Экстракорпоральная гемокоррекция

INTRODUCTION 

     In many diseases of the blame for abnormal substances circulating in the blood in atherosclerosis - the "bad" cholesterol, and gout - uric acid... Our blood supplies needed for the body of matter from one organ to another. A back carries waste products of metabolism. They are very harmful to the body, as the "domestic refuse" slows down the red blood cells, involved moving the oxygen and carbon dioxide. And because of this increased blood viscosity. Any inflammations also contribute to this. Viscous blood the first step to stroke and heart attack. Haemocorrection allows you to remove from the blood and the intercellular space of toxic substances.

     Extracorporeal haemocorrection - a modern branch of medicine based on the directed modification of components of blood outside the body of the patient to change their properties or remove pathological substances that cause or contribute to disease. This concept is widely used in clinical practice. The literature also uses a term such as "Efferent therapy".  It combines a variety of methods to reduce the toxicity of medium body and excretion of abnormal complexes (circulating immune complexes, myoglobin, blood cells in hematological disorders) by using traditional tools and modern physics and engineering systems. Removal of pathological complexes, correction and maintenance of homeostasis is achieved by various methods.

     In more simple language, easy to understand not only the leading physicians, these procedures are referred to as "facilities for the body" and find the path to eternal youth.

     Today it is being prescribed for 60 diseases. 
 
 
 
 
 

1. The history of Extracorporeal haemocorrection

 

     Ideological prototype of modern technology is the method of extracorporeal haemocorrection bloodletting described Hippocrates and Galen. In the Middle Ages - bloodletting was a universal and effective treatment for the vast number of diseases. "Open the bad blood" was considered a panacea for many centuries in the treatment of headaches, infections, poisoning, hypertension, fever, etc.

     From the standpoint of modern medical science in this method of treatment, despite the simplicity of implementation, of course, there were rational. After all, "opening the blood", the doctor reduced the concentration of substances in the body of pathologic, and decreased blood pressure.

     However, the bleeding had a number of adverse effects. After all, with the blood from the body removes not only harmful substances, but also quite normal its components, in the first place - proteins and blood cells (erythrocytes, leukocytes, and platelets).

     Therefore, in the early twentieth century, the method has lost its clinical significance, and the idea to remove from the blood only "bad" components with the return of patients' blood cleansing. "Over the next 100 years, this idea is taking shape.

