Method of treating ischemic heart diseases accompanying cholestasis

FIELD: medicine.

SUBSTANCE: antianginal therapy is accompanied by a primary discrete plasmapheresis in a refrigerate centrifuge PC-6 having a rotating speed of 2,000 rpm for 15 minutes at a temperature of 22°C in number of 5 sessions every second day. One session involves removing the whole blood in an amount of: 2 flexible PVC packages x 450 ml if the patient's body weight index is from 18 to 29.9 kg/m2, 3 flexible PVC packages x 450 ml if the patient's body weight index is over 30 kg/m2. The total volume of the removed plasma makes 600-900 ml. The circulating blood volume is replaced with 0.9% NaCl in an amount of half as much as the removed plasma volume. Once the plasmapheresis course is completed, the blood is exposed to ultraviolet light generated by OVK-3 apparatus for at wave length more than 400 nm in number of 5 procedures every second day.

EFFECT: effective treatment of the given category of the patients by improving the haemorheology, normalising the lipid spectrum without increasing liver enzymes with preserving the hepatic function, decreasing the dyslipidemia level and functional class of angina in the patients with limited use of statins with underlying cholestasis.

2 tbl, 5 ex

 

The invention relates to the field of medicine, namely cardiology and transfusion medicine, and can be used, in particular, in complex treatment of patients with ischemic heart disease when the use of lipid-lowering drugs is limited because of cholestasis and enzymatic activity of liver enzymes.

In clinical medicine currently constantly searching program for the management of patients with coronary heart disease (CHD), including the impact on different parts of the pathogenetic process. It is known that the main pathogenic factor in the progression of coronary heart disease is increasing dyslipidemia in atherosclerosis of the coronary vessels.

Among the traditional medical and surgical methods of treatment of atherosclerosis is also known, and some ways of application of gravitational blood surgery [A. I. Vorobiev / Essays on production and clinical Transfusiology. Moscow, 2006. - P. 72; P. A. Vorobev / Intermittent therapeutic plasmapheresis. Moscow, 1998. - 72 S.; Yu, S. Diasamidze // Influence of photochemotherapy on blood lipid composition in patients with CVD. - Clinical medicine. - 2004. - No. 7. - S. 14 - 17; G. I. Kozinets / Practical blood transfusion. Moscow, 2005. - S. 45; I. G. Dudkevich, V. A. Marchenko / New methods of photochemotherapy. St. Petersburg, 1993. - P. 14].

It is interesting to study, is devoted� dyslipidemia treatment with plasmapheresis and statins in postoperative period in patients after coronary artery bypass grafting [Konstantinova E. E., Shestakova L. G., Mironova E. V. et al. / Correction circuits expressed dyslipoproteinemias with the use of therapeutic plasma exchange and atorvastatin in the postoperative period of coronary artery bypass surgery // Medical view. - 2005. - No. 11. - S. 56-60.]

The disadvantages of this method are:

- the lack of combination therapy of plasmapheresis and ultraviolet blood irradiation;

- the absence of a clear program in the amount of blood sampling and the choice of modes of plasmapheresis;

- patients were not evaluated immunological status after conducting plasmapheresis.

A method of treating ischemic heart disease by intravascular ultra-violet blood irradiation, at individual selection time for photochemotherapy with the body mass index, sex of patients and also to assess the type of adaptive response calculated by the leucocyte count [Kotelnica L. I., Bykov A. T., luzecky I. V., Kostusev-N. Muromtseva.And. A method for the treatment of coronary heart disease (patent RF №2157266)].

However, the presented method has drawbacks:

- use only ultraviolet blood irradiation is insufficient for correction of dyslipidemia in high risk patients;

- the uncertainty in the choice of long ultraviolet light when carrying out make, which is important to achieve a positive effect� UFO;

- it is impossible to objectively assess the results of ultraviolet blood irradiation without monitoring the immune status of patients.

The literature describes a method comprising the introduction of crystalloid, hemodynamic, detoxification, protein solutions, followed by plasmapheresis without hemodynamic load with the removal of 40% of circulating plasma during the course of treatment from 1 to 3 sessions within 72 h [Malczewski J. E., M. D. Malczewski, a method for the treatment of coronary heart disease (patent RF №2224550)].

The disadvantages of this method are:

- limited scope, since not all patients with coronary heart disease have unstable angina and suffer a myocardial infarction;

- does not provide clear criteria for the introduction of crystalloid, hemodynamic, detoxification and protein solutions to patients with ischemic heart disease.

The closest adopted for the prototype, is to work on the treatment of patients with coronary artery disease and high levels of lipid profile with refractory to lipid-lowering therapy, by combining standard pharmacotherapy with hemocorrection methods: plasmapheresis or double filtration plasmapheresis [Silchenko V. A. Efficacy of plasmapheresis in the complex treatment of patients with coronary heart disease with R�fraternity by dyslipidemia: the dissertation... kand. honey. Sciences. - Samara, 2012, - 157 p.].

The method of complex treatment of coronary heart disease in combination with hemocorrection methods has drawbacks:

the method is based on using only plasmapheresis;

- no clear program of plasmapheresis in the number of blood sampling and frequency of treatments tailored to patients with ischemic heart disease;

- do not specify the state of the hepatobiliary system and the immunological status of patients.

The invention aims to improve the rheological properties of blood, normalization of lipid profile without raising liver enzymes with preservation of liver function, reduction of the level of dyslipidemia and functional class of angina pectoris in patients with coronary artery disease with limited use of statins on the background of cholestasis.

Said technical result is achieved by the fact that patients spend initially discrete plasmapheresis on refrigeratorall the centrifuge PC-6 with 2000 rpm in 1 minute for 15 minutes at a temperature of 22°C in an amount of 5 sessions in a day with removal for 1 session when your body mass index from 18 to 29.9 kg/m22 plastic bags of 450 ml, with a body mass index of 30 kg/m2and more than 3 plastic bags of 450 ml of whole blood, with a total volume remote plasma 600-900 ml and replenishment of circulating blood volume physiologically� with 0.9% NaCl 1.5 times the remote plasma; after completing the course of plasmapheresis start of ultraviolet blood irradiation for 60 minutes on the HVAC unit-3 at a wavelength of 400 nm in an amount of 5 procedures a day.

The indication for carrying out plasmapheresis is angina II-III functional class (FC), resistant to medical treatment, violation of microcirculation, expressed hypercoagulability of blood with decreased fibrinolytic properties. It is known that as a result of this procedure, the normalization of the state of aggregation of blood rheology and microcirculation, improving hemodynamics and cardiac function (myocardial metabolism and the walls of the coronary vessels, the delivery of oxygen and excretion of carbon dioxide), the work of other organs (lungs, kidneys, etc.).

