Method for integrated treatment of vascular complications of diabetes mellitus in obukhovskiy resort

FIELD: medicine.

SUBSTANCE: integrated resort treatment is conducted. A patient takes carbonic sodium chloride mineral water. The mineral water is heated to a temperature of 37°C before use and taken at 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals. The therapeutic course makes 18 days. The patient also takes "dry" carbon dioxide baths with the CO2 concentration of 1.2-1.4 g/l at the water temperature of 35°C. The water temperature is reduced to 32°C by the end of the course. The procedure length is 15-20 minutes. CO2 is supplied from a balloon into a special box compartment at a rate of 15-20 l/min. The gas mix temperature ranges from 28°C to 38°C. The procedures are performed every second day. The course of 8-10 procedures is required.

EFFECT: method provides normalising the complete blood count, blood sugar, common urine analysis, improving the visual analysis health, renal blood flow, ophthalmic parameters by the integrated intake of mineral water and dry carbon dioxide baths, optimum regimen and length of the therapeutic course.

1 ex

 

The present invention relates to medicine, namely to rehabilitation medicine, urology, ophthalmology, internal medicine, and is intended for the treatment of diabetic microangiopathy.

A method of treating various diseases drinking mineral water in patients (Patent for invention of the Russian Federation No. 2076713) and can be used in the treatment of gastritis with low, high secretory function, chronic colitis, cholecystitis, diseases of the operated stomach, gastric ulcer and 12 duodenal ulcer, pancreatitis, chronic hepatitis, pyelonephritis, chronic adnexitis, prostatitis without exacerbation, as well as diseases of the Central nervous system, hypertension, ischemic heart disease, pulmonary tuberculosis without exacerbation with metabolic disease (diabetes, oxaluria, obesity). Patients is a natural mineral bischofite, diluted in distilled water in various proportions(1:38 600; 1:38 - 58; 1:59 - 230; 1:231 - 460; 1:461 - 600). The disadvantage of this method is the need of laboratory manipulations with the applicable agent (cultures of bischofite in various concentrations), the presence of data on the effects of the proposed method of treatment (diuretic, choleretic and decontaminant) in the absence of information about the pathological effect on the underlying disease.

The known method prof�lit the progression of impaired glucose tolerance with mineral water Essentuki type (Patent for invention of the Russian Federation No. 2162697), the essence of which is that mineral water Essentuki №4 is taken in a dose of 200 ml for 15-20 minutes before meals for 30 days. The method allows to normalize the glycemic curve, increase the early phase of insulin secretion, improve lipid metabolism. This increases the efficiency of prevention of the disease. Despite the effectiveness of the method is highly specialized preventive orientation and does not characterize the impact on vascular changes in patients with diabetes mellitus.

The known method of prevention and treatment of mineral water (Patent for invention of the Russian Federation No. 2235547), in which the medicinal-drinking mineral water use of natural silt solution, isolated from freshwater treatment sapropel relating its characteristics to the hydrocarbonate sodium-magnesium-calcium low-mineralized water solutions. Solution obtained in the dehydration of therapeutic and enrichment of sapropel with humidity 97-93% to a moisture content of from 80 to 60% by way of gravitational hydraulic impact, with a salinity of natural silt solution is not less than 0.33 g/DM3. As the mineral and table water single dose of consumption recommended 100-200 ml 3-4 times a day when the course 21-28 days. As table water or mineral refreshing drink single dose recommended consumption 250 ml or 1.5 l up to 30 days. The disadvantage of this method is the complicated process of preparation of the dosage form, the lack of data on specific diseases and the lack of data on complex balneotherapy.

The closest method to the proposed method is the correction of metabolic disorders in patients with diabetes mellitus (Patent for invention of the Russian Federation No. 2157692). A method for the treatment of metabolic disorders in patients with diabetes by Spa treatment, including the acceptance of ascorutin at a dose of 100 mg three times a day along with taking mineral water Essentuki №4 in 200 ml 20-30 minutes before meals on the background diet (9, 9a), glucose-lowering medications (insulin and / or sulfonylurea) according to the testimony, carbonate-mineral baths in the course of 10 treatments within 30 days. The method allows to improve carbohydrate, protein, water-salt metabolism, indicators of lipid peroxidation. Despite the good results of the known method of treatment of patients with diabetes mellitus in this method, there are no data on the dynamics of ophthalmic parameters, while the organ of vision is one of the most affected anatomical structures of the organism to the influence of metabolic disturbances in diabetes mellitus. Not provided reliable data about the effect of the proposed treatment scheme, not common complex balneologist�economic factors.

