SU1273113A1 - Method of treatment of chronic nonspecific ulcerative colitis - Google Patents

Abstract

The invention relates to medicine, for the treatment of nonspecific ulcerative colitis. The purpose of the invention is to reduce the time of treatment by using freshly isolated donor leukocyte mass with a shelf life of not more than a day. The patient underwent colonofibroscopy, specifying the localization and prevalence of the lingual process. Then, an injection needle is inserted through the biofusion channel of the colonofibroscope, ulcerative defects are cut off with its help, starting with the rectum and passing to the higher sections, with the simultaneous introduction of 30 to 90 ml of freshly donated donated leykomassy. At the same time, oral treatment with oral sulphasalazyl is used.

Description

Yu

The invention relates to medicine and concerns the treatment of various forms of unspecific ulcerative colitis. The aim of the invention is to reduce the treatment time for patients by using freshly isolated donor leukocyte mass. The method is carried out as follows. The patient is prepared for colonofibroscopy. The patient does not eat dinner. At 22 h he is given a cleansing enema with water at a temperature of 36-37 ° C with a volume of 2-2.5 l. At night, a study gives you 1 tablet of seduxen. 2 hours before the examination, the patient was again given a cleansing enema with water of the same temperature in a volume of I, 5-2 liters. The day before the examination, a leukomass was ordered at the blood transfusion station, so that on the day of its introduction the storage period was no more than a day. The study was conducted in a specially equipped endoscopy room. The patient is placed on a special table in the position on the left side and a sigofibroscope is introduced by OLIMPAS KF-MB-3, KF-MB-ZR. An inspection of the direct, sigmoid, descending, transverse, ascending, and cecum intestines is performed, specifying the localization and prevalence of the lingual process. Then, an OLYMPAS injection needle is inserted through the biopsy channel of the sigmo-fibroscope or kolonofibrok.opa. produced at intervals of 7 days. Example 1. Patient K., 32 years old, suffers from nonspecific ulcerative colitis (UC) for 5 years with daily exacerbations, for which he is treated permanently for 23 months of sulfasalase On the last hospitalization in 1983, due to the ineffectiveness of treatment with sulfasalazine, treatment with prednisone at a dose of 30 mg was added. In January 1984, the general condition worsened, the temperature rose to 38-39 C, followed by frequent loose stools (up to 10 times) with an admixture blood and mucus, patient 132 lost 4 kg during the month, was referred for inpatient treatment to the clinic.Colonofibroscopy was performed on 01/10/84. The device was inserted into the transverse colon. Further its introduction is difficult because of the pronounced spasm and swelling of the intestinal mucosa. In the inspected areas, the mucous is intensely hyperemic and edematous, with multiple erosive ulcer overlays from 0.3 to 1.2 cm, sometimes forming deep ulcers of 0.5-0.8 cm. These changes are most pronounced in the direct, sigmoid and descending intestines. , physiological sphincters are smoothed, bowel tone is elevated. The patient was injected with 30 ml of donor leukocyte mass (Chetverik donor, 09.0-1.84), mainly in the rectal area. After a week, some improvement was noted: stool up to 8 times a day, blood excretion continues, temperature 37-38 ° C. Repeated examination conducted 01/17/84. The colonoscope is inserted up to the intestine. In the transverse, descending, and sigmoid colon areas, there are no speakers, multiple erosive ulcers remain, and there is intense hyperemia of the mucous membrane. Positive dynamics was observed in the rectal area: there were practically no large sores, the number of erosions was significantly reduced, and granulation along the anterior and posterior walls were determined. 30 ml of freshly isolated donor leukomassy (Sizov donor, 1/16/84) was reintroduced. After a week, there was a slight improvement in the general condition: the temperature was 37-37.6 ° C, the stool was 6 times a day, the excretion of blood somewhat decreased. A control examination was performed on January 24, 1995. The device was reintroduced to the intestine. Compared with the previous survey, there is a positive trend: single erosion is detected in the right exciso, the s / 3 sigmoid colon is practically undetermined, but multiple erosions persist, there are granulations in the anterior and posterior walls, in the descend there are no positive dynamics of the transverse colon and the colon. 30 ml of granulocyte concentrate was introduced (donor Evteev, 01.23.84). A week later, clinical improvement was noted: temperature 3–37–37.5 ° C, stool 4 times a day, decreased blood excretion, and patients had an appetite. Control examination was carried out on 3.01.84. Compared with the previous survey, there is no positive dynamics in the transverse and descending intestine. In the area of the rectum, ulcers and erosions are not detected, in n / 3 and c / 3 of the sigmoid colon, isolated erosions and pronounced granulations are retained, the swelling of the mucous membrane in these areas is significantly reduced. In a / 3 sigmoid colon, multiple erosion and hyperemia of the mucous membrane are retained, almost completely undetectable. 30 ml of donor freshly isolated leucomass (donor Kazantsev, 30-.01.84) were introduced mainly in the region of the 3 sigmoid colon. During the week, clinical examination data with insignificant dynamics: the chair remains up to 4 times per day with blood admixture, the temperature is 37-37.2 ° C, the general weakness has somewhat decreased. Control examination conducted 7.02.84. Compared with the previous examination in the transverse and descending intestines there is no positive dynamics. In the area of the rectum and the entire sigmoid colon, up to the descending, there is good positive dynamics: isolated erosion in the / 3 sigmoid colon is observed, the number of erosions significantly decreased in the downgut. practically undefined, in all these sections, especially in the rectum and sigmoid colon, multiple granulations, in places of pseudopolypose form, in places of shagreen. 30 ml of donor freshly isolated leucomass (Donor Telenkov VI, 6.02.84) was injected predominantly into the region of the descending colon. A week later, a good clinical effect was obtained: stool up to two times a day with a small amount of blood, temperature 37-37.2 ° C. Control examination was conducted on 02/14/84. Compared with the previous survey, there is a positive trend: in the transverse colon, isolated ulcers, the size of which decreased by 0.6 to 0.5 cm, in the same department there are multiple erosion in the region of the downward KII1KI not determined, erosion persists, the size and number of which have decreased, in the area of the direct and sigmoid colon, the data are the same. Introduced 30 ml of granulocyte concentrate (donor. Antonov, 13.02.84). During the week, the dynamics of the clinical data are good: the temperature returned to normal, the stools up to once a day with a small amount of blood. Control examination conducted 21.02.84. Compared with the previous survey, there is a positive trend: erosion remains in the transverse colon, almost no infection is determined, in the direct, sigmoid and descending intestine ulcers and erosions are not detected, the pseudopolypic mucosa and parts of the shagreen form are found in places. 30 ml of freshly isolated donor leukomassy (donor Timofeev, 20.02.84) were introduced, the clinical data are the same. Control examination conducted 02.28.84. Compared to the previous survey, in the transverse colon single erosion, multiple granulations, in the descending, sigmoid and rectum, the data are the same. Introduced 30 ml of freshly isolated donor leykomassy (donor Aleksandrov, 27.02.84). 1 Clinic: the temperature is normal, the stool is one-time without pathological impurities. The patient was discharged in a satisfactory condition. Due to the introduction of donor leukomassy, it was recommended that hormonal drugs be rejected. EXAMPLE 2. Patient R., 43 years old, suffers from NUC for 7 years with annual exacerbations. In the last three years, hormone preparations prednisone and triamcinolone were used in the usual dosage. Last exacerbation - within 2 weeks. In early March 1984, sharp pains predominantly occurred in the left half of the abdomen, severe weakness, repeated loose stools with a large amount of blood during each defecation event (up to 15 times a day), temperature rise to 38-38.5 ° C. Directed to the clinic for treatment.

