SU965425A1 - Method of treating periarteritis nodosa - Google Patents

Description

(5) ENVIRONMENTAL TREATMENT METHOD FOR NODELATIC PERIARTERTERIITIS

one

. The invention relates to medicine Vie and can be used for patients with periarteriotic nodosa with lesions of peripheral vessels.

There is a known method of treating periarteritis nodosa by administering leo drugs, preferably fl corticosteroids.

However, the treatment time in a known manner is long and lasts for k-6 weeks. In addition, limb necrosis is possible.

The aim of the invention is to prevent necrosis of the extremities and reduce the duration of treatment.

The goal is achieved by the fact that according to the method of treatment of periarteriptic nodosa by administering drugs, mainly corticosteroids, hyperbaric oxygenation is additionally carried out.

with a pressure of 1.7-2 atm daily 06r min, for 8-15 days.

The method is illustrated by the following examples.

5 i EXAMPLE 1. Ill M., 2 years

And the month.

Ill acutely. The first symptoms were high remitting fever, edema, and hyperleukocytosis of peripheral blood. With a presumptive diagnosis of sepsis, 8 surgical hospital was hospitalized. Against the background of treatment

M with antibiotics, the state continued to deteriorate, the temperature was maintained at 38 / 8-39 6 C, severe pain in the extremities, tree-like live and subcutaneous nodules appeared

