RU2162719C1 - Method for treating stomatitis patients - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: method involves administering laserophoresis with 0.25% Oxolinum ointment smeared in turn over every inflammation lesion focus immediately before laser exposure. The exposure is carried out in known operation modes. EFFECT: prevented microcirculation disorders.

Description

 The invention relates to medicine, namely to physiotherapy, and relates mainly to a method for treating patients with stomatitis and chronic recurrent aphthous stomatitis (CHRAS).

 Known methods for treating patients with HRAS using laser radiation in the form of local exposure to light from a helium-neon laser (GNL) (RI Mikhailova, NV Terekhova, EA Zemskaya, N. Melkadze "Laser therapy and laser acupuncture in patients with chronic recurrent aphthous stomatitis "1992, p. 27-28).

In this case, the patients hospitalized at the Central Research Institute for Nuclear Medicine, along with conventional drug treatment, were laser irradiated with pathological elements (aphthae) using the ULF-01 apparatus, radiation intensity of 200 mW / cm ² for 1-2 minutes per area of each aphtha (total 12-15 min) and laser acupuncture (APL-1 apparatus) to corporal points and bioactive points (BAP) in the oral area.

 However, in our opinion, the possibility of widespread use of combined exposure to GNL radiation and simultaneous exposure to BAP seems quite controversial, which in turn contradicts the fundamental principles of oriental medicine reflexology (Lubsak G. Traditional and modern aspects of oriental reflexology - M. - 1986 - 575 from.).

 The pronounced therapeutic effect is also known in the treatment of 15 patients with CHRAS, when along with the generally accepted regimen of drug treatment, laser irradiation from the LTM-01 apparatus was used with a course of 10-16 sessions (L. A. Kalinina "Comprehensive treatment of patients with CPAS and CPL using laser radiation "Abstracts for the V Republican Scientific and Practical Conference of Dentists and Dentists. Maykop. 1994, pp. 75-77).

 The disadvantage of this treatment method is the rather long duration of the course of treatment and the absence of prolonged remission.

The closest is a method of treating patients with stomatitis, including exposure to a drug, extinguishing the mucosa with a photosensitizer, followed by irradiation with a helium-neon laser according to a standard technique (L.A. Mozgovaya "Justification for the use of helium-neon laser light in the treatment of inflammatory diseases of the oral mucosa and skin in children "/ experimental clinical study /, abstract of thesis for the degree of Doctor of Medical Sciences Perm, 1994, p. 187-189). The patient is prescribed a course of drug therapy followed by laser therapy at a power flux intensity (IPM) of 100 - 250 mW / cm ² for 5 procedures, and in the resolution stage up to 100 mW / cm ² .

 The disadvantage of this method is that after applying the drug to the mucous membrane of the oral cavity it quickly neutralizes as a result of salivation, in addition, the proposed irradiation regime does not take into account the peculiarities of microcirculation in various phases of the XRAS, does not significantly affect the normalization of arterial flow in the phase regeneration, which can provoke the onset of short-term remission and give the disease a permanent character of the course.

 The task set by the authors is to eliminate these shortcomings by depositing the drug during laser phoresis and activating the blood circulation of the microvasculature, which leads to preventing the development of phase disturbances in microcirculation.

For this, in a method of treating patients with stomatitis, including exposure to a drug, quenching of the mucous membrane with a photosensitizer, followed by irradiation with a helium-neon laser, it is proposed to carry out laser phoresis, while using a 0.25% oxolin ointment as a drug, which is applied sequentially to each inflammation site directly before laser exposure, irradiation should be carried out for 2 minutes at a single point with a power flux density of 100 - 120 mW / cm ² 2-3 procedures , then with a decrease to 20-25 mW / cm ² 1-2 procedures, and at the stage of resolving the process, the effect should be carried out at a power density of 100 - 120 mW / cm ² 1-2 procedures.

 As a result of the fact that the effect of GNL radiation at high power flux density (PPM) is carried out for a short time (2-3 procedures) with a transition to lower parameters and with a return to the initial PPM indicators at the stage of the resolution of the process, it becomes possible to dose-induced stimulation of dilatation of microcirculatory vessels channel with subsequent design response, adapted to the specific activation of blood circulation. These transformations, within the framework of the microvasculature, lead to the restoration of vascular tone, which, in turn, is reflected in the normalization of blood flow.

 Thus, the proposed method of treatment prevents the possibility of deep hemodynamic disorders, stimulate the phase of cell proliferation and prevent microcirculatory disturbances in the regeneration phase. Therefore, one of the main pathogenetic causes of relapse exacerbation is affected. An increase in the PPM indices at the third stage of treatment allows achieving the final normalization of tissue trophism in the area of the defect of the oral mucosa (aphthae). At the same time, as a result of laser phoresis, 0.25% oxolinic ointment is deposited in the tissues of the mucous membrane, which prolongs its therapeutic effect. The above exposure regimen can reduce treatment time and increase the duration of remission.

 The method is as follows.

