducing the length of treatment and postoperative stay in hospital.
The invention relates to medicine, namely to colorectal surgery, and can be used to restore the continuity of the intestinal tube after pulmonary resections of the left departments of the colon (operations type Hartman).
The continuing high prevalence of obstructive resection distal colon due to the fact that in complicated cancer and diverticulosis, colon cancer, burns, trauma, developmental abnormalities often require multi-stage surgical treatment [Abuladze T.V. with coawt; Cocos V.I. et al. 2000; Aktov NR. et al. 2001]. The most common intervention is currently the operation Hartmann, which often occurs during working age. The frequency with complicated course of disease, colon cancer, according to different authors, ranging from 37% to 62% [Vorobyev GI et al. - 2006; Timerbulatov V.M. et al. - 2004]. However, this operation causes of disability due to the presence of single-barrel colostomy [Aktov NR. et al. 2001]. Assessment the SSC of Coloproctology health Ministry, the number of ostomy patients in the Russian Federation is 100,000 to 120,000, of which 38,2-50,8% of patients of working age [Vorobyev GI et al., 2006.; Sparrows GI, 2001].
It is known that the restoration of bowel continuity after the operation type Hartman is tositsa the most traumatic and complex reconstructive operations on the colon in open surgery, due to massive adhesions process and the technical difficulty separating out the stump of the colon (especially with short residual length less than 10 cm) from the surrounding tissues [Vorobyev GI et al. - 1994; Gulmammadov FI et al., 2000; Petrov V.P. et al., 2001].
The consistently high rate of complications in the early postoperative period requires improvement technologies for their prevention [Valenko A.V. et al., 2011]. Thus, the failure of the seams anastomosis reaches 6-25%, festering wound 26-60%, the mortality associated with the development of complications, the average is 5.2%. Most surgeons associated complications with the use of different types of intestinal sutures and anastomosis [Vorobyev GI et al., 2006]. The wide use of different types of tool joints the situation has not changed - objective comparative evaluation and evidence-based recommendations on the choice of the method of forming the anastomosis still does not exist [B.N. Zhukov et al., 2011; Ziganshin R. et al., 2000].
It is known that the wall of the colon in the area of the anastomosis is involved in the inflammatory process, loses its barrier function for microorganisms, vegetating in the lumen. The more intense inflammation, the biological permeability of the intestinal wall above. The greatest danger these changes represent the first day after application of the anastomosis. Currently, prevention is carried out by injecting antibiotics. Naumov N. et al.(1999) proved that it is necessary locally to sanitize the area of the anastomosis, the minimum to reduce the number of microbial bodies, vegetating in the bowel lumen in the area of the anastomosis. This reduces the penetration of microbial cells in inflamed tissue in the bowel wall and can reduce the intensity of inflammation in the area of surgical aggression [Naumov, N. et al., 1999).
A study of patent and scientific and medical literature revealed the following ways to prevent insolvency colonic anastomoses.
A known method of strengthening the lines of stitches biological adhesives based on cryoprecipitate fibrinogen [Sparrow A.V. Grishin I. Rehabilitation of ostomy patients. Minsk: Belarusian Nauka, 2003. - 190 S.; Sparrow AV Invagination methods they in colon surgery. Dis. ...candles. the honey. Sciences. Minsk, 1990. - 157 C.]. In 1961 known proposed A.M. Panicking method of extraperitoneal [Panickin A.M. colon Cancer. HP: Medicine, 1966. - 416 S.]. For decompression of the overlying departments colon proposed transnasal intubation probe with simultaneous prescription of laxatives. In 1985, first described the technique of blending the inter-intestinal anastomoses using auto-disable biofrag InterNIC rings [Sparrow AV, Grishin I. Rehabilitation of ostomy patients. Minsk: Belarusian Nauka, 2003. - 190 S.; Sparrow AV Invagination methods they in colon surgery. Dis. ...candles. the honey. Sciences. Minsk, 1990. - 157 C.].
However, all of the above methods in addition to strengthening the seam lines and decompression zone anastomosis does not include the possibility of active washing with antiseptic solutions and rehabilitation of the area of the anastomosis from the side of his clearance, which would reduce the probability of insolvency of the anastomosis and septic complications.
Relatively successful was the suppression of intestinal flora in the gut by fixing in the area of anastomosis of antimicrobial agents with prolonged action and intraoperative protection of fistula tubular semi-permeable cellulose membrane with antibiotic gentamicin molecular weight 4480-4760 Dalton [naoumov NV, Swedish And,,, Rangelov NV, Naumova E.B. Semi-permeable membrane in Coloproctology/Krasnoyarsk: Simmed, 1999. - 90 S.].
The disadvantages of the above method include:
1. Antimicrobial effectiveness of the proposed tools (including gentamicin) is limited and does not cover the whole of the microbial flora of the colon, especially considering the dysbiotic processes in postcolonialism cult, where the predominant pathogenic F. the ora.
2. Input with this method antibacterial drugs, in addition to local effects, have the ability to resorption in the colon and enter (in microdoses, no therapeutic effect) in the blood system, which also contributes to the formation of antibiotic-resistant microorganisms.
3. The method does not imply dosing antiseptic, resulting in an excessive intraluminal pressure in the area of the anastomosis.
