RU2014105C1 - Method of treating purulent pyelonephritis - Google Patents

Abstract

FIELD: urology. SUBSTANCE: method involves the steps of: carrying-out antibacterial, disintoxication and symptomatic therapy, additionally subjecting a patient's kidney to the action of a two-field transcutaneous laser radiation at a pulse repetition rate smoothly increasing from 4400 to 2800 Hz with an averaged pulse power lying in the range of 3.6-15.2 mWt with simultaneous intervascular irradiation of blood by a helium-neon laser with an output power of 25 mWt per 1 cm² for a time period of 25-30 min. EFFECT: reduced treatment time, complications prevented.

Description

 The invention relates to medicine, namely to urology.

 The aim of the invention is to reduce treatment time and prevent complications.

The method is as follows. Combined laser therapy is carried out on the patient against antibacterial, detoxification and symptomatic therapy: bipartite transdermal irradiation of the kidney under ultrasound guidance, which determines the location of purulent-destructive foci and the state of the kidney parenchyma, paranephral fiber, with a semiconductor laser in a pulsed mode with a gradual increase in frequency of up to 4400 times the frequency increases to 28,000 Hz, with an average pulse power of 3.6 - 15.2 mW, and intravascular blood irradiation with a helium-neon laser, output power 25 mW per 1 cm ² . External laser irradiation with an infrared laser is carried out for 5 minutes from 6 to 12 sessions. Intravascular laser irradiation with a helium-neon laser is 3-5 sessions from 25 to 35 minutes.

 Example 1. Patient Ch., 86 years old. Complaints about the lack of self-urination, pain over the bosom. Examination revealed prostate adenoma, acute urinary retention, acute urethritis, cystitis. In this connection, the patient underwent emergency trocar cystostomy. In the postoperative period, on the 9th day after the operation, the patient developed pain in the left lumbar region, fever up to 39 degrees. with chills. Examination (according to ultrasound examination) revealed an expansion of the pyelocaliceal system in the left kidney, a section of reduced echogenicity, a diffusely heterogeneous echostructure measuring 22 x 20 mm with fuzzy blurry contours, was revealed in the middle segment of the parenchyma. Right kidney without features. The performed excretory urography is uninformative due to the increased level of urea (14 mmol / L) and creatinine (128 mmol / L).

Blood test total Hb 118 g%; L 11/10 ⁶ ; stab stab 14; segmented 71; lymphocytes 9; monocytes 6; eosinophils 1; ESR 44 mm / h.

 Urinalysis is general; HC 1014; r-tion - sharply alkaline; protein 0.165; white blood cells 25-30 in the field of view; erythrocytes 10-15 in the field of view; a lot of bacteria; salts are phosphates.

In urine culture: E. coli 5 x 10 ⁶ , sensitive to aminocin, ceftriaxone, gentamicin, 5-NOC, monomycin, phosphomycin. Immunological indicators: lymphocytes 8%; T lymphocytes 70%; B-lymphocytes 8%; T-helpers 28; T-suppressors 21; IA 98 mg%; IM 65 mg%; IG 1120 mg%.

Given the presence of a carbuncle of the left kidney, the patient’s serious condition, severe intoxication and the patient’s refusal to undergo surgical treatment, bipolar irradiation of the left kidney using a semiconductor laser in a pulse mode of 12000 Hz for 5 min was started against a background of antibacterial therapy with phosphocyte in combination with ceftriaxone and infusion therapy - 2 sessions, 18000 Hz - 3, 4 and 5th sessions. 24000 Hz - 6th, 7th and 8th sessions; 28000 Hz - 9th and 10th sessions. The total number of sessions was 10, the duration of each session was 5 minutes, after 24 hours. Given the pronounced suppression of the body’s immune status, intravascular blood irradiation with an LG-75 helium-neon laser was carried out, the output power was 25 mW per 1 cm ² with a wavelength of 0.63 μm. Duration of sessions: 1st - 25 minutes; 2nd - 30 minutes; 3rd - 35 min; 4th - 35 min; 5th - 35 min. In total, 5 sessions of intravascular irradiation of blood were performed. In parallel with laser therapy, clinical and laboratory monitoring was performed, as well as ultrasound of the kidneys. On the fourth day after the start of laser therapy with an infrared laser and after two sessions of intravascular laser irradiation with a helium-neon laser during a control ultrasound examination of the kidneys, the left kidney is slightly enlarged, the pyelocaliceal system is not enlarged, the parenchyma is thickened, decreased echogenicity, in the middle segment the area is reduced echogenicity of a diffusely heterogeneous echostructure measuring 11 x 8 mm. The patient noted a decrease in the phenomena of intoxication, a decrease in body temperature, an improvement in laboratory parameters, a decrease in the level of urea and serum creatinine to normal numbers. On the tenth day after laser therapy according to ultrasound: the left kidney is of normal size, the pyelocaliceal system is not expanded, not deformed, the parenchyma is thickened in the middle segment, there is no homogeneous echostructure, foci of reduced echogenicity.

 Complete blood count Hb 120g%; white blood cells 5700; stab 2; segmented 70; lymphocytes 26; monocytes 2; eosinophils - no; ESR 38 mm / h.

