Method of treating neuropathic trophic ulcers accompanying diabetic foot

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to endocrinology, and concerns treating neuropathic trophic ulcers accompanying diabetic foot. That is ensured by an integrated treatment including administering Oktolipene and Sulodexide intravenously, then orally, as well as administering Konvalis in paraesthesias and pains in calves and feet. That is combined with applications of the preparation Acerbin on the ulcerous defect until the ulcerous-wound defect gets cleaned completely. That is followed by implanting collagen into the bottom and walls of the defect with closing the wound surface with an antiseptic.

EFFECT: complex of the therapeutic measures provides closing the ulcerous defects with no autodermoplasty applied and making the length of treatment 2-3 times as short by the synergetic action of the components of the integrated treatment.

9 cl, 4 ex, 13 dwg

 

The invention relates to the field of medicine, namely to methods for treating neuropathic ulcers, and can be used in the treatment of ulcers in the diabetic foot syndrome (hereinafter SDS). The invention can also be used to treat ulcers in patients with lesions of the spinal cord and peripheral nerves, after experiencing the source of alteration.

The known method of treatment of trophic ulcers, in which the drug is administered on the basis of subtilisin Trombovazim, neurometabolic protector Cytoflavin and drug Tipamax with simultaneous cleansing of the ulcer from necrotic plaque with 3% hydrogen peroxide solution and overlaid on the ulcer surface dressings based on Hydrofiber and AQUACEL silver ions®Ag. After the appearance of granulation tissue are drug-based bioplastic collagenous material Collost until complete healing of the ulcer (Patent RF 2423118 "Method of treatment of venous ulcers", published on 10.07.2011, Bulletin No. 19, IPC A61K 31/194).

Trombovazim has anticoagulant and thrombolytic action related to the violation of fibrin, which form the main frame of the thrombus, anti-inflammatory action affecting the oxidative response of neutrophils in the blood, and cardioprotective effect, improving the blood supply to the myocardium. Trombovazim carries out enzymatic cleaning, cleaves Belk�.

Cytoflavin activates the aerobic metabolism of cells of the Central nervous system, improves coronary and cerebral blood flows.

Tipamax is an antibacterial drug.

This method is aimed at treatment of ulcers mostly of vascular origin. There is not a single drug acting on the nerve fibres, with the base of evidence category A. in addition, the composition of Cytoflavin is nicotinamide (synonym: vitamin PP), which according to national standards of treatment of patients with diabetes (2011-2012) is not recommended for patients with diabetes mellitus (hereafter DM), as it causes an increase in the level of glucose in the blood, and it causes direct damage to nerve fibers. Also this drug is not indicated for retinopathy, which is one of the complications of diabetes. All of this is a consequence of insufficient efficacy in the treatment of diabetic neuropathic ulcers, incomplete accounting of the causes of disease. The known method of treatment is not suitable for use in neuropathic ulcer lesions. Neuropathy in DM are divided into: 1. Autonomous (it leads to autoinfection, disruption of blood flow and is clinically manifested as a "Charcot foot", 2. Touch (leads to loss of sensation and ulceration), 3. Motor (causes deformation of the foot). The last two when joining the infectious agent and are PR�chinoy purulent-necrotic lesions, gangrene and, as a consequence, amputation of the limb. To treat neuropathy in DM is much heavier than the vascular component. Vascular surgery not help. After the amputation limb amid neuropathy patient receives great pain (phantom and neuropathic pain, ulcers stump), only to have "no legs". The average duration of life after knee amputations in diabetes is 3 years. Amputation is not a treatment, it delayed active euthanasia of a patient.

