RU2325919C1 - Method of cardiospasm medical treatment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to gastroenterology and surgery and concerns cardiospasm medical treatment. For this purpose affected and abnormal areas of mucous and submucous membrane of oesophagus in oesophageal-cardial transition are endoscopic injected with agent consisting of alloplant-stimulator of connective tissue regeneration, alloplant-stimulator of phagocytosis, and stimulator of nervous structure regeneration (SNSR). To make SNSR subcortical structures are taken from allogenic donor cerebrum, rinsed in physiologic saline, frozen in cryogenic chamber and lyophilised under vacuum. Components proportion in finished agent mass %: biomaterial alloplant - stimulator of connective tissue regeneration 35-45, biomaterial alloplant - stimulator of phagocytosis 35-45, stimulator of nervous structure regeneration 10-30. Affected areas are injected in 3-7 points dosed 1-2 ml to each point. Treatment is carried out by courses in number 2-10 with intervals 1-3 weeks. Method provides complex effect on reparative regeneration of blood vessels, nerve endings and nerve fiber, causing normalisation of metabolism processes in affected area and restoration of functional activity of oesophagus.

EFFECT: normalisation of metabolism processes in affected area and restoration of functional activity of oesophagus.

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Description

The invention relates to medicine and is intended for the treatment of cardiospasm - a disease associated with the absence of reflex opening of the cardia.

The main reason for the development of cardiospasm is the degeneration of the ganglion cells of the intramural plexus. Dystrophy of nerve fibers occurs with a loss of their structure. In the intermuscular layers, proliferation of connective tissue occurs, which divides the muscle fibers into separate complexes. The mucous membrane of the esophagus becomes rough, devoid of folds, complete agangliosis is found in the nervous network.

Surgical treatment of cardiospasm is known by expanding the cardia using bloodless or surgical methods. Bloodless refers to cardiodilation, which is widely used in clinical practice. In this case, complications are possible in the form of gastric bleeding, perforation of the esophagus, etc.

Surgical methods include cardioplasty with a diaphragmatic flap according to Petrovsky (Big Soviet Medical Encyclopedia, v.10, p.145). Cut out the flap from the diaphragm. Through the arising defect in the diaphragm, the cardia is expanded with a finger through the invaginated wall of the stomach and the excision of the muscle membrane is completed. The flap is first sutured along the inner edge of the myotomy region, starting from the bottom, and then along the outer. After that restore the integrity of the diaphragm.

The disadvantage of surgical methods of treatment is a great trauma, the development of diverticulums, scars, deforming cardia.

Closest to the proposed is a method of treating cardiospasm by endoscopic blockade of the esophageal-gastric transition with atropine, a mixture of alcohol with novocaine (O.V. Galimov, D.M.Dmitriev, G.A. Abdullina "Endoscopic methods for the diagnosis and treatment of diseases of the esophagus and cardia" , Neftekamsk, 2000, p. 124-125).

However, this method of treatment is not sufficiently effective and is used only with early manifestations of cardiospasm.

The objective of the invention is to increase the effectiveness of the treatment of cardiospasm by eliminating the etiological factor - impaired nervous regulation.

The problem is solved by the method of treating cardiospasm by endoscopic injection of affected and altered sections of the mucosa and submucosa of the esophagus in the area of the esophageal-cardiac transition with drugs, in which, unlike the prototype, the Alloplant biomaterial consisting of a connective tissue regeneration stimulator and a phagocytosis stimulator in combination with a stimulator of regeneration of nerve structures, which is obtained from subcortical structures of allogeneic donor brain, which, after rinsing in saline solution is frozen in a cryogenic chamber and freeze-dried under vacuum, with the following component ratio, wt.%:

Alloplant biomaterial - regeneration stimulator connective tissue 35-45 Alloplant biomaterial - phagocytosis stimulator 35-45 nerve regeneration stimulator 10-30,

moreover, chipping is carried out along the perimeter of the affected areas at 3-7 points, 1-2 ml in each, and treatment is carried out in courses in an amount of 2-10 with intervals between them 1-3 weeks.

The proposed method due to the use of multicomponent biomaterial for chipping the affected areas of the esophagus provides a comprehensive effect on the reparative regeneration of blood vessels, nerve endings and nerve fibers. Thanks to this, metabolic processes are normalized and the functional activity of the esophagus is restored.

The unique properties of Alloplant biomaterial obtained from donor cadaveric material are known (RF patent No. 2189257, IPC A61L 27/00, A01N 1/00, publ. 09/20/2002), which allow its use in various fields of medicine.

The proposed method uses well-known components of Alloplant biomaterial (TU 42-2-537-2002), approved for wide clinical use (Alloplant biomaterials for regenerative surgery. Information letter of the Ministry of Health of the Russian Federation, Moscow-Ufa-2004):

- the stimulator of regeneration of connective tissues contains the entire spectrum of tissue components involved in the construction of the main substance of the connective tissue, the regulation of the processes of growth and differentiation of cells.