4. The technique does not allow to reliably control the number and dose of antibiotics. It is dangerous for patients, given the nephrotoxicity of gentamicin in excessive doses.
5. The method is designed for intraoperative use, which does not allow to use it again if necessary readjustment zone anastomosis in the postoperative period.
There is a method of treatment of the insolvency of the seams colonic anastomosis (RF patent No. 2294702 from 10.07.2006), including the formation of transversality. Carry out the washing with an antiseptic solution off of the intestine and the abdominal cavity through a tube introduced into the discharge Department transversally, with the washing of water falling through a defect in the anastomosis into the abdominal cavity via drains, introduced through an incision in the iliac regions to the area of the anastomosis in the cavity of the pelvis and lateral channels of the abdominal cavity. Spend lavage prior to the absence in the lavage admixture of pus. Produced in subsequent plasticity of transversality.
The method has the following disadvantages:
1. The method is adapted for the relief of manifestations of the failure of the anastomosis and is not intended for use in the preventive purposes in air-tight anastomosis.
2. The method is technically complex and is characterized by high invasiveness, its implementation is justified by leakage of the anastomosis, which does not meet the objectives for primary prevention of insolvency inter-intestinal suture.
3. The method involves the presence of a colostomy, which is not in reconstructive surgery after pulmonary resections.
4. The method is accompanied by a high risk of injury (perforation) of the wall of the colon when introducing tube in outlet Department transversality.
5. The method does not imply the controlled dosing of antiseptics.
There is a method of treating obstructive colonic ileus (RF patent No. 2452400, dated 08.02.2011 g), including intraoperative decompression and lavage leading departments through a single or double barreled probe for rinsing through cecostomy, gray-serous hub seam on the wall of the caecum over the probe impose S-shaped, the ends of the threads which hold between the cuff, is set at the level of the skin, and probe and fixed in the tensioned position. Enter through the probe ozonated crystalloid solution and wash out the colon several times with an exposure time of 3 minutes. Sutured proximal end fixed to the peritoneum. Sew laparotomic wound. In the postoperative period, leading the Department of the colon is washed through the probe periodically within 7-10 days. When restoring intestinal passage and the subsidence of the inflammatory process impose anastomosis.
The disadvantages of this method are:
1. The need for the imposition of gastrointestinal fistula (cecostomy).
2. Two-stage technically complex surgical method for extending the period of stay in the hospital.
3. The method does not allow for washing zone anastomosis antiseptics, adapted for intraluminal introduction the spectrum of the microbial flora of the intestine.
4. After pulmonary resection for rectal application of the method is inefficient because the method does not imply impact on the microflora postcolonialism stump.
5. The method is not applicable when reconstructing interventions after pulmonary resection for distal colon (operations type Hartman).
The prototype of the present invention, as the closest to the set of features of the claimed method, we have chosen "the Way to prevent insolvency is eljnosti seams anastomosis after emergency bowel resection" [E.K. Agayev., Clinchy surgery. - 2009. No. 3, p.19-23]. Patients produced resection of various segments of the intestine and colon with applying a primary anastomosis. Most patients conducted nasointestinal and transnasal intubation in order to prevent failure of the seams intestinal anastomosis. For nasointestinal intubation used probes: gastrointestinal single-channel and dual-channel silicone No. 25, and transnasal intubation - No. 33. All patients of the main group held lavage bowel with the use of antiseptic solutions (furacin), dioxidine) and antibiotics (ciprofloxacin, metronidazole), which was dissolved in isotonic sodium chloride solution. Also implemented a enterosorption to clean the intestinal microflora, toxins, stimulate the peristalsis, gas sorption, stimulate the excretion of toxins from the blood in the cavity of the intestine.
For gastroenterogie used polifan (a natural polymer of vegetable origin, consisting mainly of lignin). Sessions gastroenterogie conducted 3-4 times per day. In a container with 300 ml of isotonic sodium chloride solution was added 20-30 g Boliviana (at the rate of 0.5-1 g per 1 kg of body weight per day), was stirred. With the help of Janet's syringe, the solution was injected into a fractional 200-300 ml nasointestinal probe 3-4 times per day and with subsequent passive, and if necessary, the active excretion of 20-30 minutes In patients with severe endotoxicosis additional sessions have been conducted sorption dialysis of the large intestine.
Prototype method postoperative prevention of insolvency thick-colonic anastomosis has the following disadvantages:
1. Input with this method antibacterial drugs, in addition to local effects, have the ability to resorption in the colon and hit (in microdoses, no therapeutic effect) into the systemic circulation, which leads to the development of resistance of microorganisms and the emergence of strains resistant to antibiotic therapy.
2. The application of the method in the published edition without taking into account the specificity of the intestinal microflora contributes to the development of microbial resistance, which indirectly affects the development of septic complications of different localization due to changes in virulence of microorganisms.
3. The method does not imply the dosing antiseptic solution, resulting in an excessive intraluminal pressure in the area of the anastomosis.
4. The technique does not allow to reliably monitor daily dose antiseptic (antibacterial) of the drug.
5. The use of solutions of antibiotics and antiseptics of besuchet their osmolarity leads to hydration (swelling) of the intercellular space, resulting in excessive tension of the fabrics and their eruption in the field of mechanical seam.