However, in different literature sources data on the number of procedures performed (1 session; 3-4-5 session; 6-12 sessions), their mode of holding (after 1-2 days, 3-4 days), the volume of removed plasma (for 1 session of no more than 600-700 ml of plasma; 750-1000 ml of plasma; 2000-2500 ml plasma) and solutions for replenishment of circulating blood volume (CBV) is very inconsistent. From the solutions proposed for substitution, different authors give electrolyte solutions, crystalloids, hemodiluted [A. I. Vorobiev / Essays on production and clinical Transfusiology. Moscow, 2006. - P. 72; P. A. Sparrow� / Intermittent therapeutic plasmapheresis. Moscow, 1998. - P. 72; G. I. Kozinets / Practical blood transfusion. Moscow, 2005. - P. 45; A. I. Trawinski, M. A. Aristov // Recommendations for use of therapeutic plasma exchange. - Copyright@2004 OOO "Nord Medic"].

I must say that according to the European Association of cardiologists in the treatment algorithm of CHD included treatment with statins as drugs acting on the pathogenic origin of the disease, and in particular, atherosclerosis of the coronary vessels. Their application is limited only in patients with cholestasis and biliary dyskinesia in comorbidity, as one of the pharmacokinetic effects of all statins (simvastatin, atorvastin, flowstone) is slowing down the passage and concentration of bile from the secondary phenomena of cholestasis and elevation of liver enzymes. However, in the literature there are no clear criteria of patients with CHD and cholestasis.

According to the literary sources of ultraviolet blood irradiation is also used to treat patients with coronary artery disease, but the modes of carrying out all the different authors [J. S. Diasamidze // Influence of photochemotherapy on blood lipid composition in patients with CVD. - Clinical medicine. - 2004. - No. 7. - S. 14 - 17; A. L. Kostyuchenko / Efferent therapy. St. Petersburg, 2000. - P. 32].

It is known that therapeutic effect of UV light depends on the wavelength. Blood photomodification in dir�IU shortwave ultraviolet radiation is directed to the generation of reactive oxygen species, the intensification of lipid peroxidation, the provision of virucidal and bactericidal action, erythropoiesis, but to a greater extent than other types of UV light can damage blood cells [L. A. Kostyuchenko / Efferent therapy. St. Petersburg, 2000. - P. 32].

Medium - and long-wave ultraviolet light is an activator of cellular and humoral immunity, fibrinolysis, promotes the release of lymphokines and monokines, has anti-edematous and desensibilizing action, more brutally than other ultraviolet light alters the acid-base balance of the blood [Kostyuchenko A. L. / Efferent therapy. St. Petersburg, 2000. - P. 32].

Ultraviolet light in the visible light mode enhances metabolic reactions, activates reparative and regenerative processes, restores vitality to damaged cells, reduces the concentration in the blood concentration of cholesterol and triglycerides, reduce blood viscosity, improves the rheology and microcirculation [Kostyuchenko A. L. / Efferent therapy. St. Petersburg, 2000. - P. 32].

From our point of view, the program is a combination of plasmapheresis and UBI is needed in patients with coronary artery disease. Plasmapheresis should be performed with a certain mode of drawing blood, important to remove a sufficient amount of lipids and achieve all of the above effe�tov plasmapheresis. To achieve clinical results on the basis of the correct approach to the timing of the restoration of the physiological functions of the blood vessels and the heart must be clearly defined mode of conducting plasmapheresis (the number of sessions and the rhythm of their conduct). Given that a side effect of plasmapheresis is a slight removal from the peripheral blood of immune complexes, total protein and protein fractions UFO, platelets and monocytes, which is undesirable for homeostasis of the organism in disease, therefore, plasmapheresis blood must be supplemented by sessions UVI to restore the number of formed elements of the blood and immune status.

The proposed method is tested on 77 and patients with ischemic heart disease (stable angina II-III functional class) in cardiology units No. 1 and No. 2 NUZ "Medical sanitary Department of procurement of blood and components GUZ "Astrakhan regional station of blood transfusion" of Astrakhan in the period 2002-2012 the Age of patients ranged from 37 to 67 years. The patients were followed up from 1 month to 3 years (tab. 1, 2).

Below are the results of testing.

Example No. 1. Patient D., 48 years old, medical history, No. 4531, was admitted with complaints of crushing, burning pain behind the breastbone when walking (300-350 m), palpitations, headache, heaviness in the right potreben�e after eating.

Patients consider themselves to be about 7 years old, when he began to raise HELL. Within 2 years of pain behind the sternum, lasting about 5 minutes, stoped independently. About a month appeared fatigue, decreased performance, become concerned with disruptions in heart. In connection with deterioration of a state referred to the clinic.

On examination: General condition is unsatisfactory. Consciousness is clear. The body temperature of 36.7°C. the Patient the right physique, satisfactory power. The body mass index is 24.2 kg/m2. Skin and visible mucous membranes pale pink color, clean. Peripheral lymph nodes were not enlarged. Percussion over the lungs pulmonary sound. Auscultation in the lungs vesicular breathing, is conducted in all departments, no wheezing. Respiratory rate 18 in 1 minute. The borders of relative cardiac dullness is displaced to the left by 1 cm heart Tones are muffled, rhythmic. The heart rate of 87 beats per 1 minute, the noise does not listen. BP is 160/100 mm Hg.PT. The abdomen was painless on palpation. Liver at the edge of the right costal arch. Moderate tenderness to palpation at the point Kera. The spleen is not enlarged. Peripheral edema no.

Examination:

- General analysis of blood - hemoglobin 143 g/l, erythrocytes from 4.48×1012/l, leukocyte count of 5.7×109/l, leukocyte formula is not treason�and, platelets 240×109/L. erythrocyte sedimentation rate of 6 mm/h In the biochemical analysis of blood: glucose 6.0 mmol/l, uric acid is 7.2 mmol/l, ACT - 38 U/l, ALT 48 U/l, total cholesterol of 7.03 mmol/l, triglycerides 3,09 mmol/l, LDL cholesterol - to 4.26 mmol/l, HDL cholesterol - 0,73 mmol/l, APTT - 32, PETIT 115%, fibrinogen, 4.0 g/l, alkaline phosphatase (ALP) - 300 U/l, gamma glutamyl transpeptidase (ATG) - ED/L.

- immunological study of blood - IgA - 0,47, IgM - 0,48, IgG - 12,2;

- urinalysis: without pathology.

- ECG: sinus rhythm, right. Heart rate 72 beats/min. EOS deflected to the left. Signs of left ventricular hypertrophy. Violation of repolarization anterior-septal area.

- ECHO-COP - Thickness of the interventricular septum - 11.2 mm, posterior wall thickness - 12.7 mm, end-diastolic size is 4.8 mm, end-systolic volume was 43 ml, end-diastolic volume of 117 ml, stroke volume, 94%, and ejection fraction of 65%, E<<1,0. Areas of Hypo - and akinesia not revealed. The valves of the heart and aorta are not changed.

