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lows recommending its use in clinical practice for the treatment of local purulent-destructive diseases of soft tissues.
2. The results showed that the planimetric study with the use oflaser photodynamic therapy photo sensitizer methylene blue and
C02 laser contributes to shortening of clearance of the wounds from necrotic deposits, the appearance of granulation, epithelialization beginning.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-114-116
Murodov Alijon Salimovich, Tashkent Medical Academy Department of surgery for GP E-mail: [email protected]
Application of photodynamic therapy and laser in the treatment of infected and purulent wounds
Absctract:
Objective: to evaluate the complex action of photodynamic therapy and C02 laser in the treatment of infected and purulent wounds.
Materials and methods. Depending on the treatment, the patients were divided into 3 groups: group 1 (control group) included 26 patients who were held traditional conventional methods; in the 2nd group (main group) of 30 patients, which in combination with traditional methods applied PDT treatment with 0.05% methylene blue buffered saline and C02 laser (if necessary).
Results. Photodynamic therapy in a C02 laser complex was not sufficiently effective invasive treatment of purulent wounds and allows to recommend its use in clinical practice for the treatment of local purulent-destructive diseases of soft tissues. Complex application of PDT and C02 laser leads to an earlier cleansing from the pus, the active formation of granulation tissue and shortening deadlines complete epithelialization of the wound surface.
Conclusions: Complex treatment with C02 laser and photodynamic therapy is the most effective, as compared to other methods studied separately.
Keywords: purulent wounds, infected wounds, laser, photodynamic therapy.
Treatment of purulent — inflammatory processes of soft tis- The primary structure of the total consulting in general surgery
sues is one of the long-studied topic in Medicine, however, still re- frequency surgical skin and soft tissue infections reaches 20 to 70% mains an urgent problem surgery [4]. According to the literature, the [5; 8].
number of patients with acute purulent soft tissue diseases is among Despite the fact that the history of the issue of treatment of
the surgical patients 30-60% [1]. these pathologies has more than one decade, and to date has
Application of photodynamic therapy and C02 laser in the treatment of infected and purulent wounds
prompted a large number of different methods, the problem of the effectiveness and speed of the results is still not resolved until the end [2]. One of the promising areas of modern medicine to address this problem is the use of laser treatments. To date, the most efficient use antibacterial photodynamic therapy and C02 laser in the treatment of purulent wounds. Photodynamic therapy (PDT) is a relatively new treatment method based on the use of drugs — pho-tosensitizers (substances that are sensitive to light) and laser light with a specific wavelength corresponding to an absorption peak of a photosensitizer [3; 6; 7; 9; 10; 11].
Photocoagulating C02 laser has sterilizing properties and effect on the fabric. As a result, tissue dissection is carried out without bloodshed, and the cut surface remains absolutely sterile.
Objective — Improving the results of treatment of patients with infected and purulent wounds, through integrated use of PDT and C02 laser.
Materials and methods
We have examined and treated 56 patients with purulent and infected wounds of different etiology and localization in age from 19 to 74 years who were in the department of purulent surgery of 1 City Clinical Hospital at the Department of Surgery GP TMA from 2011-2015.
Depending on the treatment, the patients were divided into 3 groups: group 1 (control group) included 26 patients who were held traditional conventional methods; in the 2nd group (main group) of 30 patients, which in combination with traditional methods applied PDT treatment with 0.05% methylene blue buffered saline and C02 laser (if necessary).
Both groups were representative by gender, age, area and location of the wound surfaces.
Characteristics of the device. C02 laser. Laser wavelength: 10.6. Output Power: 1 ~ 15w. Output Mode: Focus or defocus.
For photodynamic therapy using a light emitter with a wavelength of 600-640 nm with a power density of 200 mW/cm2.
In the complex treatment of the traditional complement of photodynamic therapy and C02 laser (with the presence of purulent necrotic masses and films). The use of C02 laser has allowed the possibility of early and bloodless necroectomy and increased the effectiveness of PDT (as in the presence of purulent necrotic masses
Table 1. - Dynamics of the number
and films PDT effect is sharply reduced). A session on the severity of the condition of patients ranged from 3 to 7 sessions. After 2-3 sessions a purulent focus area, we observed a significant reduction in necrotic detritus and characteristic odor.
After surgical treatment of purulent focus complement traditional treatment of PDT. The wound after standard surgical treatment and drying the photosensitizer was applied. As the photosensitizer used buffered solution of 0.05% (or ointment) of methylene blue from 30 minutes exposure. Then, irradiation was carried out of wound surface of the light emitter for photodynamic therapy. The wavelength of 630-650 nm, with a power density of200 mW/cm2. The distance from the source to the wound surface was 10 cm in the absence of heat discomfort in the patient. Duration of treatment was 15-30 minutes, depending on the area of the wound surface. After radiation photosensitizer wound surface discolored since gone photodynamic reaction. After PDT superimposed ointment bandage corresponding phase of wound healing process. The multiplicity of procedures is 3-6 sessions, depending on the clinical diagnosis.
Selecting of photosensitizer and the radiation source based on the results series of in vitro experiments that allows us to select the most effective combination of photosensitizer and radiation parameters.