• In 1902, Hedon began experimenting on the "washing of red blood cells" and already in 1909, describes a case Fleig treatment of a patient with renal failure by bloodletting with subsequent return of washed red blood cells the patient.
• In 1912 a group of professor J. Abel (USA) began to develop a new experimental method of "blood cleansing" of pathological substances, which they called plasmapheresis (from the Greek. Plasma - the liquid part of blood, Apheresis-removal), i.e. removal from the body of the plasma. "Purification of Blood" included removal of blood from the body, its centrifugation, removal of plasma, its replacement with saline and return of blood to the body.
• The first successful operation of plasmapheresis were performed in humans V. Waldenstrom only in 1944 in a patient with high blood viscosity (Waldenstrom's disease), and in our country, therapeutic plasmapheresis produced R.A. Mokeeva after 20 years in 1964 in several patients with very high viscosity of blood.
• Once in the late 60s in the USA created the first automatic cell separator blood all over the world is beginning to actively use plasmapheresis in resuscitation and intensive care.
• Other areas in the extracorporeal haemocorrection are the use of sorption technologies. The best known of these methods is hemosorption. The method is based on the passage of blood through the carbon or ion-exchange sorbents, allowing the surface to hold the toxic substance. However, since then, as K. Hagstrom in 1966 described a dangerous complication hemosorption - blockage of the arteries of different particles of coal, the interest in this method, long gone, though, and today continues to be used in hemosorbtion toxicology of severe acute poisoning.
• The end of the 60s - 80s. - meeting the general medical community with such methods of extracorporeal haemocorrection as hemosorption, then plasmapheresis methods and wave processing of blood. Their use in treating the most severe patients was accompanied by impressive victories. However, the first cautious attempts to implement these rather aggressive methods, unfortunately, gave way to rage, and the use of these techniques has become a kind of panacea for a wide range of diseases. While it was difficult to find major medical institution in the arsenal that might not mean these treatments.
• The main indication for their use was carried out by medical therapy ineffective. Often it was the last step of despair, when the doctor did not know how to help the patient. At the same time, even experts in this field of medicine had a very rough idea of ​​the mechanisms of action of most of extracorporeal technology. Naturally, this "innovation", even coming from the best of intentions, in many cases led to disappointment. Moreover, the first stages of implementation of these technologies, accompanied by the development of new equipment, perfecting techniques for extracorporeal procedures. Of course, this could not lead to complications, which also did not add popularity and by causing fear among patients and physicians.
• The beginning of the 90s. - A "negative impact of the 1st stage." Most recently, supporters of the methods of extracorporeal haemocorrection impression of their low efficiency and high rate of complications. There was a complete disappointment. This was confirmed and held at this time of the first studies. They showed, for example, that a common method such as plasma exchange is effective only under very limited number of relatively rare diseases. In this regard, further development of extracorporeal haemocorrection slowed considerably. But this period did not last long.
• The boundary of centuries was marked by a revolutionary scientific advance in molecular biology, immunology, and biochemistry. As a result, the knowledge about the mechanism of many diseases revived interest in the in vitro techniques. But by that time been considered a negative past experience, understood the causes of unsatisfactory results, develop better, safer and "predictable" methods. Their use has been scientifically substantiated. In addition, new knowledge about the mechanisms of disease has allowed more thorough evaluation of the indications and contraindications to their holding. Development of new selective and half-selective techniques, implementation of complex software application of extracorporeal medicine under specific pathological processes to bear fruit. The result of numerous fundamental and applied researches was the technological change of the 1st generation (plasmapheresis, hemosorbtion, etc.) on the next generation of technology. Its development received half-selective (krioaferez, cascade filtration, etc.) and selective technology (immunoadsorption, affinity adsorption). Many of these technologies, which fairly narrow therapeutic task was used in combination with each other, expanding their therapeutic orientation, and covering several parts of the pathological process. By this time, it became clear the place of extracorporeal technologies in the complex treatment of patients, shows the special pharmacological support of patient care.
• The beginning of the XXI century - the emergence of effective, science-based and quite complex in execution methods of extracorporeal haemocorrection no longer allowed treating them as complementary technologies. Implementation of new procedures requiring extracorporeal expanding and deepening basic knowledge of doctors in many medical disciplines, the acquisition of practical skills to perform the procedures detailed study of the diagnostic and treatment protocols. All this is marked by the appearance in the world of new medical specialty - transfusiology.
• Since the mid-90s. began active development of new methods of extracorporeal haemocorrection that combines maximum safety for the patient, scientific soundness and efficiency.
• The result of the research was the development of new technologies of extracorporeal haemocorrection 2nd generation: a selective and half-selective technology - krioaferez, immunoadsorption, cascade plasmapheresis termoplazmadsorption, extracorporeal pharmacotherapy, etc. And today the number of such technology has exceeded 30.
• Currently, developed, tested and used extensively in clinical technology, which can specifically remove blood from the cells and a group of molecules that are directly involved in the development of disease. In this case, unlike the technology 1st generation, all the other blood components remain unchanged, and returned to the bloodstream. This so-called selective and techniques of extracorporeal half-selective haemocorrection.

 

2. The main treatments used in the department of Extracorporeal haemocorrection

 

• Hemodialysis;
• Hemosorbtion;
• Plasmapheresis.

     Combining the methods of extracorporeal haemocorrection optimize the expected effects of therapy. 

