SU1524903A1 - Method of treatment of psoriasis - Google Patents

Abstract

The invention relates to medicine, namely to dermatology and can be used to treat psoriasis. The aim of the invention is to lengthen the terms of remission. The goal is achieved by performing oxygenation of the blood simultaneously with hemodilution under a pressure of 0.5-0.8 atmospheres and performing ultrafiltration and hemosorption in the amount of 2.0-2.5 circulating blood volume. The method makes it possible to lengthen the remission period to 14.5 months. 1 il.

Description

The invention relates to medicine, namely to dermatology, and can be used to treat psoriasis.

The aim of the invention is to lengthen the terms of remission.

According to the proposed method, blood oxygenation is carried out simultaneously with hemodelivery under a pressure of 0.5-0.8 atmospheres and ultrafiltration and hemosorption are performed in an amount of 2.0-2.5 circulating blood volume (BCC).

The drawing is a diagram explaining the proposed method.

The method is carried out as follows.

After catheterization of the femoral vein and heparinization of the patient's blood is connected to the extracorporeal system (see drawing). The system is pre-washed and filled with heparinized saline (4 ml of heparin per 400 ml of 0.9% NaCl). Turn on the pump 1 with a vacuum of 0.5 ATM. In the exfusion mode, clips 2 and 3 are open, clips 4 and 5 are closed, and strictly

hemodilution (patient's blood is diluted with physiological NaCl solution or 5% glucose solution from tank 6), then using dialyzer 7 (DIP-02-02) oxygenation and ultrafiltration are performed simultaneously, the resulting dialysis ultrafiltrate is sucked out using suction 8 tank 9, hemosorption is carried out (column with sorbent 10), the sorbed blood accumulates in tank 11.

. In the infusion mode, clips 2 and 3 are closed, clips 4 and 5 are open. Blood | re-diluted, oxygenated, ultrafiltered, sorbed and injected into the patient.

Blood oxygenation is carried out by supplying oxygen from a balloon (pressure 0.5-0.8 atm, controlled by a pressure gauge 12) to the external circuit 13 of the dialyzer 7. Blood is supplied to the internal circuit 14 of the dialyzer 7.

As a result of the difference in pressure of oxygen in the external and internal circuits (in the external one there is more diffusion than in the internal one

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from the external circuit to the internal one, therefore, the blood is saturated with oxygen.

The volume of oxygenation, ultrafiltration and hemosorption is 1.5–2 bcc (circulating blood volume), and 1.5–2 ji ultrafiltrate is removed.

After completion of the procedure, a catheter is removed from the femoral vein 15. The puncture site of the femoral vessel is pressed by the swab until the bleeding stops and pressure is applied.

Example 1. Volna V., 26 years old, was hospitalized with complaints of the presence of hemorrhages in the skin of the trunk of the upper and lower extremities, accompanied by itching. Sick 10 years.

Objectively: the rashes are located symmetrically on the skin, mainly on the extensor surfaces of the upper and lower extremities, as well as on the skin of the front surfaces of the thighs, torso, face and scalp. Sshi elements are presented in the form of papules the size of a one-coinage, sometimes merging to form plaques ranging from a ruble coin to an adult’s palm. The color of the rash is bright pink. The surface of the papules and plaques is covered with silver-white scales throughout. When scraping the heels, the symptoms of a stearin spot, a terminal film, a point hemorrhage are caused. In places, there are excoriations covered with hemorrhagic crusts. On the skin of the scalp there are infiltrated plaques the size of a ruble coin, covered with silvery scales. The hair in the lesions is not changed. The surface of the nail plate has a pinhole - a symptom of a thimble. Subjectively: the rash is accompanied by itching.

Diagnosis: disseminated psoriasis, teardrop-plaque, progressive stage, winter-spring type. From 03.02.87 to 12.03.87, the patient received the following treatment:

1. Diet, table number 5.

2.Vitamins B, B ,. in one day

EAT.