From literature data it is known that purulent-necrotic processes in the area stop amaze from 6 to 15% of patients with diabetes; these processes in 30-79% of cases result in high amputations in patients with VTS; mortality from necrotic processes stop in diabetic patients ranges from 6 to 22%, and gangrenous processes in DM it varies from 4.7% to 50%. 82% of patients with purulent-necrotic lesions of the stop is limited in movement; because of this, and 49% of them are socially isolated, which is also a risk factor for adverse outcome. Ulcerative deformation of the lower extremities occur in 10-30% of patients with VTS; ulcers are also a risk factor for amputations and death. Amputation in diabetic patients produce in 15-45 times more often than in persons not suffering. Mortality within 12 months after the amputation above the hip is 11-39%; within 3 years after high�Oh amputation survives 50% of patients and 55% of them within 5 years after the first amputation tolerate repeated amputation; 5-year survival rate after high amputation reaches only 25-40% of patients. After the first high amputation lose the ability to walk up to 50% of patients.

This is a General picture of the status of treatment of diabetic patients, which indicates the relevance of the identified problem.

The object of the invention is to improve the treatment of neuropathic ulcers in diabetic foot syndrome by simultaneous effect of all the factors leading to the appearance of the ulcer of the skin and soft tissues. Object of the invention is to save the patient, not to bring it to amputation.

The technical result is the elimination of all factors that lead to the appearance of the ulcer of the skin and soft tissues in diabetes mellitus.

The first factor in the development of venous ulcers is neuropathy irreversible damage or destruction of nerve cells or their myelin sheath. It is known that diabetic patients with careful examination neuropathy detected in virtually 100% of cases. The basis for the development of diabetic neuropathy are metabolic and vascular disorders, leading to dysregulation of microvascular vasodilation, distribution of blood flow and its autoregulation.

The second facto�ohms for the development of venous ulcers is diabetic angiopathy - generalized damage to the blood vessels and, as a consequence, their innervation. In patients with SDS, there is a gradual occlusion of the main arteries of the lower extremities, extending from the periphery to the center. Microangiopathy manifested by changes of the walls of the microvessels: a thickening of the walls of arterioles, dilatation of venules and thickening of capillary walls.

On this basis, proposed the following method of treating diabetic neurotrophic ulcers: simultaneous

- use of drugs that have effect on diabetic neuropathy;

- the use of drugs, acute microangiopathy;

the use of preparations, cleansing the necrotic defect;

- closure of the defect on the background of the use of drugs for neuropathy and microangiopathy.

The invention consists in a method of treating neuropathic trophic ulcers in diabetic foot with carrying out the normalization of blood glucose level, wherein the patient is administered Octolite intravenously for 14 days 600 mg, then oral administration of 300 mg of Octolite 2 times a day for up to two months; enter Corvalis 300 mg at night for 10 days with paresthesias and pain in the calf muscles and feet; administered Sulodexide intravenously for 10 days at a dose of 600 LE, then per os 2 times a day for 250 LE to two month�; in parallel with the first days of treatment application on the area of the ulcer drug keratolytic, antiseptic, wound-healing actions of Acerbis within 3-5 days to cleanse the ulcer-wound defect, then subjected to implantation of bioplastic material - native collagen of the first type Collost in the form of a 15% gel, implantation is carried out in the bottom and sides of the defect, the wound is closed dressing with antiseptic 5-7 days, changing the upper layers of the bandages daily, maintaining a moist environment in the wound.

Oktolipen - a preparation thioctic acid, level of evidence A in diabetic neuropathy, according to the expert Committee for the study of diabetic neuropathy at the European Association for the study of diabetes (NEURODIAB) and the 8th International Symposium on diabetic neuropathy (13-18 October 2009, Toronto, Canada). It has antioxidant endogenous effect, binding free radicals, regulates carbohydrate and lipid metabolism. Is neuroprotection, helps overcome insulin resistance. Is a metabolic effect, stimulates the metabolism of cholesterol, improves the trophism of neurons and axonal conduction, reduces the manifestation of diabetic polyneuropathy. You can apply another drug - prod�to thioctic acid (thioctacid, Berlition, digamma). The effect is the same, but all these drugs are more expensive in 3-4 times.