- Ultrasound examination of abdominal cavity - exeprince biliary dyskinesia hypotonic type.

The diagnosis of coronary artery disease. Angina of II FC. Atherosclerosis of the aorta, peripheral vessels. Hypertension stage III, II degree. Hypertrophy of the left ventricle. Risk 4 CHF I NYHA FC II

Assigned medications: bisoprolol 10 mg per day, waltz�tan 80 mg/day, retard kardiket 40 mg/day.

Taking into account body mass index conducted discrete plasmapheresis on refrigeratorall the centrifuge PC-6 with 2000 rpm in 1 minute for 15 minutes at a temperature of 22°C in an amount of 5 sessions in a day with the removal of 2 plastic bags of 450 ml of whole blood, with a total volume remote plasma 600 ml and replenishment of circulating blood volume with saline 0.9% in volume of 1500 ml.

After completing the course of plasmapheresis carried out 5 treatments of ultraviolet blood irradiation apparatus HVAC-3 with a wavelength of 400 nm within 60 min after 1 day.

As a result of therapy showed a good clinical effect. After the sessions of plasmapheresis, the patient ceased to bother angina, palpitations. Blood pressure is stabilized at the level of 120-130/80-85 mm Hg.CT., heart rate is 70-80 beats per minute.

Laboratory tests: KLA - erythrocytes USD 4.61×1012/l, hemoglobin 130 g/l; leukocytes 5.2×109/l, ESR 2 mm/h; b/x tests: glucose 5.2 mmol/l, uric acid of 6.2 mmol/l, ACT - 20 U/l, ALT 22 U/l, total cholesterol - to 5.19 mmol/l, triglycerides of 1.93 mmol/l, LDL cholesterol - 3,02 mmol/l, HDL cholesterol is 0.99 mmol/l, APTT - 35, PETIT 98%, fibrinogen 3.1 g/l, ALP - 250 U/l, ATG - 46 U/L.

- immunological study of blood after the plasmapheresis: IgA - 1,56; IgM, 0.51 For IgG - 11,50;

- immunologists�climate study blood after UFO - IgA Is 2.86, IgM - 0,56, IgG - 12,3.

ECG sinus rhythm, right. Heart rate 65 beats/min. EOS deflected to the left. Signs of left ventricular hypertrophy. Marked improvement of repolarization anterior-septal area.

In the above clinical example No. 1 in a patient with angina pectoris II FC, having pronounced dyslipidemia demonstrated favorable clinical course of disease with positive changes in carbohydrate, lipid, volume and indicators of cholestasis with a combination of standard antianginal therapy and extracorporeal hemocorrection methods. The presented method allows to stabilize the immune system, with a significant increase in the levels of Ig A.

Example No. 2. Patient K., 56 years old, No. 0325, was admitted with complaints of pressing pain in the heart, radiating to the left arm and left shoulder, shortness of breath when walking 100-200 m, periodic rises in blood pressure to 180/100 mm Hg.CT., dry mouth, weakness.

Patients consider themselves to be from 50 years of age, when he began to raise HELL, appeared angina, stoped 1-2 tablets of nitroglycerin. Deterioration within 1.5 months, decreased tolerance to physical load.

- on examination: General condition is not satisfactory. Consciousness is clear. The body temperature of 36.7°C. the Patient correct theologen�I, overnutrition. The body mass index - 28.7 kg/m2. Skin and visible mucous membranes pale pink color, clean. Peripheral lymph nodes were not enlarged. Percussion over the lungs pulmonary sound. Auscultation in the lungs vesicular breathing, wheezing no. Respiratory rate of 16 to 1 minute. The borders of relative cardiac dullness is displaced to the left by 1.5 cm muffled heart sounds, rhythm wrong 3-4 beats per minute. The heart rate is 66 beats per 1 minute, the noise does not listen. BP is 150/100 mm Hg.PT. The abdomen was painless on palpation. Liver at the edge of the right costal arch. The spleen is not enlarged. There is no swelling.

Examination:

- General analysis of blood - the haemoglobin 137 g/l, erythrocytes of 3.98×1012/l, leukocyte count of 6.1×109/l, leukocyte formula is not changed, platelets 285×109/l ESR 8 mm/h In the biochemical analysis of blood: glucose 6.1 mmol/l, uric acid 10,2 mmol/l, ACT - 37 U/l, ALT - 49,8 U/l, total cholesterol - 6,50 mmol/l, triglycerides 2,83 mmol/l, LDL cholesterol - 3,95 mmol/l, HDL cholesterol is 0.81 mmol/l, APTT - 37, PETIT 107%, fibrinogen 3.7 g/l, ALP - 291 U/l, ATG-68 U/L.

immunological testing: IgA - 1,43; IgM - 0,65, IgG - 10,30;

- urinalysis: without pathology.

- ECG: sinus rhythm, wrong. Heart rate 64 beats/min. EOS deflected to the left. Signs of left ventricular hypertrophy. Unit supraventricular� arrythmia. Coronary insufficiency rear wall.

- ECHO-COP - Thickness of the interventricular septum is 10.5 mm, the thickness of the rear wall - 13.0 mm, end-diastolic size of 5.4 mm, end-systolic volume 56 ml, end-diastolic volume - 135 ml, stroke volume is 70%, ejection fraction 55%, E<<1,0. Areas of Hypo - and akinesia not revealed. The valves of the heart and aorta are not changed.

- Ultrasound examination of abdominal cavity - Conclusion: echoprint biliary dyskinesia on the mixed type.

The diagnosis of coronary artery disease. Angina of III FC. Supraven-ticularly arrythmia. Atherosclerosis of the aorta, peripheral vessels. Secondary arterial hypertension. CHF I FC III NYHA

Assigned medications: aspirin 100 mg daily, bisoprolol 5 mg / day, valsartan 80 mg/day, retard kardiket 80 mg/day.

The patient received plasmapheresis in combination with ultraviolet irradiation of blood by the method described in clinical example No. 1. However, given the data of body mass index patients (28.7 kg/m2), removed 2 plastic package of 450 ml of whole blood, with a total volume remote plasma 740 and replenishment of circulating blood volume with saline 0.9% in volume 1850 ml.

After therapy the patient's condition improved: pain in the heart is not disturbed, shortness of breath decreased significantly. Patient per�I began to use nitroglycerin, increased efficiency.

- on examination: Skin pale pink color, clean. Auscultation in the lungs vesicular breathing, wheezing no. Heart tones are muffled, rhythmic. The heart rate is 62 beats per 1 min, BP - 130/80 mm Hg.PT. Abdominal palpation painless. Liver, spleen not palpated. There is no swelling.