6. When performing operations on restoration of intestinal continuity tubes after pulmonary resections (operations like Hartmann) in a planned manner after adequate bowel preparation and conduct of the decompression zone anastomosis there is no need for the introduction into the lumen of the sorbents (Politeama).
7. Way in the published version does not imply a targeted impact on the area of the anastomosis when washing with antibacterial solutions, which limits its ability in the aspect of prevention of insolvency and reorganization stitched segments of the intestine from the lumen when adequate outflow of the washing liquid.
These drawbacks are eliminated in the invention. The task of the invention is a reliable post-operative prevention of insolvency thick-colonic anastomosis when performing operations on restoration of intestinal continuity tubes after pulmonary resections of the left departments of the colon (operations type Hartman).
The problem is solved in that in the present method postoperative prevention of insolvency thick-colonic anastomosis installed in the lumen of the intestine 10-12 cm proximal to the anastomosis duhk the national tube having channels of different diameters. After transanal installation of the tube through the channel of a smaller diameter using infusion dosed exercise introduction intestinal antiseptic with subsequent passive outflow channel of larger diameter. For rehabilitation of the area of the anastomosis use dosed maintain suspension of rifaximin at the rate of 0.01 μg of the active substance per 1 kg of body weight of the patient per minute. Introduction suspensions of rifaximin carried out continuously for the first day and three times per day with a duration of 3 hours in the following days until the active peristalsis of the intestines.
The technical result of the proposed method in clinical practice is that the method allows to:
to achieve adequate dosage readjustment zone anastomosis antibacterial drug, adapted as an intestinal antiseptic;
- to conduct optimal decompression zone of thick-colonic anastomosis in the postoperative period against the background of paresis of the intestine;
- to avoid through the use of suspensions of rifaximin resorption of antibacterial drug from the lumen of the colon and hit him in the systemic circulation, preventing the development of side effects, including the development of antibiotic resistant strains of microorganisms;
- to achieve meaningful economic the definition of effect by reducing the costs of technically complex and time-consuming ways to prevent insolvency anastomoses, and by reducing the volume and prolonged systemic antibiotic therapy.
Our investigations revealed several reasons for the development and clinical manifestations of the failure of the anastomosis. Of Prime importance for the prevention of insolvency anastomosis have data on the status of leading Department and postcolonialism stump, including the assessment of the severity of the changes of quantitative and qualitative composition of microflora (as disconnected plot, and proximal) colon, the results of instrumental methods of examination (colonoscopy, sigmoidoscopy). As well as data characterizing the state of the mucous membrane of these divisions of the intestine, the severity of diversion colitis, as well as the results of anorectal manometry in order to objectively interpret the state of the locking apparatus of the rectum and function of the pelvic floor muscles. The presence of pathological changes and bowel dysfunction in accordance with the results of laboratory and instrumental studies allowed us to validate the indications for intraoperative prevention of insolvency colonic anastomosis.
In recent years in the treatment of various gastrointestinal diseases have been widely used newscasino (intestinal) antibiotics. Their advantages compared what Yu with absorbed (systemic) antibiotics include: the possibility of direct exposure to the source of infection, a low incidence of systemic side effects, no drug interactions, and low risk of development of resistant strains [Scarpignato C. and coauthors 2006; Steffen R. and coauthors - 2003].
We used rifaximin (commercial name - Alfa normix) -synthetic derivative of rifamycin (4-deoxy-4'-methylpyrazol[1',2',-1,2]imidazo[5,4-C]rifamycin), synthesized with the aim of creating newsseveral antibiotic while maintaining a high antibacterial activity [Reference Vidal 2012; Scarpignato C. and coauthors 2006; Scarpignato C. and coauthors. - 2005]. This intestinal antiseptic has a wide range of actions, has very low absorption in the gastrointestinal tract (less than 1%), so that creates high concentrations of the drug in the intestinal lumen.
The novelty of the proposed method lies in the fact that transandino install dual tube 10-12 cm proximal to the anastomosis, followed by washing with antiseptic solutions through the channel of a smaller diameter with subsequent passive outflow channel of larger diameter, after installation of the tube through the channel of a smaller diameter using infusion carry out dosing suspension of rifaximin at the rate of 0.01 μg of the active substance per 1 kg of body weight of the patient per minute continuously for the first day and three times a day will continue what lnasty for 3 hours in the following days until the active peristalsis of the intestines.
Washing the suspension of rifaximin allows: a) to ensure the physical integrity of seams anastomosis; b) to wash the blood clots and mucus from the intestinal lumen in the field of fistula; b) to influence the microflora in the gut.
These techniques allow to reduce the frequency of insolvency thick-colonic anastomosis when performing operations on restoration of intestinal continuity tubes after pulmonary resections of the left departments of the colon (operations type Hartman), as well as to reduce the treatment time. To implement reliable prevention of septic complications, including parabolicheskikh infiltrates, abscesses due to adequate sanitation and decompression zone of thick-colonic anastomosis intraoperative and postoperative period.
