RADIATION SKIN INJURIES

Etiology. The causes of skin damage from exposure to ionizing radiation are alpha, beta, gamma, neutron, x-ray radiation However, the skin damage they cause clinically is identical and is divided into acute and chronic. Alpha particles are retained by the stratum corneum, beta particles are absorbed by the skin itself and penetrate 2-4 mm, gamma rays, X-rays and neutrons penetrate the entire human body.

Among acute radiation injuries skin distinguish between early radiation skin reaction, radiation alopecia and radiation dermatitis.

It should be emphasized that local changes are not always limited to the skin, which does not correspond to the concept of dermatitis, therefore the term “acute radiation injury” is justified.

Early radiation reaction develops 1-2 days after irradiation at a dose of at least 3 Gy and presents as edematous erythema, accompanied by slight itching; resolves without traces after a few hours.

Radiation alopecia characterized by loss of long hair 2-4 weeks after irradiation at a dose of at least 3.75 Gy. Hair growth begins after 1.5-2 months.

Acute radiation dermatitis develops within two months from the moment of irradiation, depending on the dose. The erythematous form is observed at a dose of 8-12 Gy. It differs from other dermatitis by purplish-cyanotic erythema, hair loss, and patients complain of a burning sensation, pain and itching. For acute bullous dermatitis, the radiation dose is 12-20 Gy. Unlike most other bullous dermatitis, regional lymphadenitis, increased body temperature, hair loss, and subjectively expressed pain and burning are often observed. Healing of erosions or superficial ulcers after opening the blisters occurs slowly over several months and is accompanied by the development of atrophy, pigmentation disorders and telangiectasia. Acute necrotizing dermatitis develops after irradiation at a dose of over 25 Gy and is characterized by excruciating pain, severe general condition (depending on the area of ​​irradiation) -

weakness, chills, high fever, insomnia. Skin lesions are represented by erythema, edema, blisters (after opening which long-term non-healing ulcers are formed), strings. After healing, scars form, against which, under the influence of minor injuries, ulcers and petechiae form, leading to necrosis.

Chronic radiation damage to the skin divided into chronic radiation dermatitis and late radiation dermatoses (indurative edema, late radiation ulcer, radiation cancer), developing at the site of acute dermatitis and long-term chronic dermatitis.

Chronic radiation dermatitis develops most often on the hands as a result of exposure to soft rays and beta particles of radioactive substances. Clinically, it is manifested by the development of dryness, skin atrophy, dyschromia, and the formation of painful cracks. Against this background, hyperkeratosis and papillomatosis often develop, which are the basis for the development of cancer.

Indurative edema develops as a result of damage to small lymphatic vessels and impaired lymph outflow. Clinically, it manifests itself as dense swelling without pain, after resolution of which atrophy and telangiectasia remain.

Late radiation ulcer is formed against the background of trophic changes in the skin resulting from the action ionizing radiation, and is characterized by severe pain.

Radiation cancer develops against a background of long-term existing ulcers for acute and chronic dermatitis or in the area of ​​chronic radiation dermatitis.

Treatment. Early radiation reaction and radiation alopecia do not require treatment. Treatment of erythematous and bullous forms of dermatitis is carried out according to the principles of dermatitis therapy; in addition, agents that enhance regenerative processes should be used. Patients with acute necrotizing dermatitis and late radiation dermatitis require surgical treatment.

SPICY EPIDERMAL NECROLYSIS (LYELL'S SYNDROME)

Definition. Acute epidermal necrolysis (toxic epidermal necrolysis - TEN) is an acutely developing dermatosis characterized by necrosis of the epidermis followed by its detachment throughout the entire skin.

Etiology and pathogenesis. A. Lyell identified 4 etiological factors of TEN - medicinal, staphylococcal, mixed and idiopathic. Currently, the cause of the development of TEN is mainly drugs - sulfonamides, antibiotics, barbiturates, pyrazolone derivatives. All types of immunopathological reactions, in particular autoimmune ones, play a role in the pathogenesis of the disease.

