A method of treating endocrine ophthalmopathy light and medium gravity in diffuse toxic goiter

 

(57) Abstract:

The invention relates to medicine, endocrinology. Perform acupuncture exposure to a second embodiment of the brake method for 20 min both right and left as corporeal point-BL2 (Quan Zhu), TE23 (si-Ju-kun), GB14 (Yang Bai), LI11 (qu Chi), ST36 (zu-San-Li) and auricular points - 8 (eyes), 13 (adrenal glands), 22 (an endocrine gland), 28 (pituitary), 45 (thyroid gland). Exposure is carried out in the period of time from 7 to 9 a.m. daily for 8-10 days on therapy with mercazole. The method allows to increase the treatment efficiency. 2 Il., 6 table.

The present invention relates to medicine, namely to endocrinology.

The most widespread in practice, treatment of endocrine ophthalmopathy light and medium severity (classification of this pathology is given by C. G. Baranov. 1977 [9])received medical methods[1, 5, 6, 11, 16] .

However, the drugs used have a number of contraindications and complications, namely allergic reactions of immediate and delayed types, toxic complications, withdrawal syndrome, as well as the oppression of the pituitary-on the military the reabsorption of sodium (glucocorticosteroids), which exacerbate endocrine ophthalmopathy [7].

Known also instrumental methods of treatment: exposure to an alternating magnetic field [8]; laser therapy in combination with glucocorticosteroids, decaris and / or indomethacin [5] ; therapeutic plasmapheresis used in case of absence of effect from treatment with corticosteroids and immunomodulators with an average degree of endocrine ophthalmopathy [2], etc.

However, the wide dissemination of these methods in practice is limited by the technical complexity, high cost of the equipment used, and most importantly, the inconsistency of data on their effectiveness compared to therapy with corticosteroids and immunotherapy [15].

The closest in technical essence and the achieved results, selected by the authors as a prototype, is a method of treatment "thyroid disease" and the associated of exophthalmos [14]. The method is carried out, affecting 20 min a second embodiment of the brake method in corporeal acupuncture points: BL10 (Tian Zhu), GB20 (Feng Chi), GV14 (Yes-Jui), GB12(11) (Shen-Zhu), CV22 (Tien-Tu), ST10 (Shui-Tu), ST9 (Ren-in), CV23 (lien-Chuan), TE3 (Zhong-Zhu), GB26 (Dai Mai), ST26 (Wai Lin), BL1 (CIN-min), GB1 (Tun-Tzu-Liao), BK6 (Yu-Yao), ST2 focus actions on endocrine function; undefined time optimal impact on biologically active points; and, furthermore, there is no differentiated approach to the treatment of endocrine ophthalmopathy varying degrees of severity. In General, the method has a low therapeutic effect in relation to effects on subjective and objective manifestations of endocrine ophthalmopathy.

Therefore, the object of the present invention is to improve the efficiency of the method of treatment of endocrinol ophthalmopathy light and medium severity, associated with diffuse toxic goiter.

The problem is solved in that in the known method of treatment of endocrine ophthalmopathy light and medium grades, pathogenetically associated with diffuse toxic goiter by a 20-minute exposure to a second embodiment of the braking method on corporal acupuncture points according to the invention acupuncture needles simultaneously, symmetrically to the right and to the left, enter in corporeal point - BL2 (Quan Zhu), TE23 (si-Ju-kun), GB14 (Yang Bai), LI11 (qu Chi), ST36 (zu-San-Li), and auricular - 8 (eyes), 13 (adrenal glands), 22 (an endocrine gland), 28 (pituitary), 45 (thyroid) - daily period of time from 7 to 9 am the next acupuncture provides a normalization of the vascularization of the periorbital area, due to the impact of the point 8; stimulation system the hypothalamic-pituitary-adrenal cortex and an increase incretii glucocorticosteroids beam zone of the adrenal cortex in physiological doses due to simultaneous exposure to point 13 (adrenal glands), 22 (an endocrine gland) and 28 (pituitary); and, in addition, leads to the reduction of excessive secretion of thyroid hormones, which occurs when the thyrotoxicosis, when exposed to a point 45 [9]. The proposed scheme impact on corporal acupuncture points BL2 (Quan Zhu), TE23 (si-Ju-kun), GB14 (Yang Bai) is related to the fact that they are periorbital in zones of innervation first BL2 (Quan Zhu), GB14 (Yang Bai) and the second TE23 (si-Ju-kun)) branches of the trigeminal nerve, as well as the fact that therapeutic effect of acupuncture is determined metamere-driven relationships and reflexes, with a selective effect on the affected organ. The use of corporal points General steps LI11 (qu Chi), ST36 (zu-San-Li) caused by the necessity to create a common background for the normalization of the main neurohormonal adaptive mechanisms.

