The method of treatment of chronic gastroduodenitis in children

 

(57) Abstract:

The invention relates to gastroenterology and can be used for the treatment of gastro-duodenitis. Impact on the closed eyelids and mastoid processes using sinusoidal modulated currents. Effect in AC mode, III is a native of work with frequency 150-100 Hz, a modulation depth of 25-50%, duration parcels of pulses and pauses 1-1,5, amperage 0.8 to 2 mA, a duration of 8 - 12 minutes depending on return, every day, on the course of 8-10 treatments. The method allows to reduce the treatment time and prolong the period of remission.

The present invention relates to medicine, in particular gastroenterology, treatment of chronic gastroduodenitis, including children, physical factors and can be used in practical health care: hospital, clinic, sanatorium.

Relevance and social significance of the problem of the treatment and rehabilitation of patients with chronic gastroduodenitis determine the progressive course of the disease with the development of severe forms, the combined character pathology of the digestive system, adverse effects on growth and development of the child, early in the year gastroduodenitis is caused by a variety of etiological factors, the complexity of the pathogenesis.

Numerous studies have established the importance of neuro-reflex processes in the development of chronic gastroduodenitis. Higher nervous activity of a child is characterized by an imbalance of inhibitory and excitatory processes, their rapid exhaustion that enhances the development of disorders of the nervous system.

Currently, progress has been made in drug therapy of chronic gastroduodenitis in children. The treatment is comprehensive, focused primarily on the normalization of the secretory function of the stomach, for which use of substitution therapy - hydrochloric acid, natural gastric juice, abomin, azedin-pepsin, etc. /Slatkin A. R. "Treatment of chronic diseases of the digestive system". - M., 1994, - S. 80-81/ and drugs that suppress the original high kislotoobrazovanie - antacids /Almagell, Maalox, mylanta etc./, blockers H2receptors of histamine - cimetidine, ranitidine, famotidine, etc. /Grigoriev, P. J. and other Chronic gastritis: current views on the pathogenesis, clinical picture, treatment in W.: "Ter. archive". - 1989. - N 2. - S. 142-152/. However, to achieve therapist is s disease, they often give adverse reactions: nausea, vomiting, irregular bowel movements, psychomotor agitation, which limits their appointment in Pediatrics /Lukas N. In. and other "On etiotropic and pathogenetic treatment of patients with chronic gastroduodenitis in W.: Doctor. case. - 1993. - N 2-3. - S. 121-123/.

In the presence of pain and dyspeptic syndromes are metoclopramide, galidor, no-Spa. It should be noted that the main disadvantage of these preparations is the presence of side reactions on the part of the nervous system that enhances existing breach in the psychical sphere of the child /Early diagnosis and prevention of gastrointestinal diseases in children: Rep. collection of scientific. works. Ed. by A. I. Volkov. - N. Novgorod, 1990. - S. 48-52/.

In recent years shows the high efficiency of treatment of chronic gastroduodenitis etiology of H. pylori when using drugs bismuth in combination with antibiotics and metronidazole. However, a combination therapy to children should be used with caution because of the possible occurrence of dyspeptic symptoms, fungal infections, allergic reactions, and General malaise. This necessitates the development of new non-pharmacological methods of treatment, the children with various physical factors, for example, ultrasound intensity of 0.2 W/cm2on the epigastric area and 0.05-0.1 W/cm2paravertebral level Th7-Th12/Talanova, I. K., and others, "the Application of some physical factors in the complex treatment of paired pancreatitis and gastroduodenitis in children" in J. : Matters. pediatric gastroenterology. Bitter, 1985. - S. 46-30/. However, this method is not indicated for the treatment of chronic gastroduodenitis in children with astheno-neurotic manifestations.

In the subacute period of exacerbation widely used electromagnetic waves of ultra-high frequency centimeter and decimeter ranges, inductothermy, sinusoidal modulated currents, electrophoresis of drugs. These treatment methods have several disadvantages: involvement in the sphere of influence of the physical factors of a large volume of tissue, which limits the possibility of purposeful action, it is not possible to clearly isolate the impact area of effect, side effects of cardio-vascular system. In addition, many drugs under the action of electric current to lose their activity and often decompose to form toxic compounds.