Clinical picture. The disease begins with a sharp increase in body temperature to 38-40 ° C, a deterioration in the general condition of the patient, the appearance of roseola, erythema, and multiforme rashes on the skin. exudative erythema, less often - urticarial elements and purpura, often the disease is similar to Stevens-Johnson syndrome.

After a few days, diffuse universal erythema forms, against which the epidermis begins to peel off with the formation of painful erosions and flabby blisters. The affected skin takes on the appearance of being scalded by boiling water. Characterized by severe pain in both affected and healthy-looking skin. Nikolsky's symptom (rubbing the skin with a finger leads to detachment of the epidermis), in areas of healthy-looking skin, is sharply positive.

General state the patient is extremely ill. There are no eosinophils in the peripheral blood, the number of band neutrophils is increased (up to 55%), toxic granularity of neutrophils is noted, laboratory parameters indicate a violation of water, electrolyte and protein balance.

Diagnostics TEN is based on the following data: epidermal detachment, increased temperature, severe pain in affected and healthy-looking skin, and absence of blood eosinophils.

Differential diagnosis. Acute epidermal necrolysis in the early stages (before clinical manifestations of epidermal detachment) is differentiated from toxicerma.

Treatment. It is advisable to treat patients with TEN in the intensive care units of burn centers, and the success of therapy largely depends on the timing of its initiation. The following drugs are used: corticosteroids, starting with 150 mg of prednisolone, agents that normalize water-electrolyte and protein balance, antibiotics wide range, which do not have a prolonged and nephrotoxic effect, symptomatic external therapy. Careful patient care using modern technical means - water mattresses, etc. is very important.

Radiation sickness can occur due to exposure of the body to quantities significantly exceeding the limit values. The circumstances that provoke the development of the disease can be called: external irradiation of the body, its individual part.

In addition, the catalyzing factor in the development of the disease is internal irradiation, which is observed due to the ingress of radioactive substances.

The method of penetration can be very diverse: Airways, contaminated food, water.

Once inside, they begin to “store” inside tissues and organs, and the body is filled with the most dangerous foci of regular radiation.

Signs of radiation sickness

Symptoms during irradiation can manifest themselves in diametrically opposite ways:

– cardinal disturbance of appetite, sleep, extremely violent excited state

– weakness of the body, “rolling” complete apathy towards everything, frequent diarrhea, vomiting.

The disease is actively manifested by significant changes (disturbances) in the normal functioning of the nervous, hormonal systems observed in conjunction with damage to cells and tissues. Especially, the cells of the intestinal tissue and bone marrow are exposed to maximum danger during radiation. The body’s defenses weaken, which inevitably entails a list of very unpleasant consequences: infectious complications, poisoning, hemorrhage.

Forms of the disease

There are two key types of this disease: acute and chronic.

1. Regarding acute form radiation sickness, then it actively manifests itself during the initial irradiation of the body. During the course of the disease, the patient is exposed to damaging radiation small intestine. Very characteristic indicators for this state are, diarrhea, high temperatures. In addition, people in the danger zone find themselves colon, stomach, and in some situations, the liver gets hit.

Of course, there are a number of others negative consequences for the body after irradiation. Areas of the skin that have been exposed to radiation experience burns, and radiation dermatitis is observed. The eyes are also in the zone of maximum risk - radiation cataracts, retinal damage - just a few of the possible consequences of radiation.

After a minimum period of time has passed, after the body has been exposed to radiation, accelerated “depletion” of the bone marrow is observed. The quantitative content in the blood decreases extremely greatly.

In the vast majority of those exposed, literally after 60 minutes nausea occurs and vomiting is possible.

Main primary symptoms, for acute radiation sickness with average degree heaviness, vomiting.

Their onset fluctuates in the range of 60-120 m, and completes their effect after 6 hours.

Vomit in severe cases of the disease, it occurs almost instantly, literally in thirty minutes, and the interval of its possible completion ranges from 8-12 hours.

Vomiting brings severe suffering to the body, is extremely painful, and is very difficult to “tame.”

