RU2082455C1 - Method to treat destructive types of pulmonary tuberculosis; gas laser and laser equipment to treat diseases accompanied with inflammatory processes and microbial flora - Google Patents

Abstract

FIELD: medicine, laser and medicinal equipment. SUBSTANCE: method deals with cavern puncture with a needle for pleura punctures along with removal of cavern content, then a light guide is inserted into cavern via puncture needle to irradiate cavern surface by defocussed radiation of nitrogen laser working at pulse-frequency mode. Laser consists of discharge chamber, excitation unit, power unit and resonator designed by mirrors placed near the edges of discharge chamber which includes electrode knot of dielectric plate, anode and cathode upon the plate to be placed into the body with conductions inside it. Laser equipment consists of optically connected laser upon nitrogen or air with control system, focusing unit, light guide with spheric disperser. EFFECT: higher efficiency. 19 cl, 1 dwg

Description

 The invention relates to medicine, in particular to methods for treating destructive forms of pulmonary tuberculosis, gas lasers and laser units for the treatment of diseases accompanied by inflammatory processes with microbial flora, laser and medical equipment and can be widely used for effective treatment up to the full recovery of diseases accompanied inflammatory processes with microbial flora, in particular destructive forms of pulmonary tuberculosis, to create compact gas lasers with high efficiency and, based on them, simple and compact laser medical devices.

A known method of treating destructive forms of pulmonary tuberculosis (V.L. Dobkin et al. Problems of Tuberculosis, 1987, No. 5, p. 25), based on the resection of the affected area of the lung or reconstruction by thoracomioplasty using powerful continuous radiation of a CO ₂ laser. This treatment method is surgical and is highly effective not only in achieving abacylation, but in the morphological treatment of patients. However, surgical methods of treatment are associated with major trauma, intra- and postoperative complications, cosmetic defects are possible. In addition, in a significant number of patients, the complication of the course of the destructive process and the presence of concomitant diseases do not make it possible to use surgical methods of treatment.

 Another treatment method is known (ed. St. USSR N 1572653, class A 61 N 1/00 5/06, 1990), including intravenous administration of chemotherapy with simultaneous galvanization of the chest in the area of the projection of the lesion, and autotransfusion is carried out immediately before the administration of chemotherapy UV irradiation of blood. This method allows to reduce adverse reactions from chemotherapy. However, a large number of patients due to the chronic course of the disease cannot be treated with existing methods of therapy due to the emergence of resistance of tuberculosis mycobacteria to chemotherapy drugs.

A known method of treating destructive forms of pulmonary tuberculosis (V.G. Dobkin et al. Problems of Tuberculosis, 1987, N 5, p. 25 28), based on endoscopic transthoracic irradiation of the destruction cavity with radiation from a neodymium laser with a wavelength of 1.06 μm at medium density radiation power 500 600 W / cm ² . The high treatment efficiency is due to the low-invasiveness of the operation during the evaporation of purulent-necrotic masses. Due to the high penetration of laser radiation with a wavelength of 1.06 μm, it causes a thermal burn to a depth of 5 mm, creating a coagulation film on the surface. However, this method of treatment is surgical in its essence, albeit organ-sparing. In addition, the infection reservoir is not completely cleaned up, since there is simply rejection (burning out) of only the surface part of the destruction, the concentration of tuberculosis mycobacteria as a whole remains high near the treated destruction cavity. There is no mechanism that suppresses the viability of mycobacteria, which leads to the possibility of postoperative relapse while maintaining the common disadvantages inherent in surgical methods.

 The effectiveness of any method of treatment using laser radiation depends on the type and design of the lasers used.

 A known gas laser (US patent N 4509176, class. H 01 S 3/097, 1985), containing resonator mirrors mounted on both sides of the discharge tube, which includes two coaxial glass tubes with several metal rings evenly spaced on the side surface, connected by a central grounded electrode and ending with two external electrodes, with the rings through the first electronic key and the external electrodes through the second electronic key connected to the pulse generator. The generator through the first electronic key generates a voltage pulse of negative polarity and feeds it simultaneously to all metal rings. In this case, a corona discharge occurs in the zone each surrounded by a metal ring, leading to the preionization of the gas mixture in the discharge tube. The generator generates a voltage pulse of negative polarity through a second electronic switch and simultaneously feeds it to the external electrodes with a delay relative to the voltage pulse supplied to the metal rings. As a result, a longitudinal section of the pump is excited in the discharge tube. A population inversion is created in the gaseous medium, and laser radiation is generated using the resonator mirrors.

 This laser is a longitudinal discharge laser. It is distinguished by a relatively low specific energy consumption, which is determined by the large length of the discharge circuit. An increase in the radiation energy in a pulse is possible due to an increase in the length of the discharge tubes, i.e., the length of the laser. However, an increase in the length of the discharge tubes leads to an increase in the pump voltage, which significantly increases the dimensions and weight of the generator.

 At a fixed energy per pulse, an increase in the average radiation power is possible due to an increase in the repetition rate of the pump pulses. However, in this case, due to an increase in the translational temperature of the gas and slow relaxation of the vibrational states, the pulsed lasing power decreases, which limits the output radiation power. Powerful longitudinal discharge lasers require liquid cooling, which complicates the design and increases their size and weight.

 Another laser is known (US Pat. No. 4,802,185, class H 01 S 3/097, 1989), comprising resonator mirrors mounted on both sides of the discharge chamber, in which the anode and cathode are located opposite each other, connected to one high voltage device, and at least one pair of additional electrodes located opposite each other at a distance shorter than the first discharge gap between the cathode and the anode and connected to another device of high voltage, the main and additional discharge gaps us dielectric wall, transparent to UV radiation. One device of high-voltage voltage generates a voltage pulse on additional electrodes, leading to the development of an arc discharge between them. The UV radiation of the arc discharge passes through the dielectric wall and ionizes the gas filling the discharge gap. The second high-voltage voltage device generates a voltage pulse between the anode and cathode, which leads to the development of a transverse discharge in the ionized gas. In the transverse discharge, gas is pumped with the creation of an inverse population, which leads to the generation of laser radiation using resonator mirrors.

 This laser is a transverse-discharge laser, characterized by a significantly larger specific energy output and lower pump voltage than a longitudinal-discharge laser. However, for its effective operation, a device for preliminary ionization of the medium is required, which increases the dimensions and weight of the laser. The pulse repetition rate in such a laser is limited by the overheating of the gaseous medium in the main discharge gap. In addition, the source of UV radiation is located outside the main discharge gap, which, firstly, reduces the efficiency of preionization, and, secondly, leads to non-uniform ionization of the main discharge gap in the transverse direction. This in turn leads to a decrease in laser efficiency or to the need to increase the power of UV radiation. Both lead to an increase in the size and weight of the laser.

 Another gas laser is known (Japanese application N 63-2117680, class H 01 S 3/03, 1989), comprising an optical resonator mounted on a discharge chamber including two main electrodes separated by a gas gap and connected to a pump system, the main electrodes are formed by a creeping discharge developing between a creeping discharge electrode mounted in the central part of the dielectric perpendicular to the optical axis and creeping discharge electrodes located at the edges on the same surface of the dielectric, and the electrodes are present discharge connected with the excitation system.

 The excitation system generates a voltage pulse between the central and edge electrodes on the surface of the dielectric, which leads to the development of a sliding discharge over the surface of the dielectric. A creeping discharge is a source of UV radiation, ionizing the gas in the main discharge gap. At the same time, a sliding discharge forms the surface of the main electrodes, to which a voltage pulse is supplied from the pump system, under the influence of which a transverse discharge develops in the ionized gas. In a transverse discharge, a gas medium is pumped and laser radiation is generated using a resonator.