t and legs. After two weeks, with a diagnosis, periarteritis nodosa was transferred to the clinic for childhood diseases in a very difficult condition with severe dyscirculatory disorders with fever and symptoms of intoxication. During an objective examination, hyperesthesia, pain in the area of the tongue, hands, and feet (the pain is immobilized) ); subcutaneous nodules bright tree-bearing. up on arms and legs; swelling, cyanosis and hypothermia of the hands, feet, skin necrosis, over the elbow and knee joints, extensive wedge-shaped necrosis of the tongue; regional cervical lymphadenitis, cough, shortness of breath, tachycardia up to 1 bO per minute, hepatomegaly (liver drained from under the rib edge of 5 cm). Laboratory tests revealed anemia (HB kj units erythrocytes 2620000), leukocytosis (63800), an increase in ESR (50 mm per hour). According to the coagulogram data, signs of hypercoagulation are observed. When radiography in the lungs, the vascular pattern is enhanced. On the electrocardiogram signs of myocardial ischemia. Diagnosis: periarteritis nodosa with primary lesion of peripheral vessels, acute course. Nodules, livedo, wedge-shaped necrosis of the tongue, multiple skin necrosis, pregangrene of the extremities. Pneumonitis. Coronary. Hepatomegali Anemi. From the first day of stay in the patient's clinics, prednisone 90 mg per day (7 mg per kg of weight), heparin were prescribed; Daily hyperbaric oxygenation sessions were started in the Oka single-seater for 60 minutes at 1.7 at mode. From the third session, the pain, swelling of the limbs and the tongue disappeared, the latter cleared of necrosis. After the sixth session, the scarring of the wound of the tongue began, the supra-articular skin necrosis began to be cleared of necrotic masses. After 10 sessions, the temperature was normalized, necrosis of the skin of the tips of two fingers was demarcated. A total of 15 sessions. By the end of the course of hyperbaric oxygenation, the temperature is normal, there is no pain, the nodules have disappeared, wounds in the place of skin necrosis and necrosis have cicatrized, lymph nodes of normal size, tachicardi and hepatomegaly decreased, all laboratory parameters normalized except leukocytosis, but the level decreased. 28000 9 4. Positive clinical and laboratory dynamics allowed starting a rapid decrease in the maximum dose of prednisone — discharged after 2.5 months on a maintenance dose of prednisolone in a satisfactory condition and at normal laboratory values. (Over the past three years, the patient had two exacerbations of nodular periarteritis, about which she was admitted to the clinic in the very first days. Treatment using the proposed method using a combination of prednisolone and the hyperbaric oxygen cursor promoted repayment of the activity of the main process within 1-2 weeks. It should be emphasized that in the presence of pregangrene at the beginning of each exacerbation, the girl did not have necrotic complications, and the daily maximum dose of prednisolone did not exceed 3 mg per kg of body weight per day and its decrease by from the second or third week, which made it possible to avoid medicinal complications. EXAMPLE 2. Patient G., 11 years old, Got sick acutely 3 months before admission to the clinic, when high fever, causalga, swelling of the hands, foot, tongue, common tree live, leukocytosis (26600, increase in ESR (67 mm in rd) In the following week, necrosis of mucous membranes, skin, dry gangrene of the terminal phalanges of four fingers were formed without clear demarcation. In the hospital at the place of residence, therapies with prednisolone at a daily dose of 60 mg, delagil, heparin and sympathetic drugs were ineffective and only after increasing the daily dose of prednisolone to 100 mg after 2 months from the onset of the disease the temperature dropped to subfebrile. figures, decreased pain. However, necrotic changes progressed, a polyneuritis was associated — the patient was sent to a clinic for childhood diseases. He complained of pain in the fingers and toes, weakness, low-grade fever. During an objective examination, the following pathologists paid attention: the boy was practically immobilized due to pain in the limbs and painful contractures, exhausted; on the skin of the hands and feet there is a bright tree; ni-onoses and edemas of the hands and feet, extensive necrosis of the skin over the elbow and knee joints, dry gangrene of four fingers without demarcation, are marked in the left pair of hands; the borders of the heart are moderately dilated to the left, the tones are muffled, the pulse is 122 for 1 min, the edge of the first liver is palpable 2 cm below the costal arch. Laboratory tests revealed leukocytosis (litlOOV, neutrophilia (U), ROE, hemological and biochemical blood counts were normal. Diagnosis: periarteritis nodosa with peripheral vascular lesion, acute course. Livedo, skin necrosis, dry gangra on terminal phalanxes And , 11 f, V finger of the right hand, IV finger of the left hand Polyneuritis. Myocarditis. Hepatomegali Dystrophy. 8 the clinic continued treatment with prednisolone (70 mg per day), della scrom and phenylin; a week after admission, a daily session was started hyperbaric oxygenation in a single Oka pressure chamber for kQ min at mode 2. At the background of treatment with the inclusion of hyperbaric oxygenation, the temperature and laboratories normalized, pain, distal cyanosis of the extremities disappeared, areas of skin necrosis and finger gangrene clearly demarcated, which allowed reduce the daily dose of prednisone to 40 mg. Through the month, a second course of daily hyperbaric oxygenation sessions per AO min. in the 1.7 at mode was performed, resulting in a significant increase in motor and the activity began to go, the rejection of necrotic areas with good granulation of wounds began, the pulse rate and the borders of the liver were normalized. In total, for the first course, 10 sessions were held, and tcypc - 8 sessions. The daily dose of prednisone is reduced to 10 mg, the patient in a satisfactory condition was discharged home, where the supportive treatment was continued for a year, and then canceled. The boy is currently in complete remission. Example 3: Sick N., 3 years. She was admitted to the hospital on the 13th day of the onset of the disease in severe standing with a high temperature (38.3;), general hyperesthesia, weakness, profuse sweats. On examination, attention is paid to the tree-like live and single prospecific nodules on the skin of the arms and legs, foci of edema, cyanosis and hypothermia of the skin over the ankle, elbow, radiocarpal joints, edema and cyanosis of two fingers of the right hand, hypothyroidism, tachycardia, moderate hepatomegaly. In a laboratory study, neutrophilic leukocytosis (ZfOpO) increased. ROE (60 fw per hour), pollockel C-reactive protein, increased D0A (0.300 units) moderate lroteinuri (0.066%). Diagnosis: periarteritis nodosa with primary lesion of peripheral vessels, acute course. Nodules, livedo, thromboangiitis syndrome, pregangrene 11,111 fingers of the right hand, polymyositis, distro: phi. The treatment prescribed in the clinic included prednisone 30 mg per day (2.5 mg per kg of weight), no-silo, butadione, komplamin, intravenous infusions of reopolyglucine. Against the background of treatment, the temperature returned to normal for several days, the pain disappeared, the fingers of the right hand became warm and normal in color, and the articular skin areas were mummified, and the laboratory indices normalized. However, the condition worsened for 30 days: abdominal pains, cyst x, two fingers of the right hand became cyanotic, increased leukocytosis). Due to the threat of finger gangrene during therapy (without changing doses of medications; daily hyperbaric sessions were started oxygenation for 60 minutes in a mode of 1.8 ata, 11seven sessions. The girl’s state of health and condition improved after the third session - pains and cyanosis of the fingers disappeared, rejection of skin necrosis began, the number of leukocytes in the blood returned to normal, which allowed starting a quick decrease in ksimalnoy dose prednisolone. After 1.5 months after arrival was discharged home on maintenance treatment prednazolonom (10 Mf a day). After 6 months maintenance treatment canceled. In the present tseevrem child is noted complete remission

