RU2268048C1 - Method for purulent-inflammatory diseases of paranasal sinuses - Google Patents

Abstract

FIELD: medicine, otorhinolaryngology.

SUBSTANCE: the present innovation deals with one of the components of complex therapy of purulent-inflammatory diseases of paranasal sinuses. For this purpose, it is necessary to conduct the puncture of paranasal sinus and its sanitation with physiological solution. Then one should introduce about 8-12%-ximedone solution into the sinus, the procedure should be repeated once daily till complete recovery. The innovation enables to decrease the acuity of inflammatory reaction, prevents the transition of inflammatory process into its chronic form and, also, enables to restore normal structure and function of paranasal sinuses mucosa.

EFFECT: higher efficiency of therapy.

4 dwg, 1 ex, 4 tbl

Description

The invention relates to medicine, namely to otorhinolaryngology, and relates to a method for the treatment of purulent-inflammatory diseases of the paranasal sinuses using the drug Ximedon.

In recent years, the leading pathology encountered by the otorhinolaryngologist, both in the clinic and in the hospital, are diseases of the nose and paranasal sinuses. Up to 50% of patients treated in the ENT department are patients with this pathology (Lopatin A.S., Piskunov G.Z. - Vestn. Otorhinolaryngology. - 1995. - No. 6. - P.35-40; Kiselev , Lushnikova T.A. - Ros.rinology 1994. - No. 2. - P.11; Arefieva N.A. Methodological recommendations. - Ufa, 1999 - p.24).

Various methods of conservative treatment of inflammatory diseases of the paranasal sinuses are known and widely used in practice by puncture, drainage, using the method of moving the fluid, and applying the Yamik sinus catheter (D.I. Tarasov, G.I. Markov, V.S. Kozlov. Methodical recommendations. Yaroslavl. 1987). In the paranasal sinuses, various drugs are introduced that have anti-inflammatory, antimicrobial, antifungicidal effects (Bykova V.P., Dzhalilov D.S., Erofeeva L.A. et al. - Arch.patol. - 1993. - No. 1. - S. 39-43; RU 2134114, C1, 1999; RU 2157116, C1, 2000; RU 2078566, C1, 1997). However, the problem remains relevant. Purulent-inflammatory diseases of the paranasal sinuses (acute and chronic rhinosinusitis) are not only very common, but also contribute to the development of chronic inflammatory processes. Currently, there is an active search for new drugs that would allow to intensify the treatment process and reduce the inflammatory response with a decrease in purulent inflammation and deep damage in the form of ulcerative necrotic defects, as well as prevent the transition of the disease into a chronic form.

At the same time, inflammation is realized not only as a local reaction, but also leads to certain shifts in many systems of the body, especially the immune one (Finger MA, Anichkov NM Pathological anatomy in 2 volumes. - M .: Medicine , 2001).

Numerous experimental studies using pyrimidine and purine derivatives have shown that they have a metabolic, catabolic effect, have a noticeable stimulating effect on the course of recovery processes, accelerating the healing of wounds with a torpid course, strengthening non-specific protective cellular and humoral factors (S.G. Izmaylov, G.A. Izmaylov, M.Yu. Averyanov, V.S. Reznik, - Xymedon in clinical practice, publishing house NGMA, - N.Novgorod, 2001). For the first time, we used the drug Ximedon - N- (β-hydroxyethyl) -4,6-dimethyldihydro-pyrimidone-2 for the treatment of purulent-inflammatory diseases of the paranasal sinuses, which was entered into the Register of Medicines by order of the Ministry of Health of the Russian Federation dated 17.12.93, approved for clinical use. The long-term use of Xymedon has shown its high therapeutic efficacy in surgical and therapeutic diseases (pneumonia, ulcers, traumatic tissue damage). In otorhinolaryngology, Xymedon was not used.

A study of the effect of xymedon on the nasal mucosa was carried out in the mucociliary transport laboratory of Mainz (Germany). As the main evaluation criterion, the change in the frequency of beating of the cilia of the ciliated human epithelium during prolonged irrigation with xymedon solutions was taken into account. The mucous membrane was taken from the nasal cavity with an antral spoon and placed in a special chamber through which the nutrient solution and the studied drug of various concentrations passed (5%, 10%, 20%, 30%, 40%, 50%). As a result of our studies, we did not reveal the toxic effect of Xymedon on ciliated epithelium.