 In this laser, due to the introduction of a preionization source (creeping discharge) practically into the region of the main discharge gap, a high uniformity of the discharge is ensured, and, therefore, high efficiency and laser output energy. However, as before, to ensure operation with a high pulse repetition rate (high average power), it is necessary to pump gas through the main discharge gap. To ensure the operation of the laser, two high-voltage systems (pumping and excitation) are required, which increases the dimensions and weight of the laser. In addition, the use of a transverse volume discharge for pumping requires high voltages, at least significantly higher than when using a sliding discharge. This leads to high voltage levels of the pump system, which in turn significantly increases the dimensions and weight of the laser.

 A decrease in the voltage of the pump system is possible by reducing the main interelectrode gap. However, in this case, the laser efficiency sharply decreases due to the relatively large size of the zones of near-electrode effects (cathode layer, anode instability) in which pumping is inefficient.

 A well-known gas laser (see Brynzalov P.P. et al. Quantum Electronics, 1988, 10, p. 1971) is closest in technical essence to the claimed one and contains a resonator mounted on a discharge chamber of circular cross section with a dielectric casing in the center which has an electrode assembly connected to the pumping unit, with a spark gap and capacitor storage device, removed from the housing and connected to a power source, and including a dielectric crystal made of crystalline leucosapphire, a steel anode located on one the surface of the dielectric plate, and a steel cathode located on the same surface at a certain distance from the anode, which is the discharge gap coaxial with the cavity and covering the dielectric plate from its opposite side up to the projection of the working edge of the anode on the opposite surface of the dielectric plate. The power source charges the capacitor bank, which, using the arrester, closes to the discharge gap. Due to capacitive coupling through a dielectric layer formed by covering the dielectric plate with the cathode, a sliding discharge develops on the surface of the dielectric plate on which the anode and cathode are located at substantially lower voltages than in the case of a sliding discharge over the surface without capacitive coupling. The plasma of the creeping discharge has a thickness of 0.5 mm and determines the active region of the laser, in which the gas is pumped and the radiation energy is removed using a resonator coaxial with the discharge gap.

 Due to the high current density of the sliding discharge, a high specific energy input is achieved, which ensures the compactness of the laser. However, in view of the long pump circuit (the pump unit is outside the laser housing), its inductance is relatively large, which increases the pump pulse duration and reduces the laser generation efficiency. In addition, for these durations, the creeping discharge is a plasma sheet with an inhomogeneous current distribution along the axis of symmetry of the discharge gap, i.e., the plasma sheet contains regular (with a step of 0.1-0.5 cm) current lines with a high electron concentration (close to the spark phase ) This reduces the efficiency of the laser and increases the divergence of its radiation. An increase in the energy input, its duration or gas pressure leads to an increase in the heterogeneity of the current distribution in the plasma sheet. These inhomogeneities lead to local overheating of the dielectric plate, local erosion of the electrodes, which significantly reduces the laser resource and limits the pulse repetition rate.

 This laser is a low-pressure laser, therefore, gas cooling in the active region due to convection is slow, especially since the laser housing is dielectric. In addition, the dielectric plate is practically insulated and, in the frequency mode of operation, serves as an additional heat source directly adjacent to the active region. Gas cooling in the active region could occur due to natural convection in the interval between the pump pulses. However, a “hot” dielectric plate prevents this, since it produces heating of a thin layer of gas adjacent to it, which is an active region, much faster than its cooling due to natural convection. These factors limit the pulse repetition rate, the energy capabilities of the laser, its life, efficiency, and also lead to an increase in the size and weight of the laser. In addition, this laser is a powerful source of electromagnetic radiation (the plasma sheet is not shielded), which determines a high level of interference, and, therefore, limits the possibilities of its use, in particular in medical equipment.

 The effectiveness of medical laser systems is determined, firstly, by a feasible method of treatment, and, secondly, by the efficiency of its individual systems, and primarily the laser. The operational qualities of the laser system are also important, in particular, ease of control, mobility, and the absence of auxiliary systems, for example, cooling systems. These qualities are achieved with low power consumption, compactness, low weight, good free cooling.

 A known laser installation (US patent N 4561440 CL. A 61 N5 5/00, 1985), containing a laser enclosed in a housing with a hole through which laser radiation is output, and on both sides of the hole there are sensors that determine the distance from the hole to the irradiated area connected to the switch.

 Laser installation works as follows. Laser radiation through the hole is directed to the irradiated area. In this case, the sensors monitor the proper distance between the hole and the surface of the irradiated area, interrupting the laser beam with a switch when this distance is not maintained. This provides for a given distance and laser power irradiation of the site with a constant given density of radiation power. However, this laser system does not have a radiation transport system, which makes it practically impossible to use it for trans-thoracic irradiation of the destruction cavity.

 Another laser installation is known (US patent N 4144888, class A 61 N 5/01, 1979,), containing a sequentially located laser and a mirror fiber, including sequentially arranged holders with mirrors having two rotation axes. Laser radiation generated by a laser (which is stationary) is directed to the irradiation section by means of a specular fiber. Moreover, due to the presence of two rotation axes in each holder, this specular fiber allows you to direct radiation to almost anywhere in the body. However, the diameter of the specular fiber has a significant value, determined at least by the dimensions of the mirrors, which allows the use of this laser unit for the treatment of destructive forms of tuberculosis only during surgical intervention.

 Another laser installation is known (German Federal Patent Application No. 3836377, class G 02 B 6/42 F 21 S 5/00, 1989) containing a laser in series, a focusing unit and a fiber optic fiber, the input end of which has a mirror coating. The mirror coating of the end of the fiber serves as a translucent mirror of the laser resonator. By minimizing the number of optical elements (excluding one of the resonator mirrors), the compactness of the laser setup is achieved. However, such a design can be used in installations with a large fiber diameter, because at a small diameter the diffraction losses of radiation in the cavity increase sharply, which on the one hand leads to a decrease in the laser efficiency, and on the other to a decrease in the output power of the laser system due to an increase radiation loss at the input end of the fiber. This sharply limits the possibility of using such an installation and increases its invasiveness when used for trans-thoracic endocavitary irradiation due to the relatively large diameter of the fiber. In addition, in such a system, losses associated with astigmatism of the elements of the focusing unit entering the cavity increase, since the laser beam passes through these elements repeatedly.

A well-known laser installation (Dobkin V.G. et al. Problems of Tuberculosis, 1987, N5, p. 25 28), which is closest to the proposed one and contains a laser, a focusing unit, and a fiber, sequentially located and optically connected with each other. A neodymium laser was used as a laser, and a quartz fiber with a diameter of 400 μm was used as a fiber. Laser radiation generated by the laser, using the focusing unit, is introduced into the optical fiber, which is introduced into the pleural cavity through the trocar. The effectiveness of the treatment using a laser installation largely depends on the type of laser used, therefore this installation can only be used to evaporate purulent-necrotic masses. This is achieved due to the high density of the radiation power (up to 800 W / cm ² ), that is, for this it is necessary to use lasers with a high average radiation power, and hence high energy consumption. As a result, the installation has large dimensions and weight, requires liquid cooling. In addition, losses in a multi-element optical system of a laser system reduce its efficiency.

 The aim of the invention is to increase the effectiveness of treatment due to disruption of mycobacterium tuberculosis, reduce trauma and reduce treatment time, as well as increase the efficiency of the laser, reduce its weight and dimensions, increase the efficiency of the laser unit while ensuring its compactness.