2. Talking about chronic form, involve repeated exposure to low-dose ionizing radiation.

In addition to the total radiation dose received by the body, it is necessary to take into account the fact over what time interval the radiation dose was absorbed by the body. Symptoms for this type of disease are very diverse:

– severe fatigue

– lack of desire to work

– feeling of weakness, severe irritability

– inhibition of hematopoiesis, expressed by a sharp decrease in formed blood elements, possible occurrence of

– it happens that with a given symptomatic background, they arise and get their further development various tumors (leukemia).

Causes of radiation sickness

Circumstances that can lead to radiation damage to the human body can be conditionally classified into emergency and general. Talking about the former is a topic for a separate article, although accidents, thank God, do not happen so often, but they still exist (Fukushima, Chernobyl). Speaking about general radiation, it means therapeutic radiological exposure, for example, during bone marrow transplants, treatment of all kinds.

In most cases, the chronic form of radiation sickness cannot be called a consequence of the acute phase of this disease. Basically, the risk group consists of employees of radiological services and X-ray laboratories.

Treatment of radiation sickness

Of course, the key, fundamental condition for treatment will be the final cessation of any contact of the patient with the source of ionizing radiation. If possible, using specialized drugs, they try to remove radioactive substances. I would like to note that this cleansing procedure, by which radioisotopes of heavy and rare earth metals are removed from the body, is relevant and can bring a positive effect only at the very early stages of the development of the disease.

In the chronic form of the disease, physiotherapy is prescribed. If there are vegetative-vascular problems that make themselves felt by dizziness, various symptoms, then this is a strong argument for using a galvanic collar, ultrasound, or massage during therapy.

The doctor also prescribes medications that have high general tonic and calming properties. Much attention during therapy, vitamins of group B are given, since they are the most in an active way take part in the production of hemoglobin and nucleoproteins. Vitamin therapy is carried out 2-3 times, with an intermediate interval of two weeks. Pine baths, showers, followed by rubbing are also useful.

1. Pre-grind the celandine completely, including the stem and leaves. Next, place the resulting mixture (200 g) in a gauze bag in advance and lower it to the bottom of a three-liter container. After filling the jar with 3 liters of whey, add sour cream (1 tsp). To completely prevent the occurrence of wine midges, it is strongly recommended to carefully cover the bottle with several (3-4) layers of gauze. For the full formation of strong lactic acid bacteria, this composition should be kept in a warm, dark place for three weeks.

Taking celandine enzymes for 10 days, 100 ml each, will significantly contribute to the restoration of the epithelial gastric surface, and indeed, completely. Radionuclides and various heavy metals are detached from the intestinal epithelial hairs.

2. Inhalation with celandine enzymes allows you to remove radionuclides from the lungs. To achieve this goal, you need to breathe over celandine vapors every day for ten minutes. After several days, dust particles containing radionuclides will be gradually removed from the lungs along with sputum.

3. The use of chestnut-based kvass, thirty minutes before meals, 200 ml, has proven extremely positive. This procedure will allow for a “drastic cleansing” of the body from radionuclides, heavy metals, By at least, from most of them. Cut 40 chestnut fruits in half. We fill them with a 3-liter container, previously filled with well water. After which, the following components should be added sequentially: sugar (200g), whey (100 ml), sour cream (20g). Kvass should be stored in a warm room (approximately thirty degrees), with a storage duration of two weeks.

Kvass based horse chestnut significantly increases immunity, minimizes the chances various diseases for penetration. Along the way it gets stronger and grows percentage iodine, calcium. One more nuance needs to be taken into account. If you consume 200 ml of kvass from a container, then you should definitely add the same amount of water plus a couple of spoons of sugar. After 12 hours, the total volume of kvass will be the same.

4. An excellent remedy that can significantly cleanse the body of radionuclides is eggshells. The intake should be no more than 3 grams. Eggs are washed thoroughly warm water with soap and then rinse well. After which, the shell should be boiled for five minutes. The best tool for bringing the shells to a powder state is a mortar. Depending on age, it is best to take it for breakfast, for example with cottage cheese or porridge.