Relevant is the need to further improve methods of combined treatment of diabetic microangiopathy.

The technical result consists in improving the state of the urinary system and the organ of vision in patients suffering from microangiopathy in diabetes mellitus, contributing to the improvement of renal function and ocular parameters (visual acuity, visual field, state of the vessels of the retina).

Significant differences of the claimed method are:

1) the Use of hydrocarbonate-chloride-sodium mineral water "Obukhovskaya" in combination with the course "dry" carbon dioxide baths in the resort Obukhov for the treatment diabeticheskoi angiopathy, providing the normalization of urinalysis tests and analysis according to Nechyporenko, blood sugar.

2) Improvement of the visual analyzer (visual acuity, performance, improvement of visual fields in patients with diabetic angiopathy of the retina after treatment hydrocarbonate-chloride-sodium mineral water "Obukhovskaya" in combination with "dry" carbon dioxide baths in the conditions of sanatorium "Obukhovskaya".

3) Improvement in renal hemodynamics (increased maximal systolic and diastolic blood flow velocity (Vmax, Vmin) and the decrease of the resistance index (RI) and pulsation (PI at the level of the great and peripheral vessels).

Said technical result is achieved in that the claimed method for the correction of vascular abnormalities in diabetic patients by conducting complex Spa treatment, including reception acidulous hydrocarbonate chloride-sodium mineral water, characterized in that the mineral water take is preheated to a temperature of 37°C at the rate of 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals, course 18 days, designate a "dry" carbon dioxide baths in the following way: the concentration of CO2- 1,2-1,4 g/l, water temperature 35°C with a decrease towards the end of the course to 32°C, treatment time of 15-20 minutes, CO2served from the bottle in a special cab-Boxing with a rate of 15-20 l/min, the gas mixture temperature from 28°C to 38°C, of the procedures performed in a day, a course of 8-10 treatments.

The advantage of the inventive method lies in the use of mineral water "Obukhovskaya" with the following characteristics:

Organoleptic properties: odorless, without color. Transparent.

The basic chemical composition of mineral water "Obukhovskaya" describes the specified formula:

CI78 HCO321SO41

C org. to 0,010 M1,97(Na+K) more than 95 Ca 3 Mg 2

pH=7,69

Study of the quality and composition of mineral water "Obukhovskaya" for many years monitored in FBSI "Yekaterinburg medical research cent� prevention and health protection of industrial workers".

Basically ionic composition of the water is dominated by bicarbonate and chloride ions and the cations of sodium, which is typical for water Obukhov field and allows us to classify this water as hydrocarbonate-chloride-sodium. The magnitude of salinity varies from to 1,96 1,92 g/DM3that allows to consider them as low-mineralized.

Along with the basic chemical composition of the medicinal properties of mineral water "Obukhovskaya" associated with present in biologically active substances, mainly represented by organic substances. In addition, due to the dominance in the composition of organic substances: alcohol resins, humic substances, the content of which varies from 2 to 7 mg/DM3this type of water it is possible to attribute to the mineral water with high content of organic matter humus type.

In addition to humic substances in mineral water detected the presence of neutral bitumen (oil, neutral resins, petroleum hydrocarbons) in the amount of 1.6-3.5 mg/DM3and sour bitumen (naphthenic acids, light, medium and acidic resins, acidic bitumen) to 1.0-1.4 mg/DM3. The total content of organic substances in General varies from 10.0 to 20.0 mg/DM3. Thus the highest organic matter content was observed�tsya in water wells 10-D (C org. from 5,19 to 11,74 mg/DM3operated and used in the health-drinking purposes sanatorium "Obukhovskaya".

In terms of content of organic matter - "org C", regulated by GOST 13273-88 "mineral drinking Water treatment and medical-table" (C org. up to 10 mg/DM).

