RU2027433C1 - Method for treating pedal mycetoma - Google Patents

Abstract

FIELD: medicine, particularly, methods of treating deep mycoses. SUBSTANCE: this method prescribes carrying out comprehensive treatment, that is, intramuscularly administering 3 ml of actinolysate two times a week, 1 g of sulfanilamide four times a week during 3 to 4 weeks, vitamins of groups B and C, carrying out hemotransfusion and transfusion of blood substitutes once a week, administering generally fortifying drugs, treating affected area by ultrasound, carrying out antibacterial therapy according to sensitivity of secondary microflora in focus with paracentetically administering angioprotectors into exterior femoral artery on affected side once a day (from 7 to 14 infusions). These steps allow obtaining high concentrations of chemopreparations in locus vascularization zone. Five patients suffering from pedal mycetoma from one to twenty years were treated by disclosed method. EFFECT: shorter treatment and pre-operation periods, lower rate of relapses, longer remission period, rapid stabilization of destructive changes, suppressed adverse toxic effect of chemopreparations on patient's organism by curtailing daily dosage and creating favorable conditions for concentration of chemopreparations in affection focus, and prompt cupping of algesic syndrome and lymphostasis. 1 tbl

Description

 The invention relates to medicine, namely to dermatology.

 Foot mycetoma is a chronically occurring deep mycosis of the skin, subcutaneous tissue and bones, characterized by the development of destructive changes in the tissues, which is manifested by soft tissue infiltration and the formation of granulomas and fistulas, a change in bone structure of an osteolytic and osteosclerotic nature, and chronic purulent intoxication.

 The problem of treating patients with mycetoma of the foot is still not sufficiently developed. Various means and methods were used to treat foot mycetoma: surgical treatment, complex treatment using bone homoplasty, regional perfusion of Amphotericin B, intraosseous administration of antibiotics, complex treatment using ultrasound. The listed methods of treatment do not always turn out to be effective, the duration of treatment of patients is measured over the years, which dictates the need to find new means and methods of treatment aimed at increasing the efficiency and reducing the treatment time for this severe chronic disease.

 As a prototype, a method was chosen where the complex of therapeutic measures for patients with deep mycoses includes: Actinolizate 3 ml intramuscularly 2 times a week, sulfonamides 1 g 4 times a day for 3-4 weeks, antibacterial drugs, depending on the sensitivity to them, secondary flora, vitamins of groups B and C, blood transfusions and blood substitutes once a day, restorative agents. In addition to the treatment complex, ultrasound is prescribed locally on the lesion site using the UTP-1 apparatus with direct contact of the vibrator in a continuous mode of 15-20 procedures per course. Then carry out surgical treatment according to indications.

 The described complex treatment method requires a long stay of the patient in the hospital, and on average, at least 2 courses are required at intervals of 3 months to prepare the lesion for surgery. The use of a comprehensive method does not exclude the possibility of relapse and the further spread of the pathological process, and does not allow for persistent and prolonged remission.

 The aim of the invention is to increase efficiency and reduce the treatment time of foot mycetoma.

 The goal is achieved by the fact that when conducting complex treatment, the combined introduction of antibacterial drugs (by sensitivity of the secondary microflora in the outbreak) and angioprotectors is punctured into the external femoral artery on the affected side.

 With intra-arterial combined administration of antibiotics and angioprotectors, the most favorable conditions are created for achieving a high concentration and their direct penetration into the vascularization zones of the lesion. As angioprotectors were used: Trental, Sermion, Curantil, etc.

 The method is as follows.

 Actinolizate is prescribed 3 ml intramuscularly 2 times a week, sulfanilamides 1 g 4 times a day for 3-4 weeks, B and C vitamins, blood and blood transfusions, ultrasound on the lesion, antibiotics and angioprotectors are administered intraarterially .

 Immediately before the infusion, a solution of the antibiotic and angioprotector in dilution is prepared. In a 10 ml syringe, 5 ml of physiological saline is added, then the antibiotic is diluted, followed by filling the syringe and adjusting the amount of solution in the syringe to 10 ml by adding an angioprotector and physiological saline. The dose and antibiotic group are selected individually for each patient, and depending on the sensitivity of the secondary microflora in the focus.