3. Mikstura Pavlova.

4. Suprastin 15 days.

5. Videhol 15 days.

6. Sodium thiosulfate in / in 10 days.

about 5

0

0

five

0

five

7. Methionine 15 days.

8. Allohol 15 days.

9. Activated charcoal for 15 days.

10. Calcium chloride 10 days.

11. Mazeva therapy: fluorocort, 2% salicylic ointment.

12. UFO skin.

From the treatment carried out, there was no improvement. The disease progressed and the patient was additionally prescribed polcortolone 5 tablets per day. On the 3rd day of the patient's condition, the condition worsened: around the psoriatic plaques vils intense red halo, itching increased, insomnia developed. Polcortolone was replaced by prednisone, which also yielded no results. I.

It was decided to apply hydroxyeferment therapy, including strictly consistent hemodilution with simultaneous oxygenation, ultrafiltration and hemosorption. According to Seldinger, a percutaneous catheterization of the femoral vein was performed. According to the scheme, an extracorporeal system is assembled, which works in recirculation mode for 30 minutes. After heparinization of the patient (300 U of heparin per kg of weight), the system is connected in the exudation mode and the pump is turned on. In t 6, the exams for shm 2 and 3 are open, the clips 4 and 5 are closed. The patient's blood was diluted with saline from the tank 6, and using the artificial kidney dialyzer 7 (DIP - 02 - 02), oxygenation and ultrafiltration were simultaneously performed. Blood oxygenation was performed by supplying oxygen from a cylinder (pressure 0.5-0.8 atm, monitored by pressure gauge 12) to the external circuit 13 of the dialyzer. Blood was supplied to the internal circuit 14 of the dialyzer. As a result of the difference in oxygen pressure in the external and internal circuits, the ultrafiltrate was removed by suction 8 into the reservoir 9. Hemosorption was carried out, the sorbed blood accumulated in the reservoir 11. In the infusion mode, clips 2 and 3 were closed, clips 4 and 5 were opened. The blood was re-diluted, oxygenated, ultrafiltered, passed through hemosorbent, and the patient was injected. The volume of ultrafiltration and hemosorption performed was 2 bcc (circulating blood volume).

The rate of oxygenation, ultrafiltration, and hemosorption was 96 ml / min. The procedure time was 2.7 hours. After the procedure, the catheter was removed and a pressure band was applied.

The next day after the procedure, the patient stopped the itching of the skin, the intense red halo disappeared around the psoriatic plaques, which turned pale, their infiltration decreased. There were no new lesions. Blood counts improved as well (SchS, immunological and biochemical). The blood pH of the patient was normalized, the base deficit decreased, the standard bicarbonate increased, the hemoglobin saturation of the blood increased from 18.08.87 to 24.08.87, the patient received the following treatment:

1. Diet, table number 5. 2. Expurgatory method 3 days.

3. Calcium gluconate / m 10 days.

4. Suprastin 10 days.

5. Allohol 10 days.

6. UFO under the scheme.

7. Ointment therapy: lanolin cream.

Treatment for a week had no therapeutic effect. The patient was additionally assigned

Polcortolone - 8 tablets per day, asparkam, splenin, ultrasound on the spine. Additional therapy also did not give positive results. September 11, 1987 the pain

thirty

35

with blood, increased blood pO, hemorrhage was carried out with hydroxyelectric terracrit, decreased erythrocyte aggregation indices and the level of serum IR decreased, increased electrophoretic mobility of erythrocytes.

The onset of the clinical effect was observed the day after the procedure, i.e. disappearance of itching, reduction of infiltration, termination of new lesions. Significant remission occurred a week after the procedure.

The patient was discharged from the hospital in a satisfactory condition. When viewed after 7 months, signs of recurrence of the disease were not revealed.

Example 2. Patient L., 50 years old, was hospitalized with a diagnosis of psoriatic erythroderma. The patient complained of chills, a feeling of skin stiffness and itching. Ill with psoriasis for 40 years.

Objectively: BP is 130/85 mm .. mercury., Pulse 70 beats / min. The affected skin is a bright red with a brown tint, for example. Peeling (lamellar), edema, infiltration is noted. Diffuse lesions in the form of plaques covered with whitening scales are noted on the scalp. When scraping papules, it is a symptom of a stearin spot, a terminal film, a point hemorrhage. Mucous membranes are not affected. Nail plates have pinholes - a symptom of a thimble. Subjectively: the rash is accompanied by itching.

