RU2246280C1 - Method for applying cryogenic treatment of pathological foci - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves covering pathological tissue surface and area adjacent to it, with light medical drug. The pathological focus is exposed to magnetic field action on the opposite side. Magnetic field direction and intensity are varied to make light magnetic drug penetrate into pathological tissue under visual control. Cryogenic treatment is combined with magnetic field therapy. Next, the lesion focus is treated with the light drug daily and subjected to magnetic field therapy until cryonecrosis area dries completely and is rejected. Laser-mediated necrosis area evaporation is carried out 3-5 days later after having applied cryogenic treatment, with incomplete destruction of the lesion focus in depth. Ferromagnetic color is used in necrotic tissue as marker. Auxiliary cryogenic treatment is applied when having achieved complete lesion focus elimination. Incomplete lesion focus elimination being found to be the case after having applied laser evaporation of the lesion focus, the drug is administered for treating the lesion focus, and cryogenic treatment is applied.

EFFECT: enhanced effectiveness of treatment.

3 cl, 2 dwg

Description

The method relates to medicine, namely to cryology, and can be used in cryodestruction of tumors and cryotherapeutic treatment of inflammation.

One of the urgent problems of cryosurgery is the complete destruction of the pathological focus, which primarily depends on the conditions ensuring the adequate heat transfer between the applicator and the surface of the pathological focus, especially when freezing dry tuberous keratinizing formations, as well as formations with a large depth of germination. This problem is solved by cryosurgeons, mainly by using a variety of heat-conducting nozzles for cryotools for tumors of various sizes and shapes, which significantly limits the versatility of the cryotool. On the other hand, to ensure heat transfer between the applicator and the surface of the pathological focus, fat and water layers are proposed, but their low thermal conductivity reduces the effectiveness of cryosurgical and cryotherapeutic effects. The problem of wet cryonecrosis in the postoperative period, which prevents the widespread use of cryogenic methods in outpatient practice, also remains relevant.

For the prototype of the proposed method, a well-known method of cryogenic treatment of pathological foci was selected, including applying a medicinal substance to the surface of the pathological tissue and deep local cooling (Paches A.I. et al. - Cryogenic method for treating head and neck tumors. - M., “Medicine”, 2000, pp. 180-185). The method consists in applying physiological saline to the surface of the tumor tissue and subsequent application cryotherapy; cryotherapy is carried out in the presence of adhesion of the applicator to the surface of the pathological tissue due to saline, which increases the depth of freezing; after warming, passively observe the healing.

However, saline due to fluidity cannot be evenly distributed in the plane of contact of the surface of the cryo-applicator and tissue. It should be a heat-conducting material that acts as a layer between the tumor and the applicator, but due to the very low thermal conductivity it interferes with heat transfer. During freezing, the fabric is deformed, microcracks and wave-like folds inevitably appear in the plane of thermal contact. At the same time, as the cooling decreases, the mechanical contact of the instrument and tissue decreases (Kochenev VI - Adhesive effect in cryosurgery. - Manuscript, Dep. At VNIIMI, No. D-5061, 18 pp.) Thermal expansion coefficients of the metal of the applicator, water and biological tissues vary greatly: metal tapers off when cooled, water expands sharply, biological tissue expands, too, but to a lesser extent than water. Such a shift of the contacting surfaces during the freezing process leads to the occurrence of rigid friction of solids, the transformation of water into snow, which in general can be called heat-insulating material at negative temperatures. Since there is no close thermal contact between the cryoinstrument and the tissue, the low temperature of the applicator deep in the tissue is not enough, and pathological cells die during a single freezing only at a temperature of -60 ° C or at multiple temperatures - from -20 ° C to -30 ° C.

The prototype method does not allow the creation of a sufficiently tight mechanical and thermal contact of the instrument and the dry or tuberous surface of the pathological tissue, since the presence of cavities and channels in the tissue does not allow modification of the cryo-damaging effect.