Initially, an antiseptic treatment of the oral cavity is carried out with a 0.5% solution of hydrogen peroxide, freeing the surface of the foci of inflammation from plaque (if possible). Then they extinguish the surface of the mucous membrane of the oral cavity with a photosensitizer - an aqueous solution of brilliant green. After this, the applied photosensitizer is expected to dry for 3-5 minutes. Then, using a glass rod, 0.25% oxolin ointment is applied to the surface of 1-2 foci of inflammation and the ointment is evenly distributed with a thin layer on the surface. The patient's mouth at the time of the procedure is open, the ducts of the salivary glands are isolated with cotton rolls. Immediately after application, the ointments are exposed to the radiation of a helium-neon laser from the AFL-2 apparatus with an MPL of 100-120 mW / cm ² , a wavelength of 0.63 μm and an irradiation time of 2 minutes per focus with a course of 2-3 sessions. In the same way they affect the remaining foci of inflammation. During treatment, the radiation parameters of a helium-neon laser are changed depending on the nature of the pathological process. So, in the initial period of the disease, they are exposed to GNL radiation with a PPM = 100-120 mW / cm ² in order to obtain an anti-inflammatory and analgesic effect, then a PPM = 20 mW / cm ^{2 is used} to stimulate cell proliferation and, at the resolution stage, they are exposed to the initial values for the final normalization of tissue trophism in the area of the defect of the oral mucosa (aft).

 To determine the power flux density, for example, an IPM-2 power flow meter is used. The required spot diameter on the irradiated surface is set using an optical nozzle (zoom).

 The methods of monitoring the treatment were clinical and rheographic, radiographic, thermometric, radiovisiographic, cytological, photoplethysmographic, immunological and intravital biomicroscopy research methods that confirmed that this physiopharmacological method of combined exposure can increase the effectiveness of each of the factors, which leads to an increase in the therapeutic effect .

Example 1
Patient L., born in 1972, and / b N 64, was admitted with a diagnosis of chronic recurrent aphthous stomatitis (fibrous form). Background pathology: chronic gastritis in remission. Sick for about 3 years, before contacting us, the patient was treated at the place of residence. Repeatedly received drug therapy (general and local). Aft healing time ranged from 14 to 17 days, remission lasted only for 2-2.5 months.

Objectively: malaise, body temperature up to 37.2 ^o C. The lymphatic submandibular nodes are slightly enlarged, painful on palpation. Single painful elements (aphthae) covered with fibrous plaque were noted. Localization of aphthae is the mucous membrane of the lip on the lower jaw and the lateral surface of the tongue.

 The prescribed course of complex treatment using laser phoresis of 0.25% oxolin ointment by radiation of a helium-neon laser.

 The patient underwent antiseptic treatment of the oral cavity with a 0.5% hydrogen peroxide solution, freeing the surface of the foci of inflammation from plaque.

Then, shell tissues were stubbed with an aqueous solution of diamond greens. After that, 0.25% oxolin ointment was applied with a glass rod in a thin layer on the surface of one inflammation site, immediately after that they were exposed to GNL radiation with an output radiation power of 25 mW with a wavelength of 0.63 μm for 2 minutes per each radiation field. The exposure was carried out from the apparatus "AFL-2". MRP was equal to 100 mW / cm ² for 2 procedures conducted daily. There were 5 foci of inflammation in total, the rest were exposed as described above. After the 2nd procedure, we noted the relief of pain, a decrease in swelling of the oral mucosa, and stabilization of the size of the lesion. It was revealed an increase in the production of immunoglobulin Jg Asc, an increase in the number of young forms of epithelial cells at different stages of mitosis.

 At the same time, there was an improvement in microcirculation and trophism in the affected areas of the oral mucosa.

Then, from the 3rd to the 4th procedure, we performed the aforementioned antiseptic treatment of the oral cavity and exposure to laser phoresis, but already with PPM = 20 mW / cm ² .

After 4 sessions, the patient had a pronounced epithelization of aphthae, further dynamics to normalize microcirculation, the absence of a pain symptom, and well-being. Then we conducted another 2 sessions of irradiation with a PPM = 100 mW / cm ² in order to finally restore the myogenic vascular tone. Clinical and laboratory studies confirmed a pronounced therapeutic effect. The persistence of the clinical effect was noted up to 1 year, after which a second course of treatment was prescribed.

Example 2
Patient D., born in 1964, and / b N 85. Diagnosis: chronic recurrent aphthous stomatitis (necrotic form). Background pathology: chronic gastritis in remission. He’s been ill for about 5 years, before contacting us, he repeatedly received medication (general and local) and physiotherapy at the place of residence. The healing time of aphthae ranged up to 15 days, the duration of remission - up to 3 months.

Objectively: malaise, rejection of many types of food that cause pain, enlargement and soreness on palpation of the submandibular lymph nodes, body temperature up to 37.5 ^o C. Numerous aphthous aphthae with a bright red rim covered with a grayish fibrous film were noted. In a number of foci, infiltration is noted, as a result of which individual aphthae slightly rise above the surrounding tissues. Aphthae is very painful on palpation, soft to the touch.