     Plasmapheresis - a method of extracorporeal haemocorrection based on the replacement of patient plasma components, blood products or blood substitutes. Used to treat the following conditions:

• severe decompensated stage toxicosis of various origins;
• severe generalized forms of infectious diseases;
• chronic autoimmune diseases: bronchial asthma, systemic connective tissue diseases, hematological diseases, rheumatoid arthritis, psoriasis, allergic diseases of various origins;
• paraproteinemia;
• toxicosis chronic liver diseases, kidney, lungs, etc.;
• total myolysis , hemolysis hemolytic poisons for poisoning, compartment syndrome, and others;
• hypercholesterinemia;
• gout.

 

     Hemodialysis - a method of correction based on the principle of diffusion and filtration exchange transport of low molecular weight substances and water through a semipermeable membrane of circulating extracorporeally blood dialysate. Used to treat the following conditions:

• acute renal insufficiency of any origin;
• end-stage renal insufficiency;
• hyperkalemia due to renal failure;
• acute intoxication with hydrophilic toxins, drugs, alcohol, technical fluids;
• gross violations of water electrolyte balance in the absence of the effect of conventional therapy.

 

     Hemosorbtion - a method of extracorporeal haemocorrection based on the derivation of the patient's blood of toxic substances endogenous or exogenous nature by extracorporeal perfusion her through the sorbent. Used to treat the following conditions:

• therapeutic and surgical toxicosis in the early stages of development (acute pancreatitis, cholecystitis, peritonitis, sepsis, etc.);
• acute poisoning with soporific drugs, alkaloid, salicylates, salts of heavy metals, etc.;
• withdrawal symptoms in drug addiction, drug addiction, alcoholism;
• manic and depressive states in mental illness.

 
 
 
 
 
 
 
 
 
 
 
 
 

3. The process of blood purification

 

     Despite the complicated name of the procedure, it is fairly simple manner. From the veins carry blood into a special machine that is running all kinds of filters - membranes with microscopic holes. Each of them works as a good detective: enfranchise some molecules and other delays. For example, in patients with atherosclerosis membrane miss small molecules of high density lipoproteins ("good" cholesterol) and other useful substances, but will delay the larger molecules of pathogenic substances - lipoproteins of low and very low density ("bad" cholesterol), as well as thrombogenic components.

     After removing all the excess blood is saturated necessary - depending on what is required for a particular disease. It could be hormones, antibiotics, high-energy compounds and the factors that block the activity of certain cells. After that, the blood can return a person back. Since all manipulations with blood components occur outside of the patient, there is no risk that the drugs would have side effects on other organs and tissues.

     In general, the method is very similar to plasmapheresis. But at last, along with the bad molecules out of blood are removed and good. And the remaining bad molecules rapidly progressed in the absence of decent resistance. That is why the effect of plasmapheresis is so short. In extracorporeal haemocorrection effect long lasting. Especially noticeable in atherosclerosis. After the procedure, the number of "bad" cholesterol in the blood is greatly reduced, it began actively washed out of the atherosclerotic plaque, and the latter decreases. In the next session again unnecessary cholesterol is removed from the blood vessels and the process of purification continues. 
 
 
 
 
 

4. Treatment and outcome of Extracorporeal haemocorrection

 

     What ailments can be treated with gravity surgery? First of all, autoimmune, in which the immune system begins to produce antibodies against its own tissues. Surgery helps blood to patients suffering from psoriasis, systemic lupus erythematous, rheumatoid arthritis, scleroderma, autoimmune hepatitis, multiple sclerosis and similar diseases.

     Extracorporeal haemocorrection amenable to the so-called storage diseases. For example, the same atherosclerosis, when the wall of blood vessels is delayed "bad" cholesterol, gout, or when the salt of uric acid leads to inflammation of the joints.