In addition to organic substances medicinal properties "Obukhovskaya" cause water present in relatively small concentrations, the following therapeutically active components:

- metasilicic acid - 40,9-43,2 mg/DM3;

- orthoboric acid of 26.3-26.6 mg/DM3;

- bromo - 3,94-to 4.26 mg/DM3;

- iron - 0.1 mg/DM;

- hydrogen sulphide to 5.0 mg/DM3;

- iodine - 0,68-0,85 mg/DM3.

The study of basic physiological groups of bacteria in "Obukhovskaya" the water showed that it is dominated by nitrification, denitrifiers and butyric acid bacteria, in a somewhat smaller number are ammonifiers bacteria.

Long-term monitoring of the content in "Obukhovskaya" mineral water trace elements with concentrations in some toxic effects (cobalt, vanadium, barium, zinc, copper, arsenic, chromium, etc.) or have an adverse effect on organoleptic properties, show that their content in water wells D is valid for mineral drinking �uchebno-table water concentrations.

It follows from the above that mineral water "Obukhovskaya" from well 1 ML, applied to internal admission to the sanatorium, and has favorable chemical, Toxicological, microbiological and organoleptic characteristics, but also has a pleasant taste.

In the complex treatment of mineral water "Obukhovskaya" is assigned to a course of "dry" carbonic baths, which use carbon dioxide CO2as a biological stimulus, which acts separately from taking place in the water bath of hydrostatic pressure and a kind of thermal irritation associated with two-phase media water-gas, according to the following method of treatment: CO2served from the bottle in a special cab-Boxing with a rate of 15-20 l/min, the gas mixture temperature from 28°C to 38°C, treatment time 15-20 minutes a day, a course of 8-10 treatments. Dosing baths exercise on the concentration of carbon dioxide, water temperature, volume and duration of the procedure. In diabetes with concomitant microangiopathy in the conditions of Sanatorium "Obukhovskaya" use the following scheme for the purpose of "dry" carbonic baths: concentration of CO2- 1,2-1,4 g/l, water temperature 35°C, with a decline to the end of the course to 32°C, as temperature increases the duration % �fools with 5-7 minutes to 12-15 minutes.

Clinical effect is a physiological reaction of an organism to carbon dioxide - the extension of all of the capillaries and blood vessels, and also increase the blood levels of oxygen, which combined with the intake of mineral water "Obukhovskaya" provides improved urinalysis, ultrasound indicators of renal blood flow, and major ophthalmic parameters.

Clinical example

As an example of treatment of diabetic microangiopathy driven scheme outpatient treatment of patient A. 1962, admitted to the sanatorium "Obukhovskaya" with complaints of weakness, fatigue, decreased performance, headache, dry mouth, thirst, polydipsia. 03.02.2014 on 21.02.2014 was observed in the endocrinology center Ekaterinburg-based MAU "GKB №40" with a diagnosis of Pancreatogenic diabetes mellitus, first diagnosed. Chronic pancreatitis in remission. Diabetic microangiopathy: initial cataract, microangiopathy of the retina of both eyes. Diabetic nephropathy stage of microalbuminuria. CKD 1".

In November 2013, suffered an exacerbation of chronic pancreatitis, underwent conservative treatment in the hospital. 03.02.2014 goes as planned in urban endocrinology centre, the examination revealed diabetes. Underwent conservative treatment: resin�Ulin WITH 28 UNITS + 16 UNITS, Robinson Π (Panfil) 12+12+12 ED.

The results of the survey before treatment: 24.02.2014 city of blood Sugar: 8:00-9:00 - 8.4 mmol/l, 11:00 - 11.3 mmol/l urinalysis: Specific gravity 1008, protein - 0.5 g/l, glucose 0.5 g/l, PL epithelium - 8-10 in p/Zr, leukocytes 10-12 in p/Zr.

Indicators of renal blood flow in major arteries (and. Hep.):

Vmax - 53,8 cm/h

Vmin is 16.4 cm/sec

S/D-or 3.28

PI - 1,3

RI-0,7

Indicators of renal blood flow in the periphery (a interlob.):

Vmax - 21.3 cm/h

Vmin - 6.1 cm/h

S/D - 2,53

PI - 1,36

RI - 0,71

Further examination by ophthalmologist:

Refractometry OD minus 0.75 s. Cyl -0,25, ax 123

OS minus 0.75 s. Cyl minus 0.75, ax 5

TVHD OD=18, TGD OD=18

VOD=0.9 n/a, VOS=0.85 s -1,0=0,9

24.02.2014 When taken to Sanatorium "Obukhovskaya" notes complaints of weakness, fatigue, decreased performance, headache, dry mouth, a veil before the eyes.