Results discussion Comparative results of treatment were evaluated in both groups in a complex on the general and local criteria, as well as laboratory parameters periphery blood. The general evaluation criteria include the timing of normalization of body temperature and heart rate control, allowing to judge the severity of intoxication and general inflammatory response. Local criteria are periods of cleansing the wound, the appearance of granulation, epithelialization of the wound beginning, on the basis of these data, judged the local stage of the process. In laboratory parameters monitored leukocytosis and severity index was calculated leukocyte intoxication index (LII).
Patients of the control group to normal body temperature (below 37.° C) by an average of 3.5 ± 1.03 days, and the use of a C02 laser, PDT resulted in a more rapid normalization of body temperature — in average 2.0 ± 0.44 hours. Control of normalization heart rate (less than 90 ppm) in the control group was 3,3 ± 0,55 days in the main 1,9 ± 0,26 days.
of heart rate and body temperature
Parameter Before treatment After treatment
Main group Control group Main group Main group
Heart rate, beats per minute. 88,1±1,9 87,9±2,3 74,0±1,0 79,5±1,8
Body temperature, ° C 38,2±0,06 38,6±0,05 36,7±0,05 37,8±0,09
Analyzing the overall clinical manifestations of wound heal- from purulent and fibrinous detritus mass occurred at 3,5 ± 0,5 day, ing is important to note that after PDT decreased clearance of the and the appearance of granulation found at 3,9 ± 0,4 hours. At 4,1 wounds from purulent detritus and a fibrinous masses, as well as the ± 0,4 day marked the beginning of the edge epithelialization, which time of appearance of granulation and epithelialization start espe- was significantly better than with conventional treatment. cially for the core group — Table 2. On average, cleaning of wounds
Table 2. - Dynamics of number of wound healing, depending on the treatment
Method of treatment Amount of patients Средние сроки (сутки)
Healing wound Appearance of granulation Getting the epithelialization
Main group 30 3,5±0,5 3,9±0,4 4,1±0,4
Control group 26 7,1±0,5 6,5±0,6 7,8±0,5
During hospitalization, all patients had signs of intoxication varying degrees of severity, as evidenced by changes in leukocyte blood: leukocytosis, increased number of immature forms of neutrophils, the appearance ofplasma cells, reducing the number of monocytes and lymphocytes, as well as the increase in the LII (up to
6 -8 conventional units). Increase in the number of immature forms of neutrophils indicated the voltage of compensatory mechanisms for the inactivation of toxins. Reducing the number of monocytes and lymphocytes, indicative of immunological suppression of the body's defense system. After 3 days, after the surgical treatment
of patients with purulent focus and a comprehensive traditional start of treatment for complex treatment of purulent wounds using therapy marked decrease LII values — to 3,2usl. Units, with an ad- a C02 laser and photodynamic therapy corresponded to the value ditional impact on the injury occurred PDT greater reduction in- of FRI normal numbers -1,56 ± 0,5 conv, while the control group dex LII — to 2,71usl. u Revealed changes suggest increasing non- remained elevated in patients — 2,14 ± 0.6 standard units specific resistance and decreasing toxicity. Within 7 days after the
Table 3. - Dynamics of FRI patients of the main and control group
Leukocyte index of intoxication (LII) Days of treatment
1 3 5 7
Main group 3,42±0,8777 2,71±0,81 1,71±0,59 1,56±0,5
Control group 3,34±1,19 3,2±1,10 2,32±0,54 2,14±0,6
Indicators of postoperative bed-days in the groups differed significantly. If the traditional treatment of patients with purulent wounds of the average hospital stay was 9 days, the patients of the main group of hospital stay was 7 days.
All 17 patients of the study group was well tolerated method of photodynamic therapy, side effects were observed. This allowed all 17 patients (100%) planned to undertake a full course of treatment, PDT. The use of PDT is not required additional analgesia.
Thus, the data prove conclusively on the basis of common assessment, local criteria and laboratory parameters ascertained a marked improvement in the results of treatment ofpatients with infected and purulent wounds when applied PDT. Clinical data correlate well with the results of bacteriological tests in vitro.
Conclusions
1. Antibacterial photodynamic therapy in complex treatment of patients with purulent destructive diseases of soft tissues allows an earlier date to achieve cleansing of purulent wounds and their healing.
2. Photodynamic therapy is a very effective non-invasive and gentle treatment of purulent wounds and serve as justification for the use of the method of photodynamic therapy in clinical practice for the treatment of acute inflammatory processes in combination with conventional treatments.
3. Experimental and clinical studies of the results of applying PDT showed its efficacy as an in vitro as in vivo.
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1. Abaev Y. K. Surgeon Directory. Wounds and wound infection/Rostov n/D: Phoenix - 2006.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-116-119
Musakhodjaeva Diloram Abdullaevna, Doctor of Biological Science, professor Head of the Laboratory of Immunomorphology of the Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan, BD, Professor E-mail: [email protected] Fayzullaeva Nigora Yakhyaevna, senior researcher of the Laboratory of Immunomorphology of the Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan, PhD
The effectiveness of immunotherapy in children with cystic fibrosis
Abstract: We observed 48 children with CF aged from 4 to 8 years, as well as the indicators of 20 healthy children of the same age were studied. Based on the dynamics of immunological parameters the effectiveness of the drug polioxidonium was
