RU2321395C1 - Method for treating patients for acantholytic bladderwort - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves administering corticosteroid preparations and cytostatics. Intravenous drop infusions of 1.5% Reamberin solution are additionally introduced beginning from the seventh treatment day in the amount of 400 ml once a day during 10 days.

EFFECT: reduced risk of adverse side effects and complications.

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Description

The present invention relates to medicine, namely to dermatology, and can be used to treat patients with acantholytic pemphigus.

This is one of the most severe dermatoses with an unclear etiology, having autoaggression in the pathogenesis directed against desmosome proteins of the cells of the prickly epidermis layer, characterized by the appearance of numerous flaccid blisters and painful erosion on the skin and mucous membranes, accompanied by severe intoxication [1].

As a prototype, the method of treatment of patients with acantholytic pemphigus with basic drugs, the action of which is aimed at actively suppressing autoimmune reactions, is selected. Such drugs are systemic corticosteroids (prednisone, dexamethasone, polcortolone, etc. [2]) and cytostatics (methotrexate and others [3]). Therapy begins with the use of corticosteroids in doses corresponding to the patient’s body weight and the clinical picture of the disease. In some cases, cytostatics are used as monotherapy, more often in combination with glucocorticosteroids.

However, prolonged use of these drugs in large doses increases the risk of side effects and serious complications, the mortality rate from which reaches 8% [link].

The objective of the invention is to reduce side effects and complications from the use of corticosteroid drugs and cytostatics.

The problem is solved in that in addition, starting from the 7th day of treatment, drip infusions of a 1.5% solution of the Reamberin preparation are carried out in a volume of 400 ml once a day for 10 days.

Reamberin is a domestic drug, characterized as a balanced isotonic polyionic detoxifying infusion solution. The drug has antihypoxic, antioxidant, detoxification, as well as hepato-, nephro- and cardioprotective effects.

Antihypoxic and antioxidant effects are realized mainly due to succinic acid, which is part of reamberin.

The therapeutic effect of succinic acid and its compounds is based on a modifying effect on the processes of tissue metabolism - cell respiration, ion transport, protein synthesis [4].

The wide spectrum of action of reamberin is due to the following molecular biological effects:

- a decrease in the intensity of endogenous intoxication by reducing the duration of lipid peroxidation (LPO);

- increase in antitoxic function of the liver;

- increased oxygen consumption by tissues, including skin;

- increased compensatory activation of aerobic glycolysis;

- An increase in the pool of natural antioxidants.

Reamberin was effective in acute conditions in toxicology, multiple organ dysfunction, sepsis, acute cerebrovascular accident as part of complex therapy [5].

The method is as follows.

A patient with a confirmed diagnosis of acantholytic pemphigus is prescribed systemic corticosteroids at a dose adequate to the clinical picture of the disease. On the 7th day, an additional 1.5% reamberin solution of 400 ml is added once a day by intravenous drip for 10 days.

EXAMPLES OF SPECIFIC EXECUTION

Example 1

Patient M., 52 years old, medical history No. 2154, was admitted to the Federal State Institution Nizhny Novgorod NIKVI on November 15, 2004 with complaints of painful erosion on the oral mucosa, burning sensation, hypersalivation, pain when swallowing. Diagnosis: Pemphigus vulgaris. Confirmed by the presence of acantholytic cells in smears-prints. The treatment was carried out: systemic corticosteroids in a daily dose of 85 mg with a gradual decrease upon reaching a clinical effect; on the 7th day, a 1.5% reamberin solution of 400 ml / cap daily for 10 days was added. A comparative analysis of biochemical parameters before and after treatment revealed a decrease in the concentration of lipid peroxidation products and an equalization of concentrations of tricarboxylic acid cycle intermediates. The patient was discharged with the disappearance of clinical manifestations.