The method does not include therapeutic measures to eliminate the characteristic negative features of the healing of cryogenic wounds at the stage of formation and rejection of cryonecrosis with parallel healing of the wound under cryonecrosis. Cryonecrosis very slowly passes into dry, destroyed tissue and is rejected only after epithelial growth with significant volumes - from 1 to 6 months. A feature of the formation of cryonecrosis is a pronounced exudation. Exudation entails the need for frequent dressings, although cryonecrosis heals better in air. If cryonecrosis is located, for example, in the larynx, then exudation is the cause of constant coughing, which affects the healing of the wound of the larynx and tracheostomy. The lack of adequate treatment for cryonecrosis due to the violent reaction of the destroyed and surrounding healthy tissue negatively affects the results of cryosurgical treatment of pathological tissues.

The objective of the proposed method for cryogenic treatment of pathological foci is to improve treatment results by ensuring adequate heat transfer, increasing the depth and speed of cryotherapy, reducing treatment time and complications by improving the quality of treatment for cryonecrosis.

The problem is achieved in that in the known method of cryogenic treatment of pathological foci, including applying a medicinal substance to the surface of the pathological tissue and deep local cooling, a soft magnetic dosage form is applied to and around the surface of the pathological tissue, the magnetic field is applied to the pathological focus, at the same time, the direction and intensity of the magnetic field are changed, achieving the penetration of the soft magnetic dosage form into the pathological visual tissue under visual control, carry out cryotherapy with simultaneous exposure to a magnetic field, then apply a soft magnetic dosage form daily to the pathological focus and expose it to a magnetic field until the cryonecrosis is completely dried and rejected; 3-5 days after cryotherapy, with incomplete destruction of the lesion in depth, laser evaporation of necrosis is carried out using the color of a ferromagnet in the necrotic tissue as its marker, and when ascertaining the complete elimination of the lesion, additional cryotherapy is performed; every 3-5 days, until the focus is completely eliminated, when a partial destruction of the focus is detected after laser evaporation of the focus, a soft magnetic dosage form is applied to its surface and cryotherapy is performed.

The proposed method meets the criteria of the invention of “novelty”, as a result of the patent information research did not identify sources that discredit the novelty of the invention.

The proposed method meets the criteria of the invention “inventive step”, since it is not revealed the presence of significant differences in the proposed method in similar solutions.

Currently, a wide range of new physical and therapeutic properties of soft magnetic dosage forms (MMLF) of different consistencies has been developed, with particles of ferromagnets ranging in size from 50 to 100 Angstroms, which can contain almost any medicinal substances used in medicine as additives (Cherkasova O.G. . - Physicochemical fundamentals of the use of finely dispersed magnetic materials in pharmacy. - Abstract of thesis, Doctor of Chemistry, Moscow, 1993, 38 pages). MMLF is used for drying wounds, antimicrobial action in the wound, and treating purulent-necrotic processes in tissues (Akhalaya MG et al. In Sat .: IV All-Union Conference on the Use of Magnetic Fluids in Biology and Medicine, Sukhumi, 1991 , p. 3-25), for fine fixing in space of various elements and creating mechanical contact between them (Kochenev V.I. et al. - Method of myringoplasty. - AS No. 1804815. - Publish. 30.03.93, bull. . No. 12).

However, cryosurgery and cryotherapy as a heat transfer agent for cryotherapy and treatment of cryonecrosis MMLF have not yet been used. One of the reasons stopping the widespread use of soft iron-containing dosage forms is the introduction of iron particles having a bright black color into the depth of necrotic tissues along with the drug substance. After healing, a black spot similar to a tattoo remains on the surface of the wound “for life”.

In a magnetic field, the MLFM itself is magnetized, acting as the pole opposite to the magnet pole brought to it, and between the two magnets the role of the core. In this case, the particles of ferromagnets inside the ointment are arranged in chains in accordance with the direction of the lines of force of the magnetic field, come into contact with each other, therefore, under the influence of a magnetic field, the thermal conductivity of the MLMF increases to the thermal conductivity of the metal. Under the influence of a magnetic field, the MMLF can penetrate into small cracks, pores, voids, channels, and various cavities.

