RU2387447C1 - Method of treating benign skin mass in children - Google Patents

Abstract

FIELD: medicine. ^ SUBSTANCE: treating benign skin mass in children is ensured by liquid nitrogen cryodestruction of pathological biological tissues. That is preceded with application EMLA 5% cream under occlusive dressing. The cream is dosed no more than 1 g per 10 cm2 with the exposition 30 minutes. ^ EFFECT: method allows relieving the pain sensations in the patient during manipulation, improving effectiveness of cryotherapy ensured by pharmacological intensification thereof. ^ 2 ex

Description

The invention relates to medicine and can be used in the treatment of children with benign skin formations by cryodestruction with liquid nitrogen.

Cryogenic methods of treatment are widely used in the treatment of hemangiomas, telangiectasias, pigmented nevi, warts, keloid and hypertrophic scars and other skin formations in children (Shafranov V.V., Kozhevnikov V.A. Combined treatment of hemangiomas and other benign skin formations in children. Guidelines. M., 1994 .; Fedotov V.K. Sparing cryosurgery of the skin in children. N. Novgorod, 2001).

Traditionally, cryodestruction in children is performed without pain relief. It is believed that exposure to a child with low temperatures is a painless procedure, however, in clinical conditions the opposite picture is noted.

In some cases (cavernous hemangiomas, hemangiomas of complex anatomical locations, keloid and hypertrophic scars) additional equipment for cryo-reinforcement is required.

There is a method for the destruction of vascular tumors in children by exposing a pathologically altered portion of a microwave tissue tissue to an electromagnetic field with a non-invasive emitter (RU 2157134, A61B 18/18).

The specified technique does not provide for anesthesia of patients during the procedure, and also requires the presence of additional expensive equipment.

The closest in technical essence is a method of treating various types of hemangiomas. Simple hemangiomas with a depth of up to 5 mm and a surface of up to 5 cm ^{2 are} exposed to cryodestruction at a temperature of -180 ° C to -80 ° C for 15-600 s. Cavernous hemangiomas with a depth of up to 2.5 cm and a surface of up to 100 cm ^{2 are} exposed to an ultra-high-frequency electromagnetic field to a temperature of irradiated tissues of 37-41 ° C for 1-10 minutes, followed by cryodestruction at a temperature of from -196 ° C to -80 ° C within 15-600 s. Hemangiomas of complex anatomical localization with a depth of up to 20 cm and a surface of more than 100 cm ^{2 are} exposed to an ultra-high-frequency electromagnetic field in the mode of destruction to a temperature of irradiated tissues of 45-80 ° C for 3-10 min (RU 2233136, А61В 18/00).

The method allows to increase the effectiveness of the treatment of hemangiomas, however, it does not provide for anesthesia of the procedure, which reduces the quality of life of patients during the manipulation and in the first hours after its completion, and also requires additional expensive equipment.

The task is to reduce pain and thereby improve the quality of life of children with benign skin formations during cryotherapy and in the first hours after its completion, as well as to increase the effect of pharmacological cryo-reinforcement without the use of additional equipment.

The solution to the problem is carried out using the cream "EMLA" 5% in a dose of 1 g / 10 cm ² under an occlusive dressing with an exposure of 30 minutes.

The proposed method is as follows. In place of the proposed cryotherapy, the cream “EMLA” 5% is densely applied, but not more than 1 g / 10 cm ² , after which an occlusive dressing (of the Tegaderm type) is applied. Exposure time 30 min. Next, the bandage is removed, and the remaining cream is removed with a dry swab. After removing the dressing, cryodestruction is performed on a pre-anesthetized area with a metal applicator corresponding to the shape and size of the skin formation, cooled with liquid nitrogen. The duration of the procedure is from 20 seconds to 2 minutes, depending on the nature and localization of the pathological process. At the end, the site of exposure is treated with an antiseptic (70% alcohol, a solution of brilliant green, etc.) and protected by an aseptic dressing.

EMLA Cream 5%, being a mixture of local amide type anesthetics (lidocaine and prilocaine), blocks the transmission of pain impulses along sensitive nerve fibers in the area of the drug, so significantly improves the quality of life of patients during cryotherapy. An increase in the hydrophilicity of tissues in the local area of influence of EMLA cream 5% increases the destruction zone due to a change in the kinetics of crystallization of liquid elements of biological tissues during their freezing and thawing and thereby increases the overall effectiveness of cryotherapy.