This goal is achieved by the fact that in the method of treating destructive forms of pulmonary tuberculosis based on transthoracic exposure of the cavity of the cavity with laser radiation, the effect is carried out by defocused pulse-frequency radiation of a nitrogen laser with a power density of 3 to 30 mW / cm ² , energy density per pulse from 100 to 250 μJ / cm ² , peak power density from 70 to 200 kW / cm ² and exposure from 1 to 15 minutes.

 This makes it possible to increase the effectiveness of treatment due to disruption of the vital functions of Mycobacterium tuberculosis and other microbial flora under the influence of nitrogen laser radiation with minimal trauma of the procedure, and, as a result, leads to a reduction in treatment time. The selected range of variation of the parameters of the nitrogen laser provides for any cavity size a fixed density of high-energy photons incident on the irradiated surface, a strict dosage of laser exposure and, as a result, eliminates the possibility of injury, including burns.

The impact is carried out first with a power density of 15 to 30 mW / cm ² for 1 to 3 minutes, and then with a power density of 3 to 10 mW / cm ² for 4 to 12 minutes.

 This makes it possible to increase the effectiveness of treatment due to the maximum combination of the bactericidal effect, most pronounced at high intensities and short durations of exposure, and the stimulating effect, most pronounced at low intensities of exposure for a longer time.

 The goal is also achieved by the fact that the gas laser contains a resonator installed in the discharge chamber and an electrode assembly including a dielectric plate, an anode located on one of its surfaces, a cathode mounted at a distance from the anode with the formation of a discharge gap coaxial with the cavity and covering the dielectric plate from its opposite side, at least until the projection of the working edge of the anode, as well as containing a power source connected to the capacitor bank of the pumping unit, soy dynamically integrated with an electrode assembly, characterized in that two distributed current conductors are hermetically installed in the housing of the discharge chamber, one of which is in contact with the anode and the other with the cathode in the area at least partially opposite the discharge gap, and the storage capacitors are directly mounted on the side of one from distributed conductors located outside the discharge chamber, while the housing of the discharge chamber and the pumping unit are enclosed in a common conductive grounded shell, directly contact a guide portion located outside the discharge chamber of another distributed electrical pathway.

 This allows for high efficiency and high pulse repetition rate while ensuring its noise immunity and compactness by minimizing the inductance of the discharge circuit, optimal current supply to the electronic unit and effective cooling of the dielectric plate.

 The anode is made in the form of a conductive strip located on a dielectric plate near its center, while the edges of the anode are located at the same distance from the edges of the cathode.

 This embodiment of the electrode assembly can reduce the size and weight of the laser by reducing the required voltage of the pump unit.

 The housing of the discharge chamber is combined with a conductive sheath and one of the distributed conductors and is made in the form of a metal cylinder with a flange on the side surface with a through slot parallel to the axis of the flange on which the dielectric plate is hermetically fixed, while the other distributed conductor is installed hermetically near the center of the plate, and the electrode assembly is located in the diagonal plane of the metal cylinder, perpendicular to the dielectric plate.

 This makes it possible to increase the compactness of the laser while increasing the efficiency and pulse repetition rate due to efficient cooling.

 The housing of the discharge chamber is made in the form of a hollow dielectric parallelepiped, and the electrode assembly is mounted on one of its inner surfaces.

 This makes it possible to eliminate the deformation of the dielectric plate and thereby stabilize the energy and spatial characteristics of the radiation.

 The electrode assembly is mounted on the lower inner wall of the dielectric parallelepiped of the housing of the discharge chamber, and the upper wall is made in the form of a metal plate with ribs perpendicular to the axis of the discharge gap.

 This allows you to organize effective convective cooling of the active region and, as a result, increase the efficiency at a high pulse repetition rate.

 The housing of the discharge chamber is combined with a conductive grounded sheath and one of the distributed conductors, is made of metal and has a flange with a through slot, on which a dielectric plate is hermetically sealed, in which is located near its center another distributed conductor directly in contact with the anode, while the cathode is in contact with the inner surface of the housing.

 This makes it possible to achieve maximum laser compactness while optimally conducting conductors, efficient cooling and noise immunity.

 The cathode is a part of the metal casing of the discharge chamber in contact with the dielectric plate, and the anode in contact with it is part of a distributed current path.

 This simplifies the design of the laser and ensures its compactness.

 The resonator is formed by rectangular dielectric mirrors mounted coaxially with the discharge gap on a dielectric plate near its ends and perpendicular to its plane.

 This allows you to reduce the size and weight of the laser by eliminating the alignment nodes of the resonator.

 The resonator is combined with a dielectric plate made of a material transparent to laser radiation and having protrusions at the ends whose height exceeds the thickness of the discharge plasma, and their surface facing the discharge gap is perpendicular to the plane of the dielectric plate and provided with a dielectric reflective coating.

 This allows you to integrate the resonator with the electrode assembly as much as possible and, as a result, increase the compactness of the laser while reducing its weight.

 The surface of the protrusion facing the exit of the gas laser is made in the form of a convex cylindrical surface, the forming of which is perpendicular to the plane of the dielectric plate.

 This ensures the compactness of the laser during the formation of laser radiation with simultaneous focusing.

 Nitrogen was used as a gaseous medium.

 This allows for efficient generation of laser radiation in the near UV range at a wavelength of 337 nm.

 Air was used as a gaseous medium.

 This allows for efficient generation of laser radiation in the near UV range at a wavelength of 337 nm.

 Neon was used as the gaseous medium.

 This allows the effective generation of laser radiation in the visible range at a wavelength of 540.1 nm.

 Hydrogen was used as a gaseous medium.

 This allows efficient generation of laser radiation in the vacuum UV range.

 This goal is achieved by the fact that in a laser installation for the treatment of diseases accompanied by inflammatory processes with microbial flora, containing a laser, which is optically connected in series with each other, with a resonator and a control system, a focusing unit and a fiber, nitrogen is used as a gas medium in the laser or air.

 This increases the efficiency of its work while ensuring its compactness, mobility, low energy consumption and ease of operation and management.

 The output node of the resonator is combined with the focusing unit and is made in the form of a plano-convex lens, the flat face of which faces the inside of the laser.

 A reflective translucent coating is applied to the flat face of a plano-convex lens.

 This allows you to reduce optical loss and increase the efficiency of the laser system.

 The body of the focusing unit is made in the form of a hollow cylinder, coaxial with a flat-convex lens, and a focusing cylindrical lens is installed with the possibility of movement along its axis, the surfaces of which are perpendicular to the plane of the dielectric plate.

 This allows, due to improved focusing, to reduce the diameter of the used optical fibers and, as a result, to reduce the invasiveness of treatment.

 The focusing unit is made in the form of a concave-convex cylindrical lens coaxial to the resonator, the surfaces of which are mutually perpendicular and one of them is parallel to the plane of the dielectric plate, and the radius of curvature of its surface refers to the radius of curvature of the other cylindrical surface as d: h, where d is the value of the discharge gap, and h is the thickness of the discharge plasma in the same units.

 This ensures effective focusing of laser radiation on the input end of the fiber and allows you to reduce the diameter of the used fiber, which is equivalent to reducing the morbidity of the treatment.

 The invention does not follow explicitly from the prior art, since the transformations prescribed by this invention, characterized by significant features distinctive from the prototype to achieve a technical result, are not identified from the latter, which allows us to conclude that it meets the criterion of "inventive step".

 The inventive method for the treatment of destructive forms of pulmonary tuberculosis, a gas laser and a laser device for their implementation are intended for use in healthcare, which determines the compliance of the invention with the criterion of "industrial applicability".