5. Flax-seed(200 g), pour into a container filled with two liters hot water. By betting on water bath, cook for two hours. After cooling, drink the decoction often in 100 ml doses.

6. The removal of radioactive substances from the stomach will be actively facilitated by the consumption of seaweed, steamed bran.

Nutrition for radiation sickness

The issue of well-planned nutrition is very important, since some foods, when ingested by the body, contribute to the elimination of certain types of radioactive substances. For example, magnesium salts (prunes, apples) can successfully combat “retained” strontium. White bread and cereals are consumed in extremely limited quantities.

– the daily protein component should be quite significant (minimum 140 g)

– for normalization, a nutritious diet must contain dairy products

– from fats, special preference should be given to those with a plant base.

When eating salads, adding a forest fern leaf will be very beneficial. Carrots, apples, and beets have a good binding effect against radionuclides.

Radiation sickness represents the final stage of a series of events that are actively developing due to the impact of large doses of radiation on the body. At the same time, molecular changes, the emergence of active elements in liquids and tissues, inevitably entail contamination of the blood with toxins, poisons, and most importantly, cells inevitably die.

Beware of this disease, take an interest in your health in a timely manner, goodbye.

RADIATION ULCER (synonym for x-ray ulcer)- a defect in the skin or mucous membrane and underlying tissues resulting from exposure to ionizing radiation.

The etiology and pathogenesis of radiation ulcers are associated with the effect of ionizing radiation (see) on biological objects. Radiation ulcers can occur under conditions of therapeutic irradiation with radiation loads exceeding the tolerance of the skin and mucous membranes (see Radiation damage; Burns, radiation burns). The total doses leading to the development of radiation ulcers are different, which is associated with dose fractionation over time and the volume of radiation (see Radiation therapy). Modern methods personnel protection virtually eliminates the risk of occupational radiation ulcers.

The appearance of a radiation ulcer is usually preceded by itching, hyperemia, and a burning sensation in the area of ​​the previously irradiated area of ​​the skin. As a rule, radiation ulcers develop against the background of sluggish radioepidermitis (see) and radioepithelitis (see). They are characterized by a torpid course, gradual but steady progression. Symptoms depend on the location of the ulcer, its size, and the proximity of nervous, vascular and other anatomical structures to it. Radiation ulcers on the extremities are accompanied by swelling and pain. Radiation ulcers of the oral mucosa are dangerous due to infection, development of phlegmon and sepsis. Ulcerative radiation cystitis (see) is manifested by frequent painful urination. A radiation ulcer of the rectal mucosa is accompanied by pain, the appearance of blood and mucus in the stool, and impaired bowel movements. They may be complicated by perforation into the abdominal cavity or the formation of fistulas.

IN differential diagnosis important has a morphological examination of tissue from the edges of the ulcer to exclude recurrence of the tumor for which radiation therapy was performed.

Treatment usually begins with conservative measures, consisting of a complex of general and local effects. The first include the prescription of vitamins and the regulation of homeostasis, in particular its immune and endocrine components. 10-50% ointment with dimexide is applied locally, treatment is carried out under conditions of gnotobiological isolation (see Controlled abacterial environment). In some cases, with a radiation skin ulcer, its complete excision within healthy tissue with possible plastic surgery with a free flap is indicated (see Skin plastic surgery).

The prognosis with timely treatment is usually favorable.

Prevention of the occurrence of radiation ulcers during therapeutic irradiation consists of rational planning of the volume and time of irradiation, protection of the skin and mucous membranes, taking into account the tolerance of the irradiated integument, as well as creating conditions for differentiated effects on the tumor and healthy tissues during the irradiation period (see). Drug prophylaxis includes lubrication of the skin and mucous membranes during and after irradiation until radiation reactions are completely eliminated. Vitamin-containing ointments and oils (sea buckthorn, peach or rosehip), disinfectant solutions, etc. are used.