The analysis showed that earlier, for the anesthesia of the skin in the cryoinfluence zone, the EMLA cream was not used in children's practice. This meets the patentability criterion of "novelty." An analysis of the sources of scientific and technical information confirmed the existence of the criteria of the invention "significant differences".

Examples of specific performance.

Extract from the medical records of outpatients No. 13217.

Lepikhin Mikhail Maksimovich, born March 29, 2008, lives at the address: Stavropol, st. Serova 480-91. I was outpatiently treated by a pediatric surgeon at the Regional Children's Clinical Clinic in Stavropol on September 11, 2008.

The boy was referred for treatment to a pediatric surgeon at the Regional Children's Advisory Clinic in Stavropol from the Children's City Clinic No. 2 with a diagnosis of Capillary hemangioma of the frontal region.

Complaints on admission for the presence of education in the frontal region.

For the first time, parents noticed a red spot of 1 mm in diameter at the age of 1.5 months of life. Over the past 3 months, there has been an increase in education, for which they sought medical help from a pediatric surgeon at a local clinic.

Locally: in the frontoparietal region at the border of hair growth, a bright red spot up to 0.5 cm in diameter is visualized, not rising above the skin surface, turning pale when pressed.

Diagnosis: capillary hemangioma of the frontoparietal region.

Under local anesthesia (EMLA cream 5% application for 30 minutes under an occlusive dressing), cryosurgery of the formation was performed with liquid nitrogen, an applicator with an exposure of 30 seconds. Ace. bandage. Recommendations for care are given.

During the manipulation by the child, the manifestations of anxiety and pain were minimal. With further observation, an increase in the volume of cold damage to pathological tissues was noted. Repeated cryotherapy was not required.

Extract from the ambulatory card of the patient No. 19083.

Ksenia Yuryevna Polosina, born on July 5, 2008, residing at the address: Stavropol, Peredovoy 6-7. I was outpatiently treated by a pediatric surgeon at the regional children's advisory clinic in Stavropol on September 19, 2008.

Complaints on admission for the formation of abdominal skin.

Sick from birth when a bright red formation was noticed on the skin of the anterior abdominal wall. According to the parents, the area of education grows in accordance with the growth of the child, but it began to rise above the level of the skin and became brighter. Independently turned to the children's surgeon of the Regional Children's Advisory Clinic in the city of Stavropol.

Locally: on the anterior abdominal wall in the left hypochondrium there is a bright red formation of a triangular shape of 1.5 × 1.0 × 0.5 cm, towering 0.3 cm above the skin surface, tuberous in appearance of a raspberry berry, turning pale when pressed.

Diagnosis: capillary hemangioma of the anterior abdominal wall.

Under local anesthesia (EMLA cream 5% application for 30 minutes under an occlusive dressing), cryosurgery was performed with liquid nitrogen, an applicator with an exposure of 45 seconds. Ace. bandage. Recommendations for care are given.

During the manipulation by the child, the manifestations of anxiety and pain were minimal. With further observation, an increase in the volume of cold damage to pathological tissues was noted. Repeated cryotherapy was not required.

Using the proposed method allows you to:

- the use of EMLA cream 5% in cryosurgery of skin lesions in children improves the quality of life of patients during the procedure and in the first hours after its completion by relieving pain in comparison with cryotherapy without pain relief;

- an increase in the hydrophilicity of tissues in the local area of influence of EMLA cream 5% increases the zone of destruction of vascular formations by changing the kinetics of crystallization of liquid elements of biological tissues during their freezing and thawing and thereby increases the overall effectiveness of cryotherapy;

- an increase in the hydrophilicity of tissues in the local exposure zone of EMLA cream 5% increases the destruction zone of superficial benign skin epithelial formations by changing the crystallization kinetics of liquid elements of biological tissues during their freezing and thawing and thereby increases the overall effectiveness of cryotherapy;

- the use of EMLA cream 5% before cryodestruction of skin formations, being a factor in enhancing the freezing of biological tissues, in fact, is a combined cryosurgical treatment and eliminates the use of expensive additional equipment used for cryo-amplification (low-frequency ultrasonic and laser power units, microwave ovens therapy, etc.).

Claims (1)

A method for the treatment of benign skin lesions in children, including cryodestruction of pathological biological tissues with liquid nitrogen, characterized by preliminary application of 5% EMLA cream under an occlusive dressing in a dose of not more than 1 g per 10 cm ² with an exposure of 30 minutes.