Closest to the claimed method for the treatment of inflammation of the paranasal sinuses is the introduction of drugs into the sinus after application of the JAMIC sinus catheter (RU 2151563, C1, 2000). As medicines, an aqueous solution of gentamicin 4 mg / ml with oxytocin 1 IU / ml is used. However, this method has disadvantages. Injection into the sinus should be physiological, i.e. do not have toxic effects on the mucous membrane. The optimal concentration of the antibiotic has not been determined (the effect of the antibiotic gentamicin on the cilia beating has not been studied. The cilia oscillation normally 16 times per second ensures evacuation of the secretion from the sinuses).

There are still no specific recommendations on the optimal concentrations of drugs for topical use.

The aim of the invention is a new method for the treatment of purulent-inflammatory diseases of the paranasal sinuses, expanding the arsenal of known methods.

The goal is achieved by the proposed method for the treatment of purulent-inflammatory diseases of the paranasal sinuses, which consists in the fact that as a component of complex therapy after performing a sinus puncture and removing the products of inflammation with a physiological solution, 5-10 ml of 8-12% are introduced into the sinus xymedon solution with subsequent fixation of the head for 20-30 minutes. The procedure is carried out 1 time per day until complete cure.

The proposed method allows you to more effectively influence the course of the inflammatory process in the sinus. The use of the claimed concentration of xymedon solution is optimal, since the use of lower concentrations reduces the effectiveness of treatment, and higher ones are uneconomical.

Since it is impossible to take the mucous membrane from patients for morphological examination, this part of the experiment was performed on animals. For this, 44 rabbits of the chinchilla breed were used, weighing 1930 ± 80 grams. The inflammatory process was modeled by introducing into the sinus 0.5 ml of 10% ammonia solution with the introduction of 2 billion suspension of Staphylococcus aureus Staphylococcus aureus strain ATP SS-25923 in 0.5 ml daily culture broth. After exposure to the damaging factor, after 24 hours, all animals showed signs of acute inflammation. The experimental animals were divided into two groups of 22 rabbits in each: 1 - with induced inflammation without treatment (control), 2 - treated with xymedon (experimental). Rabbits of the experimental group were daily injected into the sinus with 2.5 ml of a 10% aqueous solution of Xymedon. Animals were slaughtered after 1, 3, 7, 14, 30 days from the start of the experiment by air embolism. The section evaluated the macroscopic picture of the mucosa of the maxillary sinuses. Pieces of the mucous membrane taken for the study were fixed in a 10% solution of neutral formalin according to Lily. The material was embedded in paraffin, followed by the manufacture of histological sections, which were stained with hematoxylin and eosin, according to van Gieson, Brachet pyronine and toluidine blue.

Immunohistochemical reactions were carried out by the biotinstreptavidin (BSA) method on dewaxed sections, which, after appropriate processing (Ugryumov MV - In the book: Microscopic technique / under the editorship of D.S. Sarkisov, Yu.L. Perova. - M .: Medicine , 1996. - P.125-155; Taylor CR, Cote RJ Immunomicroscopy: - Philadelphia, 1994. - 450 p.) Were stained with diaminobenzidine or aminoethylcorbazole with dyeing with hematoxylin. For electron microscopy, the material was fixed in a 2.5% solution of glutaraldehyde, and after washing in phosphate buffer, it was fixed in a 1% solution of osmium tetroxide. After dehydration, the samples were poured into epon-812.

Ultrathin sections were contrasted with uranyl acetate and lead citrate. The study was carried out in an electron microscope "JEM 100C".

If the antigen was poorly detected on paraffin sections, then the antigenic determinants were unmasked by the BRA method (Heat Induced Antigen Retrieval) in citrate buffer (Grown AM - Acta Histochem. Cytochem. - 1996. - V.29. - P.88-89; Shi SH, Key ME, Kalra KL - J. Histochem. Cytochem. - 1991. - V.39. - P.741-748). The specificity of the immunohistochemical reaction was controlled by replacing primary antibodies with non-immune mouse serum.

The characteristics of the first antibodies and tissues and the cytospecific distribution of antigens are presented in table 1.

Morphological changes in the mucous membrane of the maxillary sinus of animals of the control group.