Detailed description of the method and examples of its clinical implementation
Under General anesthesia in the position of the patient, as for the perineal lithotomy, when performing the operation for restoring the continuity of the intestinal tube after pulmonary resections of the left departments of the colon (operations type Hartman) after applying thick-colonic anastomosis transandino install dual tube 10-12 cm proximal formed anastomosis under the control of the hands of the surgeon, holding the area of the anastomosis from the abdominal Palast is. Assistants, typing in the syringe Jean suspension of rifaximin, diluted with water for injection, through the channel of smaller diameter dual channel tube is washed until visually clean washing solution.
After transporting the patient to the recovery room by infusion through an opening of smaller diameter provide dosing suspension of rifaximin with a speed of 0.01 μg of the active substance per 1 kg of body weight of the patient continuously for the first day and three times per day with a duration of 3 hours in the following days until the active peristalsis of the intestines.
Rifaximin is a granules for the preparation of suspensions, located in an enclosed sealed vial [Reference Vidal, 2012]. Granules for preparation of oral suspension are in a sealed vial. The vial should be open, add water to the mark and shake. Again, add water until the level of the suspension reaches the specified level. The concentration of rifaximin in the finished suspension 100 mg per 5 ml To measure 5; 10 or 15 ml of the suspension is added a measuring Cup (http://www.zdravnik.com.ua/guides/dmg/alfa-normiks-alfa-normix).
In the postoperative period also prescribe antibiotics, analgesics, prebiotics, substitution therapy to conventional circuits according to the current standards.
The performance of the proposed method is confirmed by the following clinical examples.
Example 1. Patient G-s, 54 years old, medical history, No. 034583/553, was admitted to the surgical Department of the clinic 03.07.2012, with complaints about the presence of intestinal fistula. It is known that 08.12.11 was diagnosed with colon cancer, complicated by the development of acute obstructive ileus, emergency operative intervention in volume laparotomy, viscerality, obstructive resection of the sigmoid colon imposed single-colostomy. Objectively: on the anterior abdominal wall in the mid-clavicle line to the right, 4 cm below the costal arch, is rendered single-barrel colostomy "column" size outlet mucous 35×40×20 mm, the inner diameter of the stoma 20 mm Abdomen is soft, painless, pathological abdominal symptoms is not defined. Stoma is functioning adequately. When rectal finger study the tone of the sphincter saved. The vial is empty. Overhanging wall is not. When rectoscopy length postcolonialism stump 18 cm, friable mucosa, focal hyperemic, there are endoscopic signs of diversion colitis.
The patient performed the FCC from 22.06.13 year, the endoscope is held to the stump of the transverse colon at 18 cm from the anal verge. Mucosa pale pink, sostituiranno pronounced the folds of the mucous medium caliber, the tone of the intestine is reduced. Peristalsis is observed, sluggish. Through the colostomy endoscope introduced into the dome of the caecum.
Given the single-barrel colostomy, full of intestinal fistula, the indications for surgery, 06.07.12, under General anesthesia performed surgery in the amount of laparotomy, liquidation of the colostomy, blending thick-colonic anastomosis end-to-side using the method of prevention of insolvency of the anastomosis of the claimed method.
In the postoperative period metered flow of the suspension of rifaximin by infusion with a speed of 0.80 mg per minute (0,01 μg per 1 kg of body weight) of the active substance continuously for the first day and three times per day with a duration of 3 hours in the following days. Removed dual tube on the 4th day of the postoperative period when the patient appeared active peristalsis, went gases. In the postoperative period conducted comprehensive therapy, including antibiotics, analgesics, parenteral nutrition, anti-inflammatory and antisecretory therapy in traditional schemes. Performed daily bandaging.
The postoperative period was uneventful with no complications.
At the control examination after 2 months fulfilled stake is noscope, the device is introduced at 80 cm from the caecum. Examined the mucous membrane of the colon pale pink color, vascular pattern is stored, the normal peristalsis, the folds of medium caliber. 15 cm from the anal verge visualized the line of anastomosis without signs of inflammation and ulceration. Conclusion: the status after resection of the intestine, overlay inter-intestinal anastomosis.
Example 2. Patient M-s, 60 years, history of No. 025413/1179, was admitted to the surgical Department of the Rostov state medical University clinic 21.11.2011, with complaints about the presence of a colostomy, the inability to evacuate the bowels in a natural way, General weakness. From the anamnesis it is known that 20.05.11, the patient was hospitalized on an emergency surgical hospital at the place of residence for cancer of the sigmoid colon T4NlMo complicated by the development of internal thick-small bowel fistula, meritline and subphrenic abscess. As follows from the submitted documentation, the patient made an urgent surgical intervention in volume laparotomy, opening and drainage of abscess subphrenic space, extended left-hand hemicolectomy with resection of the sigmoid colon containing the tumor and colonic fistula, the mobilization of the jejunum with its wedge-shaped resection, the imposition of a single-colostomy, hygiene and Dreux is the key of the abdominal cavity.
Thus, as of 21.11.11, the patient was hospitalized in the surgical Department of the Rostov state medical University clinic to perform reconstructive surgery volume: restore the continuity of the colon, the elimination of colostomy. Objectively: on the anterior abdominal wall in the mid-clavicle line to the left, 4 cm below the costal arch, is rendered single-barrel colostomy "column" size outlet mucous 35×38×22 mm, the inner diameter of the stoma 25 mm Abdomen is soft, painless, pathological abdominal symptoms is not defined. Stoma is functioning adequately. When rectal finger study the tone of the sphincter saved. The vial is empty. Overhanging wall is not. When rectoscopy length postcolonialism stump 15 cm, friable mucosa, focal hyperemic vascular pattern is reinforced. Conclusion: endoscopic signs of diversion colitis.