- positive dynamics is observed in biochemical parameters - total cholesterol of 5.0 mmol/l, LDL cholesterol - of 2.97 mmol/l, HDL cholesterol - 1,2 mmol/l, blood glucose is 5.0 mmol/l, ACT - 18 U/l, ALT 20 U/l, APTT - 31, PETITE - 87%, fibrinogen 2.5 g/l, ALP - 237 U/l, ATG - 40 U/l

immunological testing after conducting plasmapheresis: IgA - 0,71; IgM - 0,66, IgG - 14,10;

immunological testing after UFO - IgA Is 2.54, IgM - 0,56, Ig G - 9,62.

The patient was discharged with improvement under the supervision of the local General practitioner and cardiologist. After analyzing the data, we see that the treatment has improved the quality of life of patients achieved target blood pressure levels, improved lipid profiles, the positive dynamics in the rheology of blood and liver.

Example No. 3. Patient A., 60 years old, medical history, No. 4708, was admitted with complaints of intermittent burning pain behind the breastbone, a feeling of numbness in the left hand, periodic interruptions in heart work, with�abost. From the anamnesis of disease: with 55 years began to experience angina. The deterioration in the last year: appeared regularly pain in the heart that requires taking nitroglycerin, decreased the effectiveness of antianginal therapy.

- during the inspection - the condition is not entirely satisfactory. The patient's body. The body mass index of 32.5 kg/m2. Skin clean, normal color. Peripheral lymph nodes were not enlarged. Percussion over the lungs pulmonary sound. Auscultation in the lungs vesicular breathing, is conducted in all departments, no wheezing. Respiratory rate of 16 to 1 minute. The borders of relative cardiac dullness is displaced to the left by 1 cm heart Tones are muffled, rhythmic. The heart rate is 80 beats per 1 minute, accent II tone at the point of listening to the aorta. The abdomen was painless on palpation. Liver at the edge of the right costal arch. Peripheral edema no.

Examination:

- General analysis of blood - hemoglobin 148 g/l, erythrocytes-is 4.85×1012/l, leukocyte count of 6.4×109/l, leukocyte formula is not changed, the platelet count of 300×109/L. erythrocyte sedimentation rate 10 mm/h In the biochemical analysis of blood: glucose of 5.7 mmol/l, uric acid 10,2 mmol/l, ACT - 26 U/l, ALT 37 U/l, total cholesterol - 5,98 mmol/l, triglycerides of 3.05 mmol/l, LDL cholesterol - 3.88 mmol/l, HDL cholesterol and 0.80 mmol/l, APTT - 37 C, PETIT - 100%, fibrino�Yong 3.5 g/l, ALP - 302 U/l, ATG - 73 U/L.

immunological testing: IgA - 0,70; IgM - 0,61, IgG - 10,84;

- urinalysis: without pathology.

- ECG: sinus rhythm, right. Heart rate 64 beats/min. Scarring of the anterior-septal area. Blockade of the anterior branch of the left legs of p. GISS. Coronary insufficiency rear wall.

- ECHO-COP - Thickness of the interventricular septum - 11.1 mm, thickness of the posterior wall - 11.1 mm, end-diastolic size of 5.6 mm, end-systolic volume of 62 ml, end-diastolic volume - 154 ml, stroke volume - 90%, ejection fraction was 56%, E<<1,0. The valves of the heart and aorta are not changed.

- Ultrasound examination of abdominal cavity - Conclusion: Deformation of the gallbladder. ULTRASOUND signs of thickening of bile.

The diagnosis of coronary artery disease. Angina of III FC. Atherosclerosis of the aorta, peripheral vessels. Secondary arterial hypertension. CHF I FC III NYHA.

Assigned medications: aspirin 100 mg daily, bisoprolol 5 mg / day, valsartan 80 mg/day, retard kardiket 40 mg/day.

Complex therapy of coronary heart disease included plasmapheresis and ultraviolet blood irradiation, using the methodology described in clinical example No. 1. The body mass index of the patient amounted to 32.5 kg/m2therefore removed 3 plastic package of 450 ml of whole blood, with a total volume remote plasma and 80 ml volume replacement with saline 0.9% in volume of 2000 ml.

Upon completion of a course of extracorporeal hemocorrection methods repeated comprehensive examination.

The patient noted improvement. Pains in heart region not concerned about interruptions no heart, notes the increase of tolerance to physical load.

- on examination: Skin pale pink color, clean. Auscultation in the lungs vesicular breathing, wheezing no. Heart tones are muffled, rhythmic. The heart rate is 75 beats per 1 minute, blood -125/80 mm Hg.PT. Abdominal palpation painless. Liver, spleen not palpated. There is no swelling.

- biochemical parameters - total cholesterol 4.5 mmol/l, LDL cholesterol - of 2.97 mmol/l, HDL cholesterol - 1,2 mmol/l, blood glucose is 5.0 mmol/l, ACT -18 U/l, ALT 20 U/l, APTT - 31, PETITE - 87%, fibrinogen 2.5 g/l, ALP - 262 U/l, ATG - 38 U/L.

immunological testing after conducting plasmapheresis: IgA - 1,56; IgM, 0.51 For IgG - 11,5;

immunological testing after UFO - IgA - 2,86, IgM - 0,58, IgG - 9,9.

ECG - sinus rhythm, right. HR - 62 strike in min Coronary insufficiency on the back wall there.

Thus, in the clinical example shows that on the background of plasmapheresis in combination with UBI achieved rapid positive dynamics of the clinical condition of the patient, lipid metabolism and indicators of coagulogram. The proposed method medical�of coronary heart disease has proven its effectiveness and safety in patients with severe high functional class of angina pectoris.

Example No. 4. Patient N., 57 years old, medical history, No. 4772, was admitted with complaints of shortness of breath on exertion, headache, fatigue, dryness and bitter taste in the mouth, worse after eating.

The patient considers himself since 37 years, when he began to raise HELL, was not treated regularly. In 53 years appeared angina, manifested by shortness of breath when walking (200-300 m). Repeatedly treated permanently, with a short-term effect. On nitrates severe headache.

- during the inspection: the Condition is not entirely satisfactory. The patient's body. The body mass index of 36.5 kg/m2. Skin clean, normal color. Peripheral lymph nodes were not enlarged. Percussion over the lungs pulmonary sound. Auscultation in the lungs vesicular breathing, is conducted in all departments, no wheezing. Respiratory rate of 16 to 1 minute. The borders of relative cardiac dullness is displaced to the left by 1 cm heart Tones are muffled, rhythmic. The heart rate of 82 kick in 1 minute, accent II tone at the point of listening to the aorta. BP - 160/110 mm Hg.PT. The abdomen is soft, moderately painful on deep palpation in the right hypochondrium. Liver at the edge of the right costal arch. Peripheral edema no.