Convales - drug group gabapentine, level of evidence A in diabetic neuropathy, according to the expert Committee for the study of diabetic neuropathy at the European Association for the study of diabetes (NEURODIAB) and the 8th International Symposium on diabetic neuropathy (13-18 October 2009, Toronto, Canada). Convales has antiepileptic and analgesic effect; it is an anticonvulsant drug that relieves pain. In addition, the drug improves the nutrition and restores the affected nerve fibers, improves the conduction of impulses along the nerve fibers. You can also use other gabapentine (Gabapentin, Tebantin, Gabagamma), but they are more expensive.

Sulodexide - heparinoid - is an anticoagulant, antibacterial, fibrinolytic, anti-adhesion, angioproteguoe, gipolipidemiceski means. Angioprotegus his action is based on the ability to restore the structural integrity and function of endothelial cells. Sulodexide is used for the relief of microangiopathy, peripheral vascular (do not worsen the retinopathy), with high risk of thrombosis. In the proposed scheme of treatment you can use other drugs anticoagulant, fibrinolytic, an�adhesives, angioproteguoe, gipolipidemicheskoe action. But Sulodexide good because it is inin, and the tablet form. In addition, today it is the only drug that does not impair vision. Other known drugs impair vision in patients with diabetes. This drug not only affect the disorder, but also improve the nutrition of the nerve fibers affected in DM.

Acerbis - antiseptic, analgesic and wound healing agent. It is used without the use of local anesthetics and with no need in the operating room. Its advantages are simplicity, accessibility, good clinical effect, the possibility of using both in outpatient and inpatient practice, good ratio "price-quality".

Collost in the form of a 15% gel get without disruption of the collagen matrix of the skin tissue of cattle with the removal of the epidermis, fatty tissue and dermal cells. Its use in the treatment avoids the rejection of foreign tissue by the body of the patient, to stimulate the formation of collagen, accelerate reparative-proliferative processes. The use of Collost for patients with neuropathic ulcers at DFS allows you to close the soft tissue defect without causing the patient yet another injury, as occurs when autografting (donor and receptor defects).

All of these drugs known. The essence of the invention is to use them in combination in a single regimen. Offers a systematic multimodality therapy with exposure to both General and local components of neuropathic ulcers at DFS. Drugs must be used together and long lasting. Due to the presence of both in/in their form and preformed, treatment is not interrupted outside the hospital, and continues on an outpatient basis. Additionally, besides saving the life and health of the patient, there is a savings on the cost of treatment because of one bed-day in the Department of purulent-septic surgery SAHI "municipal clinical hospital №5" Kazan is 1120,08 rubles, in accordance with approved standards of the Department of health MOH of the RT, Kazan (data as of July 2013) and the transfer of the patient to outpatient treatment without reducing its quality reduces the cost of treatment. In addition, all drugs except Zerbina, domestic production and significantly cheaper than their foreign counterparts.

Separate application of the proposed remedies will not lead to the effect, when combined application. They do not lead, in addition to the loss of money and time. It is in the overall scheme of treatment show a positive result of implantation of Collost. Many are trying and trying to implant Collost - no effect. One disappointment and �everie patients in success. And as a result the use of an integrated method has good results not only for health reasons, but also economic. Drugs known and recommended. But it is precisely in this combination was not used. And it is in this pathology. When you have diabetes microangiopathy (neuropathy is one of its manifestations), and macroangiopathy. Now, Sulodexide is used in macrovascular disease. It is not used in the treatment of neuropathy. Complex application of Octolite, Konvalina and Sulodexide give a General background for the relief of neuropathy. However, without overgrowing ulcers no effect, and the patient can walk to infection and amputation. On the background of General treatment and at the same time carry out the cleansing of the defect and immediately implanted collagen as a material to restore the integrity of the skin". Ulcers, the body loses water through the defect, salts and proteins. And neuropathy, do not respond to drugs, exacerbates the malnutrition of the tissues, and tendency to heal the wound does not appear. Proposed impact on the patient's body in all directions this pathology: mild damage to the nerve fiber, nutrition and his tissues, cleansing the ulcer and promote early healing. Thereby overlap all pathogenetic direction. Naturally, all this is going on�it against normalization of blood glucose level (tableted medications or insulin in the required doses). Another effect: the faster will close the defect, the faster the relief of inflammation and normalization of blood sugar level; disappears striking factor for the nervous system. The result: the patient recovered.