When the FCC 22.11.11, the colonoscope is introduced to transrectal blind end postcolonialism stump. Mucous inspected departments diffuse diperkirakan, swollen. Pathological formations are not revealed. With the introduction of the endoscope through the stoma held up to the cecum. Mucous inspected departments diffuse moderately hyperemic with increased vascular pattern. The tone of the intestine satisfactory. Loops of intestine sedentary. The conclusion of the tion: the state after colon resection. Signs of diversion colitis.
Given the single-barrel colostomy, full of intestinal fistula, the indications for surgery, 25.11.11, performed surgery in the amount of laparoscopy, viscerality with the mobilization of the hepatic flexure and transverse colon, elimination colostomy, the imposition of mechanical hardware transverse-rectorates end-to-side using the method of prevention of insolvency of the anastomosis of the inventive method, the drainage of the abdominal cavity.
In the postoperative period using infusion was performed metered flow of the suspension of rifaximin with a speed of 0.50 µg per minute (0,01 μg per 1 kg of body weight) of the active substance continuously for the first day and three times per day with a duration of 3 hours in the following days. Removed dual tube on the 4th day of the postoperative period when the patient appeared active peristalsis, went gases. In the postoperative period conducted comprehensive therapy, including antibiotics, analgesics, parenteral nutrition, anti-inflammatory and antisecretory therapy in traditional schemes. Performed daily bandaging.
The postoperative period was uneventful with no complications. At the control examination FCC 2 months colonoscope led to 7 cm from the caecum. Examined mucous colon pale pink color, vascular drawing is saved, the active peristalsis, the folds of medium caliber. At 13 cm from the anal verge visualized the line of anastomosis without signs of inflammation and ulceration. Conclusion: the status after resection of the colon, overlay inter-intestinal anastomosis.
The claimed method postoperative prevention of insolvency thick-colonic anastomosis us 12 patients were operated on. All patients achieved satisfactory functional result, there were no postoperative complications. After surgical treatment all patients were under community supervision at the time of monitoring for at least 3 months.
Thus, the inventive method postoperative prevention of insolvency thick-colonic anastomosis takes into account the main reasons for the failure of the anastomosis and allows you to:
to achieve a stable functional results,
to reduce the probability of insolvency colonic anastomoses,
to reduce the frequency of postoperative complications,
to shorten postoperative hospital stay due warning infiltrative inflammatory phenomena in the area of the anastomosis, early recovery of bowel function.
Compared to promotionally method has the following advantages:
1. The application of the method allows for a quantitative dose daily dose
input antiseptic (antibacterial) of the drug.
2. The method involves targeted impact on the area of the anastomosis under irrigation suspension of rifaximin with adequate outflow of the leaching solution and the absence of increased intraluminal pressure.
3. There is no increase of the intraluminal pressure in the area of the anastomosis due to the dosing antiseptic solution.
4. Dosed application of suspension of rifaximin prevents hydration (swelling) of the intercellular space and, accordingly, does not cause excessive tension of the tissues in the sphere of inter-intestinal suture.
5. Used suspension of rifaximin does not cause absorption in the large intestine and into the blood system, does not occur microbial resistance.
6. Rifaximin is an intestinal antiseptic, adapted for intraluminal introduction, and has no systemic effects.
The proposed method postoperative prevention of insolvency thick-colonic anastomosis is tested on sufficient clinical material and can be recommended in clinical practice surgical hospitals.
The way postoperative prevention of insolvency thick-colonic anastomosis in the with transanal the intubation and the introduction of antiseptic solution, characterized in that after applying thick-colonic anastomosis 10-12 cm proximal to the anastomosis into the intestinal lumen install dual tube after transanal install the tube with the help of infusion carry dosed introduction of the suspension of rifaximin at the rate of 0.01 μg of the active substance per 1 kg of body weight of the patient per minute through one channel and the passive outflow through the second channel, with the suspension of the rifaximin is administered continuously during the first day, then 3 times per day with a duration of 3 hours before the appearance of the active peristalsis of the bowel.
SUBSTANCE: ronkoleukin is administered in a dose of 500,000 units in a 0.9% physiological saline 20.0 ml. The prepared solution in an amount of 10.0 ml is administered into a round ligament of the liver through a catheter inserted under visual control. The rest amount of 10.0 ml is introduced into incisional wound edges on the 1st and 3rd postoperative days.
EFFECT: method provides stimulating local immunity in both the incisional wound, and the hepatoduodenal region ensured by a separate effect of cytokines on various groups of lymphatic nodes.
SUBSTANCE: invention relates to medicine, namely to surgery and gastroenterology, and can be applied in treatment of patients with acute gastroduodenal bleedings. For this purpose on the 2-nd - 3-rd day after stabilisation of hemostasis a monitor purification with rinsing water is carried out. Temperature of water constitutes 30-32°C, and an intracolonic pressure is 20-25 mm Hg. Adsorbent polyphepan is added into rinsing water in a dose 10 g per 1500 ml of chemically pure decontaminated water of drinking water supply. Speed of supply and exhaust of rinsing water constitutes 1.0-1.6 l/min.