Example 2

Patient F., 55 years old, medical history No. 2422, was admitted to the Federal State Institution Nizhny Novgorod NIKVI on December 20, 2004 with complaints of rashes on the skin of the chest, back, and upper limbs. Sick for 14 years. It is treated at NIKVI annually. Received with a relapse of the disease. Diagnosis: Pemphigus vulgaris. Confirmed histologically and cytologically. The treatment was carried out: systemic corticosteroids in a daily dose of 20 mg, methotrexate 50 mg per course; on the 7th day, a 1.5% solution of reamberin, 400 ml / cap daily, was added for 10 days. Discharged with the disappearance of clinical manifestations.

The results of the biochemical examination after treatment had the same trends as in example 1.

Compared with the previous hospitalization, there were no complications and side effects of therapy.

Example 3

Patient L., 76 years old, medical history No. 215, was admitted to the Federal State Institution Nizhny Novgorod NIKVI on January 31, 2005 with complaints of rashes on the skin of the trunk and extremities, accompanied by moderate itching, and painful erosion on the oral mucosa, severe weakness. Diagnosis: pemphigus vulgaris. Cytologically confirmed. Treatment: systemic corticosteroids in a daily dose of 65 mg; on the 7th day, a 1.5% solution of reamberin in a dose of 400 ml / cap daily for 10 days was added. Discharged with the disappearance of clinical manifestations.

Example 4

Patient V., 62 years old, medical history No. 854, was admitted to the Federal State Institution Nizhny Novgorod NIKVI on April 20, 2005 with complaints of rashes on the skin of the face, scalp, chest, back and upper limbs, soreness in the foci, intense itching, weakness. Diagnosis: erythematous pemphigus. The diagnosis is histologically confirmed; acantholytic cells were found in fingerprint smears. The treatment was carried out: systemic corticosteroids in a daily dose of 90 mg in terms of tablet prednisolone taking into account body weight; on the 7th day, a 1.5% solution of reamberin in a dose of 400 ml was added intravenously daily for 10 days. Discharged with the disappearance of clinical manifestations.

In this way, 9 patients with acantholytic pemphigus were treated in Nizhny Novgorod NIKVI.

The advantages of the proposed method in comparison with the prototype are as follows.

1. Increasing the effectiveness of treatment, which consists in reducing the total dose of corticosteroid hormones and cytostatics, reducing side effects from these drugs. A comparative analysis of the development of side effects and complications in patients receiving standard therapy (prototype) and treated by the proposed method are presented in table 1.

2. Shortening the length of stay of patients in the hospital by 7% compared with the control group.

3. Improving the well-being of patients and reducing the phenomena of intoxication (according to laboratory tests) in comparison with patients in the control group.

Analysis of scientific, technical and patent information showed that the proposed method is new and meets the criterion of "inventive step".

Table 1. Name of complication or side effect The frequency of complications or side effects,% Prototype The proposed method High blood pressure fifty 22 Impaired glucose tolerance fifty 22 Increased white blood cell count 63 56 The development of Itsenko-Cushing's syndrome 63 44 The development of acute or exacerbation of chronic gastroduodenitis or gastric ulcer fifty 33 General weakness fifty 33

LITERATURE

1. Skripkin Yu.K. Skin and Sexually Transmitted Diseases: A Guide for Physicians. - M .: Medicine, 1996. - S.247-295.

2. Torsuev N.A., Sheklakov N.D., Romanenko V.N. Bullous dermatoses. - M.: Medicine, 1979. - S.9-120.

3. Mashkillayson A. L., Antonova T. N., Glebova L. I. Combination therapy of pemphigus with corticosteroids and methotrexate // Bulletin of Dermatology and Venereology. - 1977. - No. 3. - S.60.

4. Afanasyev V.V. Clinical Pharmacology of Reamberin: A Manual for Doctors. - St. Petersburg. 2005.

5. Obolensky S.V. Reamberin - a new tool for infusion therapy in the practice of medicine of critical conditions: guidelines. - St. Petersburg, 2002.

Claims (1)

A method of treating patients with acantholytic pemphigus, which consists in the appointment of corticosteroid drugs and cytostatics, characterized in that, additionally, starting from the 7th day of treatment, intravenous drip infusions of a 1.5% solution of Reamberin in a volume of 400 ml once a day are carried out within 10 days.