The proposed method implements the following treatment regimen:

In the body of the patient is administered Octolite 600 mg intravenously for 14 days, then oral administration of 300 mg of Octolite 2 times a day for up to two months;

Enter Convales for pain relief 300 mg at night for 10 days, followed by 300 mg at night when paresthesia and pain in the calf muscles and feet;

Administered Sulodexide 600 LE intravenously for 10 days, then 250 LE per os 2 times a day up to two months;

At the same time to cleanse the ulcer using drugs keratolytic, antiseptic, wound-healing actions of Acerbis within 3-5 days.

This is followed by implantation of bioplastic material - native type 1 collagen Collost in the form of a 15% gel. In patients with DFS and so disturbed the body, the body is nowhere to take the material (fabric) for healing of the defect. The use of autodermoplasty in this case inadmissible, because it will lead to the appearance of two of skin defects: donor site and recipient. Implantation is performed in the bottom and sides of the defect, the wound is closed dressing material with a solution of ant�septic tank for 5-7 days, changing the upper layers of the bandages daily, maintaining a moist wound environment by moistening the dressing material. Antiseptic at this stage you can apply any: Miramistin, dioxidine, an aqueous solution of chlorhexidine, etc.

Photographs 1-6 shows snapshots of trophic ulcers of patients before treatment and after treatment in a comprehensive manner in accordance with the invention, at different stages. The photographs 7-13 shows the States of trophic ulcers at different stages fragmentary treatment of known drugs.

Below are examples of implementation of the proposed method of treatment.

Example 1. Patient M., born in 1969 came to the Center "Diabetic foot" in Kazan with a diagnosis of diabetic foot syndrome (W2) to the right, diabetic neuropathy, diabetic angiopathy KHAN 2, article, condition after amputation of the 3rd toe of the left foot, diabetes mellitus of the 2nd type, severe, subcompensated (photo 1). At the time of receipt of the complaint in the presence of a defect of the skin in the area of the plantar surface of the right foot, pain; swelling of the tissue of the right foot, the body temperature to 37,5°C. Before admission she was treated in hospital and outpatient without success for 5 months.

Assigned: Ostalpen 600 mg intravenously on 200,0 saline; Corvalis 300 mg at night; Sulodexide (�business name of vessel due f) 600 LE/on 200,0 saline. Locally: the defect was treated with the drug Acerbis 1 time/day (only at the stage of cleansing the wound) superimposing the wet-dry dressings with this medicine. This therapy was carried out on the background of insulin therapy. On the fifth day received a complete cleansing of the defect and produced by implantation of Collost - bioplastic material 1 collagen type I. in the form of a 15% gel. Specified conservative therapy was continued. The wound was closed drying wet wipes with a solution other standard antiseptics. Visually marginal epithelization was observed on the 14th day (photo 2). Patient is removed to form of drugs: Ostalpen 300 mg 2 times a day; Corvalis 300 mg at night; Sulodexide (vessel due f) 250 LE 2 times a day. Was discharged for outpatient monitoring and dressings. Healing of the defect was noted on the 23rd day (photo 3). Remission was observed within 12 months.

Example 2. Patient N. born in 1946 he enrolled in the Center "Diabetic foot" in Kazan with a diagnosis of diabetic foot syndrome (W2) to the right, diabetic neuropathy, diabetic angiopathy KHAN 3 of the article, diabetes mellitus of the 2nd type, a serious condition, subcompensated. At the time of receipt of the complaint in the presence of a defect of the skin in the posterior surface of the ankle joint on the right, pain; sharp limitation of movement in the ankle with�the composition right; the swelling of tissues, body temperature 37.2°C. In the wound rendered elements of the Achilles tendon. Before admission he was treated inpatients and outpatients without success for 8 months. There have been attempts plasty with local tissues and autodermoplasty. The tissue defect tended to increase, increased pain, limited movement, movement on crutches and with a Walker (photo 4).