Objective data: the condition is satisfactory. Consciousness is clear. Skin normal physiological staining. There is no swelling. Tongue moist, coated with white bloom. The abdomen is soft, slightly painful in the epigastric region. Kidney not palpable symptom Pasternatskogo negative right, left weakly positive. There is a weakening of the pulsation of the arteries of the lower extremities. Growth 164 cm, weight - 89 kg, the body temperature is 36.6°C, BP - 130/80 mm Hg.PT.

In the conditions of sanatorium patient A. appointed PR�eat inside of low-mineralized mineral water with high content of organic matter: hydrocarbonate-chloride-sodium mineral water "Obukhovskaya". The water took preheated to a temperature of 37°C at the rate of 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals, course of 18 days. In addition, patients received diet food table # 9 + additional meals, exercise therapy, dry carbon dioxide baths (concentration of CO21,2-1,4 g/l, temperature 35°C, the duration of 7-12 minutes) No. 10, massage on the collar area No. 10 in a day, whirlpool baths on the upper and lower extremities No. 10 in a day, magnetic therapy to the lower extremities No. 10 in a day.

Control examination was conducted on 8th and 14th day of stay at the resort.

8 days of treatment. The indicators of the General analysis of urine and analysis according to Nechyporenko in the normal range. Blood sugar: 8:00-9:00 - 7,6 mmol/l, 11:00 to 9.5 mmol/L.

Ophthalmologist consultation: Refractometry OD minus 0.75 s. Cyl -0,25, ax 123

OS minus 0.75 s. Cyl minus 0.75, ax 5

TVHD OD=18, TGD OD=19

VOD=0.9 n/a, VOS=0.9 n/a

14-e the day of treatment. The indicators of the General analysis of urine and analysis according to Nechyporenko in the normal range. Blood sugar: 8:00-9:00 - 5,82 mmol/l, 11:00 - 8,12 mmol/L. ophthalmologist Consultation:

Refractometry OD minus 0.75 s. Cyl -0,25, ax 123

OS minus 0.75 s. Cyl minus 0.75, ax 5

TVHD OD=18, TGD OD=19

VOD=1.0, VOS=0.95

Indicators of renal blood flow in major arteries (a. ren.):

Vmax - 60,9 cm/h

Vmin - 19.7 cm/h

S/D - 3,09

PI - 1,25

RI - 0,68

Indicators of renal blood flow in the periphery (a interlob.):

Vmax - 25,3 cm/h

Vmin - 8.1 cm/h S/D-3,01/p>

PI - 1,31

RI - 0,68.

Method of correction of vascular abnormalities in diabetic patients by conducting complex Spa treatment, including reception acidulous hydrocarbonate chloride-sodium mineral water, characterized in that the mineral water take is preheated to a temperature of 37°C at the rate of 3 ml per 1 kg of body weight 3 times a day 40 minutes before meals, course 18 days, is carried out "dry" carbon dioxide baths in the following way: the concentration of CO2- 1,2-1,4 g/l, water temperature 35°C with a decrease towards the end of the course to 32°C, treatment time of 15-20 minutes, CO2served from the bottle in a special cab-Boxing with a rate of 15-20 l/min, the gas mixture temperature from 28°C to 38°C, of the procedures performed in a day, a course of 8-10 treatments.



 

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EFFECT: method enables improving the health status in the individuals subject to the hazardous effect of radionuclides taken with water or food.

2 cl, 6 tbl, 3 ex

FIELD: heating.

SUBSTANCE: steam generator for bath consists of an evaporator and a heating element. The heating element is made of the material with heating capacity coefficient no less than 45 W/(m·K), and the evaporator is a bunch of metal wiring or shavings connected to the heating element along the whole surface of one of sides of the latter.

EFFECT: possibility of generation of steam with the pre-set level of humidity and high efficiency of steam generation at compact sizes of the device.

1 dwg

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