7

After a course of hyperbaric oxygenation, there was not only a positive clinical dynamics, but also a significant improvement in rheovasogram. Before treatment in the patient at the level of the right shoulder, signs of impaired vascular tone, a picture of angiospasm, venous congestion, a decrease in pulse cushion by more than 50% were observed. After a course of hyperbaric oxygenation, the pulsatile blood volume normalized and the appearance of venous congestion disappeared.

The proposed method of treatment was used in 5, patients aged 2 to years, in k observations, hyperbaric oxygenation was included

 As can be seen from the table, in local patients treated by the proposed method, local swelling and pain disappeared twice as fast (in no case was it necessary to administer drugs); during the week (against 10–15 days in the group treated by a known method) i there was a clear demarcation of the necrotic areas, in the first sessions necrosis of the mucous membranes were cleaned and epithelialized.

In children treated by the proposed method (the rest were admitted for treatment with necrotic complications), He1 against the background of treatment proisfisjzs 8

in the treatment complex from the first days pos | of subsequent exacerbations (i.e., the indicated Method of treatment was administered according to the proposed scheme, and under these conditions the daily dose of prednisolone was usually a smaller dose than that required to suppress the previous exacerbation, and no observation required an immobilization of 0 nodo-depressants.

The results of treatment according to the proposed method with a selective group of patients with f9 children of equal age and clinical characteristics of Bolzenia, in which the treatment was carried out according to a known method, are presented in the table (the days are shown from the moment of the start of therapy).

Claims (1)

The rapid reverse dynamics of pathology1 and mummification of skin areas and phalanges did not occur, in two patients, necrosis was superficial and rejected within 1-2 weeks, and mummification of 1-2 phalanges was limited to marginal skin necrosis. At that time, in patients treated in a known manner, the disease was complicated by deep long non-healing skin necrosis of supra-articular surfaces and dry aseimetric gangrene of 1–3 fingers (in one finger, in three children, and in legs. The proposed method of treatment allows within 1-2 weeks to eliminate, eliminate intoxication, pain, swelling, reduce necrosis doses, clearly demarcate the lesions, quickly clear and epithelialize skin and mucous membranes. Timely treatment will prevent the development of distal gangrene, and, consequently, the subsequent disability of the child. The use of hyperbaric oxygenation in the treatment of nodular periarteritis can reduce the duration of treatment with a maximum dose of corticosteroids from 4-6 weeks to 1-2 weeks, thus reducing the likelihood of developing drug disease and economic costs 10 5 Claim of the invention A method of treating periarteritis nodosa by administering drugs, preferably corticosteroids, characterized in that In order to prevent necrosis of the extremities and shorten the treatment time, hyperbaric oxygenation is additionally carried out at a pressure of 1.7-2 atm daily AO-B min for 8-15 days. Sources of information taken into account during the examination 1. T. V Bova, G. Lyskina. And. On the treatment of periarteritis nodosa in children - Questions of rheumatism, 1975 № 1, p.58-62 ..