Assigned: Ostalpen 600 mg intravenously on 200,0 saline; Corvalis 300 mg at night; Sulodexide (vessel due f) 600 LE/on 200,0 saline. Locally: the defect was treated with the drug Acerbis 2 times a day with the imposition of the wet-dry dressings with this medicine. This therapy was carried out on the background of insulin therapy. On the third day received a complete cleansing of the defect and produced by implantation of Collost - bioplastic material 1 collagen type I. in the form of a 15% gel. Specified conservative therapy was continued. The wound was closed drying wet wipes with the solution of the standard antiseptics. Type of wounds on the 18th day from the start of treatment by the proposed method shown in photo 5, which marks the beginning of regenerative processes, the proliferation of tissue in the wound, not marked inflammatory and necrotic processes. Patient is removed to form of drugs: Ostalpen 300 mg 2 times a day; CONV�IP 300 mg at night; Sulodexide (vessel due f) 250 LE 2 times a day. Was discharged for outpatient monitoring and dressings. Healing of the defect was noted at 34 day (photo 6). Remission was observed in 15 months. The patient moves independently, drives a car. Complete rehabilitation.

Example 3 (an example of a negative result of unilateral effects on the body of the patient during the treatment).

Patient G., 63 years old, was admitted to the Center "Diabetic foot" in Kazan with a diagnosis of diabetic foot Syndrome (W2) to the right. Of diabetic neuropathy. Diabetic angiopathy. JAN. Trophic ulcer of the inner surface area of the right ankle, right foot and lower third of the right tibia. Diabetes mellitus type 2, severe course, subcompensated (photo 7). Upon receipt of the complaint in the presence of a defect of the skin in the ankle on the right, severe restriction of movement in the ankle joint right; the pain only occurs when dressings and manipulation in the defect area. The movement on crutches.

Appointed: Napolion 600 mg intravenously on 200,0 saline; Pentoxifylline 200 mg IV on 200,0 saline. Locally: the defect was treated with a solution of chlorhexidine digluconate aqueous 0.05% to ligation with NaCl 10%, the application with the ointment "levomekol". This therapy Prov�was born on the background of insulin therapy.

In photo 8 the state of the ulcer patient G., 5th day of treatment.

As can be seen, the positive dynamics from the ulcer-wound defect no. In the wound plaque fibrin, areas of necrotic tissue. Was performed necrectomy under local anesthesia.

Patient G., 50 day treatment (photo 9). Observed weak positive effect (slow marginal epithelialization, focal proliferation of granulation in the wound) was achieved only in long-term care patient. Closure of the ulcer being achieved. Noted wound cachexia.

Example 4 (as an example of a negative result of unilateral effects on the body of the patient during the treatment).

Patient Y., 52 years old, was admitted to the Center "Diabetic foot" in Kazan with a diagnosis of diabetic foot Syndrome (W2) to the right. Of diabetic neuropathy. Diabetic angiopathy. JAN-2A, Trophic ulcer of the inner surface of the left foot. Diabetes mellitus type 2, severe course, subcompensated. Diabetic retinopathy (photo 10).

Upon receipt of the complaint in the presence of a defect of the skin in area 1 of the metatarsophalangeal joint of the right foot, moderate limitation of motion; the pain only occurs when the manipulation in the area of the defect. The movement is independent.

Appointed: Actovegin 1200 mg IV on 200,0 saline. Topically: defect clicks�was battiwalla solution of Miramistin overlaid with wet-dry dressings with this medicine. This therapy was carried out on the background of insulin therapy. Patient Y., 11 days of treatment (photo 11). Treatment completed milestone gentle necrectomy.