Examination:

- General analysis of blood - hemoglobin 125 g/l, erythrocytes-to 4.36×1012/l, leucocytes-4,4×1 9/l, leukocyte formula is not changed, platelets 241×109/l ESR 8 mm/h In the biochemical analysis of blood: glucose of 4.8 mmol/l, uric acid of 11.3 mmol/l, ACT - 45 U/l, ALT 41 U/l, total cholesterol - 7,41 mmol/l, triglycerides 2,68 mmol/l, LDL cholesterol - 3.72 mmol/l, HDL cholesterol - 0,65 mmol/l, APTT - 39, PETIT 120%, fibrinogen 3.9 g/l, ALP - 270 U/l, ATG - 55 U/L.

immunological testing: Ig A - 1,2; Ig M - 0,67, Ig G - 14,3;

- urinalysis: without pathology.

- ECG: sinus rhythm, right. Heart rate 78 beats/min. Coronary insufficiency anterior-septal area.

- ECHO-COP - Thickness of the interventricular septum - 12,0 mm, posterior wall thickness - 10.5 mm, end-diastolic size of 4.9 mm, end-systolic volume was 36 ml, end-diastolic volume - 124 ml, stroke volume is 80%, ejection fraction was 66%, E<<1,0. The valves of the heart and aorta are not changed.

- Ultrasound examination of abdominal cavity - Conclusion: echoprint biliary dyskinesia. Deformity of the gallbladder. ULTRASOUND signs of thickening of bile.

The diagnosis of coronary artery disease. Angina of III FC. Atherosclerosis of the aorta, peripheral vessels. Secondary arterial hypertension. CHF I FC III NYHA.

Assigned medications: aspirin 100 mg daily, bisoprolol 10 mg / day, valsartan 80 mg/day.

Complex therapy of coronary heart disease included the exclusion of�their plasmapheresis and ultraviolet blood irradiation using the methodology described in clinical example No. 1. The body mass index of the patient amounted to 36.5 kg/m2therefore removed 3 plastic package of whole blood 450 ml, with a total volume remote plasma 850 and replenishment of circulating blood volume with saline 0.9% in volume 2125 ml. Upon completion of a course of plasmapheresis carried out through day 5 treatments of ultraviolet blood irradiation with a wavelength of 400 nm for 60 min.

Upon completion of a course of extracorporeal hemocorrection methods repeated comprehensive examination.

Notes improvement. No complaints. The General condition is satisfactory. Auscultation in the lungs vesicular breathing, wheezing no. NPV - 17 in 1 minute. Muffled heart sounds, regular rhythm. Heart rate is 68 beats per 1 minute. BP - 130/80 mm Hg.PT. Abdominal palpation soft, painless.

The biochemical study demonstrated improvements in the lipid profile - total cholesterol - to 5.04 mmol/l, triglycerides of 1.75 mmol/l, LDL cholesterol - 3, 03 mmol/l, HDL cholesterol - 1,08 mmol/l, ACT - 21 U/l, ALT 23 U/l, APTT - 33, PETIT - 88%, fibrinogen 2.8 g/l, ALP - 220 U/l, ATG - 30 U/L.

immunological testing after conducting plasmapheresis: IgA - 1,76; IgM - 0,61, IgG - 11,8;

immunological testing after UFO - IgA - 1,93, IgM - 0,68, IgG - 13,5;

ECG - sinus rhythm, right. HR - 62 blow in mins compared to� with previous ECG dynamics no.

This clinical example demonstrates the effectiveness of standard antianginal therapy in combination with individualised plasmapheresis and ultraviolet irradiation of blood in patients with functional class III angina, II degree of obesity. The positive influence of hemocorrection methods on the clinical picture of the disease, with a significant reduction of angina attacks and increasing the physical activity of patients. The use of this method results in the regression of dyslipidemia, improvement of immune status and rheology of blood.

Example No. 5. Patient N., 40 years old, medical history, No. 5679, was admitted with complaints of intermittent pressing chest pain radiating to the interscapular region under stressful situations, shortness of breath during physical activity, disruption of the heart that occurs suddenly without precipitating factors, stoped independently.

Medical history: Arterial hypertension at the age of 27, with a rise in blood pressure up to 200/100 mm Hg.PT. First chest pain appeared 3 years ago. Regularly taking nitrates, beta-blockers, antiplatelet agents. Heredity burdened by hypertension, diabetes mellitus.

- during the inspection: the Condition is not entirely satisfactory. The patient's body. The body mass index is 40.5 kg/m2 . Skin clean, normal color. Peripheral lymph nodes were not enlarged. Percussion over the lungs pulmonary sound. Auscultation in the lungs vesicular breathing, is conducted in all departments, no wheezing. Respiratory rate 18 in 1 minute. The borders of relative cardiac dullness is displaced to the left by 1.5 cm heart Tones are muffled, rhythmic. The heart rate is 85 cob in 1 minute, accent II tone at the point of listening to the aorta. AD - 200/110 mm Hg.PT. The abdomen is soft, moderately painful on deep palpation in the right hypochondrium. Liver at the edge of the right costal arch. There is no swelling.

Examination:

- General analysis of blood - hemoglobin 158 g/l, erythrocytes 5,16×1012/l, leukocyte count of 6.5×109/l, leukocyte formula is not changed, platelets 292×109/L. erythrocyte sedimentation rate 10 mm/h In the biochemical analysis of blood: glucose 5.8 mmol/l, uric acid of 10.5 mmol/l, ACT - 48 U/l, ALT 55 U/l, total cholesterol -8,5 mmol/l, triglycerides 4,08 mmol/l, LDL cholesterol - 4,20 mmol/l, HDL cholesterol - 0,55 mmol/l, APTT - 30 C, PETIT 108%, fibrinogen, 4.0 g/l, ALP - 310 U/l, ATG - 73 U/L.

immunological testing: IgA - 0,66; IgM - 0,56, IgG - 10,74.

- urinalysis: without pathology.

- ECG: sinus rhythm, wrong. Heart rate 90 beats/min. Single ventricular extrasystoles. Hypertrophy of the left ventricle.

- ECHO-COP - Thickness of the interventricular septum - 12,0 mm,�schina back wall - 12.3 mm, end-diastolic size is 5.3 mm, end-systolic volume was 36 ml, end-diastolic volume of 138 ml, stroke volume and 47%, ejection fraction 60%, E<<1,0. The valves of the heart and aorta are not changed.

- Ultrasound examination of abdominal cavity - Conclusion: echoprint biliary dyskinesia. ULTRASOUND signs of thickening of bile.

The diagnosis of coronary artery disease. Angina of III FC. Atherosclerosis of the aorta, peripheral vessels. Hypertension stage III, III degree. Hypertrophy of the left ventricle. Dyslipidemia. Risk - 4. CHF I FC III NYHA.

Assigned medications: aspirin 100 mg daily, bisoprolol 10 mg / day, valsartan 80 mg/day, retard kardiket 40 mg/day.

Standard anti-anginal therapy combined with hemocorrection methods described in clinical example No. 1. Given that the body mass index of the patient was 40.5 kg/m2for one session of plasmapheresis removed 3 plastic package of 450 ml of whole blood, with a total volume remote plasma 900 and replenishment of circulating blood volume with saline 0.9% in the volume of 2250 ml.