EFFECT: method ensures fast recovery of peristalsis and temperature normalisation, induced by development of endotoxicosis, due to effective purification of intestine from products of blood decay and microbial insemination as a result of selection of optimal parameters of the monitor intestine purification and required adsorbent.
1 tbl, 2 ex
SUBSTANCE: feeding a medical solution is combined with an exposure to low-frequency ultrasound generated by a low-frequency ultrasonic cavitator that is AUZKh-100 PHOTEK apparatus. The medical solution is presented by a solution of metrogyl and dioxydine in ratio 5:1 or 1:1 respectively. The exposure involves feeding the solution at 0.2-0.5 ml/s. The cavitator is placed at 0.2-0.5 cm from a defect surface. First, the defect is exposed to an average-density ultrasonic flow of power 1.6-3 Wt/cm2 for 1-2 min. Then, the exposure is characterised by average-density ultrasonic power 3.1-8 Wt/cm2 for 4-10 min. The therapeutic course is 3-15 sessions every second day.
EFFECT: method provides the maximum mechanical debridement of the purulent-fibrinous impositions and the qualitative wound disinfection ensured by selecting the cavitation mode for specific drug preparations and deep penetration of the above drug preparations into the lesion.
3 cl, 1 ex
SUBSTANCE: invention refers to medicine, namely to therapy, purulent surgery, and may be used for treating chronic wounds. That is ensured by implementing the versions of the methods of treating chronic wounds involving removing a portion of necrotic or other devitalised tissue from the wound with healthy tissue coated with a solvated system of an extracellular polymeric substance. The above system contains an aqueous solution of an agent isolating metal ions, a surfactant and a buffer substance. An osmolarity of the solvated system makes from approximately 1000 to approximately 4000 mOsm of the dissolved substance per one litre. What is also presented is a device for treating the given pathology comprising a wound cleansing instrument, a container for the solvated system of the extracellular polymeric substance, and an aspirator. What is presented is a kit for care for the patients suffering chronic wounds, comprising a tray, a syringe, a vessel with the solvated system of the extracellular polymeric substance, and printed application instructions.
EFFECT: presented group of inventions provide the effective treatment of chronic wounds by introducing the solvated system of the extracellular polymeric substance biocompatible with healthy tissues containing the ingredients preventing the binding of polymer chains in the extracellular polymeric material of a biofilm matrix and promoting transferring them into the solution for more complete removal from the wound.
67 cl, 2 tbl, 1 ex, 3 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to medicine, particularly to traumatology, orthopaedis, maxillofacial surgery, dentistry, neurosurgery, namely to osteoplastic formulation of biocomposites for treating human bone diseases and injures, and can be used as a material fully degradable in the body and replaceable by new bone tissue, for bone cell regeneration, as a biological filler for bone tissue defects, as an osteoconductive and osteoinductive biological frame for bone tissue regeneration. The hardened biocomposite for bone defect replacement on the basis of calcium phosphate contains magnesium phosphate, calcium hydrophosphate, amino acid; calcium phosphate is biological hydroxyapatite in the following proportions, wt %: hydroxyapatite - 45-47, magnesium phosphate - 32-34, calcium hydrophosphate - 16-19, amino acid - 1-5, as a binding agent - casein.
EFFECT: implementing the expansion of the biocomposites for bone defect replacement and endoprosthesis fixation.
SUBSTANCE: invention refers to medicine, particularly coloproctology, and may be used for treating chronic anal fissure. The method involves an anal fissurectomy with a graduated sphincterotomy and a drug-induced therapy. A patient's preoperative psychoemotional status is assessed by questionnaire survey according to the Hospital Anxiety and Depression Scale (HADS). If the disorders have been shown by the questionnaire survey, namely 8-10 points "subclinical anxiety/depression" or 11 points and more "clinical anxiety/depression", a psychopharmaceutical therapy with Grandaxin or Tianeptine. The preparations are administered in common doses for 4 weeks.
EFFECT: method provides the effective treatment of the disease with comorbid psychoemotional disorders, exposure on the additional mechanisms of the anal fissure pathogenesis in this case.
SUBSTANCE: invention refers to medicine, more specifically to injectable bioresorbable compositions of biocomposite materials for treating human bone diseases and disorders as: a material able to be biodegradable in the body completely and to be replaced by new bone tissue for the purpose of bone cell regeneration, osteoconductive and osteoinductive biological support frame for bone tissue regeneration, applied in traumatology, orthopaedics, maxillofacial surgery, and neurosurgery. The injectable biocomposite material contains biological hydroxyapatite, calcium hydrophosphate, amino acid arginine, as well as phosphoprotein (casein) recovered from skim milk, and glutaric aldehyde as a hardener.
EFFECT: preparing the bioresorbable material having the biocompatibility and the pronounced osteoconductive and osteoinductive properties.