The proposed method allows the use of MMLF as a heat transfer agent in cryotherapy and treatment of cryonecrosis, to vary the properties of MMLF, consistency, medicinal additives, and with additional exposure to a magnetic field, to vary the shape, direction and intensity of the magnetic field itself, which together makes it possible to modify the heat transfer intensity. As a source of a magnetic field, you can use either a permanent magnet, moving it in space, or an electromagnet, both constant and variable, periodically changing the working current of the winding current. In this case, a pulsed change in the intensity of a constant magnetic field is used for a deeper and more intensive incorporation of ferromagnets into tissues; rotational movement of magnetic particles in an alternating magnetic field is used to enhance the destructive effect of MMF embedded in the pathological tissue; a high-frequency alternating magnetic field can be used to heat the MLF embedded in the pathological tissue, which also enhances cryo-damage.

The known parameters of cryotherapy when using CMLF and simultaneous exposure to pathological formations by a magnetic field change significantly: exposure decreases, freezing speed increases, freezing depth and thawing time increase, cryo-damage increases, and this tendency persists in each subsequent freeze-thaw cycle. At the same time, lethal temperatures in the depths of tissues repeatedly increase cryo-damage, and a magnetic field provides cryoprotection in the hypothermia zone and enhances postoperative perifocal tissue reactions. Thus, the proposed method makes it possible to freeze biological tissue of any density and eliminate keratinized formations, which in principle are not destroyed by other known application methods due to the impossibility of achieving adhesion for such formations.

The parameters of cryotherapy are selected in accordance with clinical practice, taking into account the variety and localization of the pathological formation, depending on the purpose of the treatment (cryodestruction, anti-inflammatory effect). The interval of 3-5 days for the subsequent laser and cryotherapy is due to the fact that it is during this time that the pathological tissue after cryo- and magnetic exposure is completely necrotic, absorbs MMLF and becomes black due to the presence of ferromagnets in it.

Figure 1 and 2 presents illustrations of methods of cryosurgical treatment of pathological foci using MMF and magnet (figure 1) and without their use (figure 2). In both methods, a standard cryogenic apparatus of active action (such as “Ledok”) is used, which ensures the circulation of liquid nitrogen. 1 and 2 are designated: 1 - a channel for supplying liquid nitrogen, 2 - the working surface of the applicator, 3 - MMLF, 4 - freezing zone, 5 - pathological tissue, 6 - healthy tissue, 7 - magnet. Cryotherapy of the pathological tissue 5 is carried out by the applicator 2 cooled by the circulation of liquid nitrogen through the channel 1 of the instrument 2. When the equal number of freeze-thaw cycles are performed in both methods, the freezing zone 4 in the method with applying an MMFL layer 3 to the pathological tissue 5 and exposing it to magnet 7 is more depth (focus 5 is frozen to the full depth and in the entire volume) and a smaller area of distribution on the surface of healthy tissue 6. Obviously, cryodestruction of pathological foci is more effective with Using MMLF and when subjected to a magnetic field.

The proposed method allows you to:

- create reliable thermal contact between the instrument and the pathological tissue through the use of CML as a layer between them;

- to increase the intensity of penetration of cold into the depths of tissues due to the entry of heat-conducting MMLF into microcracks of the keratinous surface of pathological tissue, into recesses and channels in the thickness of the focus and passage of a ferromagnet through cell membranes, that is, to accelerate cooling and thereby increase the damaging effect of cold in the depths of tissues;

- increase cryo-damage due to modification of the magnetic field effect;

- carry out additional cryo-damage due to the rotation of ice crystals in a magnetic field as it cools, since water molecules are also micromagnets;

- freeze biological tissue of any degree of density;

- eliminate keratinized formations, which in principle are not destroyed by other known application methods due to the impossibility of achieving adhesion for such formations;

- bring the temperature border of cryonecrosis of biological tissue (skin) closer to -10 ° С - 12 ° С due to increased cryo-damage;

- improve the quality of wound healing after cryodestruction: dry cryonecrosis almost twice as fast, accelerate its rejection, reduce swelling and exudation, and stimulate regeneration under cryonecrosis.

The method is as follows.

Before exposure, choose the consistency of the magnetic form and medicinal additives, which is advisable to apply in this case: it depends on the surface configuration of the pathological focus, the presence or absence of cavities, channels in the thickness of the focus, the nature of the surface (skin, keratinized layer, mucous membrane). Determine the need for tight thermal contact between the instrument and the tissue.