 The inventive method, the finished laser and the laser installation differ from the prototype in the totality of the essential features set forth in the claims, which allows us to conclude that it meets the criteria of the invention of "novelty."

 In FIG. 1 schematically shows the proposed laser with drive capacitors mounted on a distribution conductor in contact with the cathode; in FIG. 2 laser with drive capacitors mounted on a distribution conductor in contact with the anode; in FIG. 3 is an example of a circuit diagram of a discharge circuit with a positive voltage pulse of a pump voltage; in FIG. 4 is an example of a circuit diagram of a discharge circuit with a negative voltage pulse of a pump voltage; in FIG. 5 is an example of an electrode assembly with an anode located near the center of the dielectric plate; in FIG. 6 is an example of a gas laser with a cylindrical metal body; in FIG. 7 transverse distribution of current lines in a gas laser with a cylindrical metal body; in FIG. 8 is an example of a gas laser with a rectangular dielectric housing; in FIG. 9 transverse distribution of current lines in a gas laser with a rectangular dielectric body; in FIG. 10 is an example of a gas laser with a rectangular dielectric body with an upper metal plate with ribs; in FIG. 11 is an example of a gas laser with a metal housing adjacent to the cathode; in FIG. 12 is an example of a gas laser with a metal housing adjacent to the dielectric plate of the electrode assembly; in FIG. 13 an example of a resonator in the form of mirrors mounted on a dielectric plate; in FIG. 14 is an example embodiment of a resonator combined with an electrode assembly in the form of a dielectric plate with protrusions transparent to laser radiation; in FIG. 15 is an example of an electrode assembly in the form of a dielectric plate with protrusions, one of which has a cylindrical surface; in FIG. 16 is a diagram of a laser apparatus for treating diseases accompanied by inflammatory processes with microbial flora; in FIG. 17 is an example of a laser installation with a combined output node of the resonator and the focus node; in FIG. 18 is an example of a laser installation with a combined output node of the resonator and the focusing unit and an additional focusing cylindrical lens; in FIG. 19 is an optical diagram of the beam path in a laser system with a single cylindrical lens; in FIG. 20 optical beam pattern in a laser system with a single spherical lens; in FIG. 21 is an optical diagram of the beam path in a laser system with a concave-convex cylindrical lens.

 A method of treating destructive forms of pulmonary tuberculosis based on transthoracic exposure of the cavity of the cavity with laser radiation includes puncture of the cavity of the cavity with a needle for pleural punctures with cleansing of the contents of the cavity of the cavity, for example by suction, then a light guide is inserted through the puncture needle into the cavity of the cavity until its output is illuminated end with the center of the cavity and is produced by irradiating the surface of the cavity with defocused radiation of a nitrogen laser operating in a pulse-frequency mode with a density energy per pulse Q, peak power density Wi, average power density W (pulse repetition rate f W / Q) during the exposure time T.

 The choice of the range of variation of the parameters f, Q, Wi, W is determined by the following factors.

 The effectiveness of the disruption of mycobacterium tuberculosis and other microbial flora of the cavern under the influence of laser radiation depends on the photon energy e = hc / λ fixed for the selected wavelength l and the number density of photons n Q / e, where h is the Planck constant, c is the speed of light. Obviously, the required photon density n is proportional to the concentration of microbial bodies in the affected area. However, photons interact not only with mycobacteria, but also with cells of the surrounding tissue, so there is a limit level of energy density, from which the effect on surrounding tissues becomes a significant side factor.

 Since the penetration of laser radiation into biological tissue is proportional to the wavelength, the radiation of a nitrogen laser is almost completely absorbed in the surface layer. In this regard, there is also a limitation on the photon input rate, i.e. peak power density wi.

Conducted studies with a young ten-day culture, as well as experiments on pieces of postoperative material, allowed us to determine the optimal energy values per pulse from 100 to 250 μJ / cm ² with a peak power density of 70 to 200 kW / cm ² .

An increase in the average radiation power density W due to an increase in the pulse repetition rate f (i.e., at a fixed energy density per pulse) while maintaining the integral radiation dose (i.e., the total number of photons) can reduce the irradiation time T. However, the average power W is limited from above by power, leading to an affected effect on the surrounding tissues of the body. Up to W 30 mW / cm ² , and time from 3 to 8 min, as clinical studies have shown, such a negative effect on the body does not occur, and with average power densities W less than 10 mV / t / cm ² , complete healing is not observed tuberculous cavity scar.

In addition to bactericidal effects, nitrogen laser radiation stimulates the body's immunological reactivity, activates microfogal reactions and reparative processes in the irradiation zone. Moreover, the stimulating nature is manifested at lower radiation power densities. Therefore, it is advisable during the first 1 3 min to irradiate with a power density of 15 30 mW / cm ² (powerful bactericidal effect), followed by a decrease in the pulse repetition rate and, accordingly, the average radiation power to 3 10 mW / cm ² for a longer time 1 12 minutes

 The high effectiveness of this method of treatment is confirmed by the following examples from clinical practice.

 Example 1

 Patient H., 40 years old, case history No. 1697, was admitted September 15, 88, the duration of the disease was 1.5 g. The clinical diagnosis of fibro-cavernous tuberculosis of the upper lobe of the right lung in the insemination phase. Bacillus excretion - constant, sensitivity to all drugs. The nature of the course of the disease with relapse. X-ray characteristic before treatment: on the left in 1 2 segments there is a cavity of destruction (cavity) 4 x 2 cm and several cavities of smaller sizes.

Treatment. 12/10/88, a cavity was punctured and a one-time exposure to its internal cavity was performed with defocused radiation of a nitrogen laser, an energy density of 200 μJ / cm ² and an average power density of 10 mW / cm ² for 3 min.

 Clinical, bacteriological, hematological changes after treatment: blood counts returned to normal after a month, bacillus excretion stopped.

 Radiological changes: resorption of perifocal infiltration after 2.5 months was observed by X-ray tomography. The maximum decrease in the cavity in the lung after 3 3.5 months. Currently healthy.

 Example 2

 Patient U. 26 years old, case history No. 1821, was admitted on 10/10/08, duration of the disease was 3 g. The clinical diagnosis of fibro-cavernous tuberculosis of the upper lobe of both lungs in the insemination phase. Bacillus excretion - constant, sensitivity to all drugs. The nature of the course of the disease with relapse. X-ray characteristic before treatment: in the upper lobe of the right lung there is a ring-shaped shadow 4 cm in diameter in diameter, on the left in 1 and 2 segments there are several ring shadows from 2 to 0.5 cm with focal seeding.

Treatment. On 03/03/08, the cavity was punctured and a one-time exposure to its internal cavity was performed with defocused radiation of a nitrogen laser, an energy density of 200 μJ / cm ² and an average power density of 12 mW / cm ² for 6.5 minutes.

 Clinical, bacteriological, hematological changes after treatment: intoxication disappeared after 20 days, recovered by 8 kg within 2 months. abacillarity after 2 months.

 X-ray changes: in a month, a significant decrease in the destruction cavity on the right to 3 cm, on the left 1.5 cm, after 60 days was noted. there was a cystic cavity with thin walls up to 1.0 cm. Complete closure of the cavities on both sides after 4 months. The process is stable. Relapse of the disease to date has not been observed.

 Example 3

 Patient Sh. 46 years old, medical history N 38, was admitted on 08.10.88, the duration of the disease was 6 months, was not treated. Clinical diagnosis of infiltrative tuberculosis of the upper lobe of the left lung in the decay phase. Bacillus excretion is permanent. The acute nature of the course of the disease. X-ray characteristic before treatment: in the upper lobe of the right lung there is a destruction cavity of 4 x 5 cm in size with infiltration and focal seeding around and in the right lung.