The need for exposure to acupuncture points during the day from 7 to 9 o'clock in the morning due to the characteristic circadian rhythm of secretion is effective. At the specified effect on the acupuncture points above, from 7 to 9 a.m. cortisol plasma was increased, according to our data, in the physiological limits 33,07 % and by 15.33 % in patients with ophthalmopathy light and medium degrees, respectively, which is the maximum for this disease.

The need for a 8-10 day course of acupuncture is due to the fact that during the first 8 days of each procedure there is a gradual disappearance of subjective symptoms and increased levels of plasma cortisol. After 8-10 days there is a stabilization of these indicators in any further impact on the acupuncture points, so more than ten days to course of treatment is impractical.

The need for exposure to a second embodiment of the brake method for 20 minutes at specified acupuncture points due to the fact that this method of exposure has a harmonizing effect [12, 14].

The necessity of a combined use of acupuncture and treatment mercazole due to the fact that an undeniable link endocrine ophthalmopathy and diffuse toxic goiter, and acupuncture is traditionally analyzed is expressed [13].

In the sources of scientific and patent information is not revealed information about the implementation of the method of treatment of endocrine ophthalmopathy in diffuse toxic goiter due to alleged essential features. Therefore, the estimated technical solution of the method meets the criteria of "novelty" and "inventive step".

The proposed method is as follows. Patient diagnosed with endocrine ophthalmopathy mild or moderate severity with diffuse toxic goiter in the face of thyreostatic medicinal therapy mercazole up to 30 mg/day given a course of acupuncture, affecting a second embodiment of the braking method on auricular - 8 (eyes), 13 (adrenal glands), 22 (an endocrine gland), 28 (pituitary), 45 (thyroid gland), and corporal acupuncture points: BL2 (Quan Zhu), TE23 (si-Ju-kun), GB14 (Yang Bai), LI11 (qu Chi), ST36 (zu-San-Li), right and left, introducing acupuncture needles nichrome production Kazan medical instruments plant. Needle injected to a depth recommended for each acupuncture point [3]. The duration of the session - 20 minutes. Procedure carry out daily from 7 to 9 a.m. for 8-10 days.

Example 1. Extract liricheskoy hospital n.a.A. Semashko about diffuse toxic goiter II moderate severity; endocrine ophthalmopathy mild severity.

The main complaints at admission were: reduction of physical and mental health, emotional lability, irritable weakness, sleep disturbance (insomnia), weight loss of 5 kg for 10 months, the high humidity of the skin, including Acrocephalus, feelings of "shivering" in the body, an increase in the size of the neck, palpitations, shortness of breath during strenuous exertion. Along with this was an increase of Vistana eyeballs from their sockets, accompanied by pain in the eyes, amplified at the visual load, photophobia, persistent swelling of the eyelids.

From the anamnesis of the disease it is known that the effects of thyrotoxicosis (decrease physical and mental health, emotional lability, irritable weakness, sleep disturbance (insomnia), weight loss of 5 kg for 10 months, the high humidity of the skin, including Acrocephalus, feelings of "shivering" in the body, an increase in the size of the neck, palpitations, shortness of breath during strenuous load) appeared and gradually increased in the last 10 months, and the phenomenon of endocrine ophthalmopathy, the patient was noted after 5 months of th the UIS during the visual load, photophobia, transient, and later persistent edema of the eyelids). Noted the existence of a relationship of this disease with menstrual cycle for 12 months, and with trassoviki situations at work. The patient was examined by a physician at the place of residence, where they were suspected diffuse toxic goiter II moderate; endocrine ophthalmopathy I. therefore the patient was referred to a neuro-endocrine branch of the Nizhny Novgorod regional clinical hospital for further evaluation and treatment.

The history of life without features.

Menstrual cycle irregular. Married. Pregnancies - 2, delivery - 1, medical-abortion - 1.

Of illness notes frequent sore throats since childhood, chronic tonsillitis, acute respiratory viral infection. Smokes - 1/4 pack a day.