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Colonofibroscopy was performed .84, A coloscope was inserted before the dome of the cecum. In the areas of direct, sigmoid, descending, transverse and ascending intestines - multiple linear and oval shaped ulcers with dimensions of 0.4-1, S cm, around multiple erosion, in places forming contacting surfaces, when in contact with the device, are pronounced contact sanguises; the mucous in these areas is intensely hyperemic, edematous, with multiple submucous hemorrhages. In the area of the direct and n / 3 sigmoid colon 90 ml of freshly isolated donor fluid mass (donor Guimaev, 9.03.84) were injected. After a week, the clinical dynamics were insignificant: the temperature was the same, the stool was 15 times a day, the discharge of blood at each defecation event was slightly reduced , pain syndrome decreased, general weakness maintained.

Control examination conducted 17.03,84. Compared with the previous survey, there is a positive trend: in the area of the direct and sigmoid colon, no ulcer is detected, the number of erosions has significantly decreased, in the descending, transverse and upstream intestines the picture is the same. 90 ml of freshly added donor leukomass were introduced mainly into the zone of the descending colon (donor Evsikov, 03/16/84). On the 56th day after the administration, the dynamics of the clinical picture of the disease was noted: the fever decreased to 37-37.5 ° C, the blood flow decreased during bowel movements 9 times a day, the pain syndrome significantly decreased.