 Palpation determines the maximum pulsation of the external femoral artery on the affected side, the femoral artery is fixed between two fingers of the left hand, injections of the needle connected to the syringe are carried out strictly perpendicular to the skin and the projection of the vessel, to a depth of 2 to 4 cm, depending on the severity of subcutaneous fat layer until a pulsating blood fountain appears in the syringe, then the prepared solution is slowly introduced into the artery at a rate of 1-2 ml per 1 minute. Injections are carried out by subcutaneous or intramuscular needles of 0.8x38, or 0.8x28 mm Luer, which avoids trauma to the arteries during course treatment. The number of infusions varies from 7 to 14 per course, depending on the severity of inflammatory manifestations. We noted no complications during intra-arterial infusions, the tolerability of the procedure is good.

 PRI me R 1. Patient A., 36 years old, East. b-ni N 2126, diagnosis: Mycetoma of the right foot. The duration of the disease is 10 years. During treatment, there is a tendency to disease progression, with the process moving to the ankle joint, epiphase of the tibia and fibula. After the complex treatment according to the method described as a prototype, remissions were no more than 1-2 weeks, forced to constantly take analgesics, walks with a stick. He was treated twice in the department of deep mycoses in March and May 1990 - a short-term improvement, further relapse and progression of the disease.

 PRI me R 2. The same patient, East. b-ni N 17125, diagnosis: Mycetoma of the right foot and ankle joint. He was hospitalized with pronounced signs of exacerbation of the disease: a sharp deformation and an increase in the volume of the foot and lower leg, cyanotic-crimson color of the skin to the level of the lower third of the lower leg, the presence of functioning 15 fistulas with copious purulent-hemorrhagic discharge on the front-lateral surfaces of the foot and sole, constant aching pain character, aggravated at night and during physical exertion, a feeling of heaviness in a limb, walking with a stick. When conducting complex therapy, antibiotics (Vibramycin-0.1) were not administered intramuscularly, but intra-arterially in combination with angioprotectors (Trental-5.0) in dilution in saline up to 10 ml. Intraarterial transfusions were carried out once a day according to the described technique, puncture, into the external femoral artery. After the third infusion, the pain stopped, the swelling of the foot decreased by 2 cm, movements in the ankle joint became more active. After the fifth infusion of 15 fistulas, only 4 functioned, went without a stick. After 14 infusions (course), the edema practically disappeared, the cyanotic-crimson color of the skin disappeared, all fistulas closed, for a long time I could walk without a stick (1.5-2 hours). The duration of remission is 2 months. A repeated course of intra-arterial transfusions was performed (Kefzol - 1 g, Trental - 5 ml diluted with saline to 10 ml), 14 infusions. Under the influence of the treatment, the fistulas closed (8 fistulas functioned), the edema of the foot and lower leg disappeared, goes without a stick, the skin of the foot is of a normal color, there are no pain at night and during physical exertion.

 The proposed method has been treated 5 patients with mycetoma of the foot, with a disease duration of 1 year to 20 years. All patients showed improvement in well-being after 1-2 infusions, itching and pain stopped, the phenomena of lymphostasis decreased, lightness in the extremities appeared, fistulas tended to close, the phenomena of regional lymphadenitis significantly decreased, exercise tolerance increased, no worsening was noted in one case, there were no complications.

 This invention has the following advantages: reduces the time of treatment and preoperative preparation, reduces relapse of the disease, prolongs the period of remission, which helps to stabilize the process (see table), i.e. the goal is achieved.

Claims (1)

 METHOD OF TREATING STOP MITZETA by exposing the lesion to antinolysate, antibiotics, detoxification agents and ultrasound, characterized in that, in order to increase effectiveness and reduce treatment time, antibiotics are administered in combination with angioprotectors to the external femoral artery on the affected side once a day 7 -14 times.

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