 General urine analysis: HC 1016; protein 0.066 g / l; white blood cells 10-15 in the field of view; erythrocytes 4-5 in sight, no bacteria.

 In urine culture - no growth.

Immunological parameters: lymphocytes 26%; white blood cells 5.7 x 10 ³ ; T lymphocytes 93%; B-lymphocytes 18%; T-helpers 53%; T-suppressors 7%; IA 192 mg%; IM 171 mg%; IC 1340 mg%.

 Example 2. Patient S., 40 years old. Complaints of severe pain in the right lumbar region, fever up to 39 degrees, accompanied by chills, nausea, vomiting. After a cystoscopy performed at the clinic three days later, the above complaints are noted. It was treated on an outpatient basis, with no visible effect. Delivered an ambulance to the hospital. During the examination: the condition of the patient of moderate severity, the skin is pale with an earthy tint, the temperature is 38.4 degrees; pain in the right kidney during palpation is noted. On the survey roentgenogram - no shadows of stones were revealed. On a series of excretory urograms - the release of contrast medium is timely on both sides, the pyelocaliceal system is not expanded, not deformed. Passage along the upper urinary tract is not impaired. Ultrasound: kidneys of normal shape and location, moderate parenchyma edema on the right. No calculi were detected.

 General blood test: Нb 134.1 g%; white blood cells 22.4 thousand; stab 25; segmented 56; lymphocytes 15; monocytes 4; ESR 50 mm / h.

 Urinalysis (general): HC 1022; protein 0.132 g / l; leukocytes are all visual fields; red blood cells 1-2 in the field of view, a lot of bacteria.

 In urine culture, 5 million E. coli; sensitive to tarevid; 5-NOC, gentamicin, lidoprim. Immunological parameters: lymphocytes 15%; T-helpers 22; T-suppressors 29; IA 190 mg%, IG 659 mg%.

Along with detoxification, antibacterial and symptomatic therapy, the patient began laser therapy in connection with the refusal of surgical intervention. External irradiation of the right kidney was carried out by an infrared laser in a pulsed mode: 4400 Hz - 1 session for 5 min; 12000 Hz - 1 session - 5 min; 18000 Hz - 2 sessions of 5 minutes each; 24000 Hz - 1 session - 5 min; 28000 Hz - 1 session 5 min. A total of 6 irradiation sessions, the duration of each session is 5 minutes after 24 hours. For the purpose of immunomodulating the body, an intravascular laser irradiation of blood with an LG 75 helium-neon laser was performed, the output power was 25 mW per 1 cm ² with a wavelength of 0.63 μm. The duration of the first session is 25 minutes, the second - 3 minutes, the third 35 minutes. In total, three sessions of intravascular irradiation of blood were performed.

 Clinical, laboratory and ultrasound monitoring showed that after the fourth external laser irradiation and the second intravascular, the patient returned to normal body temperature, significantly reduced pain in the lumbar region on the right, and intoxication decreased.

 Ultrasound examination of the kidneys - the right kidney is of normal size, parenchyma edema is less pronounced, there is minimal expansion of the pyelocaliceal system of the kidney, a section of reduced echogenicity is noted in the upper pole, and mobility is limited.

 General blood test: Нb 112 g%; white blood cells 8.7 thousand; stab 9; segmented 72; lymphocytes 18; monocytes 1; ESR 48 mm / h.

 Urinalysis: HC 1009; acidic reaction; protein 0.033 g / l; white blood cells 40-50 in the field of view; red blood cells 3-4 in the field of view. Urine culture - no growth. After six sessions of external laser irradiation of the right kidney and three sessions of intravascular laser irradiation of blood during ultrasound examination of the kidneys - the right kidney is of normal size, parenchyma of a normal echostructure, a small area of a heterogeneous echostructure is noted in the upper pole. The mobility of the kidney is preserved.

 Complete blood count: HB 144 g%; white blood cells 6.8 thousand; stab 3; segmented 65; lymphocytes 26; monocytes 5; eosinophils 1; ESR 14 mm / h. In the analysis of urine: HC 1010; protein 0.066 g / l, white blood cells 10-15 in the field of view; red blood cells 3-4 in the field of view; no bacteria. Urine culture - no growth. Immunological parameters: lymphocytes 26%; white blood cells 6.8; T lymphocytes 92%; B-lymphocytes 8%; T-helpers 47%; T-suppressors 12%; IA 413 mg%; IM 137 mg%; IG 895 mg%.

 The proposed method was tested in the treatment of five patients with acute purulent pyelonephritis and made it possible to stop the purulent-inflammatory process in the kidney (carbuncle) and eliminate the septic state in patients without surgical intervention, reduce the patient's stay in the hospital, and reduce the hospital bed by 30%.

Claims (1)

METHOD FOR TREATING PURULENT PYELONEPHRITIS, including the introduction of drugs, characterized in that, in order to reduce treatment time and prevent complications, additionally affect the kidney with bipartite percutaneous pulsed irradiation with a gradual increase in the repetition rate of radiation from 4400 to 28000 Hz with an average pulse power of 3, 6 to 15.2 mW, with simultaneous intravascular irradiation of blood with a helium-neon laser with a power density of 25 mW / 1 cm ² for 25 - 35 minutes.