2 cl, 1 ex
SUBSTANCE: invention refers to medicine, specifically to physiotherapy, surgery. A method consists in conducting a course of pelotherapy by applications. The therapy is started within the first four weeks following a laparotomy. The therapy involves the sulphide mud applications on an anteriolateral abdominal wall. The sulphide mud temperature is 42° C. The application length is gradually increased from 10 to 20 minutes. The procedures are performed every second day. A minimum number of the applications is 10.
EFFECT: method reduces the peritoneal adhesions.
SUBSTANCE: invention relates to medicine, namely to anaesthesiology, resuscitation and urology, and can be applied for prevention of cardiovascular complications in patients with syndrome of endogenous intoxication against the background of acute purulent pyelonephritis in perioperative period. For this purpose reamberine 1.5% in dose 400 ml is introduced to patient from the moment of clinical diagnosis daily to the moment of performing operation. After that, in the process of operation, at the stage of kidney decapsulation infusion of reamberine in the same dose in combination with intravenous blood irradiation is realised, with duration constituting 25 minutes. After that, in post operational period reamberine infusion is continued in the same dose during 8 days. Simultaneously for 3 days after operation intravenous blood irradiation is realised. From the 4-th day of post-operative period for five days reamberine infusions 1 time per day are combined with transdermal laser irradiation of operated kidney projection with duration 10 minutes. Then, without stopping reamberine infusion, biologically active points, connected with heart meridian C1, C2, C3, C4, C5, C6, C7, C8, C9, sympathetic point of heart meridian V15, ear points AP19, AP21, AP60, AP100, AP105, AP115 are successively exposed to laser irradiation.
EFFECT: method ensures effective prevention of cardiovascular complications due to reduction of level of toxic action of products of peroxide oxidation of lipids on myocardium, which makes it possible to improve functional state of myocardium.
1 tbl, 1 ex
SUBSTANCE: invention refers to medicine. What is described is using the material for the purpose of neural dysfunction recovery with the above material containing a polysaccharide derivative hydrogel wherein 0.5 wt % of the aqueous solution contains a complex module in the amount of 1 to 1000 N/m2, while a loss factor makes 0.01 to 2.0 that is measured at angular velocity 10 rad/sec with using a dynamic viscoelasticity meter. The above material for neural dysfunction recovery may represent hydrogel injected with using a syringe and has an excellent body residence, and has a restorative effect on the damaged or degenerated nerve function.
EFFECT: preparing the material for neural dysfunction recovery.
19 cl, 6 dwg, 6 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: group of inventions refers to medicine, namely to veterinary science, and can be applicable for using a composition for protection against an infection caused by Lawsonia intracellularis. That is ensured by using a non-living composition containing carbohydrate which is also found in living cells of Lawsonia intracellularis in association with an external cell membrane of the above cells. The vaccine is presented in the form applicable for intramuscular introduction, and contains an oil-in-water adjuvant containing oil drops with an average size of 400 nm.
EFFECT: using the given non-living composition leads to effective immunisation in intramuscular introduction with using small drops of the oil-in-water adjuvant which provides protection of animals against Lawsonia intracellularis.
7 cl, 9 tbl, 4 ex
SUBSTANCE: invention relates to compositions and polymeric materials for biomedical use, comprising silver nanoparticles (0.0005-0.02 wt %) stabilised by amphiphilic copolymers of maleic acid (0.0008-0.05 wt %), low molecular weight organic amines (0.0002-0.04 wt %) and water. In addition, the said composition may additionally comprise the polymeric structure-forming agent.
EFFECT: introduction to the composition of the polymer structure-forming agent enables to obtain the macroporous structured hydrogel materials having prolonged bactericidal and antifungal action.
3 cl, 2 tbl, 9 ex
SUBSTANCE: inorganic clay, represented by sodium-calcium, and/or calcium and/or ferrous forms of montmorillonite, is modified with a water solution of silver nitrate with a concentration 0.16-9.9 wt % in a weight ratio clay:water solution of silver nitrate 1:5. Modification is carried out with mixing from 3 to 7 hours at a temperature in the interval from 10°C to the temperature of boiling. The obtained material is washed with distilled water to pH ≈6-5, until excess of silver nitrate is removed, stood at room temperature and decanted. The material is dried at a temperature of 20-160°C.
EFFECT: obtaining an efficient antibacterial material for traditional and veterinary medicine.
2 tbl, 5 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: given invention refers to a compound of formula its stereoisomers, including R and S isomers, wherein: 'A' represents N; Y and Y' represent O; '---' is absent; R1 and R2 are identical or different, and independently represent hydrogen or C1-12 alkyl; R3 represents hydrogen; R4 represents heteroaryl which can be optionally substituted in any acceptable position by one or more substitutes Ra; Z represents -(CH2)n-heteroaryl which can be optionally substituted in any acceptable position by one or more substitutes Ra; T, U, V and W are identical or different, and independently represent hydrogen or halogen; Ra is independently specified in hydrogen, halogen, C1-12 alkyl, C1-12 haloalkyl, -C(=Y)OR7, -(CH2)nYR7, each of which can be optionally substituted in any acceptable position by halogen; R7 represents hydrogen or C1-12 alkyl; m represents 1; m′ represents 0; n represents 1; wherein: the above heteroaryl is specified in 1,2,3-triazolyl, pyridinyl, 1-oxypyridinyl (pyridinyl-N-oxide), pyrazinyl, isoxazolyl, imidazo[1,2-α]pyrimidinyl, imidazo[1,2-α]pyrazinyl. The compounds of the given invention are applicable to prevent, relieve and/or treat bacterial infections in an individual. The bacterial infection is caused by the drug-resistant species Staphylococcus, Streptococcus, Enterococcus, Bacterioides, Clostridia, H. influenza, Moraxella, acid-resistant species like Mycobacterium tuberculosis, as well as linezolid-resistant species Staphylococcus and Enterococcus.