 Localization: the mucous membrane of the cheeks, the area of transitional folds.

A course of complex treatment was prescribed using laser phoresis of 0.25% oxolinic ointment by radiation from a helium-neon laser. The patient was given non-specific desensitizing therapy (tavegil 0.001, 1 tablet, 1 time per day), antiseptic treatment of the oral cavity with 0.5% hydrogen peroxide solution, treatment with proteolytic enzyme solutions (trypsin), application of an oil solution of vitamin A, 2% lidocaine solution. The patient was prescribed multivitamins and the use of spicy, spicy and rough food was forbidden. It was recommended to reduce the frequency of smoking and drinking alcohol. After daily antiseptic and analgesic treatment of the oral cavity, as well as quenching with a photosensitizer, the patient using a glass rod applied a 0.25% oxolin ointment to the affected area with a thin layer of 1-2 points and immediately after that they were exposed to radiation from a helium-neon laser with a radiation power of 25 mW with a wavelength of 0.63 microns for 2 minutes for each lesion with a total time of up to 10 minutes per session. The exposure was carried out from the apparatus "AFL-2". For three sessions, we used the PPM = 120 mW / cm ² . A significant improvement in the general condition, normalization of body temperature, a decrease in pain symptom, a decrease in swelling of the mucous membrane and the size of the lesion foci were noted. The processes of intense epithelization of the elements of the lesion, restoration of the immunoglobulin spectrum of saliva, improvement of microcirculation and trophism in the affected areas of the oral mucosa were revealed.

After the 3rd session, when the results described above were noted, we applied the effect of photophoresis with PPM = 25 mW / cm ² along with the indicated treatment of the oral cavity and quenching for two sessions conducted daily. After the fifth session, we observed a further downward trend in the symptoms of inflammation. Further, after the 5th session, we used photophoresis with PPM = 120 mW / cm ² for two procedures.

 After the end of the course of treatment (7 sessions), the absence of venous stasis phenomena, normalization of blood flow, complete epithelization of aphthae, absence of pain symptom, and well-being were revealed.

 The results of clinical and laboratory studies confirmed the achievement of a pronounced therapeutic effect. A persistent clinical effect was observed for 12 months, after which a second course of treatment was prescribed.

 Example 3

 Patient R., born in 1979, and / b N 110. Diagnosis: acute herpetic stomatitis, moderate form. Background pathology: chronic gastritis in remission. Sick for about 3 years. The period of exacerbation of the disease is every 6-7 months.

Similarly to the above, the course of treatment was carried out: laser phoresis of 0.25% oxolinic ointment, 3 procedures for the MRP of 120 mW / cm ² , 2 procedures for the MRP of 25 mW / cm ² , 2 procedures for the MRP of 120 mW / cm ² .

 At the end of the course of treatment, the patient's condition is good, there is no discomfort, the lymph nodes are not palpable and painless, hemorrhages on the mucous membrane of the cheeks and erosive elements on the tongue are not marked, the gums do not bleed, the crusts on the lips have disappeared. It was revealed the absence of venous stasis, normalization of microcirculation, complete epithelization of the lesions. A persistent clinical effect was observed for 14 months, after which a second course of treatment was prescribed.

 In a similar manner, 84 patients with chronic recurrent aphthous stomatitis were treated. A positive effect of up to 12 months was observed in 89.6% of patients, in the remaining patients, the remission period was 9-10 months.

 The proposed method due to extinguishing with a photosensitizer, using the combined effect of radiation from a helium-neon laser and 0.25% oxolinic ointment and summing up their effects, can significantly accelerate the duration of treatment of the disease and the period of remission. In addition, this technique allows for outpatient treatment at the place of residence with a reduction in the patient's incapacity for work.

 Using the method allows to reduce the treatment time to 7 days and increase remission to 12 months due to preliminary quenching with a photosensitizer and laser phoresis of 0.25% oxolinic ointment.

 As a result of such effects, a pronounced therapeutic effect is achieved in the form of a reduction in the pain symptom and acceleration of epithelization of the foci of inflammation. However, it is known that this disease has a chronic course and is characterized by periodic exacerbations.

 Thus, this physiopharmacological method of combined exposure increases the synergy of the effects of laser therapy and a pharmacological preparation, which allows you to influence the various mechanisms of the pathogenesis of the pathological process and, as a result, increase the effectiveness of each of the factors, which leads to an increase in the therapeutic effect.

Claims (1)

A method of treating stomatitis, including exposure to a medicament, quenching of the mucosa with a photosensitizer, followed by irradiation with a helium-neon laser, characterized in that laser phoresis is performed, while a 0.25% oxolin ointment is applied as a medicament, which is applied sequentially to each inflammation site immediately before laser exposure, irradiation is carried out for 2 minutes at a single point with a power flux density of 100 - 120 mW / cm ² 2 - 3 procedures, then with solutions up to 20 - 25 mW / cm ² 1 - 2 procedures, and at the stage of resolving the process, the effect is carried out at a power density of 100 - 120 mW / cm ² 1 - 2 procedures.