Heredity both lines on the pathology of the thyroid gland is not burdened.

Objective status at admission.

The condition is satisfactory. Clear consciousness. The shape is correct, normostenichesky Constitution, satisfactory power. Growth = 167 cm, weight = 62 kg, the Broca index = - 7 %. Skin warm, moist, pale pink, clear. The swelling. Ocular symptoms (Dalrymple, Moebius, Geoffroy, Kocher, Kraus, Ellinika) positive. The chest is symmetrical, the right shape, evenly participates in the act of breathing. Percussion - clear lung. The vesicular breathing, wheezing no. Respiratory rate = 14 min. The heart is not changed. Percussion borders of the heart is within normal limits. Tones hearts 2 (I > II) frequent, rhythmic, clear. Heart rate = heart rate = 112 in 1 minute. Blood pressure = 130/70 - 135/65 mm RT.article Edema of the lower extremities no. The abdomen is soft, painless. Liver and spleen not palpable. Symptom of Pasternack negative on both sides, dysuria no. Thyroid gland: palpable both share increased to second degree, maglalatik consistency, palpation pain-free. Nodes it is not defined. Bilateral symmetric melcorazmashisty tremor of fingers of hands. The type of higher nervous activity weak, excitable, unstable. Emotional lability.

As a result of the survey was diagnosed with diffuse toxic goiter II moderate; endocrine ophthalmopathy mild severity. The patient had been assigned: FIPA-mercazole 30 mg/day under the control of the number of leukocytes and leukocyte indicators formula 1 once a week. 10 day marked overall improvement of health of the patient manifested by the disappearance of periorbital edema, painful sensations in the eyes, photophobia, positive eye symptoms, tremor of fingers of hands and "shivering" in the body. Recovered physical and mental health, normalized sleep and mood, heart rate, dyspnea disappeared. Data of laboratory and instrumental studies to (15/XI 1993) and on the 10th day of treatment (27/XI 1993) is presented in table 1.

12 months (17/XI 1994) data eye, hormonal studies did not differ from normal values.

Example 2. Extract from history N 9503641.

The patient 3. , 43 years old, was admitted in neuroendocrine Department of the regional clinical hospital n.a. A. Semashko about diffuse toxic goiter II moderate; endocrine ophthalmopathy moderate severity.

The main complaints at admission were: reducing physical, mental health, emotional lability, irritable weakness, weight loss of 2 kg for 24 months, the high humidity of the skin, including Acrocephalus, feelings of "shivering" in the body of hydrocarbons is accompanied by pain in the eyes, the feeling of "sand" in them, amplified at the visual load, photophobia, lacrimation, blurred vision, persistent swelling of the eyelids, decreased visual acuity.

From the anamnesis of the disease it is known that the effects of thyrotoxicosis (decrease physical and mental health, emotional lability, irritable weakness, weight loss of 2 kg for 24 months, the high humidity of the skin, including Acrocephalus, feelings of "shivering" in the body, an increase in the size of the neck, palpitation after low physical activity) appeared and gradually increased during the last 2 years, and phenomena EA, the patient was noted after 14 months after the onset of the above symptoms (symmetric exophthalmos, accompanied by pain in the eyes, amplified at the visual load, photophobia, lacrimation, transitory, and in consequence of persistent swelling of the eyelids, blurred vision). Noted the existence of a relationship of this disease with stressful situations at work, frequent sore throats (1-2 times per year). The patient was examined by a physician at the place of residence, where they were suspected diffuse toxic goiter II moderate; endocrine ophthalmopathy II. Therefore the patient was referred to neuroendo MNEs life without features.

The menstrual cycle is regular, 28 days. Married. Pregnancies - 2, birth - 2.

Of illness notes frequent sore throats since childhood, chronic tonsillitis, acute respiratory viral infections.

Heredity in pathology of the thyroid gland burdened by the mother (endemic diffuse euthyroid goiter II).

Objective status at admission.