Patient Y., 23 days of treatment (photo 12). The patient was transferred to Actovegin tablets 200 mg 3 times/day. Local treatment is supplemented by applications of the ointment "Flamelet".

Patient Y., 34 days of treatment (photo 13). Marked islet proliferation of granulation tissue in the wound, the alignment of the wound edges and sluggish marginal epithelization.

As can be seen from examples 3 and 4, the fragmentary treatment of the individual drugs does not lead to a cure, the treatment results of examples 3 and 4 differ sharply from the results of examples 1 and 2.

The treatment regimen in accordance with the invention was applied to 38 patients with neuropathic ulcers at DFS. Managed to achieve purification of defects of 3-5 hours, to close ulcerative defects without resorting to autografting (when autografting there are two wounds: the donor and recipient, which often aggravates the course of the local process on the background of diabetic neuropathy) 23-36 day during term treatment by known methods to 58 days with questionable results. After the specified course of treatment was greatly facilitated the course of the disease and obtained a stable remission. All patients treated by the proposed method, the term �to enable decreased almost 2-3 times which proves the effectiveness of the proposed method of treatment.

1. A method of treating neuropathic trophic ulcers in diabetic foot with carrying out the normalization of blood glucose level, which in case of simultaneous use of drugs in the patient's body is injected Oktolipen intravenous, then oral; injected Convales; administered Sulodexide intravenous, then oral; simultaneously hold application on the area of the ulcer drug keratolytic, antiseptic, wound-healing actions of Acerbis to cleanse ulcerative wound defect, then subjected to implantation of collagen Collost in the form of a 15% gel, implantation is carried out in the bottom and sides of the defect, the wound is closed dressing with antiseptic.

2. A method according to claim 1, characterized in that the intravenous Octolite administered for 14 days 600 mg.

3. A method according to claim 1, characterized in that the oral Octolite administered at 300 mg 2 times a day for a long time.

4. A method according to claim 1, 3, characterized in that the oral Octolite administered for up to two months.

5. A method according to claim 1, characterized in that Convales administered at 300 mg at bedtime for 10 days.

6. A method according to claim 1, characterized in that the intravenous Sulodexide administered for 10 days at a dose of 600 LE.

7. A method according to claim 1, characterized in that the oral Sulodexide enter�t 2 times a day for 250 LE to two months.

8. A method according to claim 1, characterized in that Acerbis use within 3-5 days.

9. A method according to claim 1, characterized in that after implantation of a collagen surface wounds closed dressing with antiseptic for 5-7 days.



 

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1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: blood is examined for angiogenic factors, namely soluble fms-like tyrosine kinase (sFlt-1) and placental growth factor (PIGF). An angiogenic factor (Ka) is calculated by formula: Ka=sFlt-1/PlGF×10. If Ka is 10 or less, the pregnant woman is stated to require no admission to hospital, no case follow-up; doctor's appointments are scheduled. If Ka falls within the range of 10 to 50, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed; an amniotic fluid index (AFI) is calculated; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 10 days. The amount of infusion makes 400 ml a day. The prescribed preparations are Actovegin, Trental, Instenon, Carnitini chloridum. Control ultrasonography, Doppler monitoring, foetal monitoring, AFI and Ka measurements are performed 2 weeks later. The pregnant woman is discharged from hospital if observing no negative trends. If Ka falls within the range of 50 to 100, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed, and AFI is measured; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 14 days The amount of infusion makes 800 ml a day. The prescribed preparations are Actovegin, Trental, Instenon, Carnitini chloridum. Control Doppler monitoring and foetal monitoring are performed every 3 days; 2 weeks later control Ka is measured. If the trend is positive, the pregnant woman may be discharged from hospital, while no positive trend requires another 2 weeks of the therapy. If Ka is 100 or more, but less than 150, the pregnant woman is admitted to hospital, wherein foetal monitoring, Doppler monitoring are performed, and AFI is measured; a therapy aiming at the uterine-placental blood flow improvement is prescribed for 14 days. The amount of infusion makes not less than 800 ml a day with the same preparations prescribed. Those are added with the preparations for homeostasis correction, including Fraxiparine, Fragmin, Clexane optionally. Control Doppler monitoring and foetal monitoring are daily. Hypamnion also requires measuring control AFI. If a gestational age is less than 34 weeks, respiratory distress syndrome (RDS) should be prevented by administering the preparation Dexon 24 mg according to the schedule: 6 mg every 12 hours 4 times. Control Ka is necessarily measured after 2 weeks of the treatment. If the trend is positive, the pregnant woman may be discharged from hospital, while no positive trend requires another 2 weeks of the therapy. If Ka is 150 or more, and the gestational age is more than 34 weeks, the therapeutic approach is the same, as for Ka being within 100 to 150, control Doppler monitoring, foetal monitoring are performed twice a day, as well as measuring AFI. If observing no foetal weight gain for 2 weeks of the therapy or the functional state of the foetus deteriorates, a Cesarean section is performed. If the gestational age is 34-36 weeks, the therapeutic approach and follow-up are the same as for the gestational age of 34 weeks, except for the prevention of foetal RDS. However, if observing the deterioration of a foetal movement pattern or the functional status of the foetus, a Cesarean section is performed according to the foetal monitoring and Doppler monitoring findings. If the gestational age is more than 36 weeks, and Ka is 150 or more, pre-mature delivery is applied.