10 minutes - 1 hour before cryogenic exposure, MLMF 3 is applied to the surface of the pathological focus 5 and around it. A magnetic field source 7 is placed on the opposite side (for example, under a pathological focus, while the external magnetic field is oriented perpendicular to the tissue surface). It can be, depending on the specific localization and form of the pathological formation, a permanent magnet or an electromagnet, both constant and variable.

Next, the field of magnet 7 acts on the pathological focus 5 with MMLF 3 for the specified time: slightly randomly move the permanent magnet 7 within the pathological focus (for example, along the surface of the pathological tissue 5 or removing and bringing the magnet 7 closer to tissue 5) or, when using an electromagnet , periodically change the working current strength of the winding and, thus, change the direction and intensity of the magnetic field, while creating wave-like changes in the force of magnetic attraction between magnet 7 and MMF 3. MMF 3 under m of the magnetic field is immersed in cracks, crevices, gaps between the keratinous layers of tissue, it enters through open cavities and channels into the depth of tissue 5, thereby creating the most thermally conductive medium just in those parts of the pathological tissue 5 that could be an obstacle to passage cold to the depth of the fabric 5. At the same time, visual control of the movement of the MMF 3 is carried out following changes in the magnetic field, and the criterion of the sufficiency of exposure to the magnetic field is the reduction in the number of MMF 3 Nost pathological tissue 5, which indicates the occurrence of deep, penetrating MMLF 3 in abnormal tissue 5. Given the tendency of introduction MMLF 3, first of all, in the inflamed tissue, these areas are subjected to the most severe effects of the subsequent cryogenic freezing.

Further, if necessary, local anesthesia is performed before cryotherapy, or the patient is anesthetized, and surgical access to the pathological focus is provided.

Then carry out cryotherapy on the pathological tissue 5 chilled due to the circulation of liquid nitrogen through the channel 1 of the tool by the applicator 2 by means of cycles of freezing and thawing. In this case, the magnet 7 can also arbitrarily move, change the direction or intensity of its field, which contributes to a more snug fit of MLFM 3 to the deepest lying parts of the surface of the pathological tissue 5, the entry of particles of the ferromagnet into the thickness of the tissue 5, for example, keratinized skin layers, and therefore , deeper and faster penetration of cold and tissue cooling. Freeze control is carried out visually. Report the exit of the freezing zone 4 beyond the boundaries of the surface of the pathological focus 5 within the specified limits (which is a criterion for the sufficiency of cryotherapy) at a lower exposure than without MMF 3 and magnet 7; moreover, in each next cycle they realize the opportunity to reduce the exposure of freezing due to more intensive penetration of cold into the hearth 5, and the thawing time, respectively, is increased, while there is no spread of the freezing zone 4 over the surface of surrounding healthy tissues 6. During the thawing period of pathological tissue 5 and at the time of removal of the applicator 2 from the tissue 5, the magnetic field can be suspended.

After cryosurgery, the MLMF is not removed from the surface of the destroyed but not yet necrotic tissue. MLMF remains in the recesses of the tumor surface. The medicinal components included in the MMLF can inhibit the development of severe swelling of the destroyed tissue, sharply reduce exudation, therefore, cryodestructed tissues already begin to necrotic in the first day. At the same time, ferromagnets together with medicinal components penetrate even more into destroyed tissues, since it is necrotic tissues that absorb MMLF, and the introduction of ferromagnets occurs constantly under the influence of the Earth's natural magnetic field.

At the same time, ferromagnetic particles stain necrotic tissues outside and in their thickness (for example, iron-containing ones - black), and thus, the color is an indicator of the penetration of MMLF into the tissue, a criterion for the death of tissue cells and serves as a kind of marker of cryonecrosis mass and its borders.

Then daily, starting from the day after cryodestruction, the MMF is applied to the pathological tissue and is exposed to a magnetic field until the cryonecrosis is completely dried and rejected, turning it into a dry crust, under which regeneration of the skin or mucous membrane continues aseptically and without exudation, since it is MMLF contributes to the rapid drying of necrosis. A ferromagnet that has penetrated into the thickness of a cryonecrotic tissue is rejected with it, so there is no black spot.