- the phagocytosis stimulator performs the function of resorbing coarse connective tissue and scar tissue as a result of the release of the proteoglycan complex and the growth of the macrophage cell population, which releases the intramuscular nerve plexuses from the scars and restores the function of cholinergic and adrenergic receptors of the affected areas of the cardia.

A composition of brain tissue with a high content of neurotrophic factors (nerve growth factor, cerebral neurotrophic factor, neurotrophins, gangliosides, etc.), which are known to act on nerve endings and restore the function of affected nerves, is used as a stimulator of regeneration of nerve structures (Ashmarin I. .P., Stukalov P.V. Neurochemistry, Moscow: Institute of Biomedical Chemistry, Russian Academy of Medical Sciences, 1996 - 470 p .; Semchenko V.V. et al. Neurotransplantation: Textbook. - Omsk, 2004. - 308 from.). The specified composition is prepared as follows. From the allogeneic donor brain, prepared in accordance with the Law of the Russian Federation “On transplantation of organs and (or) human tissues”, subcortical structures (in particular, the hippocampus and brain stem) are separated, which are rinsed in physiological solution from tissue fluid, then frozen in cryogenic chamber and freeze-dried under vacuum. The dried material is crushed, Packed in glass bottles and sterilized by the radiation method at a dose of 2.5 Mrad.

The method is as follows. Under aseptic conditions, Alloplant biomaterial - a stimulator of regeneration of connective tissues (35-45 wt.%), Alloplant biomaterial - a phagocytosis stimulator (35-45 wt.%) And biomaterial - a stimulator of nerve structure regeneration (10-30 wt.%) Are mixed in aseptic conditions. ) The resulting mixture was diluted in 10 ml of a 2% lidocaine solution. An esophagoscopy is performed. Visible affected areas of the esophagus, esophagus-cardiac junction are chipped with the prepared preparation using an Olympus NM-3K injector. Chipping is carried out around the perimeter of the changed areas in 3-7 points of 1-2 ml each until pronounced infiltration of the mucous and submucous affected areas and the formation of a visible depot of this drug. Treatment is carried out with courses in an amount of 2-10 with an interval between them of 1-3 weeks.

Clinical examples.

1. Patient N., 44 years old with a clinic of cardiospasm of the 3rd degree (cicatricial changes in the cardia and expansion of the esophagus), compensated form. The duration of the disease is 7 years, it has been repeatedly treated with conservative methods of cardiodilation almost every year. Anamnestically, according to discharge epicrisis, a progression of the course of the disease is noted.

Was treated according to the proposed method in the amount of 3 courses with breaks between them for 2 weeks. Chipping was carried out using a preparation based on a combined biomaterial using the components of the Alloplant series and a stimulator of regeneration of nerve structures along the perimeter of the affected areas at 6 points, 2 ml each. The result is a persistent clinical effect. The permeability of liquid and solid foods has increased, and the diet has expanded significantly. The patient recovered within 2 months by 6 kg, returned to his previous job.

2. Patient 3., 47 years old with a clinic of cardiospasm of the 3rd degree, decompensated form. The duration of the disease is 7 years, asthenization, severe weight loss, only liquid food is observed.

The treatment was carried out according to the proposed method, the chipping was carried out along the perimeter of the affected areas at 7 points, 2 ml each. To obtain a satisfactory clinical result, it took 7 courses of treatment for 3 months.

Subsequently, the patient was followed up for 1.5 years. Every 0.5 years, treatment was carried out according to the specified method in the amount of 3 courses of pricking in 6 points. A persistent clinical result was achieved with the restoration of patency of liquid and solid foods. The patient gained 10 kg in weight, restored working capacity.

Thus, the proposed invention improves the effectiveness of the treatment of cardiospasm due to the complex effect of multicomponent Alloplant biomaterial on the affected areas of the esophagus.

Claims (1)

A method for treating cardiospasm by endoscopic injections of a drug into the affected and altered sections of the mucosa and submucosal esophagus in the area of the esophagus-cardiac transition, characterized in that the drug consists of an Alloplant-stimulator of regeneration of connective tissue, Alloplant-stimulator of phagocytosis, and a stimulator regeneration of nerve structures, which is obtained from the subcortical structures of the allogeneic donor brain, which, after rinsing in Physiological solution, frozen in the cryogenic chamber and freeze-dried under vacuum at following component ratio, wt.%: Alloplant biomaterial - regeneration stimulator connective tissue 35-45 Alloplant biomaterial - phagocytosis stimulator 35-45 nerve regeneration stimulator 10-30, moreover, chipping is carried out along the perimeter of the affected areas at 3-7 points of 1-2 ml per each, and treatment is carried out in courses of 2-10 with intervals between them 1-3 weeks.