PIA, which includes strictly consistent hemodilution with simultaneous oxygenation, ultrafiltration, and hemosorption.

25 According to Seldinger, percutaneous catheterization of the femoral vein was performed (see drawing). According to the scheme, an extracorporeal system was assembled, which was operated in recirculation mode for 40 minutes. After heparinization of the patient (300 IU of heparin per kg of weight), the system was connected in the operating mode and the pump was turned on. In the exfusion mode, clips 2 and 3 are open, clips 4 and 5 are closed. The patient's blood was diluted with saline from the tank 6, and using the dialyzer 7 (DIP-02-02), oxygenation and ultrafiltration were simultaneously performed. Hemosorption was carried out, sorbed

dd blood accumulated in the tank 11. In the infusion mode, clips 2 and 3 were closed, clips 4 and 5. were opened. The blood was re-diluted, oxygenated, ultrafiltered, passed through hemosorbent and injected into the patient. The volume of ultrafiltration and hemosorption was 13 liters. The perfusion rate was 96 ml / min. The duration of the procedure was 3 hours. The amount of the removed ultrafiltrate was 1.7 l. After the procedure, the catheter was removed and a pressure band was applied.

The next day after the procedure, the patient's skin itching significantly decreased, which stopped completely on the second day. Edema, infiltration, on the affected skin decreased on the 3rd day after 50

55

0

five

0, the hydroxefferent tera-

PIA, which includes strictly consistent hemodilution with simultaneous oxygenation, ultrafiltration, and hemosorption.

5 According to Seldinger, percutaneous catheterization of the femoral vein was performed (see drawing). According to the scheme, an extracorporeal system was assembled, which was operated in recirculation mode for 40 minutes. After heparinization of the patient (300 IU of heparin per kg of weight), the system was connected in the operating mode and the pump was turned on. In the exfusion mode, clips 2 and 3 are open, clips 4 and 5 are closed. The patient's blood was diluted with saline from the tank 6, and using the dialyzer 7 (DIP-02-02), oxygenation and ultrafiltration were simultaneously performed. Hemosorption was carried out, sorbed

d the blood accumulated in the container 11. In the infusion mode, the clips 2 and 3 were closed, the clips 4 and 5. were opened. The blood was re-diluted, oxygenated, ultrafiltered, passed through hemosorbent and injected into the patient. The volume of ultrafiltration and hemosorption was 13 liters. The perfusion rate was 96 ml / min. The duration of the procedure was 3 hours. The amount of the removed ultrafiltrate was 1.7 l. After the procedure, the catheter was removed and a pressure band was applied.

The next day after the procedure, the patient's skin itching significantly decreased, which stopped completely on the second day. Edema, infiltration, on the affected skin decreased on the 3rd day after at 0

five

meniemi hydroxyeffective therapy began to appear a nidus and apparently healthy skin. New vys: 1pain not bsho. Significant remission occurred a week after the procedure. Blood counts improved (acid-base, immunological and biochemical).

The condition of the patient in the following days after hydroxyeffective therapy was improved and after 7 days the patient was discharged from the hospital with a significant improvement. When re-examining 10 days after discharge, the patient did not show signs of psoriasis, i.e. recovery has come. Secondary examination of the patient after 2 carried. You did not recur rypany.

A comparative assessment of the effectiveness of the SF4) of the current and hydroxyeffective therapy of patients with psoriasis in terms of remission is given in Table 1.

Claims (2)

The dynamics of the main clinical symptoms of psoriasis in the course of treatment are given in Table. 2. The formula of the invention Method of treating psoriasis by hemodilution, ultrafiltration, and hemo-I sorption, characterized in that, in order to lengthen the missions simultaneously hemodiluction blood oxygenation is performed under pressure of 0.5-0.8 atm., and ultrafiltration is carried out in the amount of 2-2.5 circulating blood volume. IT a b l and c a 1 I Average 12 "