With a large mass of the pathological focus and suspicion of incomplete destruction of the focus in depth 3-5 days after cryotherapy, laser evaporation of necrosis is performed, and the color of the ferromagnet in the necrotic tissue is used as a marker of the mass of the necrosis and its boundaries. At the same time, an increased activity of absorption of laser beams by a pathological necrotic tissue and its evaporation due to the presence of a black magnetic substance in it is noted. After this, when stating the complete elimination of the lesion by laser evaporation, additional cryotherapy is performed, which contributes to the achievement of a better cosmetic effect, since healing occurs without a scar characteristic of laser exposure.

When ascertaining, after the first laser evaporation of incomplete destruction of the focus, a soft magnetic dosage form is again applied to its surface and cryotherapy is performed. Then repeat laser evaporation, applying a soft magnetic dosage form and cryotherapy if necessary every 3-5 days until, after the next laser evaporation, the complete elimination of the pathological focus is detected.

Using the proposed method in the cryology laboratory of NGMA, more than 100 patients with various tumor formations and inflammatory diseases were treated: nasal septum hemangioma - 1 patient, auricle skin basal celloma - 1, lip cancer - 3 patients, external nose skin tumors - 5, cancer tumors the bottom of the oral cavity - 2, cancer of the larynx - 3, skin melanoma - 5, hyperkeratosis on the foot - 8, extensive warts of the hands and feet - 25, lipoma on the leg - 1, keratinizing extensive nevi of the skin - 12, hemangiomas of the skin of the face - 17, there were skin hemangiomas another okalizatsii, one patient made kriotonzillotomiya tonsils, more than 50 patients underwent cryotherapy on the palatine tonsils for therapeutic purposes (for immune stimulation). The method was used for cryodestruction of pathological tissue, cryolaser destruction (skin tumors and cancer of the larynx), cryoextirpation of neoplasms (skin melanoma), therapeutic effect without adhesion in the treatment of chronic tonsillitis.

Examples confirming the implementation of the method.

Example 1. Patient S.A.M., 42 years old, turned to the cryology laboratory with complaints of changes and bleeding of the front surface of the skin of the inner part of the auricle, lasting about a year. The patient had the results of a histological examination with the conclusion: basal cell cancer of the skin of the right auricle.

The tumor with a diameter of 1.5 cm had an ulcerated bleeding surface with a crust, hyperemic, slightly raised edges above the surrounding skin.

During the examination, it was decided to produce immediate cryodestruction of the tumor. Due to the fact that the tumor was covered with a dry crust, had significant dimensions, a tuberous surface and an irregular star shape, it was decided to use magnetic drug ointment for cryodestruction.

To avoid bleeding, the crust was not removed. A layer of magnetic ointment about 5 mm thick, with a 50% ferromagnet content, was applied to the surface of the tumor, including its elevated edges.

On the opposite side of the auricle, a permanent magnet was let down. The magnet was moved within 3-5 mm. At the same time, the ointment was displaced with its partial and under the crust.

Then made cryotherapy on the tumor. The cryoapplicator was brought to the tumor and pressed into the layer of magnetic ointment, then the circulation of liquid nitrogen through the channels of the instrument began, and the almost instantaneous occurrence of adhesion was detected. Cooling was continued for about 50 seconds until the freezing zone reached the specified limits (with a 5 mm extension beyond the tumor), and natural thawing was expected for about 5 minutes. During thawing, the tool and fabric were disconnected. A total of three freeze-thaw cycles were carried out, while a significant decrease in the freezing time was noted in each next cycle (in the second cycle it was 45 seconds, in the third - 38 seconds) and the corresponding increase in the thawing period (3.5 minutes in the first, 4.5 min - in the second and 5 min - in the third cycle). The operating temperature of the applicator was -182 ° C, as evidenced by the condensation of liquid oxygen from atmospheric air on the surface of the applicator near the working plate. The magnet was held in place throughout the cryodestruction procedure. Upon removal of the applicator, excess magnetic ointment was removed. At the end of the operation, an intense black color of the cryonecrotic tissue was noted. No bleeding was observed. The patient with recommendations was released for outpatient treatment.