     For the treatment of many diseases requires directed transport of drugs with which copes gravitational medicine. Necessary drugs, bypassing the stomach and liver, and therefore, without harming them, blood will enter immediately into the inflammatory focus. Compare: if people drink the pill, the diseased organ will receive only 1.5% contained therein dose of medicine. And if you include the preparation of their own white blood cells, he finds problematic place, and its concentration increases once there 6-8 times. That is why the gravitational surgery is very effective in chronic disease - obstructive bronchitis, inflammation of the uterus in women, prostatitis in men, maxillary sinusitis, furunculosis, a viral infection.

     Finally, the new method allows removing the hepatitis C virus from the blood. A smaller concentration of virus in the blood, the more effective drugs are working with the remaining pathogens. Until recently, the efficacy in the treatment of hepatitis C was only 40-50%. Haemocorrection improves this figure: a full recovery occurs in 80-86% of patients.

     What results are obtained by this procedure? Lowers blood viscosity - improves blood supply to all body systems. It is better to work the kidneys, liver, heart, brain, endocrine system. Haemocorrection can reduce the dose of the prescription, because it promotes better, spot delivery of drugs to the centers of the disease - respectively, the reduced treatment time. Purification of the blood gives good results in vascular damage in diabetes mellitus, chronic inflammation of female reproductive organs, problems with cleft sutures after operations, the prevention of stroke with increased blood viscosity, obliterating diseases of vessels of legs, an excess of cholesterol in the blood. Rehabilitation is faster after illness. Subject to the recommendations of the physician effect on haemocorrection saved up to 1-1.5 years.

     For any medical appointments reduced the toxic effect of drugs on the body - that is excluded dysbiosis, toxic liver damage, nervous system and kidneys. Alcohol and drug intoxication, poisoning pills are removed. In Europe and in America haemocorrection widely used in cosmetics, as a natural rejuvenating. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5. Extracorporeal haemocorrection the treatment of autoimmune diseases of the eye in children

 

     The problem of the treatment of autoimmune diseases of the eye in children is of great social significance and is one of the most important in ophthalmology because of the wide spread and severity of the disease, the complexity of the pathogenesis and high disabling factor due to the development of numerous complications: complicated cataract, glaucoma, vitreous fibrosis, retinal detachment. In autoimmune diseases of the eye revealed autoantibodies to their own tissues in the tear fluid and in serum (keratitis, anterior uveitis, scleritis, inflammatory diseases of the retina, optic nerve, traumatic iridocyclitis, sympathetic ophthalmia). Often occurring immunological disorders, frequent complications are significant challenges to treatment. Disability-free sets in 20-50% of children had been ill. There is a number of immunological features of the flow process in the eye of the child: children inflammatory process develops in the immature and not formed by the body to the presence of biochemical and morphological features of most structures, which causes more rapid and severe anatomic and clinical changes with disruption of normal growth and formation of the eyeball. Given that the basis of the pathogenesis of autoimmune diseases of the eye and lie immunodependent and immune-mediated reaction, immunotropic treatment is the basis of the treatment. A special place among extracorporeal immunotherapy is haemocorrection - plasmapheresis and its combination with extracorporeal laser irradiation of blood and ultraviolet irradiation of blood lymphocytes. Treatment should be conducted in accordance with the type of inflammation and immunity disorders character and is directed at relief of the inflammatory process, the preservation of function and prevention of relapse. 
 
 
 
 
 

5. 1. Materials and methods 

     Under the supervision of health workers were 51 children, of whom 10 children assigned to group comparisons. Age children of the main and control groups - 8 to 14 years. The children were characterized by severe inflammation in the eye, frequent recurrences of the disease, to use in the treatment of methods of extracorporeal haemocorrection failed to arrest the inflammatory process in the eye to halt recurrence of the disease or reduce their number.

     The form of the disease and immunological localization of the children were divided into 3 main groups:

     In group I assigned 12 children with the following diseases: keratitis and keratouveit - at 5 and children, scleritis - at 2 children, anterior uveitis - at 5 children. Previously, children received traditional medical treatment. Relapse in this group were 2-3 times a year. Complications were detected in 3 children: secondary glaucoma, complicated cataract. Disease duration ranged from 6 months to 3 years or more.