Morphological changes in the mucous membrane of the maxillary sinuses in animals of the control group showed that, after exposure to a damaging factor, all animals developed acute inflammation of the paranasal sinuses. After 24 hours, pronounced plethora of the vessels of the lamina propria of the mucous membrane was observed, the marginal standing of leukocytes, edema and the appearance of neutrophils outside the vascular bed.

Immunohistochemistry at this stage revealed the swelling of the basement membrane of the epithelium (collagen IV), which is located in areas adjacent to the damage site.

Histological analysis revealed deep damage to the vessels of the own plate of the mucosa, which was expressed in the complete desquamation of the endothelial lining.

The destroyed endotheliocytes in the form of conglomerates were in the lumen of the vessels, but the basement membrane was preserved, although it was significantly thickened, judging by the expression of AT to collagen-IV.

After three days, serous inflammation passed into either catarrhal or purulent, but more often had a mixed character such as purulent catarrh.

In some cases, a hemorrhagic component was mixed with the exudate. Neutrophilic infiltration was accompanied by cell death and the formation of leukocyte-necrotic masses. The goblet cells of the undamaged sections of the epithelium and the glands of their own plate were in a state of hypersecretion, which led to an increase in mucus exudate.

At the same stage, the number of macrophages increased, mainly due to newcomers of monocytic origin, which was determined using AT to CD 68. These cells were detected both in the vessels and in the damage zone.

In parallel with the macrophage reaction, CD 30 (+) and BLA 36 (+) activated lymphocytes were detected immunohistochemically, although the total number of CD 3 (+) T cells and CD 20 (+) B cells did not change significantly.

In parallel with the described changes, separate epithelial cells appeared on the border of the damaged area, crawling on the erosive surface. At the same time, in the marginal zone of inflammation, the vascular endothelium expressed CD 34 antigen (Fig. 1).

One week after the onset of the inflammatory process, the population of free macrophages increased slightly. In parallel, there was a decrease in the volume of leukocyte-necrotic masses. In the area of inflammation, newly formed vessels were found. However, typical granulation tissue at this stage was not formed in all observations. At the edges of the defect, proliferation of the epithelium occurred, which in some cases completely covered the surface of the mucous membrane. It should be noted that the nature of the epithelial layer was different than normal. The epithelium here was single-layered single-row, and its cells had a flattened or cubic shape.

In some cases, at this period of inflammation, focal accumulations of lymphocytes took place, most of which expressed CD 3 protein. CD 3 (+) T was detected in the integumentary respiratory epithelium as intraepithelial lymphocytes (figure 2).

A similar lymphocytic reaction, along with the preservation of macrophage infiltration, indicates the preparation of proliferative inflammation and the beginning of reparations, but may also indicate the persistence of the inflammatory process and its transition to a chronic form (Finger M.A. Anichkov N.M. Pathological anatomy in 2 volumes. - M .: Medicine, 2001).

By the end of the second week, the nature of the reactive changes was not the same, but, on the whole, came down to four main manifestations:

1. Complete restoration of the epithelial layer, the presence of well-defined granulation tissue, resorption of leukocyte-necrotic masses, subsidence of edema, and minor lymphocytic-macrophage infiltration. This picture was observed in isolated cases.

2. Closure of the defect with epithelium with the phenomena of squamous metaplasia, ie "multilayer squamous regenerative epithelium" and severe lymphoid infiltration. This group also includes cases of the formation of cystic formations due to the closure of the lumen of the glands and their extension with atrophy or desquamation of the epithelial lining. Similar processes took place in about 1/3 of all observations.

3. Restoration of the epithelial layer identical to normal or hyperplastic with the onset of sclerotic processes in the subepithelial region. Cell infiltration is not expressed. The described processes were characteristic for 1/3 of the cases.

4. The persistence of a pronounced inflammatory reaction with the formation of a peptic ulcer without epithelization with the presence of necrotic areas, hemorrhages and the development of granulations at the border of the damage took place in individual observations (figure 3).

One month after the start of the experiment, the above reactions were completed as follows: in the first case, the normal structure of the mucous membrane was restored; in the second, the process finally took a chronic form with the presence of polyps, true cysts and / or squamous metaplasia of the epithelium, as well as with the preservation of mononuclear infiltration; in the third, proliferation of connective tissue led to severe sclerosis with atrophy of the glands of the lamina propria mucosa. (figure 4) in the fourth - there was a preservation of a peptic ulcer without signs of repair.