The condition is satisfactory. Clear consciousness. The shape is correct, normostenichesky Constitution, satisfactory power. Growth = 161 cm, body mass = 60 kg, the Broca index = -2%. Skin warm, moist, pale pink, pure. Turgor saved. Peripheral lymph nodes are not palpable. Symmetric proptosis, periorbital swelling. Ocular symptoms (Dalrymple, Moebius, Geoffroy, Kocher, Kraus, Ellinika, Stasinska, hyperemia of the conjunctiva) is positive. The chest is symmetrical, the right shape, evenly participates in the act of breathing. Percussion - clear lung. The vesicular breathing, wheezing no. Respiratory rate = 12 in 1 minute. The heart is not changed. Percussion borders of the heart is within normal limits. Tones hearts 2 (I > II) frequent, rhythmic,Edema of the lower extremities no. The abdomen is soft, painless. Liver and spleen not palpable. Symptom of Pasternack negative on both sides, dysuria no. Thyroid gland: palpable both share increased to second degree, maglalatik consistency, palpation pain-free. Nodes it is not defined. Bilateral symmetric melcorazmashisty tremor of fingers of hands. The type of higher nervous activity weak, excitable, unstable. Emotional lability, fidgeting.

As a result of the survey was diagnosed with diffuse toxic goiter II moderate; endocrine ophthalmopathy moderate severity. The patient had been assigned: pruposely regimen, diet N 15 h 10 sessions of acupuncture on the method developed by us on the background of therapy with mercazole 15 mg/day under the control of the number of leukocytes and leukocyte indicators formula 1 once a week. 10 day marked overall improvement of health of the patient, manifested by a reduction of periorbital swelling and watery eyes, the disappearance of painful sensations in the eyes, photophobia, diplopia, positive eye symptoms, including redness of the conjunctiva, tremor of fingers R is astate heartbeat. Data of laboratory and instrumental studies to (14/II 1995) and on the 10th day of treatment (2/III 1995) is presented in table 2.

Presents examples reflect a positive trend in the use of acupuncture in combination with the basic therapy of thyrotoxicosis in patients with endocrine ophthalmopathy light and medium gravity, pathogenetically associated with diffuse toxic goiter.

The proposed method treated 60 patients with endocrine ophthalmopathy associated with diffuse toxic goiter moderate. Men accounted for in this group 11 (18,33 %), and women - 49 (81,67%) persons. Fluctuations in age was from 18 to 63 years. The middle figure was 39,80 of 1.44 years. The average duration of development of the endocrine ophthalmopathy had 14,37 1.86 month. Patients with mild was 31 (51,67%), middle - 27 (45,00%) and heavy - 2 (3,33%) people.

We have developed a method for the treatment of endocrine ophthalmopathy provided stable, without any side effects improvement in clinical status of patients of the main group:

1. Reduce the frequency of asymmetrically exophthalmos in comparison with 60.87% (from 23 to 9 people), while the right-sided asymmetry of exophthalmos disappeared in 8 patients (18 to 10 patients who La on 4,59% (0.77 mm) in patients with mild severity 30 (PL. 3);

3. Positive dynamics in the form of reduced frequency detection range disincarnation symptoms (Moebius, Gref) 90 - 83%; tearing and photophobia 81%; diplopia 80%; conjunctival signs (Stasinska and hyperemia of the conjunctiva) 78 - 77%; finally, pain in the eyes of 77%, swelling eyelids 68%, symptom of Dalrymple 54%, paresis of gaze by 33% (table. 4);

4. The improvement of the picture of the fundus: the complete elimination of ischemia of the optic nerve, reducing the frequency of detection of plethora of veins and narrowing of the retinal arteries on 45,45 and 30,77%, respectively (table. 4).

The maximum efficiency of combination therapy with the inclusion of acupuncture in its effect on the clinical manifestation of the EA noted in the case of mild disease. This is determined by, first, a stable, reversible changes in extraocular muscles and retro-bulbar tissue, and secondly, local and segmental response of the patient to a specified method of treatment, expressed in toning these muscles and the reduction of conjunctival lesions, and, thirdly, normalizing the total reaction of the organism as a whole, the basic parts of which are discussed below.

The study sanogenesis acupuncture in patients with endocr the ical endocrine glands".

At the end of a course of reflexology on the method developed by us for the treatment of thyreostatics there was a significant suppression of excessive production of iodized tironina (free triiodothyronine (CT3) and thyroxine (CT4), total thyroxine (TT4)), approaching the performance of the control group (table. 5). Along with this there was an increase in physiological limits, incretii cortisol luchkovymi zones of the adrenal cortex on 22,85% of baseline, exceeding the reference level was 1.45 times. In particular in patients with mild ophthalmopathy its content increased by 33,07%, and the average - by 15.33 %. Our study revealed a downward trend in the concentration of corticotropin (ACTH) plasma: decline of 33,58% in General, the maximum - 50,64% - with an average severity of the disease (table. 5).