Upon completion of a course of extracorporeal hemocorrection methods repeated comprehensive examination.

During re-examination the following results were obtained: no Complaints. Notes dyspnea, Bo�sternal and arose. The General condition is satisfactory. Auscultation in the lungs vesicular breathing, wheezing no. NPV - 18 in 1 minute. Muffled heart sounds, regular rhythm. Heart rate is 78 beats per 1 minute. BP - 130/80 mmHg.PT. Abdominal palpation soft, painless.

The biochemical study demonstrated improvements in the lipid profile - total cholesterol - 6,03 mmol/l, triglycerides of 2.7 mol/l, LDL cholesterol - 3,25 mmol/l, HDL cholesterol - 0,89 mmol/l, ACT - 26 U/l, ALT 15 U/l, APTT - 37, PETIT - 78%, fibrinogen 3.0 g/l, ALP - 268 U/l, ATG - 44 U/L.

immunological testing after conducting plasmapheresis: IgA - 2,32; IgM - 0,75, IgG - 9,62;

immunological testing after UFO - IgA - 3,04 IgM - 0,77, IgG - 10,3;

ECG - sinus rhythm, right. HR - 62 strike in min. compared with the previous ECG violations rhythms is not registered.

Thus, the presented clinical examples demonstrate the increased efficiency of treatment of patients with stable angina II-III FC, with signs of cholestasis. The introduction of the proposed method will allow time to carry out preventive measures progression of coronary artery disease, will improve the results of its clinical course, and outcome of the disease will change the traditional approach to therapy. The proposed method in contrast to drug therapy with statins can improve not only the performance of the whole lipid profile�, the coagulation system, but also to normalize the indicators of liver enzymes with the positive changes of the immune status of patients (table. 1, 2).

The proposed method of treatment of ischemic heart disease on the background of cholestasis achieved:

1. The high specificity of the proposed combined treatment of coronary heart disease on the background of cholestasis associated with the use of discrete plasmapheresis and ultraviolet irradiation of blood, manifested by improvement of clinical indices, lower functional class of angina, reduction of lipid profile.

2. High informative value of the results is associated with normalization of lipid profile with maintaining liver and gallbladder without increasing liver enzymes.

3. Ease of use in the method of the invention due to the possibility of application in a clinical setting, the technical simplicity of execution and speed of obtaining results.

4. Diagnostic efficiency of the method of the invention presents associated with improving the quality of laboratory screening lipid profile and liver enzymes in patients with ischemic heart disease: angina pectoris.

5. Therapeutic effectiveness is the improvement of clinical performance and decreased functional class of angina, improve the rheological St�right of blood, correction of dyslipidemia without provocation cholestasis and acute exacerbation of chronic cholecystitis.

6. Economic efficiency of the method of the invention presents, some quick effect after lipid-lowering therapy, reduction of angina functional class, manifested in the decrease in the number of days of hospital stay.

7. The proposed method is a real alternative to aggressive treatment of progressive atherosclerosis and, in some cases, avoids surgical treatment of coronary artery disease. It can be used for therapeutic purposes to reduce the class of stable angina and improve the quality of life in patients with coronary heart disease.

A method for the treatment of ischemic heart disease on the background of cholestasis, by combining standard pharmacotherapy with hemocorrection methods, characterized in that in patients with coronary heart disease on the background of standard antianginal therapy is carried out primarily discrete plasmapheresis on refrigeratorall the centrifuge PC-6 with 2000 rpm in 1 minute for 15 minutes at a temperature of 22°C in an amount of 5 sessions in a day with removal for 1 session when your body mass index from 18 to 29.9 kg/m22 plastic bags of 450 ml, when the index� body weight of 30 kg/m 2and more than 3 plastic bags of 450 ml of whole blood, with a total volume remote plasma 600-900 ml and replenishment of circulating blood volume with saline 0.9% NaCl 1.5 times the remote plasma; after the course of plasmapheresis start of ultraviolet blood irradiation for 60 minutes on the HVAC unit-3 with a wavelength of 400 nm in an amount of 5 treatments after 1 day.



 

Same patents:

FIELD: medicine.

SUBSTANCE: urgent surgery on vessels of a lower extremity involves placing an electrode for transoesophageal atrial temporal pacing (TOTP). That is followed by administering a beta adrenergic blocking agent intravenously in a load dose to achieve a decreased heart rate of ≤ 60 beats per minute. The dose of the beta adrenergic blocking agent is reduced to a maintaining one with preserving a sinus decreased heart rate from 72 to 74 beats per minute for the whole surgery and for 2-3 days thereafter as it may be necessary. The surgical repair of coronary arteries is performed at least 3-4 weeks after the surgery on the vessels of the lower extremities.

EFFECT: therapeutic approach provides preventing minor cardiac output syndrome and other cardiovascular adverse effects accompanying the repair surgeries on the arteries of the lower extremities that enables a coronary artery bypass surgery 3-4 weeks later.

2 cl, 2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to a novel compound of formula

(I)

or its pharmaceutically acceptable salt, possessing properties of the IKKβ and TNFα inhibitor. The compound can be used with an additional therapeutic agent, selected from vincristine, camptothecin hydrochloride (CPT-11), lefunomid, dexamethasone and TNFα. Preferable are compounds of formula (I), corresponding to 2-{5-chloro-2-[(1R,2R)-2-hydroxycyclopentylamino]pyrimidin-4-yl}-N-cyclopropyl-1H-indole-4-carboxamide and 2-{5-chloro-2-[(1R,2S)-2-hydroxycyclopentylamino]pyrimidin-4-yl}-N-cyclopropyl-1H-indole-4-carboxamide.

EFFECT: compound can be applied in the treatment of inflammatory diseases such as rheumatoid arthritis, chronic obstructive lung disease, bronchial asthma, multiple sclerosis and intestinal inflammatory diseases, or cancer diseases, such as multiple myeloma, colon cancer, pancreas cancer and ovary cancer, by IKKβ inhibition.

30 cl, 4 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to cardiac surgery, and concerns intraoperative coronary spasmolysis. That is ensured by 1-minute by-pass cross clamping of an ascending aorta involving administering nitroglycerol solution 4ml containing nitroglycerol 0.1mg in each ml, into an aortic root.

EFFECT: simple technical performance of the method provides the spasmolysis as soon as possible.

1 ex, 1 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to a method for producing 2-methylene-1,3-dinitroxypropane. The method involves a reaction of silver nitrate and tris(chloromethyl)acetic acid in the acetonitrile medium. The reaction is performed at heating to 60-70°C.

EFFECT: method enables producing the good yield product from the accessible compound in the comfortable medium as well as reducing the number of stages.

5 dwg, 5 tbl

FIELD: medicine.