From the next day, according to these recommendations, the patient applied a thin layer of magnetic ointment to the cryonecrotic tissue daily in the morning, after which she applied a permanent magnet to the auricle on the opposite side for 5-10 minutes, while not removing the ointment from the cryonecrosis surface during the day . The composition of the magnetic ointment as drugs included dioxidine, adrenaline, dimethyl sulfaxide. On the second day, cryonecrosis was saturated with MLMF throughout the entire thickness, on the third day a dense, dry crust of black cryonecrosis was noted, a small swelling was kept under it, slight hyperemia, edema and hyperemia on the fifth bitches disappeared, a black dry crust remained at the site of the tumor; on the twenty second day there was a complete rejection of cryonecrosis, at the site of which the regenerated skin was slightly dyed brown.

Example 2. Patient M-in K.I., 60 years old, turned to the cryology laboratory of NGMA with complaints of pain in the nose. On palpation I felt pain, there was swelling and hyperemia of the right wing of the nose, extending to the bottom of the nasal cavity. Rhinoscopy showed a bulging skin of a bright red color with purulent discharge in the lower part of the right wing of the nose, at the place of transition of the skin into the mucous membrane. The diagnosis was made: boil of the right wing of the nose. The patient was offered cryosurgical treatment.

From the mouth of the furuncle with cotton wool on the probe with winding, pus was partially removed, as well as the stem of the boil. When removing purulent discharge, a hole with a diameter of up to 2 mm was determined.

On the surface of the boil from the nasal cavity was applied a layer of MLMF with a thickness of up to 5 mm, the consistency of an ointment, with a 50% content of a ferromagnet. A permanent magnet was brought to the outside of the right wing of the nose. The magnet was moved within 3-5 mm. At the same time, the ointment was displaced with its entry into the boil cavity.

Then carried out cryotherapy on the boil. The cryoapplicator with the magnetic tube put on it was brought to the tumor and brought into contact with the MMFL layer, then the circulation of liquid nitrogen through the channels of the instrument began. At the beginning of the cooling of the applicator due to the circulation of liquid nitrogen, almost instant adhesion was noted. Continuing cooling, we reached the exit of the freezing zone of the given limits (with a small exit outside the boil) for 25 seconds. Then they waited for its natural thawing. Spent another freeze-thaw cycle. The pause between cycles was about two minutes. During a pause, the instrument and tissue were disconnected, the magnet on the outside of the wing of the nose was left. At the same time, an additional entry of CMLF into the cavity of the boil was noted, in connection with which the freezing time decreased in the second cycle to 20 seconds, and the thawing period increased accordingly to 3 minutes. The applicator was cooled at a temperature on its surface below -182 ° C, as evidenced by the condensation of liquid oxygen from atmospheric air on the surface of the applicator near the working plate. After the applicator was retracted after the second freezing, the magnet was retracted, excess magnetic ointment was removed from the nasal cavity. The patient was released with recommendations for outpatient aftercare. According to these recommendations, the patient applied a thin layer of CML every day in the morning, containing dioxidine, adrenaline, dimethyl sulfaxide, to cryonecrosis, after which he applied a permanent magnet for 5-10 minutes from the opposite side of the nose wing. During the day, he tried not to remove the MLMF layer from the surface of cryonecrosis. On the second day, cryonecrosis was saturated with MLMF throughout the entire thickness; on the third day, a dense, dry crust of black cryonecrosis was observed, there was no purulent discharge under it, and slight hyperemia was noted. On the 14th day, cryonecrosis was completely rejected. No signs of inflammation were noted.

Example 3. Patient K-va OM, 62 years old, came to the cryology laboratory of the NGMA on January 14, 2003 with complaints of pain when walking in the area of the sole of the right leg. Examination of the sole revealed hyperkeratosis with an uneven tuberous surface, deep cracks from 2 to 1.5 cm. The diagnosis was made: a plantar wart of the right leg. During the examination of the patient, immediate cryodestruction of the neoplasm was proposed and the patient's consent to treatment was obtained. Due to the fact that cryodestruction by the known methods of these formations is ineffective, it was decided to carry out cryodestruction by the method of cryogenic treatment of pathological foci, including applying MMFL to the surface of the pathological tissue and exposure to a magnetic field.