Increase incretii cortisol, as well as reducing the excessive production of iodized tironina resulted in the presence of positive dynamics in the content of ceruloplasmin, haptoglobin in serum in patients with mild ophthalmopathy after a course of combination therapy with the inclusion of acupuncture as a statistically significant reduction in 22,11% (p' < 0.001) and 15,07% (p' < 0,0 is at an average severity of the disease (table. 5). Using reflexology with mild to moderate degrees of severity is also justified in terms of providing a tonic effect on the body of the patient.

The study sanogenesis acupuncture in patients with ophthalmopathy associated with diffuse toxic goiter, also shows a decrease in the manifestations of immunological imbalance. Despite the fact that the course of treatment did not lead to statistically significant change in the number of leukocytes and the relative level of lymphocytes in the peripheral blood of patients with mild and moderate degrees of severity of the disease (P' > 0.05), and the relative content of the E-ROCK and their subpopulations (E-TGF-ROCK, and E-TCP ROCK) it grows significantly, with a tendency to normalization, 37,52; 50,06 and 28,06%, respectively (p' < 0,001). Taking into account the above quantitative dynamics E-TGF-ROCK, and E-TCP ROCK under the influence of combined therapy including acupuncture, it should be noted that the ratio of E-TGF-ROCK/E-TFC ROCK, approaching the performance of the group is healthy, significantly increases 14,69% only with mild EO (p' < 0,05). Also shown is a normalizing effect on the relative level of M-ROCK, reflecting the dynamics of B-lymphocytes: reliable red eye reduction is weaker ekzotermicheskogo rate is associated with improvement in the immune status, as well as stimulation incretii cortisol luchkovymi zones of the adrenal cortex, leading to reduced rates of acute phase of inflammation, in patients with mild and moderate degrees of endocrine ophthalmopathy.

In the analysis of remote results of clinical, hormonal and immunological effects established their good condition 12 months after treatment in 26 (84%) patients with mild and in 14 (50%) with average severity of endocrine ophthalmopathy.

Any adverse reactions and complications in using this method we have not met.

The proposed method is efficient, cost-effective, technically simple.

Acupuncture was shown in patients ophthalmopathy light and medium degrees in diffuse toxic goiter with severe allergic attitude of the body, the presence of contraindications to the use of glucocorticoids and hardware methods of non-medical effects, as initial treatment of this disease. This allows you to prevent further disease progression and development of complications. In comparison with the prototype of this method was more efficient, because it has a greater effect the immunological imbalance; provides long-lasting prolongation of the effect more than 50% of patients.

Sources of information

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2. Balabolkin M. I. Endocrinology: Textbook. the allowance. - M.: Medicine, 1989. - 416 S.

3. Gaponyuk P. I., Klimenko, L. M., Levin, C. N. Acupuncture (replacepattern) therapy: Topography points. - Yaroslavl, 1983. - 270 S.

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5. Zefirov, C., Kondratyev, L. C., Wójcik E. A., Klimov, N. And. New approaches to the treatment of endocrine ophthalmopathy//proc. Dokl. II scientifically conference. Congress of endocrinology, ,Chelyabinsk, Oct. 1991 - Chelyabinsk, 1991. - S. 252.

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9. The doggies, J. C., Rybalko, S. J. Atlas of clinical auriculotherapy. - M.: Medicine, 1990. - 256 S.

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12. Tikochinsky E. D. basics of acupuncture. - M., 1979. - 343 S.

13. Cibulec Century. N. Reflexology in clinical anesthesiology. Tashkent, 1985. - 284 S.

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16. Wulle K. G., Utech C., Bicler U., et al. Treatment of severe Graves' ophthalmopathy with cyclosporine A//Acta Endocr. (Kbh.). - 1985. - Vol. 110, N 4. - P. 493-298.

A method of treating endocrine ophthalmopathy light and medium severity with diffuse toxic goiter by exposure to a second embodiment of the brake method for 20 min in corporeal acupunture point, characterized in that the acupuncture needles are injected simultaneously to the right and to the left as in corporeal point BL2 (Quan Zhu), TI (si-Ju-kun), GB14 (Yang Bai), LI11 (qu Chi), S is vidna iron) daily time interval from 7 to 9 a.m. for 8 - 10 days on therapy with mercazole.

 

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