EFFECT: optimal selection of the therapeutic approach ensured by determining the values reflecting the severity of the cardiovascular disorder directly in the uterine-placental complex and mother's and foetus's compensatory capacities.

5 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to dermatology, and can be used for treating androgenic alopecia. For this purpose heparin or its salts in a composition of medications for local treatment is locally applied on foci of baldness. Application is performed daily during the first three months 1 time per day, and after 3-months course every second day.

EFFECT: method makes it possible to restore the hair-covering.

5 dwg

FIELD: medicine.

SUBSTANCE: what is described is an osteoplastic composition containing a mixture of hyaluronic acid, chondroitin sulphate and heparin in sodium chloride and an osteoconductive material presented by non-demineralised osseine or demineralised osseine in the following ratio of the ingredients, wt %: hyaluronic acid 0.1-4.0, chondroitin sulphate 0.1-4.0, heparin 0.1-0.5, non-demineralised osseine or demineralised osseine 25-94.0, sodium chloride 0.8-0.85, distilled water - the rest. According to the other version, the osteoplastic composition uses an osseous mineral ingredient as an osteoconductive material.

EFFECT: osteoplastic composition is presented in the form of gel or chips, and possesses the protective viscoelastic properties prolonging the osteoconductive and osteoinductive properties of the ingredients of the composition filling and keeping the bone defect volume by the fact that they are considered as the natural mechanical support components of the bone tissue.

4 cl, 3 dwg, 5 ex

FIELD: medicine.

SUBSTANCE: invention relates o medicine and can be applied in treating varicose disease of veins of lower extremities with application of endovenous laser vein coagulation (ELVC). For this purpose skin area, which is subjected to operation, is processed with antiseptic solution. Under control of ultrasonic apparatus into vessel lumen introduced is catheter, through which light-conductor is passed to saphenofemoral fistula. After that, tumescent anesthesia is performed by creation of water "cushion", at that applying cold, ozonised 0.9% physiological solution with temperature 5-7°C, ozone concentration 4-5 mcg/ml and time of saturation with ozone 5-8 minutes. Or ozonised 0.1% lidocaine solution with temperature 5-7°C, ozone concentration 4-5 mcg/ml and time of saturation with ozone 5-8 minutes is introduced. After that, pathological vessel is exposed to laser energy. If necessary, applications of 50 ml ozonised heparin-containing gel are made after procedure in projection of coagulated vein with exposition 60-90 minutes until ozone concentration of gels reaches 6500-7000 mcg/ml.