Treatment. On 03/03/08, the cavity was punctured and a one-time exposure to its internal cavity was performed with defocused radiation of a nitrogen laser, an energy density of 200 μJ / cm ² and an average power density of 12.5 mW / cm ² for 6.5 minutes.

 Clinical, bacteriological, hematological changes after treatment: intoxication disappeared after a week, bacillus excretion stopped the next day. Radiological changes: radiographically and tomographically after a month, a significant decrease in the destruction cavity to 3 cm with resorption of infiltration. After 60 days, a decrease in the destruction cavity to 1 x 2 cm. Relapse of the disease has not yet been reported.

 Example 4

 Patient S. 37 years old, medical history N 2112, was received on November 22, 88, the duration of the disease was 3 g. The clinical diagnosis of fibro-cavernous tuberculosis of the upper lobe of both lungs in the insemination phase. Bacillus excretion - constant, sensitivity to all drugs. The nature of the course of the disease with relapse. X-ray characteristic before treatment: the right lung is reduced in volume, in the region of the upper lobe of the right lung there is a cavern 5 x 6 cm in size with thick walls, seeding around and in the left lung.

Treatment. 12.27.88 and repeated 01.02.89 puncture of the cavity and exposure to its internal cavity by defocused radiation of a nitrogen laser, an energy density of 200 μJ / cm ² and an average power density of 14 mW / cm ² for 4 min and again for 8 min average power of 6 mW / cm ² .

 Clinical, bacteriological, hematological changes after treatment: blood counts returned to normal over 1.5 months. bacillus ceased after a week.

 X-ray changes: after the first treatment, the destruction cavity decreased in size, after 9 days there was an intense shadow at the site of the cavity within the lobe of the lung; after 30 days, the cavity was not detected on the right, and at the site of the cavity there was an intense uniform shadow within the lobe. After repeated treatment, X-ray diffraction of 7-8 cm thickens the intensity of the shadow, the upper lobe is wrinkled, the mediastinum is pulled upward to the right, focal seeding has resolved; after 15 days, the picture was preserved, after 10 months the wrinkling of the upper lobe was even more intense, the former cavity was not identified, pyrrosis of the upper lobe on the right, well-being, tests were normal. Currently, the patient is healthy, relapse of the disease to date has not been observed.

 Example 5

 Patient S., 28 years old, case history N 1933, was admitted on 10.26.88, disease duration 3 g, was treated systematically in a hospital, as an outpatient. The course of the disease with relapses during the year on average 2 times. Bacillus excretion is constant, sensitivity is preserved to the main drugs.

 X-ray characteristic before treatment: in the upper lobe of the right lung there is a cavity 6 x 7 cm in size against the background of cellular pneumosclerosis and focal seeding.

Treatment: On 10.12.88, the cavity was punctured and the internal cavity was exposed to defocused radiation of a nitrogen laser with an energy density of 200 μJ / cm ² with an average power density of 15 mW / cm ² for 4 minutes.

 Clinical, bacteriological, hematological changes: blood counts returned to normal within 10 days, abacillation occurred immediately after treatment.

 X-ray shifts: after 5 days, decrease in cavity size to 5.5 cm, resorption of infiltration; after 2 weeks to 4 cm; after 60 days - reduction of the cavity to 1.5 1.0 cm, pyrrhotic changes. The process in the lung is stable. Currently, the patient is healthy.

 Observations showed that patients tolerate radiation well. Violations of the functions of the main organs are not observed. The maximum therapeutic effect is achieved with irradiation times of 3 to 8 minutes. Intoxication disappears within the first week. There is a sharp decrease in the amount of sputum excreted, a decrease in temperature to normal, the appearance of appetite and an improvement in blood counts. The results of microbiological studies prove complete abacillation of patients. The results of x-ray analysis show that in 80% of patients, scarring of destruction cavities, formation of cystic cavities or post-tuberculosis pneumosclerosis is observed after 1.5–2 months. Long-term (over 6 years) observations showed the absence of long-term negative consequences and repeated relapses of the disease.

 The patented method is characterized by technical simplicity, the possibility of its implementation on an outpatient basis, high treatment efficiency up to complete recovery, achieved in a short time, elimination of the epidemiological danger due to rapid abacillation.

 The laser (FIGS. 1 and 2) contains a discharge chamber 1, a pump unit 2, a power supply 3, and a resonator formed by mirrors 4 mounted near the discharge chamber 1. The chamber 1 includes an electrode assembly consisting of a dielectric plate 5, anode 6, and a cathode 7 located on the plate 5, and placed in a housing 8, in which the conductors 9, 10 are sealed, directly contacting, respectively, with the anode 6 and the cathode 7. The pump unit 3 contains storage capacitors 11 mounted on the outer surface of the current lead 10, sharpener nye vessel 12 and the switch 13. The case 8 and the pump unit 2 is surrounded by a conductive grounding sheath 14. The power source 3 is electrically connected with the pump unit 2 and the sheath 14. A reference numeral 15 denotes a discharge plasma (plasma sheet discharge gap). As the switch 13 in FIG. 1, 2 used controlled arrester.

The conductors 9, 10 are made, for example, in the form of metal strips with thickenings at the ends, have a high integrated thermal conductivity and provide a uniformly distributed conductivity to the cathode 6 and anode 7, however, conductors 9, 10 and other shapes can be used if they provide a distributed length discharge gap 15 current supply. The lasers of FIG. 1, 2, correspond to the electrical circuit diagrams shown in FIG. 3, 4 and differing in the connection pattern of the anode and cathode to block 2 and, accordingly, the polarity of the pump voltage pulse. In FIG. 3, 4, C _n equivalent capacitance capacitor 11 drive, C _{of the} equivalent capacitance of peaking containers 12, L _n - self-inductance of the drive circuit, L _{of the} self-inductance sharpener contour, L _of charging inductance, U _of the charging voltage applied to the switch 13 from the source 3, the dotted line shows the grounded shell 14.

The laser operates as follows. The power source 3 (Fig. 1) charges the capacitors 11 of the drive to a voltage U _about through the charging inductance L _s (Figs. 3 and 4). Then, a control pulse U is formed by a source 3, including a switch 13 and a closing discharge circuit, i.e. closing charged capacitors 11 through the conductors 9, 10 and the sheath 14 to the discharge gap 15. At the initial moment of time, the capacitance C _n (capacitors 11) charges the capacitance C _о (sharpening capacitances 12), which is much smaller in magnitude C _n and is also closed to the discharge gap 15. by peaking containers 12 occurs increase in voltage across the discharge gap 15 in 2 / (1 + C _on / C _n) times and the breakdown of the discharge gap 15 along the surface of the dielectric plate 5 between the cathode 6 and the anode 7 to form a moving plasma s to defuse, which is supported by more current discharge capacitor 11. Due to capacitive coupling through the dielectric plate 5, plasma is almost completely fills the surface of the plate 5 between the anode 6 and cathode 7 and has a thickness h 0,3 0,5 mm, i.e. has the form of a plasma sheet 15. In the volume of the plasma sheet 15, which is the active volume of the laser, the population of the molecules (or atoms) of the gas in the chamber 1 is inverted. The radiation is generated by the laser cavity formed by the mirrors 4, coaxial with the discharge gap 15.