Bibliography: Bardychev M. S. and Ts y b A. F. Local radiation damage, M., 1985; Kozlova A.V., Possible consequences damage to organs and tissues during radiation therapy of malignant tumors, Med. radiol., t. 22, no. 12, p. 71, 1977; Pavlov A. S. and Kostromina K. N. Cervical cancer, p. 136, M., 1983; Strelin G.S. Regeneration processes in the development and elimination of radiation damage, M., 1978; Alexandrov S. N. Late radiation pathology of mammals, B., 1982.

This information is intended for healthcare and pharmaceutical professionals. Patients should not use this information as medical advice or recommendations.

Happening successful treatment patient with late radiation ulcer shin and osteonecrosis (osteomyelitis) tibia

Yu.A. Amiraslanov, I.V. Borisov, A.P. Ivanov, A.A. Ushakov
Federal State Institution Institute of Surgery named after A.V. Vishnevsky Federal Agency for High-Tech Medical Care, Moscow (Director, Academician of the Russian Academy of Medical Sciences V.D. Fedorov)

Currently, in patients with soft tissue sarcomas of the extremities, the combination is most often used surgical treatment and radiation therapy. However, during the latter, there is often significant damage to the healthy tissue surrounding the tumor. According to Cannon C.P. et al. with combined treatment of soft tissue sarcomas of the lower extremities, early radiation damage (epithelitis, dermatitis) that occurred in the first 3 months after irradiation developed in 27%, late radiation damage (radiation fibrosis, late radiation ulcers) in 13% of cases.

Local radiation injuries are characterized by torpidity to treatment with various medications. A long, progressive course of radiation damage with frequent relapses and the addition of purulent infection negates the good results of treatment of the underlying disease and reduces the quality of life of patients.

In case of extensive radiation damage to soft tissues and bones with the addition of a purulent infection, the only way to prevent serious complications is to perform amputation of the affected limb segment. Only use of active early surgical intervention with the need to operate outside the area of ​​irradiated tissue and the use of plastic surgery with tissue flaps with axial circulation, as well as microsurgical autotransplantation, made it possible to fundamentally change the situation in better side.

The principles of active surgical treatment of local radiation injuries were applied in the treatment of patient M., 35 years old, who was treated at the Institute for a late radiation ulcer of the upper third right shin with osteonecrosis (osteomyelitis) of the tibia.

In 1991, the patient was operated on at his place of residence for synovial sarcoma of the upper third of the right leg - combined treatment was performed - marginal resection of the right tibia and radiation therapy with a total dose of 120 Gy (which is 2-3 times higher than the standard radiation dose) with a positive effect. Over the next 15 years, he had no complaints, but in 2006, as a result of a bruise, an ulcer formed in the area of ​​the operation.

In this regard, the patient was re-hospitalized. With repeated biopsies, no evidence of recurrence of sarcoma was obtained. A marginal resection of the tibia was performed with the implantation of a silicone expander to attempt plastic closure of the resulting defect. IN postoperative period suppuration developed with necrosis of stretchable tissues and the formation of an extensive ulcer on the lower leg.

In December 2006, he was examined at the Oncological Research Center named after Academician N.N. Blokhin RAMS - data for relapse tumor process not received. However, the diagnosis remained unclear. To verify it and determine treatment tactics, the patient was hospitalized at the Institute on February 5, 2007.

Upon admission, the condition was satisfactory. Clinically, according to a comprehensive radiation examination and laboratory data, evidence for metastatic lesions of the thoracic and abdominal cavities and no signs of radiation sickness were found.

In the upper third of the right leg along the anterior surface there was a purulent wound 15x15 cm with areas of necrosis of the tibia and granulations gray. A defect in the knee joint capsule opened into the upper part of the wound with the leakage of synovial fluid. There were cicatricial changes in the soft tissues around the ulcer. Right flexion knee joint limited, active extension was absent. Due to pain, the supporting function of the limb was absent. Regional inguinal lymph nodes are not enlarged.

Bacteriological examination identified methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa.

On plain radiography A postoperative defect of the upper third of the tibia was revealed. The CT picture was consistent with osteomyelitis of the proximal part of the right tibia.