SUBSTANCE: pharmaceutical composition contains a therapeutic amount of a sterile isolated chemotactic stem cell product, a stabilising amount of serum and a therapeutic agent for promoting the existing cardiomyocyte function in order to compensate the deprivation of the cardiomyocyte function caused by the cardiomyocyte death.

EFFECT: reducing the number of injuries at the infarction due to preventing the cardiomyocyte loss following the acute myocardial infarction by improving perfusion and preventing apoptosis.

27 cl, 13 ex, 4 dwg, 36 tbl

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention relates to pharmaceutical industry, in particular to application of composition for preparation of medications aimed at secondary prevention of cardiac infarction. Application of composition based on substances, applied in Chinese medicine, for preparation of medications aimed at secondary prevention of cardiac infarction, with composition, based on substances, applied in Chinese medicine, is prepared from composition, which contains Radix Astragali, Radix Salviae Miltiorrhizae, Radix Notoginseng and Lignum Dalbergiae Odoriferae, taken in specified ratio.

EFFECT: composition makes it possible to prepare medication, which is effective for secondary prevention of cardiac infarction, prevents stenocardia, improves coronary blood flow.

14 cl, 8 dwg, 74 tbl, 10 ex

FIELD: medicine.

SUBSTANCE: invention concerns using a pharmaceutical combination of an angiotensin-converting enzyme inhibitor and a pineal hormone for treating ischemic heart disease (IHD) in elderly patients. What is declared is using fozinopril 10 mg 2 times a day at 8.00 am and at 8.00 pm, and melatonin 3 mg half an hour before going to bed once a day.

EFFECT: reducing the length of the therapeutic therapy of IHD in the elderly patients and normalising the state within 12-14 days.

4 ex

FIELD: medicine.

SUBSTANCE: claimed invention relates to the field of biotechnology, namely to the preliminary estimation of the efficiency of the autologic cell material transplantation to stimulate the growth of blood vessels, and can be applied in medicine. Claimed is a method of the complex estimation of the angiogenic potential of progenitor cells in patients with cardiovascular diseases, tested on mesenchymal stromal cells of the adipose tissue (MSC-AT) of patients with ischemic heart disease and including the measurement of content of mRNA and proteins of basic angiogenic factors, produced by the progenitor cells such as the vascular endothelial growth factor (VEGF), the placental growth factor (PIGF), the hepatocyte growth factor (HGF), angiopoetin-1 and angiogenin, the angiogenic activity of total cell secretion products, as well as the estimation of the ability of the progenitor cells to stimulate the vascularisation of subcutaneous Matrigel implants, introduced to immunodeficient mice. As the screening method used is a simpler and more available but less informative method of express-assessment of the angiogenic properties of the progenitor cells, based on the measurement of the angiogenic activity of the total cell secretion products.

EFFECT: invention makes it possible to carry out testing of the autologic cell material obtained from the patients, including those with ischemic heart disease, before transplantation in order to choose the optimal tactics of cell therapy aimed at the stimulation of the growth of blood vessels.

2 cl, 2 dwg, 4 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: skin graft is simulated in laboratory animals on the second experimental day. Dihydroquercetin is administered intragastrically in a daily dose of 5.5 mg/kg from the first day every 46 hours of the experiment.

EFFECT: increasing the skin graft survival in the reduced circulation environment by activating the pre-conditioning process.

1 ex, 1 tbl

FIELD: chemistry.

SUBSTANCE: invention relates to 2-ethyl-6-methyl-3-hydroxypyridinium N-acetyl-aminoethanoate, which can be applied as a neurotropic preparation with anti-hypoxic, neuroprotective, anti-amnestic and vestibular-protective activity.

EFFECT: increase of the compound activity.

8 tbl, 7 ex

FIELD: medicine.

SUBSTANCE: as medications administered are: methotrexate 15 mg per week intake, folic acid 5 mg per week intake, movalis 15 mg per day intake. Laser therapy is administered in differential way depending on degree of disease activity and level of glucosaminoglycanes (GAG). In case of second stage of rheumatoid arthritis - index DAS28 3.2-5.1, level of glucosaminoglycanes 0.510±0.032 g/l, 7 daily procedures of intravenous laser irradiation are carried out. Radiating head KL-VLOK with wavelength 635 nm, power at the end of disposable light guide 1.5 mW, exposure time 15 minutes and laser head KL-VLOK-365 with wavelength 365 nm, power at the end of light guide 1.0 mW, exposure time 5 minutes, are alternated. In case of third degree of activity index DAS28 is higher than 5.1, GAG level is equal or is higher than 0.618±0.069 g/l, 10 procedures are carried out Radiating head KL-VLOK with wavelength 635 nm, power at outlet of disposable light guide 1.5-2.0 mW, exposure time 15 minutes and laser head KL-VLOK-365 nm, power at outlet of disposable light guide 1.0 mW, time of exposure 5 minutes.

EFFECT: method makes it possible to reduce frequency of exacerbations, reduce expression of clinical manifestations, reduce drug load on patient, provides earlier arrest of disease symptoms due to differentiated approach in case of administration of intravenous laser irradiation of blood and its normalising action on GAG indices and reduction of disease activity degree.

2 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: group of inventions relates to medicine, namely to dermatology and mycology, and can be applied in the treatment of skin and its appendages. A pharmaceutical composition for external application contains nanoparticles for the laser thermotherapy of infectious affections of the skin and its appendages. The nanoparticles are characterised by, at least, one localised surface Plasmon resonance in the range of a wavelength from 400 to 1100 nm. The nanoparticles are dispersed in a physiologically acceptable carrier, which is characterised by the absence of the absorption or weak absorption and/or weak dispersion of light radiation in the said range of wavelengths and possessing biocidal properties. The pharmaceutical composition is applied on an affected area and irradiated by laser radiation with a wavelength close to the wavelength of the localised surface Plasmon resonance of the nanoparticles, contained in the composition, or equal to it. The irradiation is continued until the desirable temperature of heating of the said area is achieved.

EFFECT: group of inventions ensures an increased treatment efficiency, reduction of a risk of development of side effects, reduction of the number of recurrences due to the application of the pharmaceutical composition, capable of absorbing energy of the light radiation and transforming it into heat energy with the achievement of the specified temperature with laser irradiation at the specified wavelength with the lower intensity of laser radiation and possessing biocidal properties.

63 cl, 3 dwg, 1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: in rapid eye movement sleep the patient is exposed to flash lights in the range of 0.5-3.5 Hz in a combination with audio signals not interrupting physiological sleep. The above is also accompanied by the tactile exposure of at least three vibration motors mounted on a wrist cuff. Modes of exposure are first selected individually. That is ensured by recording the eye movements during rapid eye movement sleep, determining the movement frequency and amplitude; the derived parameters are used to set the modes of the exposure: light flashes of at least three different colours, audio signals within the range of 20-20,000 Hz and tactile pulses.

EFFECT: method increases the exposure effectiveness that is ensured by the integrated exposure to tactile, light and audio pulses according to the individual mode of exposure.