 In the process of pumping, the gas in the active volume of the laser overheats, especially in the frequency-pulse mode. Since this laser is a low-pressure laser, gas cooling in the active region due to convection is slow. However, the patented laser implements a mechanism for efficient gas cooling associated with the presence of an effective heat-conducting channel: plate 5 conductors 9, 10 capacitors 11 - shell 14. Indeed, plate 5, made of, for example, leucosapphire or high-temperature ceramics, directly contacts the heated gas through large area and has high thermal conductivity. The plate 5 is in direct contact with the metal conductor 9 (or 10) with high integrated thermal conductivity near the region of the discharge gap, where the gas has the highest temperature. Capacitors 11 are installed directly on the conductor 9 (or 10), which have a developed surface located in a gaseous atmosphere of atmospheric pressure, and the insulating material of the high-voltage capacitors 11 has high thermal conductivity. So, capacitors 11 due to the developed surface located in a dense gas medium, act not only as energy storage devices, but also as radiators. Finally, the capacitors 11 (through the switch 13) and the conductor 10 (or 9) transfer heat to the shell 14, which efficiently dissipates it due to the maximum developed surface. The shell 14, in addition to performing the functions of a current lead and a radiator, shields the electromagnetic radiation of the plasma sheet 15 and the pump unit 2, which determines the high noise immunity of the laser.

When using 11 ceramic capacitors with ceramic with a negative coefficient of temperature capacity as capacitors, there is an additional mechanism that stabilizes the thermal regime of the laser. It is as follows. With an increase in gas overheating in the active region, for some reason, the temperature of the capacitors 11 increases, which is equivalent for capacitors of this type to a decrease in the capacitance C _n . In this case, the energy input into the active region decreases, since the energy stored in the capacitors 11 decreases. Due to this, the gas overheating in the active region decreases, that is, the self-regulation effect takes place, which stabilizes the laser parameters on the one hand and increases its life on the other. .

 Efficient cooling without forced cooling allows you to work with a high pulse repetition rate and high average power without increasing the size and weight of the laser.

 For many gases, such as nitrogen, the dispersion of the lower laser levels occurs when molecules (or atoms) collide with the walls, and the efficiency of the distribution depends on its temperature. Therefore, the presence of a “cold” plate 5 near the active region is also a factor that increases the efficiency.

 Due to the distributed current lead and the installation of the capacitors 11 of the drive directly to the current lead 9 (or 10), i.e. near the discharge gap 15, a small inductance of the discharge circuit is achieved with the maximum structural simplicity of the arrangement. This allows you to provide energy input into the active region in a short time. In this case, the current density of the plasma sheet 15 is almost constant along the axis of the resonator and does not have current lines with an electron concentration close to the spark phase. This allows you to avoid local overheating of the plate 5, to increase the resource, the laser efficiency and reduce the divergence of its radiation.

 The electrode assembly (Fig. 5) may comprise an anode 6 made in the form of a conductive strip adjacent to the dielectric plate 5 near its center, and a cathode 7 covering the plate 5 so that its edges are at the same distance d from the edges of the anode 6. Here h the thickness of the plasma sheet 15.

 The implementation of the electrode assembly in the form shown in FIG. 5 allows, while maintaining the same total value of the discharge gap 15 in comparison with the electrode assembly shown in FIG. 1, 2, halve the supply voltage. This for high-voltage systems is equivalent to a significant reduction in weight and dimensions, that is, it increases the compactness of the laser.

 The gas laser (Fig. 6) contains a discharge chamber 1 formed by a metal cylindrical housing 8, a pump unit 2, a resonator formed by mirrors 4. On the side surface of the housing 8 there is a flange 16 on which a dielectric plate 17 is sealed with a current lead 10 installed near its center. A plate 5 with an anode 6 and a cathode 7 is mounted diagonally to the housing 8, and is fixed to the housing 8, for example, by a spring clip 19. The drive capacitors 11 are equipped with drive capacitors 11 connected via a switch 13 to a metal cover 20 of unit 2 connected to the flange 16. Sharpening containers 12 are located on both sides of the conductor 10 along the surface of the plate 17 and are connected to the conductor 10 and the cover 20.

 The current lines in the cross section of the discharge circuit (Fig. 7) for the laser (Fig. 6) are two symmetrical half-ring turns with a counter current flow: ABCA and ADCA for the sharpener circuit, AEFBCA and AEGDCA for the drive circuit. Here, the sections BA and DA correspond to the flow of current from the cover 20 through the capacitance 12 of the current lead 10, AG to the current flow in series through the current lead 10, terminal 12, cathode 7, plasma sheet 15, anode 6, terminal 18, GB and GD of the side surface of the housing 8 and the flange 16, BF-DE and DG-GE on the lateral surface of cover 20, EA through switch 13 and capacitors 11.

 In the laser (Fig. 6), the cylindrical metal casing 8 acts as a distributed current lead 9, a shielding sheath 14 and a radiator due to the developed surface, which ensures the compactness of the laser. The symmetry in the location of the plate 5 relative to the housing 8, the plate 17 and the block 2 leads to the fact that the current lines (Fig. 7) are two symmetrical half-cylinders with a counter current flow, and such an electrical circuit has the least inductance, all other things being equal.

 This leads to a decrease in duration, effective natural cooling of the gas in the active region and an increase in efficiency.

 The gas laser (Fig. 8) contains a discharge chamber 1 with a rectangular dielectric body 8, to the wall 21 of which, with the aid of an abutment 22 and a current lead 9, a plate 5 is fixed with an anode 6 and a cathode 7 adjacent to the current lead 10 installed in the wall 21. On the current lead 10 installed capacitors 11 drive. Sharpening containers 12 are connected between the conductive 10 and the conductive sheath 14, with which the conductive 9 is in contact.

 The current lines of the discharge circuit (FIG. 9) for the laser shown in FIG. 8, cover a region whose area is practically determined by the thickness of the plate 5 and the wall 21. Here, the portion K corresponds to the current flow along the part of the cathode 7 located on the side of the plate 5 opposite the discharge gap 15, LM along the part of the cathode 7 located on the end of the plate 5, MN - sequentially along cathode 7, plasma sheet 15, anode 6, current lead 9, NP through sheath 14 from current lead 9 to the point of connection of capacitance 12, PS from capacitor 12 to lead 10, SK through lead 10, PO-OR through sheath 14 to the connection points of the switch 13, RS through the switch 13 and condensers 11 to the current conductor 10.

 In the laser of FIG. 8, the plate 5 is pressed against the wall 21 due to the stop 22 and the current lead 9, i.e. the wall 21 serves as a mounting surface, which avoids any deformation of the plate 5 during operation, which can lead to the departure of the axis of the plasma sheet 15 from the axis of the resonator.

и увеличению ресурса, КПД лазера.The laser discharge circuit is a single-turn spiral (Fig. 9), the inductance of which is determined by the cross-sectional area of the region covered by the circuit. The cross-sectional area for this embodiment of the laser is minimal, since it is practically determined only by the total thickness of the plate 5 and wall 21. This is equivalent to the minimum possible duration of the pump pulse

and increase the resource, laser efficiency.

 The gas laser (Fig. 10) contains a discharge chamber 1 with a dielectric casing 8, on the lower wall 21 of which a dielectric plate 5 with an anode 6 and a cathode 7 in contact with a current lead 10 installed in the wall 21 is fixed with a stop 22 and a current lead 9. the outer side of the wall 21 of the housing 8 has a pumping unit 2.

 The upper wall of the housing 8 is made in the form of a metal plate 23 with ribs 24 perpendicular to the axis of the discharge gap 15. Here d is the magnitude of the discharge gap 15.