To establish the diagnosis, on February 9, 2007, the patient underwent a biopsy with excision of the ulcer in a single block. results morphological research: chronic inflammation with fibrosis of soft tissues and bone structures.

In the postoperative period it was carried out local therapy various drugs (PEG-based ointments, 1% iodopirone solution), antibacterial, anticoagulant and antiplatelet therapy. However, despite the treatment, secondary necrosis appeared in the wound (Fig. 5).

Due to suspected radiation damage, the patient was consulted by specialists in the treatment of radiation injuries from City Clinical Hospital No. 6 (Moscow) and the Medical Radiological Scientific center of the Russian Academy of Medical Sciences(Obninsk). Conclusion - a trophic ulcer is a consequence of radiation therapy.

A patient aged April 3, 2007 underwent repeated debridement with excision of the trophic ulcer and marginal resection of the tibia. As a result, the dimensions of the wound were 20x20cm. The wound was initially closed with a gastrocnemius musculocutaneous flap on a permanent pedicle. Isolation of the flap was accompanied by technical difficulties due to fibrotic changes soft tissues, especially the posterior group of muscles of the leg. The donor wound is closed with split perforated skin flaps. The patient received local treatment of wounds with a 1% solution of iodopirone, Actovegin-gel, as well as antibacterial, anticoagulant therapy, and intravenous administration of Actovegin. The flaps have completely healed. The sutures were removed on the 14th day. The patient was discharged in satisfactory condition on May 11, 2007.

As a result of the treatment (hospitalization period was 92 days), it was possible to eliminate purulent infection, close the wound surface, restore microcirculation in the irradiation zone and restore limb function.

Conclusion: Diagnosis of late radiation ulcers can present significant difficulties. Successful treatment is possible subject to radical excision of the ulcer with primary closure of the defect with well-vascularized tissue.

Literature

1. Cormier J.N., Polock R.E. Soft tissue sarcomas. C. A. Cancer J. Clin. 2004; (54). 94-109.

2. Cannon C.P., Ballo M.N., Zagars G.K. et al. Complication of combined modality treatment of primary lower extremity soft-tissue sarcomas. Cancer. 2006; Nov. 15; 107(10). 2455-61.

3. Bardychev M.S. Treatment of local radiation damage. Attending doctor. 2003; (5). 78-79.

4. Guide for doctors. Radiation medicine. T.2. Milanov N.O., Filin S.V. Publishing house, 2001; 186-202.

In 14 patients suffering from malignant skin tumors complicated by radiation ulcers, a 0.25% Derinat solution for external use was used as the main treatment. “Derinat” was used to moisten sterile napkins that were used to cover ulcerative defect skin twice a day, a course of 10-24 procedures. Complete effect was obtained in 9 patients (64%), partial - in 2 (14%), stabilization of the process - in 2 (14%), no effect - in 1 (8%).

The incidence of malignant skin tumors has remained very low for many years. high level both in developed Western countries and the Russian Federation, ranking 1-3 in frequency. In complex therapeutic measures Radiation therapy plays an important role in malignant tumors. However, along with the positive effects this treatment noted side effect. Radiation reactions are an inevitable companion to radiation treatment. According to M.S. Bardycheva et al. , late radiation damage to the skin and underlying tissues occur in 41.5% of patients after radiation therapy. The incidence of radiation ulcer is 3.5% of cases. In the treatment of primary malignant neoplasms of the oral mucosa, radiation ulcers account for 15.0%, recurrent and residual tumors in 33.0% of cases.

A common complication of radiation therapy for skin cancer is radiation ulcers, the treatment of which is incredibly difficult and takes many months and even years. Radiation ulcers are persistent and require long-term treatment. Difficulties in therapy are caused by disruption of metabolic and proliferative processes in tissues, changes in the state of tissue and regional circulation in the area of ​​radiation damage. Developing early and late radiation injuries lead to social disability active persons and significantly reduce their quality of life. Therefore, it is necessary to search and implement new methods of treatment and rehabilitation of this category of cancer patients, taking into account cost-effectiveness.