EFFECT: method ensures effective treatment of said pathology due to selection of most optimal type of anesthesia and following therapy, which contribute to reduction of pains, local manifestations of inflammation, activation of processes of focal and marginal epithelisation processes.

2 cl

FIELD: chemistry.

SUBSTANCE: method of obtaining low-molecular heparin includes obtaining benzethonium salt of non-fractionated heparin in 0.05-0.5 M water solution of sodium chloride at temperature 50-60°C, pH=8.2-8.8 and weight ratio heparin/benzethonium chloride 1/(2,35-2.70), benzylation of heparin benzethonium salt, being carried out for 2-3 hours in medium of bipolar aprotic solvent with benzylchloride in ratio heparin/benzylchloride 1/(0.2-1.0), which is preliminarily subjected to activation in aprotic solvent for 15-20 min, precipitation of heparin benzyl ether by method of Spiro with ethyl alcohol, preliminarily saturated with water-free sodium acetate, with the following removal of protection from sulfo groups, carrying out β-elimination of benzyl ether with degree of heparin etherification 9-13% 1±0.5 N with alkali NaOH at temperature 55±5°C, duration of process is 40-60 min and weight ratio of reagents benzyl ether/alkali 1/(0.5-2).

EFFECT: method improvement.

4 ex, 3 tbl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to surgical dentistry, traumatology and orthopaedics, and can be used as a coating solution for protecting and fixing (immobilising) biologically active substances on dental implants, biomaterials placed into bone defects, for fixing the biologically active substances on metal structures for osteosynthesis used in traumatology and orthopaedics. The technical effect is achieved by using the implant and biomaterial coating solution that contains a viscous biopolymer solution in the form of a mixture of hyaluronic acid, chondroitin sulphate and heparin in normal saline in the following ratio, wt %: hyaluronic acid - 1.0-4.0, chondroitin sulphate - 1.0-4.0, heparin - 0.1-0.5, normal saline - 0.85-0.9, purified water - the rest.

EFFECT: preparing the coating solution having the evident the barrier protective effect ensured by adding the viscoelastic ingredient hyaluronic acid, chondroitin sulphate, and the binding agent heparin, the solvent normal saline to the composition, as well as developing the bone neogenesis induction processes, shortening the treatment and rehabilitation.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly ophthalmology, and may be used for treating inflammatory and dystrophic eye diseases. If observing an anterior segment of an eyeball, therapeutic agents are administered subcutaneously into a temporal region 1.8-2.2 cm above the middle of a cheek bone into a lymphatic capillary accumulation. If observing a posterior segment of the eyeball, the therapeutic agents are administered subcutaneously 0.8-1.2 cm below the top of a mastoid bone, as well as into the lymphatic capillary accumulation. Heparin in a single dose of 0.3 to 0.6 ml with the therapeutic substance concentration of 96% to 100% is initially administered into the above regions. The basic substance solution in a single dose of 0.6 to 0.8 ml with the therapeutic substance concentration of 45% to 55% is administered thereafter. That is followed by administering Contrykal in a single dose of 0.4 to 0.6 ml with the substance concentration of 45% to 55%. The manipulations are daily for 7-10 days with the therapeutic course repeated every 1-6 months.

EFFECT: method provides better trophism and microcirculation of an optic disk and retina, lower intensity of pathological reactions with obtaining the therapeutic substance concentrations faster, reducing injuries of the manipulation and doses of the administered preparations.

FIELD: medicine, pharmaceutics.

SUBSTANCE: group of inventions relates to composition for oral cavity care and method of its application Claimed composition includes therapeutically efficient quantity of, at least, one carbonate compound, selected from

or

and, at least, one excipient, where composition for oral cavity care possesses antimicrobial activity and activity in prevention biofilm attachment Also claimed is method of providing favourable effects in oral cavity care, including introduction of claimed composition into oral cavity.

EFFECT: application of, at least, one of said compounds as component of composition for oral cavity care provides efficient antimicrobial activity and inhibition of biofilm formation.

4 cl, 1 tbl, 2 ex

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