 The cooling efficiency increases when the upper metal plate 23 with ribs 24 (Fig. 10) is introduced into the dielectric housing 8 due to the optimal formation of convection flows along the shortest path. In addition, the location of the “cold” plate 23 on top and the “hot” plate 5 on the bottom creates a temperature gradient that facilitates the removal of superheated gas from the discharge gap 15. This makes it possible to increase the laser efficiency and pulse repetition rate.

 The gas laser (Fig. 11) contains a discharge chamber 1 with a metal casing 8 adjacent to the cathode 7, covering a dielectric plate 5 on both sides, near the center of which the anode 6. The housing 8 has a flange 16 on which the dielectric plate 17 is sealed, on which the pumping unit 2 is mounted with a metal cover 20 fixed to the flange 16. Near the center of the plate 17, a current lead 9 is installed directly at the installation site of the anode 6, pressing the plate 5 to the housing 8.

 In the laser of FIG. 11, the metal housing 8 is adjacent to the cathode 7 and acts as a current lead with a maximally developed surface. At the same time, it performs the functions of a shielding shell and a radiator, which leads to high laser compactness. Moreover, due to the contact of the "massive" body 8 with the entire surface of the cathode 7 and, accordingly, the plate 5, in this case, the heat removal mode is provided with a maximum speed. In this design, in addition to the small area of the region covered by the discharge circuit (i.e., small inductance), a symmetrical current supply is provided on both sides with a counter current flow (from the edges of the cathode 7 to the anode 6 and then through the current lead 9), which is even more reduces inductance. These factors lead to an increase in efficiency, an increase in the pulse repetition rate and the average radiation power.

 The gas laser (Fig. 12) contains a discharge chamber 1, a metal housing 8, which is directly adjacent to the dielectric plate 5, supported by the center of the opposite side on the end face 25 of the current lead 9, and the pumping unit 2 is mounted on a dielectric plate 17 sealed on the flange 16.

 In the laser of FIG. 12, with a metal casing 8 adjacent directly to the dielectric plate 5, the role of the cathode and anode 6 is played directly by the laser structural elements, a part of the housing 8 adjacent to the plate 5 is the cathode, and the outer end 25 of the current lead 9 is the role of the anode.

 The gas laser resonator (Fig. 13) is formed by rectangular dielectric mirrors 4 mounted near the ends of the dielectric plate 5, so that their axis coincides with the axis 25 of the discharge gap 15.

 The execution of the resonator in the form of dielectric rectangular mirrors 4 (Fig. 13) installed near the ends on the plate 5 greatly simplifies the design of the laser and increases its compactness, since the rigid attachment of the mirrors 4 to the active region (plasma sheet 15) allows you to exclude alignment nodes from the laser structure .

 The resonator (Fig. 14) is aligned with the electrode assembly containing the anode 6 and cathode 7 adjacent to a dielectric plate 5 made of a material transparent to laser radiation, and at the ends of the plate 5 there are protrusions 27 with a dielectric reflective coating 28. The surface of the protrusions 27 is perpendicular the plane of the plate 5, and their height exceeds the thickness of the plasma sheet 15.

 The implementation of the plate 5 with the protrusions 27 with a dielectric reflective coating 28 (Fig. 14) allows you to further simplify the design of the laser and to eliminate radiation losses at the mounting points of the mirrors 4, which take place in the laser shown in Fig. 13.

The electrode assembly (Fig. 15) contains a dielectric plate 5 made of a material transparent to laser radiation, and protrusions 27, the surface of one of which facing the laser output, is made in the form of a cylindrical surface 29, the forming of which is perpendicular to the plane of the plate 5. Arrow A denotes laser radiation with a wavelength of λ
If the surface 29 of the protrusion 27 is cylindrical, then the radiation at the laser output will be focused, which is useful when creating installations with fiber optic attachments.

 The proposed laser is characterized by a short pump pulse duration; therefore, it is most optimal for generating radiation in gas molecules at self-limited transitions. Therefore, nitrogen, neon or hydrogen can be used as the gaseous medium in this laser. Since air contains a large amount of nitrogen, and with a short duration of the energy input, the discharge does not have time to go into the spark phase, this laser can operate in air.

 When easily oxidized metals (for example, copper) are used as anode 6 and cathode 7, there is a mechanism that further increases the generation efficiency. It is associated with the fact that the oxide film is an additional potential barrier, which leads to an increase in the voltage at the discharge gap 15. Upon reaching the critical field strength, this film breaks down, which has an explosive character with the formation of a large number of electrons. They initiate the development of a uniform plasma sheet 15 with a high density and current rise rate, i.e., a shortening of the pump pulse and an increase in peak power.

 The laser has a high efficiency and high pulse repetition rate while ensuring its compactness and noise immunity. It is characterized by high noise immunity, small dimensions and weight, structural simplicity.

 The laser installation (Fig. 16) for the treatment of diseases accompanied by inflammatory processes with microbial flora, in particular destructive forms of pulmonary tuberculosis, contains a nitrogen (or air) laser 30 sequentially located one after another and with a control system 31, a focusing unit 32 , the light guide 33 with a spherical diffuser 34 at the end. 35 denotes a puncture needle, 36 scattered radiation, 37 the irradiation surface (in particular the cavity of the cavity).

 Laser installation (Fig. 16) works as follows.

 The light guide 33 is installed near the surface 37 of the irradiation. In the treatment of destructive forms of pulmonary tuberculosis, it is inserted through a needle 35 into the cavity 37 until the scatterer 34 is aligned with the center of the cavity 37. A train of control pulses is formed by the control system 31 to ensure the laser operates with a given frequency f during the irradiation time T. Moreover, the frequency f depends on the size of the irradiation surface area 37 and is selected from the condition of ensuring the required value of the average radiation power. The radiation of the laser 30 through the focusing unit 32 is introduced into the optical fiber 33, by which it is transported and then scattered (defocused) by the diffuser 34. The defocused radiation 36 coming out of the diffuser 34 enters the surface 37. The compactness of the laser system is provided by the type of laser used its efficiency is determined by a high output power and a high pulse repetition rate (due to an increase in the energy input and laser efficiency and its good cooling), which allows irradiating the surfaces of different of a different size.

 The laser installation (Fig. 17) contains a laser 30 with a resonator formed by a deaf mirror 4 and a plano-convex lens 38, the plane face 39 of which faces the inside of the laser 30 and may have a dielectric reflective coating 28.

 The combination of the output node of the resonator with the node 32 focusing (Fig. 17) can reduce optical loss with a significant simplification of the design and the reduction of the longitudinal dimensions of the laser system.

 Due to the large gain in a nitrogen laser, a lens 38 can also be used as a mirror without a reflective coating 28, since reflection from a flat face 39, which as a rule is several percent, is already sufficient for the development of generation and formation of laser radiation.

 However, to obtain maximum laser efficiency, it is necessary to provide optimal values of the reflection coefficient, which usually exceeds the value of the reflection coefficient from face 39 without coating 28.

 In FIG. 19 is an optical focusing diagram of laser radiation 42 having a cross-section h • d when using a cylindrical plano-convex lens 38. Position 43 denotes the focus, D the size of the waist of the laser radiation in focus 43.

 In FIG. 20 shows an optical focusing scheme of laser radiation 42 when using a spherical plano-convex lens 38. Positions 44 and 45 indicate constitutions corresponding to laser beams having different divergences in two mutually perpendicular directions along the beam cross section.

 The use of a cylindrical lens 38 as a plano-convex lens 38 (Fig. 19) leads to beam compression in only one plane; therefore, the spot diameter D in focus cannot be less than the discharge plasma thickness h.