In our work we Special attention turned to the use of "Derinat" for visible localizations of malignant neoplasms due to the fact that the assessment of the therapeutic effect can be visual, objective and easily documented. In addition, tumors of the named localization are among the most common. Thus, in the Republic of Moldova, the incidence of skin cancer ranks 1-2 among other malignant tumors. This is true for other regions as well.

Patients and methods.

We used external use of Derinat in 14 patients suffering from malignant skin tumors. The study included 14 men and women. The age of the patients participating in the study ranged from 58 to 92 years. All patients included in the study showed signs of trophic disturbances in the affected area (where it was previously localized). primary focus) in the form of hyperpigmentation, areas of soft tissue necrosis, fibrin deposits, peeling of the skin, cyanosis and the presence of ulcers. Average duration Treatment period for a patient with Derinat in a clinical study was 6.7 weeks. Patients underwent a course of 10-24 procedures of external administration of the drug “Derinat” into the skin of the area of ​​trophic disorders.

A sterile solution of Derinat (0.25%) was used externally, moistening sterile napkins with it to cover the ulcerative skin defect. To keep the napkins in a damp state for 1-2 hours (no more, to eliminate the possibility greenhouse effect) they were covered with an insulating material such as parchment paper. Dressings were performed in the dressing room twice a day - morning and evening. The dosage depended on the area of ​​the problem area and could include from 2.0 to 5.0 ml of the drug.

The effectiveness of the drug "Derinat" was assessed using standard clinical and instrumental research methods before the start of use, in the middle (2 weeks from the start of treatment) and at the end of the course (4-5 weeks) from the moment of use of the drug.

Data on patients are presented in Table 1.

Table 1

Distribution of patients who received external treatment with Derinat by gender, nosology and stage

Clinical examples.

Observation #1. Patient N., 92 years old, three years ago received radiation treatment (close-focus radiotherapy) for stage I basal cell skin cancer of the right temporal region. at a dose of 56 Gray. Over the past 8 months. on site cancerous tumor There is an ulcer with a diameter of 2.5 cm, which gradually increases in size. The ointment treatment provided no effect. The diagnosis was made: “Basal cell skin cancer of the right temporal region, stage I.” II class group. Condition after radiation therapy (in 2003). Radiation ulcer." There was no evidence of cancer recurrence. Objective picture pathological process at the time of treatment is shown in Fig. 1. Figures 2 and 3 show changes in a radiation ulcer due to topical application of Derinat.

Fig.1. Patient N., 92 years old. Three years after close-focus radiotherapy for basal cell carcinoma of the skin of the right temple at a dose of 56 Gy, a radiation ulcer with a diameter of 2.5 cm appeared at the site of the cancerous tumor after 2 years

Fig.2. 2 weeks after topical application of Derinat, the bottom of the ulcer began to clear of necrotic plaque

Fig.3. After 3 months, complete healing of the radiation ulcer occurred

It should be noted that a similar effect for radiation ulcers with traditional methods treatment (ointment dressings, local application rosehip or sea buckthorn oils, hormonal ointments etc.) is impossible to achieve. Average term cure radiation ulcers by the indicated methods treatment is more than 12 months.

Clinical observation No. 2. The use of derinat for long-term non-healing of a postoperative wound after radical excision of soft tissue sarcoma back surface thighs followed by radiation therapy in terms of combined treatment at a dose of 70 Gy in a 48-year-old man.

Fig.4. Appearance wounds after 3 months. after surgery

Fig.5. After local treatment the wound has cleared of purulent plaque, but the depth of the wound has not decreased - there is no tendency to heal. Treatment with Derinat was started on an outpatient basis

Fig.6, 7. After 2 months. After using Derinat, the wound decreased by 50% and became superficial. Active epithelization can be seen

Research results and discussion.

Of the listed 14 patients full effect was obtained in 9 (64%), partial effect - in 2 (14%), stabilization of the process - in 2 (14%), no effect - in 1 (8%).