Morphological changes in the mucous membrane of the maxillary sinus of animals treated with xymedon.

By the end of the first day, changes in the paranasal sinuses are observed, almost identical to those in the control group. Serous inflammation develops with a pronounced reaction of the microvasculature, edema, neutrophilic infiltration, etc. Immunohistochemical analysis does not reveal any features at this stage.

Three days after the start of the process, the inflammation takes on the character of a catarrhal and less often purulent one. Goblet cells of the undamaged sections of the epithelium increase quantitatively. The serous-mucous glands of the lamina propria are also hyperplastic. In parallel, neutrophilic macrophage infiltration changes, although the former still remains in the damage zone. An immunohistochemical study shows an increase in the color intensity and the number of cells detected by macrophage markers: AT to CD 68. In parallel, the number of fibroblasts increases with an increase in their functional activity, which is documented immunohistochemically by an increase in vimentin expression.

Noteworthy is the increase in the number of myofibroblasts that were detected by antibodies to fascin in the area of the emerging granulation tissue.

About half of the observations at this stage have a formed granulation tissue that completely fills the defect in the damage zone. In other cases, although the newly formed vessels are not yet fully formed, there is an accumulation of significant groups of endothelial cells in the vascular kidneys, which is detected by the expression of the CD 34 antigen.

At the same periods of inflammation, there is lymphoplasmacytic infiltration, which, however, is significantly less than in the control group. This is determined by the expression of CD 3 and CD 20 antigens. Moreover, the activation markers of lymphocytes - CD 30 and BLA 36 are detected in individual cells. A distinctive feature of the lymphocytic reaction at this stage is the redistribution of cells and a shift towards B-lymphocytes. So, if the normal ratio of CD 3 / CD 20 is 4: 1, then here this ratio in some cases reached 2: 1.

As regards the regeneration of the epithelial layer itself, in about 1/2 of all observations on the surface of the defect there was already complete epithelization. However, the newly formed epithelium was still single-row and cubic or even flat. In other cases, the defect was partially closed, but separate groups of epithelial cells on the surface of granulation tissue were already detected, judging by the expression of pan-cytokeratins and EMA. The presence of a well-defined epithelialization process is also important for repair as a whole. Epithelial development and connective tissue growth are closely related. Epithelial cells have the ability to stimulate the growth of the latter, as well as produce collagenase, which is involved in the restructuring of the scar. Delayed epithelization leads to premature sclerosis of granulation tissue, which in turn slows down the growth of epithelium in such areas (Serov V.V., Shekhter A.B. - M .: Medicine, 1981 - 312 p.).

It should be noted that there was no gross damage to the endothelium of the vessels of the own plate of the mucosa, as was already the case in the early stages of inflammation in the control group. Immunohistochemical analysis using AT for the CD 34 antigen and collagen IV showed preservation of both the endothelial lining and its basement membrane.

After 1 week, in most cases, neutrophils were detected as single cell forms. Macrophage infiltration also decreased. In the vast majority of cases, there was formed granulation tissue with accumulation of collagen and high fibroblastic activity. In this tissue, fully formed CD 34 (+) vessels lined with endothelium were detected immunohistochemically.

The epithelial lining was practically restored, and in some cases the nature of the epithelium did not differ from the norm and looked like a typical single-layer multilayer ciliated with a clear distribution of ciliary, basal and goblet cells. In the epithelial layer, good expression of pan-cytokeratins and EMA was detected, and its basement membrane corresponded to the normal structure, as can be seen from the reaction with AT to collagen-IV.

Compared with the 3-day period, at this stage lymphoid cell infiltration with the usual ratio of CD 3 / CD 20 - 4: 1 decreased to normal. Activated lymphocytes were not detected immunohistochemically.

It should be especially noted that, compared with the control group, there was no persistence of non-healing ulcerative defects with neutrophilic leukocyte infiltration and tissue necrosis. At the same time, in some cases, there was still a chronicization of the inflammatory process with the formation of polyposis structures infiltrated by CD 3 (+) cells, as well as squamous metaplasia.