EFFECT: phenyloxazolidinone compounds as antimicrobial agents.
12 cl, 8 tbl, 3 ex
SUBSTANCE: claimed is a cocrystalline form of fenbufen with pyrazinamide, where molar ratio of fenbufen with pyrazinamide constitutes 1:1, which has an endothermal peak from 148 to 152°C by the data of measurements by means of differential scanning calorimetry and peaks at 2θ(°) 7.38, 10.43, 11.04, 21.67 by the data of measurement of polycrystal X-ray radiation diffraction.
EFFECT: increased rate and level of solubility of the crystalline form of fenbufen and its suitability for application in the pharmaceutical industry.
2 ex, 7 dwg
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to immunology, molecular biology and genetic engineering. There are presented an immunogenic composition containing a mixture of staphylococcal proteins, and comprising a staphylococcal protein binding an extracellular component, and a staphylococcal transport protein, or the staphylococcal protein binding the extracellular component, and a staphylococcal virulence regulator or a toxin, or the staphylococcal transport protein and the staphylococcal virulence regulator or the toxin. There are also presented vaccines, methods of treating, using and methods for preparing a staphylococcus vaccine.
EFFECT: invention may be used in medicine for treating and preventing a staphylococcal infection.
23 cl, 8 tbl, 7 dwg, 8 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to pharmaceutical formulations and is applicable for providing bactericidal efficacy. A pharmaceutical formulation contains two various antibiotics as active ingredients in the form of a synergetic combination of a fixed dose in a parenteral dosage form. The first antibiotic represents carbapenem or its pharmaceutically acceptable salts, while the second antibiotic represents aminoglycoside which represents etimycin or its pharmaceutically acceptable salts. The above first antibiotic and the above second antibiotic are found in weight ratio of 6:1 to 13:1. Besides, the pharmaceutical formulation contains one or more additives specified from a group of synthetic/natural amino acids/vitamins/stabilisers/polymers/antioxidants/micronutrient elements.
EFFECT: pharmaceutical formulation used in the very low concentrations, provides higher clinical effectiveness in the patients suffering from or sensitive to mixed multibacterial lethal infections, with a low tolerance to drugs and disease, and having a risk of potential toxicity, wherein potential toxicity caused by high doses provides a cause for concern.
8 cl, 3 tbl, 6 dwg, 1 ex
SUBSTANCE: composition includes a bactericidal substance - catapol - in amount of 2.1-2.5 wt %, zosterin in amount of 1.1-5.0 wt % and distilled water.
EFFECT: providing a composition which stimulates a reparative process in external protective tissue, having anti-inflammatory and radioprotective action.
1 tbl, 1 ex
SUBSTANCE: invention relates to the field of organic chemistry and medicine and deals with novel 4-(pyrrolidine-1-yl)quinoline compounds, a method of their obtaining and application for treatment of bacterial or fungal infection.
EFFECT: invention provides extension of arsenal of means for fighting "latent" bacteria.
17 cl, 3 dwg, 1 tbl, 47 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention relates to the field of pharmaceutics, namely represents compositions for treating nail and nail bed diseases and methods of treating nail diseases.
EFFECT: claimed compositions do not form a film when applied on the nail surface and contain a carrier, in which suspended, dispersed or emulsified are all components of the composition, a non-volatile solvent, a moistening preparation and a pharmaceutically active ingredient, soluble in the non-volatile solvent and/or in a mixture of the carrier and the non-volatile solvent, with the composition being efficient in treatment of nail or nail bed diseases.
30 cl, 2 dwg, 4 tbl, 5 ex
SUBSTANCE: invention relates to medicine, namely to gynaecology, reflexotherapy and pelotherapy. A method includes carrying out a course of antibacterial and/or antiviral therapy, which is started on 5-7 day of a menstrual cycle. From 5-7 day of the following menstrual cycle a course of pharmacopuncture is performed by introduction of homeopathic preparations into acupuncture points (AP). On 1, 3, 5, 7, 9, 11 and 13 days of the course Traumel C is introduced into points E36 (2), V31 (2), V32 (2), V33 (2), V34 (2). On 2, 4, 6, 8, 10, 12, 14 days of the course Ovarium compositum is introduced in AP Rp6 (2). Simultaneously with the course of pharmacopuncture or starting from 5-7 day of the following menstrual cycle a course of pelotherapy is carried out. Introduction of gel, based on the Dead Sea mud, is performed rectally for 30 minutes, 1 time per day.
EFFECT: method ensures recovery of the two-phase menstrual cycle due to normalisation of endometrium and vagina biocenosis, improvement of local immune and vegetative status, increases duration of remission.
4 cl, 2 ex