RU2375088C2 - Method of treating newly diagnosed infiltrative destructive pulmonary tuberculosis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely phthisiology. The patient is exposed to three-field low intensity laser skin irradiation in a projection of pathological process in lungs and then spleen at wave length 0.85-0.95 nm in infra-red range. Pulse power is 7 Wt, pulse repetition rate is 2.5 kHz, modulating frequency is 100 Hz, and exposition time is 2 minutes per each field. One session lasts for 8 minutes, for therapeutic course 10 sessions every second day.

EFFECT: fast regress of clinical, laboratory and radiological manifestations of the disease, reduced treatment time.

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Description

The invention relates to medicine, namely to TB, and can be used to treat newly diagnosed infiltrative destructive pulmonary tuberculosis.

In phthisiology, physical factors are increasingly being used, including low-intensity laser radiation [1, 2]. Laser exposure to pulmonary tissue affected by tuberculosis is widely reported in the literature, but there is no data on irradiation of the spleen as an immunocompetent organ. The use of low-intensity laser radiation on the spleen is justified by the fact that this is one of the central organs of the immune system and laser exposure stimulates its work [3]. Destructive tuberculosis is often accompanied by disorders of the immune system, which makes the use of a laser relevant.

Closest to the proposed method is a method of exposure to ultrasound on the spleen in acute progressive forms of pulmonary tuberculosis [4]. The disadvantage of this treatment is the occurrence of side effects in a number of patients during or after the end of a course of physiotherapy (pain in the heart, hypoglycemic state). The author in the experiment established the appearance of dystrophic changes in the tissues of the spleen of experimental animals after a course of ultrasound exposure. This suggests that ultrasound is a fairly rigorous procedure, because the basis of its action is the occurrence of elastic mechanical vibrations.

The objective of the proposed method is to increase the effectiveness of treatment of infiltrative destructive pulmonary tuberculosis by laser exposure to the affected area in the lung tissue and the spleen.

The task is carried out by the fact that patients undergo cutaneous irradiation of the projection of the pathological process in the lungs from three fields, and then the spleen with low-intensity laser radiation with a wavelength of 0.85-0.95 nm, in the infrared range, with a pulse power of 7 W, pulse repetition rate of 2 5 kHz, with a modulating frequency of 100 Hz, the exposure time is 2 minutes per field, the duration of one session is 8 minutes, the course of treatment is 10 sessions every other day.

The proposed method is characterized in that using the Helios-01M apparatus, previously not used in phthisiology, for one session, a sequential effect of low-intensity laser radiation on the lung tissue and for the purpose of immunostimulation on the spleen is performed.

The choice of this device is justified by the fact that it differs significantly from the pulsed lasers produced in the world by its compactness, autonomy, higher power and the presence of additional adjustable parameters. In the Helios-01M apparatus, for the first time in medicine, an independent adjustment of all radiation parameters was implemented, which made it possible to solve any clinical problems with a minimal (safe, non-addictive) energy effect on the body.

The method is as follows.

3-4 weeks after the completion of the chemotherapy regimen, the patient is given cutaneous irradiation of the projection of the pathological process in the lungs from three fields, and then irradiation of the spleen is started. Laser therapy is carried out with a pulse power of 7 W, a pulse repetition rate of 2.5 kHz, a modulating frequency of 100 Hz. The wavelength of the apparatus is 0.89-0.95 nm. The exposure time is 2 minutes per field, in total - 8 minutes per session. The course of treatment is 10 sessions every other day. Scanning technique. The radiating head of the nozzle is set in contact. A nozzle is used for "work on deep structures", which provides sufficient penetration - up to 7 cm.

Clinical examples

Example 1

Patient L., 28 years old, medical history 51. Received January 27, 2006. The diagnosis is infiltrative tuberculosis of the upper lobe of the left lung in the phase of decay and contamination of the office (+). Upon receipt of a complaint about an increase in body temperature to 38.0 ° C, weakness, drowsiness, weight loss of 6 kg, cough with mucopurulent sputum up to 50 ml per day, chest pain, shortness of breath during physical exertion. The condition is relatively satisfactory. With percussion - shortening of the pulmonary sound on the left in the upper third of the interscapular space, wet rales were heard during auscultation. MBTs were detected by bacterioscopy up to 10 in the field of view, confirmed by the method of culture. In the general analysis of blood ESR 25 mm / h, leukocytes - 8.9 · 10 / l, lymphocytes - 19%. Immunological studies: CEC - 77.3 cu, RBTL on PHA - 45%, on PPD - 2.5%, Jg A - 7.9 g / l, Jg G - 18.0 g / l, Jg M - 4.5 g / l.

During an X-ray tomographic examination, infiltration of the lung tissue was determined in the upper lobe of the left lung, against the background of which a decay cavity with a diameter of 3.0 cm was visualized, and foci of screening in the lower lobe of the left lung.