By the end of the second week, the observed changes were mainly related to the transformation of granulation tissue, which was accompanied by the accumulation of collagen and a decrease in vascularization. The appearance of individual groups or single CD 34 (+) endotheliocytes along with the preservation of capillary structures was determined immunohistochemically. According to available data (Sarkisov D.S., Kolokolchikova E.G., Kai R.N., Paltsin A.A. - Arch.pat. - 1989. - No. 1. - S.9-14) a decrease in the number of vessels in The process of maturation of granulation tissue consists not only in their disappearance due to progressive dystrophic changes in the walls, but also in a peculiar rearrangement and transformation of capillaries, which consists in the gradual separation of the cells that make up their wall and transformation into cellular elements freely lying in the interstitial tissue. The essence of this phenomenon, according to the authors, is that small vessels continuously “disintegrate”, being part of the cellular elements of the interstitial tissue, and at the same time they are formed again, thereby providing physiological regeneration of cells and fibrous structures.

After one month from the start of observation, in most cases, the mucous membrane of the paranasal sinuses was completely restored with an immunohistochemical phenotype corresponding to the norm and normal ultrastructure. In about 1/4 of the observations, recovery was incomplete with the presence of a single-row cubic epithelium, sclerosis of the lamina propria, and atrophy of the serous-mucous glands. And only in some cases, the inflammation turned into a chronic form in the form of polypous growths with the preservation of lymphoid cell and macrophage infiltration, as well as hypersecretion of goblet cells.

The result of animal tests and the use of the proposed method for the treatment of purulent-inflammatory diseases of the paranasal sinuses (acute and chronic rhinosinusitis) showed the effectiveness of the proposed method.

Clinical trials of the proposed method was performed on patients with a diagnosis of acute purulent sinusitis, who are on an outpatient and inpatient basis. In the treatment, a sinus washing method with physiological saline followed by the administration of 5.0 ml of a 10% solution of Xymedon was used.

Example.

Rozhkova A.G., 48 years old, was admitted with complaints of difficulty in nasal breathing, mucopurulent discharge from the nose, and weakness.

From the anamnesis: ill for the first time, the onset of the disease is associated with a transferred ARVI.

Rhinoscopy: the mucous membrane of the nasal cavity is edematous, hyperemic, in the middle and general nasal passage on the left, purulent discharge. Other ENT organs without features.

Diagnosis: acute left-sided purulent sinusitis. After applying a sinus catheter and washing the sinuses of the nose with saline, 5.0 ml of a 10% solution of Xymedon was injected into the sinus and the patient's head was fixed for 20-30 minutes. This procedure was carried out for 10 days. At the same time, restoration of nasal breathing, relief of inflammation and clinical recovery were noted.

For the clinical evaluation of the drug Ximedon in the treatment of acute bilateral purulent maxillary sinusitis, the following methodology was used.

For clinical evaluation of the effectiveness of the drug Xymedon, 3 groups of patients were formed, 30 patients each, a total of 90 people. Of these, 48 men (53.33%) and 42 women (46.66%) aged 16 to 54 years.

The examination included collection of complaints, anamnesis, anterior and posterior rhinoscopy of the nasal cavity followed by endoscopy, radiography of the paranasal sinuses in the nasal-chin projection, a smear from the nasal cavity on the microflora and determination of sensitivity to antibiotics, a general blood test.

Medical history goal

1. Identify concomitant diseases that can affect the course of sinusitis. Patients with combined sinus lesions, also with a history of diabetes mellitus, bronchial asthma, blood diseases, immunodeficiency, stigma of dysembryogenesis (constitutional prerequisites), pregnancy, and the period of breastfeeding, were excluded from the study.

2. Determine the timing of the onset of the disease. All applicants were ill for 3-5 days. Eliminate the possibility of damage to other paranasal sinuses, and also to find out if patients took any medications. Patients taking antibacterial drugs 1 month before the disease were also excluded from the study.

Complaints at admission: difficulty in nasal breathing, purulent discharge from the nose, head and facial pains, weakness. Overall health was assessed as satisfactory, body temperature 37-37.5. It was also suggested that patients themselves evaluate their complaints in scores from 0 to 10 points on a visual scale with 10 divisions.

1. Nasal breathing: free - 0 points, lack of nasal breathing - 10 points.

2. Facial pains: absence of pain - 0 points, severe pain - 10 points.

3. Discharge from the nasal cavity: lack of discharge - 0 points.

a large number of discharge - 10 points.