 When using a spherical plane-convex lens 38 (Fig. 20) due to different divergences (by an order or more) of radiation in the plane along the plasma sheet and in the plane perpendicular to it (they correspond to focal points 44 and 45), the diameter D of the laser beam waist is usually not less than h.

 The laser installation (Fig. 18) contains a laser with a dielectric plate 5 and a resonator formed by a blind mirror 4 and a convex flat lens 38, the focusing unit 32 contains an additional focusing cylindrical lens 40 mounted in a cylindrical body 41 with the possibility of movement along its axis coinciding with the axis 26 of the resonator.

 The introduction of an additional focusing cylindrical lens 40 (Fig. 18) allows you to combine points 44 and 45 due to movement along the axis of the cylinder 41, which leads to a significant reduction in diameter D, which reduces the invasiveness of the treatment procedure.

In FIG. 21 is an optical focusing scheme using a concave-convex lens 46, the radii of curvature of the surfaces of which are referred to as R ₁ : R ₂ d: h.

 Since the divergence of the radiation of the patented nitrogen laser in mutually perpendicular planes with respect to the plate 5 is different and proportional to the ratio of the corresponding size of the cross section of the plasma sheet 15 to its length, the use of a concave-convex cylindrical lens 46 allows optimal conditions for the input of radiation into the optical fiber 34 when using one optical element. This increases the efficiency of the laser system while simplifying its design.

 In general, in a laser installation, along with the simplicity and compactness of the design, optical losses are reduced and the design is simplified by integrating the functions of the optical elements.

 Due to the general nature of the bactericidal and stimulating effect of the radiation of the proposed laser on the aorta (or air) and a wide range of changes in the parameters of the output radiation when measuring (controlling) the pulse repetition rate, the laser installation is highly effective in treating various diseases accompanied by inflammatory processes with microbial flora, in particular destructive forms of pulmonary tuberculosis, inflammation of the mucous membranes and skin, gastrointestinal tract, upper respiratory tract, m chepolovyh organs, genital organs, festering postoperative, traumatic wounds and trophic.

 More than 600 patients underwent laser treatment. Moreover, clinical improvement and recovery were achieved in 90% of patients.

 Long-term follow-up (up to 6 years) did not reveal long-term negative consequences.

 The laser installation is characterized by compactness, low power consumption, mobility, small dimensions and weight, the absence of auxiliary support systems, and high performance.

 The technical simplicity of the laser unit, its high efficiency, as well as the epidemiological well-being created along with the moral and ethical side of the problem give a great economic effect.

Claims (21)

1. A method of treating destructive forms of pulmonary tuberculosis, including transthoracic exposure to the cavity of the cavity with laser radiation, characterized in that they use defocused frequency-pulse radiation of a nitrogen laser with a power density of 3 30 mW / cm ² , energy density per pulse of 100 250 μJ / cm ² , peak power density of 70,200 kW / cm ² and an exposure of 1 15 min. 2. The method according to claim 1, characterized in that the exposure is first carried out with a power density of 15-30 mW / cm ² for 1 to 3 minutes, and then with a power density of 3 10 mW / cm ² for 4 to 12 minutes.  3. A gas laser containing a resonator installed in the discharge chamber and an electrode assembly including a dielectric plate, an anode located on one of its surfaces, and a cathode mounted at a distance from the anode to form a discharge gap coaxial with the resonator and covering the dielectric plate with the opposite its sides, at least until the projection of the working edge of the anode, as well as containing a power source connected to the capacitor bank of the pump unit connected to the electrode assembly, characterized This is because two distribution conductors are hermetically installed in the discharge chamber housing, one of which is in contact with the anode and the other with the cathode in the area at least partially opposite the discharge gap, and the storage capacitors are directly mounted on the side of one of the distributed conductors located outside the discharge chamber, while the discharge chamber housing and the pumping unit are enclosed in a common conductive grounded shell directly in contact with a portion located outside row camera, another distributed electrical pathway.  4. The laser according to claim 3, characterized in that the anode is made in the form of a conductive strip located on a dielectric plate near its center, while the edges of the anode are located at the same distance from the edges of the cathode.  5. The laser according to claim 3, characterized in that the housing of the discharge chamber is combined with a conductive sheath and one of the distributed conductors and is made in the form of a metal cylinder with a flange on the side surface with a through slot parallel to the axis of the flange on which the dielectric plate is sealed, in this case, another distributed current lead is installed hermetically near the center of the plate, and the electrode assembly is located in the diagonal plane of the metal cylinder perpendicular to the dielectric plate.  6. The laser according to claim 3, characterized in that the housing of the discharge chamber is made in the form of a hollow dielectric parallelepiped, and the electrode assembly is mounted on one of its inner surfaces.  7. The laser according to claim 6, characterized in that the electrode assembly is mounted on the lower inner wall of the parallelepiped, and the upper wall is made in the form of a metal plate with ribs perpendicular to the axis of the discharge gap.  8. The laser according to claim 4, characterized in that the case of the discharge chamber is combined with a conductive grounded sheath and one of the distributed conductors, made of metal and has a flange with a through slot, on which a dielectric plate is sealed, in which another distributed a conductor directly in contact with the anode, while the cathode is in contact with the inner surface of the housing.  9. The laser according to claim 8, characterized in that the cathode is part of the metal housing of the discharge chamber in contact with the dielectric plate, and the anode in contact with it is part of a distributed current path.  10. The laser according to paragraphs. 3 to 9, characterized in that the resonator is formed by dielectric rectangular mirrors mounted coaxially with the discharge gap on the dielectric plate near its ends and perpendicular to its plane.  11. The laser according to PP. 3 to 9, characterized in that the resonator is combined with a dielectric plate made of a material transparent to laser radiation and having protrusions at the ends whose height exceeds the thickness of the discharge plasma and their surface facing the discharge gap is perpendicular to the plane of the dielectric plate and provided dielectric reflective coating.  12. The laser according to claim 11, characterized in that the protrusion surface facing the exit of the gas laser is made in the form of a convex cylindrical surface, the shape of which is perpendicular to the plane of the dielectric plate.  13. The laser according to PP. 3 12, characterized in that the gas medium used is nitrogen.  14. The laser on PP. 3 to 12, characterized in that air is used as the gaseous medium.  15. The laser on PP. 3 12, characterized in that as a gaseous medium used neon.  16. The laser according to PP. 3 12, characterized in that hydrogen is used as a gaseous medium.  17. A laser device for the treatment of diseases accompanied by inflammatory processes with microbial flora, comprising a laser optically connected in series with each other with a resonator and a control system, a focusing unit and a light guide, characterized in that nitrogen is used as a gas medium in the laser or air.  18. Installation according to claim 17, characterized in that the output node of the resonator is aligned with the focusing unit and is made in the form of a plano-convex lens, the flat face of which faces the inside of the laser.  19. Installation according to claim 18, characterized in that a reflective translucent coating is applied to the flat face of the plano-convex lens.  20. Installation according to paragraphs. 17 and 18, characterized in that the body of the focusing unit is made in the form of a hollow cylinder, coaxial with a plano-convex lens, and a focusing cylindrical lens is installed with a possibility of movement along its axis, the surfaces of which are perpendicular to the plane of the dielectric plate.  21. The installation according to p. 17, characterized in that the focusing unit is made in the form of a concave-convex cylindrical lens coaxial with the resonator, the surfaces of which are mutually perpendicular and one of them is parallel to the plane of the dielectric plate, and the radius of curvature of its surface refers to the radius of curvature of the other cylindrical surface as the magnitude of the discharge gap to the thickness of the discharge plasma.

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