A magnetic consistency gel layer with a 50% ferromagnet content was deposited on the surface of the formation; the thickness of the MLMF layer was 2 mm.

On the back of the foot, a permanent magnet was let down. The magnet was moved in a circular motion within 1–2 cm. When the magnet moved, the gel was displaced according to the magnet’s movements and the MMFL entered the formation cracks.

The cryoapplicator was let down and pressed into the MMFL layer. They started cooling the applicator due to the circulation of liquid nitrogen, noted the very fast, almost instantaneous occurrence of adhesion. Cooling was carried out further until the freezing zone exceeded the outbreak by 5 mm, which was reached within 50 seconds, and its natural thawing was expected. Just spent three cycles of freezing and thawing. The pause between cycles lasted about five minutes. During the pause, the instrument and the fabric were disconnected. At the same time, a significant decrease in the freezing time was noted in each next cycle: in the second cycle it was 40 seconds and in the third - 30 seconds and the corresponding increase in the thawing period: 3.5 minutes in the first cycle, 4.5 minutes in the second, 5 minutes in third. The magnet was held in place throughout the cryodestruction procedure. Upon removal of the applicator, excess magnetic ointment was removed. At the end of the procedure, an intense black color of the cryonecrotic tissue was noted.

The patient was recommended at home to apply magnetic gel to cryonecrosis twice a day and come for examination in two days.

On the third day, when the patient appeared, a diagnostic laser evaporation of cryonecrosis was performed. The black color of the cryonecrotic tissue served as a marker of the depth of cryonecrosis. The depth of cryonecrosis was 5 mm, the width was 15 mm. There was no bleeding. A layer of a magnetic gel with a thickness of about 2 mm was deposited at the bottom of the cavity and three cycles of cryodestruction were again carried out using a magnet. With the same recommendations as after the first procedure, the patient was released for outpatient treatment.

On the 30th day, complete regeneration of the skin with rejection of cryonecrotic tissue was noted.

Then, daily application of MLMF to the regenerated tissue and exposure to a magnetic field were carried out. On days 3-4, a clear contouring of the necrotic site was noted. It is known from clinical experience that the depth of the wart is greater than its outer diameter; therefore, moderately focused radiation of a carbon dioxide laser (Romashka-2 apparatus) at a power of 20 W produced black cryonecrotic tissue from an implanted ferromagnet whose depth was 4 mm. An increased selective absorption of laser radiation by black cryonecrotic tissues was noted. Evaporation was carried out before the appearance of light, non-necrotic tissue on the bottom of the wound; in the center of the wound, the presence of dense tissue sections — the wart core — was detected, which was an indication for additional cryodestruction by the proposed method: a magnetic gel layer about 2 mm thick was applied to the bottom and again carried out three cycles cryodestruction using a magnet. With the same recommendations as after the first procedure, the patient was released for outpatient treatment.

5 days after laser evaporation, the absence of a wart was ascertained, and additional cryotherapy was performed to achieve better healing. After a 3-week outpatient treatment, the cryonecrosis was completely healed according to the recommendations.

Claims (3)

1. The method of cryogenic treatment of pathological foci, including applying to the surface of the pathological tissue of a medicinal substance and deep local cooling, characterized in that a soft magnetic dosage form is applied to the surface of the pathological tissue and around it, the pathological focus is affected from the opposite side by a magnetic field, change the direction and intensity of the magnetic field, achieving the penetration of a soft magnetic dosage form into the pathological tissue under visual control it is carried out with simultaneous exposure kriovozdejstvie magnetic field is then applied to the soft magnetic daily dosage form for palogichesky hearth and act on it by a magnetic field before complete drying and cryonecrosis rejection. 2. The method according to claim 1, characterized in that 3-5 days after cryotherapy with incomplete destruction of the lesion in depth, laser evaporation of necrosis is carried out using the color of a ferromagnet in its necrotic tissue as its marker, and upon cessation of the complete elimination of the lesion, additional cryotherapy is performed . 3. The method according to claims 1 and 2, characterized in that every 3-5 days, until the lesion is completely eliminated, when a lesion is detected after laser evaporation of incomplete destruction, a soft dosage form is applied to its surface and cryotherapy is performed.

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