When re-questioning, patients did not see the results of the previous study, as this could affect the objectivity of the study.

Puncture of the maxillary sinus was performed according to the generally accepted technique. Evaluated the nature of the contents (purulent, mucopurulent, mucous).

Patients who did not receive pus during sinus puncture were excluded from the study.

The volume of pathological contents was measured using a 20 ml syringe. Obstruction of the natural sinus anastomosis was evaluated according to the following scheme:

1) degree - the norm, contents are freely aspirated from the sinus and washed freely;

2) degree - the sinus is washed freely, but it is impossible to aspirate the contents;

3) degree - difficulty washing the sinus and it is impossible to aspirate the contents;

4) degree - the inability to rinse the sinus and aspirate the contents.

Radiography of the nasal cavity and paranasal sinuses was carried out in the nasal-chin projection and the purpose of this study was to study the condition of all paranasal sinuses and to evaluate inflammatory changes in the maxillary sinuses. Changes in the maxillary sinuses were described as: parietal thickening of the mucous membrane, decreased pneumatization, total homogeneous dimming.

Everyone was diagnosed with acute bilateral purulent maxillary sinusitis.

A solution of Xymedon was prepared immediately before the experiment or in advance. The shelf life of a 10% solution of Xymedon is unlimited. Xymedon powder was dissolved in sterile water.

Of the antibacterial drugs, we chose Amoxiclav. The spectrum of action of this drug is maximally adapted to the microflora, most often causing inflammation in the paranasal sinuses, and the presence of clavulanic acid makes it more stable. Vasoconstrictor drops Naphthyzin (a drug from the group of α-adrenergic agonists) are effective and quite often used by patients with rhinosinusitis.

The following treatment algorithm has been developed:

1 - a group of amoxiclavs 1 tablet 2 times for 10 days, naphthyzine 3 drops 3 times a day.

2 - a group of amoxiclavs 1 tablet 2 times a day for 10 days, naphthyzine 3 drops in the nasal passages 3 times a day, the maxillary sinus was rinsed after a puncture with warm saline.

3 - a group of amoxiclavs 1 tablet 2 times for 10 days, naphthyzine 3 drops 3 times a day, the maxillary sinus was washed with a 10% aqueous solution of xymedon.

Under supervision were 30 people. The results of the treatment are shown in table 2.

Patients of the first group treated with D / S acute purulent maxillary sinusitis were given standard treatment with the exception of puncture of the maxillary sinus.

Nasal discharge disturbed observed patients up to 7 days. This was probably the contents of the affected sinus secreted into the nasal cavity. Facial pain bothered patients up to 3 days. These pains can be explained by the presence of pathological discharge in the sinus leading to compression of the nerve endings of the mucous membrane.

However, judging the dynamics of freedom of nasal breathing is not possible, since all patients received the vasoconstrictor drug Naphthyzin from the first day and had no complaints of nasal congestion. However, it should be noted that patients of the first group used naphthyzin for up to 7 days. It is not possible to judge the nature of the contents, the volume of the pathological discharge and the state of the natural anastomosis, since the puncture of the maxillary sinus was not performed.

Treatment of patients of the 2nd group differed from the 1st in that puncture of the maxillary sinus was performed. And although the sinus was washed only with physiological saline, this allowed to significantly intensify the treatment compared with the 1st group. So, on the third day of treatment, patients of the first group of discharge from the nose were rated at 3.7 points, when in the second group this indicator was 1.34 points. By the third day, facial pains bothered only patients of the first group and were estimated at 1.4 points. Comparison of the treatment results of patients of the 1st and 2nd showed that the puncture of the maxillary sinus is an effective procedure and with the same treatment allows to achieve better results. The results of the treatment of the 2nd group of patients are shown in table 3.

The use of Xymedon in the treatment of sinusitis has shown its clinical efficacy. Significantly, patients of the 3rd group showed faster dynamics in the main complaints and clinical manifestations. So, when washing the sinus with 10% xymedon solution, the volume of pathological discharge was significantly less. Patients of all groups noted facial pains, but they significantly less disturbed patients of 3 groups. This can be explained by the decongestant effect of xymedon. The blockade of the natural anastomosis lasted longer in patients who had their sinuses washed only with physiological saline. In the third group, due to the decongestant action of xymedon sinus, it was easier to rinse and aspirate the pathological discharge. The results of the treatment of the 3rd group of patients are shown in table 4.