The patient received chemotherapy with 4 anti-TB drugs: iv isoniazid, iv kanamycin, rifampicin per os, pyrazinamide per os. After 4 weeks from the start of treatment, laser therapy was prescribed for the zone of damage to the lung tissue and to the spleen area according to the proposed method. By the end of the course of laser therapy, the patient stopped symptoms of intoxication and respiratory complaints (normalized body temperature, added 3.0 kg in weight, chest pain stopped, the amount of sputum decreased to 10.0 ml per day, its nature ceased to be purulent). Blood counts returned to normal: ESR decreased to 7 mm / h, white blood cells became 5.6 · 10 / L, and the number of lymphocytes increased to 28%. The functional activity of T-lymphocytes in RBTL on the PHA - 50% and on the PDP - 3.5%, the level of the CEC decreased to 72.2 cu The content of immunoglobulins in the blood decreased: Jg A - 4.5 g / l, Jg G - 15.0 g / l, Jg M - 2.5 g / l. In sputum analyzes, by the 2nd month of treatment, MVT was no longer determined.

X-ray tomography by the 3rd month of treatment showed a significant decrease in infiltrative changes, the decay cavity lost its display.

Example 2

Patient M., 33 years old, medical history 441. Received October 6, 2005. The diagnosis was infiltrative tuberculosis of the right lung in the phase of decay and contamination of MVT (+). Complicated by infiltrative tuberculosis B6 on the right. Upon receipt of a complaint of weakness, fever up to 37.7 ° C, sweating, loss of appetite, weight loss by 5 kg, shortness of breath during physical exertion, white sputum up to 70 ml per day. With percussion, shortening of the pulmonary sound in the middle third of the interscapular space was shortened, and moist rales were heard during auscultation. In sputum analysis by bacterioscopy, abundant bacterial excretion. In the general analysis of blood ESR 35 mm / h, stab neutrophilia - 8%, lymphopenia - 19%. Immunological studies: CEC - 82.5 cu, RBTL on PHA - 43%, on PPD - 0%, Jg A - 4.6 g / l, Jg G - 16 g / l, Jg M - 3.8 g / l

An X-ray tomographic examination in the upper lobe and C6 of the right lung determined the infiltration, against which two decay cavities were visualized, the maximum size of one of which was about 3.0 cm in diameter, with foci of exudative type around.

The patient received 4 anti-TB drugs: iv isoniazid, iv kanamycin, rifampicin per os, pyrazinamide per os in doses relative to weight.

After 3 weeks from the start of treatment, laser therapy was prescribed by the proposed method, after which the patient disappeared complaints of weakness, sweating, she gained weight, the amount of sputum excreted decreased. Clinical blood counts returned to normal. Immunological studies revealed an increase in the functional activity of T-lymphocytes in RBTL on PHA - 53%, on PPD - 9%, overproduction of immunoglobulins detected before laser therapy decreased: Jg A - 3.3 g / l, Jg G - 8.6 g / l, Jg M - 3.0. Bacterial excretion stopped after 2 months from the start of treatment. An x-ray tomographic examination performed after the end of the laser therapy course revealed a regression of the tuberculous process in the form of resorption of infiltration, a decrease in the number of foci. The decay cavity in C1 of the right lung lost its display, in C6 it was reduced in diameter by 2 times. By the 3rd month of treatment, further positive dynamics of resorption of specific changes in the lung tissue was noted, the decay cavity in C6 of the right lung was closed. When control fibrobronchoscopy revealed a complete resorption of infiltration in B6 on the right.

The proposed method was tested in an experiment on 260 white outbred mice.

In mice infected with tuberculosis, which underwent complex chemotherapy, laser irradiation of the lungs and spleen significantly reduced the index of lung damage, while increasing the clearance of the spleen from the office and stimulating the macrophage immunity compared to infected, treated only with anti-tuberculosis drugs.

Clinical observations of 40 patients who received laser therapy for the lungs and spleen showed that this treatment contributes to a faster regression of the clinical, laboratory and radiological manifestations of the disease, which reduces the patient’s hospital stay by 1-2 months depending on the severity of the initial process.

In patients who underwent a course of laser therapy, the appearance of any adverse reactions was not noted. Ultrasound of the abdominal organs immediately after physiotherapy did not reveal an increase in the size of the spleen.

Literature

1. Lomachenkov V.D., Strelis A.K. Physiotherapy for pulmonary tuberculosis. - M., 2000, 136 p.

2. Dobkin V.G., Bagirov M.A., Bondarev G.B. and others // Problems of tuberculosis, 1996, No. 6, p. 54-57.

3. Ketlinsky S.A., Kalinina N.M. Immunology for the doctor. - SPb., 1998, 156 p.

4. Patent RU No. 2154510 A method for the pathogenetic treatment of pulmonary tuberculosis / G.S. Balasanyants and others.

Claims (1)

A method for the treatment of newly diagnosed infiltrative destructive pulmonary tuberculosis, comprising complex therapy, characterized in that the patients undergo cutaneous irradiation of three fields of the projection of the pathological process in the lungs, and then the spleen with low-intensity laser radiation with a wavelength of 0.85-0.95 nm in the infrared range with pulsed with a power of 7 W, a pulse repetition rate of 2.5 kHz, a modulating frequency of 100 Hz, an exposure time of 2 minutes per field, a duration of one session of 8 minutes, a course of treatment of 10 sessions, conducted x every other day.