     Group II - 19 children - inflammatory diseases of the choroid and retina: chorioretinitis, retinitis, vasculitis. Relapses are marked from 1 to 3 or more times a year. Complications were detected in 6 children: complicated cataract in 4 children, exudative retinal detachment, with 2 children. Inflammatory diseases of the optic nerve were observed in 8 and children. The disease duration ranged from 6 months to 2 years. Relapses occurred from 1 to 3 times a year.

     Group III - 10 children - traumatic iridocyclitis at 5 and children, endophthalmitis - at 2 children, sympathetic ophthalmia - in 3 children. In 7-traumatic iridocyclitis and children and endophthalmitis occurred after a penetrating wound, in 3 children diagnosed with sympathetic ophthalmia. Control group consisted of children with similar illnesses, comparable in age and sex with the main group.

     The program included a survey visometria, biomicroscopy, ophthalmoscopy, ophthalmoplethysmography, electro-oculography, study of the main indicators of immunity. Before treatment, the major groups of children a central visual acuity of less than 0.3% was observed in 70 eyes and 30% of eyes more than 0.3.

     The children of the control group visual acuity less than 0.3 before treatment was observed in 54% of eyes. To assess the nature and gravity of the violations observed at the regional hydro-, hemodynamic children used ophthalmoplethysmography. Statistically significant hemodynamic instability in the eyes of children have been identified that can explain the elasticity of the structures of the eyeball and increased compensatory abilities. In children with autoimmune diseases eye was also noted significant violations of the basic hydrodynamic parameters of the high compensatory capacity and resilience of the anatomical structures of the eyeball. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5. 2.The methodology of plasmapheresis 

     Of use in clinical practice methods shall elect a discrete, due to its simplicity and accessibility. The volume of blood depends on the hemodynamic and usually does not exceed 200 ml per 1 exfusio. After centrifugation, plasma was removed. In one session the user agent shall 3-2 exfusio bloods, of which 400-500 ml of plasma was removed. The course consists of 4-5 sessions. Loss of plasma during the first two sessions reimburses crystalloid and nonprotein colloid solution, in the future - proteins: albumin, protein, native plasma at a ratio of 2:1 or 3:1. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5. 3. The method of plasmapheresis with extracorporeal laser irradiation of blood 

     Technique of extracorporeal laser irradiation of blood is that during the plasmapheresis erytchromass irradiated helium-neon laser through the fiber, attached to the system of blood and blood products, without compromising its integrity. As a source of coherent radiation using a helium-neon laser LG-75 with a maximum output power not less than 25 mW/cm2, the wavelength of 0.6328 micron and with a flow capacity at the end of the fiber from 5 to 15 mW/cm2. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

5. 4.The methodology of plasmapheresis with ultraviolet irradiation of blood 

     The methodology of ultraviolet irradiation of blood lymphocytes is as follows: by cytapheresis patient recovered cells from 1 liter of blood, and subjected them to UV effects on device "AWARD 2" for 30 min. Power of UV radiation is 2 J/cm2. Treated in this way the plasma leukocyte suspension was then administered to the patient.

     Indications for use of various methods of extracorporeal haemocorrection in children with autoimmune diseases is a serious eye for immunological processes in the eye, the ineffectiveness of traditional medical therapy, frequent relapses of the disease. PA carried out with less severe disease with a minimum number of relapses. PA in combination with quantum hematherapy carried out at a long, protracted process, with frequent relapses. Plasmapheresis conducted with extracorporeal laser irradiation of blood children at a frequency of recurrence from 2 to 3 times a year with severe regional hydro-, hemodynamics, metabolic processes in the outer layers of the retina. In the long process of immunological irregularities in immune status and complications of the disease used plasmapheresis with ultraviolet irradiation of blood lymphocytes.

     Clinical evaluation of the effectiveness of extracorporeal haemocorrection based on relieving inflammation in the eye and improves functional parameters of immunity correction and reduction or termination of relapses.