Animal tests and the application of the claimed method of treatment in the clinic showed that the achieved technical result is expressed in:

1) a decrease in the severity of the inflammatory reaction with a decrease in the number of cases of purulent inflammation;

2) the absence of deep damage to the mucosa in the form of non-healing ulcerative necrotic defects with persistent neutrophilic infiltration;

3) an obstacle to the transition of the inflammatory process into a chronic form with a significant decrease in the number of observations with the formation of polyps, false cysts and the presence of lymphocytic infiltration;

4) an increase in the number of cases with a complete restoration of the normal structure of the mucosa (restitution) and a decrease in the phenomena of sclerosis, epithelial metaplasia and rearrangement of the serous-mucous glands;

5) accelerating the resolution of the inflammatory reaction with the restoration of the function of the mucous membrane, including the synthesis of Ig A.

Thus, the data obtained allow us to recommend the proposed method of treatment using xymedon as one of the components of the complex therapy of purulent-inflammatory diseases of the paranasal sinuses.

Table 1.
Characterization of the used antibodies Detectable antigen Clone Manufacturing firm Localization Cd 3 PS 1 Novocastra T lymphocytes CD 20 L 26 Novocastra B lymphocytes CD 30 1G12 Novocastra Activated T and B lymphocytes BLA 36 A27.42 Novocastra Activated b lymphocytes CD 34 QBEnd / 10 Novocastra Endothelial cells Cd-68 KR-1 Dako All macrophages fascin 55K-2 Dako Characterization of myofibroblasts of stress fiber Collagen IV CIV 22 Dako Basement membranes vimenitin V 9 Dako fibroblasts Pan-cytokeratins (CCR) Mnf116 Dako epithelium Epithelial Membrane Antigen (EMA) GP 1.4 Novocastra epithelium

Table 2.
The results of the treatment of the 1st group of patients Main manifestations 1 day 3 day 7 day 10 day Discharge from the nasal cavity 4.9 points 3.7 points 1.5 points 0 points Nasal breathing 3.81 0 points 0 points 0 points Facial pain 3 points 1.4 points 0 points 0 points

Table 3.
The results of the treatment of the 2nd group of patients Main manifestations 1 day 3 day 7 day Discharge from the nasal cavity 4.75 points 1.34 points 0.5 points Nasal breathing 3.74 points 0 points 0 points Facial pain 3.2 points 0 points 0 points The amount of pathological contents in the sinus 4.45 cm ³ 1.84 cm ³ On day 5, 0 points Blockade of the natural anastomosis 1 tbsp. - 63.3% (19 h)
2 tbsp. - 20% (6 h)
3 tbsp. - 10% (3 h)
4 tbsp. - 6.6% (2 h) 1 tbsp. - 66.6% (20 h)
2 tbsp. - 23.3% (7 h)
3 tbsp. - 10% (3 h)
4 tbsp. - 0% On day 5, 1 tbsp. - one hundred%

Table 4
The results of the treatment of the 3rd group of patients Main manifestations 1 day 3 day 7 day 10 day Discharge from the nasal cavity 4.92 points 1.2 points 0 points 0 points Nasal breathing 3.94 points 0 points 0 points 0 points Facial pain 3 points 0 points 0 points 0 points Blockade of the natural anastomosis 1 tbsp. - 66.6% (20 h)
2 tbsp. - 23.3% (7 h)
3 tbsp. - 10% (3 h)
4 tbsp. - 0% 1 tbsp. - 80% (24 hours)
2 tbsp. - 13.3% (4 h)
3 tbsp. - 6.6% (2)
4 tbsp. - 0% 5 day 1 tbsp. - 13.3%
2 tbsp. - 10%
3 tbsp. - 3.4%
4 tbsp. - 0% The amount of pathological contents in the sinus 5.11 cm ³ 1.12 cm ³ 0 cm ³ The puncture was not performed

Claims (1)

A method of treating purulent-inflammatory diseases of the paranasal sinuses, comprising administering drugs to them, characterized in that, as a component of complex therapy, after removing the products of inflammation with a physiological solution, an 8-12% solution of xymedon is introduced into the sinus and this procedure is repeated 1 time per day until cure.

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