So, our first experience of using Derinat for malignant neoplasms of visible localizations complicated by radiation ulcers, when applied topically, revealed a high therapeutic effect drug. Although a relatively small number clinical material does not allow us to draw far-reaching conclusions at this stage, but does provide an opportunity to discuss the likely mechanisms of drug effectiveness.

Of course, local use of Derinat ensures its direct contact with the epithelial cells of the epidermis, as well as with the immune system through the lymphoid tissue located at the site of inflammation. This is a condition for the onset of the immunomodulatory properties of the drug, which can be manifested by a decrease in the level of pro-inflammatory cytokines, a decrease in the level of adhesive function of cells and their apoptosis, a significant increase in the activity of tissue macrophages, these “cells for all occasions”, responsible for the completion of reparative processes. In addition, the literature describes positive influence"Derinata" on microcirculation in trophic ulcers, reducing antioxidant deficiency, as well as suppressing the infectious factor.

Our experience shows that Derinat has a very great healing potential, which is obviously due to its ability to penetrate cells by pinocytosis without compromising the integrity of membranes, stimulating metabolic and reparative processes. Therefore, it is able to support the restoration and differentiation of skin cells.

It is also necessary to note the obvious feasibility of using Derinat as a universal metabolic modulator based on nucleic acids already in early period acute radiation injuries of the skin. Since it is during this period that, due to both direct and indirect effects of radiation, damage to biomacromolecules and disruption of the synthesis of nucleic acids occurs, changes in immunity and the intensity of proliferation and transformation processes. Already at these early stages during irradiation, the metabolism of nucleic acids undergoes significant changes, therefore the issue of protection and restoration of biosynthesis is one of the most important in pathogenetic therapy.

In addition, it is known that activation of cells during regeneration by tissue decay products occurs through nucleic acid metabolism. Therefore, it seems reasonable to include “Derinat” in the composition complex therapy at all stages of treatment of such patients.. We did not specifically use the combined method of combined administration of Derinat (combination of intramuscular injections of Derinat with an external form) since it is obvious that the effect would be much higher.

Our work has shown that even external use of the drug makes it possible to use this medicine directly into the ulcer as monotherapy and effectively stimulate regenerative processes. results clinical trial on external use of the drug "Derinat" in patients with malignant tumors external localizations and radiation ulcers demonstrate a good therapeutic effect.

The method of external use of the drug “Derinat” can be used in oncology for the purpose of treatment, prevention and correction of external skin damage, including radiation ulcers.

Conclusions:

1. For external use of the drug "Derinat" side effects was not observed.

2. The study revealed the safety of using the drug “Derinat”.

3. External use of the drug "Derinat" leads to accelerated healing trophic changes in tissue and radiation ulcers.

4. After a course of external use of the drug "Derinat" there is a significant improvement in the repair processes, resulting in complete healing even severe forms radiation damage to the skin in almost 65%.

M.T. Kulaev, G.G. Meltsaev, S.A. Shchukin

Mordovian Republican Oncology Dispensary

Saransk Medical Institute, Moscow State University. N.P. Ogareva

Kulaev Mikhail Timofeevich - candidate medical sciences, Associate Professor, Head of the Department of Oncology medical institute Moscow State University named after N.P. Ogareva.

Literature:

1. Kaplina E.N., Weinberg Yu.P. "Derinat" is a natural immunomodulator for children and adults. M., 2007.

2. Zhavrid E.A., Khodina T.V. Report on a clinical study of the hemostimulating properties of the drug "Derinat". Research Institute of Oncology and Medical Radiology of the Ministry of Health of the Republic of Belarus, 1994.

3. Tarelkina M.N. The use of the drug "Derinat" in the complex treatment of cancer patients. Report from the Research Institute of Emergency Medicine named after. I.I. Dzhanelidze. St. Petersburg, 2002.

4. Pluzhnikov N.N. "Experimental study of the effectiveness of the drug "Derinat" as a means of early treatment radiation injuries." Research Institute of Military Medicine of the Ministry of Defense of the Russian Federation, St. Petersburg, 1997.

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