5 cl, 1 dwg

FIELD: medicine.

SUBSTANCE: nucleus of lens is fragmented completely by femtosecond laser light at power 7,000-8,500 nJ; that is followed by making a corneal flap incision, dilating the pupil mechanically, and separating the synechias. A continuous circular capsulorhexis is performed, and the fragmented crystalline substance is emulsified. If observing degree II nuclear density, the nucleus is fragmented on 8 segments, while degrees III and IV requires fragmenting the nucleus on 8 segments in a combination with the circular incision in the centre 3 mm in diameter.

EFFECT: method provides creating the optimum conditions for phakoemulsification of the crystalline lens in the narrow rigid pupil and iris-lens synechias for enabling the adequate fixation of the IOL in the capsular sac with reducing intraoperative injuries and preventing the complications.

3 cl, 3 ex

FIELD: medicine.

SUBSTANCE: method involves performing a vitrectomy with removing a posterior hyaloids of a vitreous body, and a laser retinal endocoagulation at wave length 532 nm, emitting power 120-200 mWt, pulse length 0.1-0.2 s, spot diameter 150-200 mcm. A chorioretinal venous anastomosis (CRVA) is induced by exposing the branches of the central vein of the retina to the third-order laser light at wave length 532 nm in a number of 4 coagulated, emitting power 500 mWt, pulse length 1 sec and spot diameter 50 mcm. The vitrectomy is preceded by the intramuscular injections of 12.5% etamylate 4ml and the intravenous administration of 0.5% tranexamic acid 1 g 25-30 minutes before. That is followed by the droplet intravenous administration of an infusion solution containing 0.1% perlinganit 10 ml in 0.9% normal saline 100 ml at an initial rate of 5 mcg/min. The area to be exposed to laser is specified at least in 3 diameters of the disk from the optic disk. The third-order laser applications are applied on the branches of the central vein of the retina in a number from 2 to 4 at wave length 532 nm, emitting power 300-400 mWt, exposure 0.5 s, spot diameter 500 mcm in two points in the proximal and distal direction from the CRVA induction point. Immediately before the CRVA induction, a salt-water infusion flow is increased until the central retinal artery starts pulsating. The surgical management is completed by plugging the vitreal cavity with 20% air-gas mixture SF6.

EFFECT: effective management of the clinical course of the retinal venous thrombosis by considerable reduction of postoperative haemophthalmias.

2 ex

FIELD: medicine.

SUBSTANCE: method involves professional oral hygiene is carried out consisting in ultrasonic removal of supra- and subgingival dental deposits and polishing of supragingival teeth. Bite splinting and recovery of dentition integrity may be required. After dissecting a mucoperiosteal flap according to the known technique, an incision area is sanitated by means of a photodynamic therapy (PDT). The PDT is conducted with the use of a diode laser at wave length 660±5 nm and emitting power 0.5-1.0 Wt. The photosensitiser "Photoditasin" in the form of 0.5% gel is introduced by means of a cannula into dental gaps, under the dissected segments of the flap and onto the mucosal tissue for 5 minutes. The photosensitiser is washed out, and the gingival pockets are repeatedly exposed to laser light for 2-3 min in the same environment. Sterile osteoplastic material is introduced into bone defects, and the flap is sutured together.

EFFECT: effective cleansing of the surgical area, eliminating the periodontal inflammation, stimulating tissue osteogenesis and regeneration, stabilising the processes of bone tissue absorption of alveolar interdental septa and preserving the tissues.

2 cl, 1 ex

FIELD: veterinary medicine.

SUBSTANCE: in down-calving cows the entire mammary gland is irradiated with the contact method with scanning using laser beam with a wavelength of 0.63 microns. The low-intensity laser emitter power is 30 mW. The procedure is carried out for five minutes and is repeated five times with an interval of 48 hours.

EFFECT: method enables to increase the effectiveness of prevention of mastitis by increasing the overall and the local resistance of the cow organism prior to calving, increase in the activity of antioxidant defence of the organism, reduction of toxic load to its organism.

3 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy, dermatology and cosmetology, and can be used in stimulating regenerative processes in the face and/or neck skin. That is ensured by performing three stages, first two of which involve preparing to the third one. The first stage involves blood sampling from the patient, recovering the blood plasma, and enriching it with thrombocytes; the purified and enriched plasma is administered intradermally under the skin. Two days later, the second stage follows that involves the subcutaneous injections of hyaluronic acid. The third stage is performed 2-3 days later to expose different skin layers to laser light passing through different face and/or neck sections two to five times for one procedure. Passing once involves the alternating short-wave and long-wave laser exposure at a wave length of 1564-2940 nm. The procedure is repeated every 3-5 days with an increasing laser beam pulse energy from 35 mJ to 65 mJ.

EFFECT: method provides the safe effective stimulation of the regenerative processes in the face and/or neck skin ensured by the complex exposure covering different layers of derma and epidermis and involving different regeneration links.

2 ex

FIELD: medicine.

SUBSTANCE: what is presented is a kit for corneal saturation with a photosensitiser. The kit comprises a porous coating impregnated with 0.1% riboflavin and fitting the size of the corneal surface. The kit also comprises a coating fixation instrument comprising a semispherical umbrella-shaped base of 10-11.5 mm in diameter, 7.5-8.0 mm in radius of curvature, and a holder handle.

EFFECT: using the kit simplifies and accelerates the procedure of corneal saturation with the photosensitiser and reduces the time for the corneal collagen cross-linking procedure.

2 cl, 2 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to the technology of hygienic drying of hands and/or feet after washing and to the technology of the biological activation of a blood flow in veins of hands and feet. The claimed method is characterised by the fact that by means of an infrared mirror lamp of IKZK-250 with red glass of the bulb created is a flow of electromagnetic radiation, the spectrum of which is changed from red and near-infrared to far-infrared with transition through middle infrared and in a reverse order by the reduction/increase of the lamp supply voltage relative to the nominal one. A lamp reflector is made narrowing towards the side opposite to the bulb, therefore compacting the radiation flow. Hands and feet are placed below the reflector. A lamp case is fixed either in an immobile way with respect to hands and/or feet or with a possibility of linear and angular travel with respect to them.

EFFECT: possibility of hygienic drying hands and feet, possibility of the biological activation of blood flows in them, reduction of the radiation flow density at the output of the lamp reflector, increase of the emitter operation duration.

10 dwg, 4 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: etiotropic therapy is preceded by 2-3 sessions of cascade plasma filtration in an amount of 1-1.2 amounts of circulating plasma. The prepared plasma is passed through capillary filters with a certain pore diameter. In viral hepatitis, the pore diameter makes 30 nm, and in autoimmune hepatitis - 10 nm.

EFFECT: method provides conducting the effective therapy of the given pathology by selecting filters with the optimum pore diameter for various types of chronic hepatitis.

4 tbl, 4 ex

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