Control examination conducted. 24.03.85. Compared to the previous survey, there are half-hearted dynamics: in the area of the rectum and sigmoid colon, isolated erosions were observed, - in the region of the descending intestine there was no infection, the number of erosions significantly decreased, in transverse colon and ascending kigaks, the links decreased in size , by E1Is isolated granulation. 90 ml of freshly blasted donor leukomassy were introduced, mainly in the area of the transversely intestine Sdonor Kolesnikov, 23.03.84). In the clinical picture of the disease: significant improvements;

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stool 5 times a day, pain practically does not bother, temperature returned to normal.

Control tests were performed on 31.03,84. Compared to the previous one, the mucous membrane in the direct, sigmoid and descending intestines is uneven with pseudo-polypous growths, there are small areas of the hyperemic mucosa, in the transverse-colon and ascending intestines the infections are almost undetectable, granulation growths, single erosions of the mucous membrane, no contact bleeding. 90 ml of freshly isolated donor leukomassy (donated Chertkov, 30.03.84) were introduced. After 4 days, the stool is once a day without impurities of mucus and blood, there is no abdominal pain. All treatment was carried out against the background of sulfasalase in the usual dosage. The patient was discharged in a satisfactory condition. Thus, the use of donor leykomassy allowed us to refuse taking glucocorticoids and to obtain a good clinical effect,

EXAMPLE 3. Patient S., 39 years old, has had NUC for three years with annual exacerbations, which is treated permanently, during the last hospitalization with prednisolone 40 mg. During September 1984, intense pains predominantly occurred in the left half of the feces, painful defecation up to 8 times a day with a large amount of: blood and mucus, a decrease in temperature to 37-37.5 ° C. Sent to the clinic.

Claims (1)

At the initial examination, Kolofofibroskopi was performed on 09/07/84, the Kolonofibroskop was inserted before the intestine, - The further introduction of the device is difficult due to the painful sensations in the patient. The mucous in the area of the direct, sigmoid and descending intestines is actively hyperemic and edematous, almost all the walls are covered with multiple erosions 0.3-0.3 cm in size, oval and linear in shape, with numerous pharynxes covered with grayish fibrinous bloom, size 0.4- 1.6 cm, in the area of the transverse colon and ascending intestine of the mucous is actively hyperemic and edematous, with non-unit sub7 mucous hemorrhages. 15 ml of granulocyte concentrate was introduced predominantly in the rectal area (donor Katkov, 06.09.84). During the week, there was no positive clinical dynamics: there is a pronounced pain syndrome, the same stool frequency and a large amount of blood remain. A follow-up examination was conducted on 09/14/84. Positive dynamics were noted, the number of erosions in the rectum somewhat decreased. Introduced 20 ml of freshly isolated donor leykomassy to the bottom of Evremov 13,09,84). During the week of the clinic, the picture is without significant dynamics: there is pain syndrome, a chair up to 6 times a day with a large amount of mucus and blood. Control tests were carried out on 21.09.84. An insignificant positive dynamics was noted: the number of ulcers in the rectum decreased, isolated granulations appeared, the fibrinous overlaps decreased, in the rest the data was the same. 25 ml of donor leukomass were introduced mainly in the rectum and sigmoid colon. During the week, there was a clinically weak positive dynamics: pain syndrome somewhat decreased, stool up to 6 times a day with the release of blood. Control tests were performed 28.09.84, Compared to a previous survey showed a positive trend: the decrease in ko138. The number of erosions in the rectum and sigmoid colon, but the links of the previous size remained, there are granules in place at the site of the former colon in the rectum, the rest of the data are unchanged. This clinical example shows the ineffectiveness of administering a freshly isolated donor leukomassy in a dose of less than 30 ml per session. The treatment was carried out against the background of sulfasalazine in the usual dosage. The introduction of a donor leukocyte mass in the amount of 92 MP was accompanied by a concomitant complication in the form of increased pain syndrome, fever, decrease in blood pressure. According to the proposed method, the duration of inpatient hospital treatment is 37 ± 2.8 days, and by a known method - 58 ± 3.6 days, the claims of the method of treating chronic nonspecific ulcerative colitis by administering drugs to the pathological focus and oral use of sulfasalazine, characterized in that ascheni terms of treating a patient is administered weekly by injecting donor freshly isolated buffy coat in an amount of 30-90 mp 8-4 times per course of treatment.