Napolneniy pulse current low frequency rectangular pulse shape, mostly a constant direction. The treatment of the AIDS "Electrosleep-2", "Electrosleep-3" when orbital-mastoid location of the electrodes, the frequency of 5-10 Hz, pulse duration of 0.5 MS, the current strength of 1.5-2.0-3.0 mA /depending on the sensitivity of the child, duration of the procedure 20-30 minutes, at the rate of up to 20 procedures carried out daily or every other day /karachevtseva So Century. and others, "the Use of physical factors in the treatment of diseases of the digestive system in children. The methodological. recommendations, 1985, S. 15/.

The disadvantage of this method is pererastaniye center of the vagus nerve in the application of low-frequency pulsed current, which often leads to increased secretory and motor functions of the stomach, other regulatory systems and the deterioration in the clinical course of chronic gastroduodenitis. In addition, the pulse currents constant direction have a pronounced irritant effect under the electrodes, which causes a negative attitude to a method especially in younger children. When using this method there is also no age differentiation procedure duration and uses a high duration of treatment /to 20/.

Technical achiev the deposits and the extension of the period of remission.

This technical result is achieved by acting on the closed eyelids and mastoid processes using sinusoidal modulated currents in AC mode, III is a native of work with frequency 150-100 Hz, a modulation depth of 25-50%, duration parcels of pulses and pauses 1-1,5, amperage from 0.8 to 2 mA, lasting from 8 to 12 minutes depending on age, every day, on the course of 8-10 treatments.

A distinctive feature of this method of treatment is that the sinusoidal modulated currents have a special trapnest to the neuromuscular system and have an active, but a subtle influence on the excitability of the structures of the nervous tissue. The application of the III kind of work causes a slight irritant and stimulant action, makes it possible to reduce the "burden" to the child's body, adapting to current, to improve the functional state of the nervous system. Use I and IV delivery of work had no therapeutic effect due to rapid adaptation to current /at I R. R./ and pronounced stimulating action /IV R. R./. Use current "make-break" /II R. R./ in connection with a pronounced stimulating effect often prescribed to stimulate the muscles. Attempt to use it caused negative richesse nervous system, influence on the secretory and motor function of the stomach, the frequency below 100 Hz caused pronounced irritant effect. The depth of modulation of 50% allowed to directly affect deep tissue, limiting the intensity of the excitation. When the modulation depth is less than 25% of the current has a very weak influence on the nerve receptors, more than 50% of the intensity of the incident action current increases sharply, which was for children with chronic gastroduodenitis inadequate, increased pain and dyspeptic syndromes manifested by deterioration data rheoencephalography. Used the duration of the series of pulses and pauses 1-1,5 is more physiologically optimal for effects on the Central nervous system. Localization of electrodes in the proposed method allows to provide both direct and reflex effects on the brain, especially on the autonomic division with the aim of reducing vagosympathetic dysfunction, withdrawal pathological dominant, normalization regulation of secretory and motor functions of the gastrointestinal tract.

Description of method of treatment

After pre-clinical, laboratory and instrumental ASCS is, emancipatory/ during the reduction of symptoms of intoxication /3-5 day period of exacerbation of chronic gastroduodenitis/ start treatment.

A sick child laid on the couch in specially equipped rooms. Procedures performed using rubber masks with built in it a metal Cup-electrodes, containing a cotton swab moistened with warm tap water, from device "Electrosleep" change plug the device in relation to the apparatus Amplipulse". Electrodes placed on closed eyelids and the area of the mastoid processes. The impact of the conduct sinusoidal modulated currents from device "Amplipulse-4" in AC mode, III is a native of work with frequency 150-100 Hz, a modulation depth of 25-50%, duration parcels of pulses and pauses 1-1,5 s, the current is from 0.8 to 2 mA. The duration of the treatment for children 6-10 years - 10 minutes 11 to 14 years - 12 minutes on the course of 8-10 daily procedures.

Examples of the method

Example 1. Patient Baht Anton 7 years was admitted to the gastroenterology Department of the Institute of Pediatrics of Russian Academy of medical Sciences with a diagnosis of chronic gastroduodenitis with increased secretory function of the stomach, aggravation, disiacjuly complaints of abdominal pain, often after eating, occasionally nausea, poor appetite, fatigue, irritability, tearfulness, sleep disorders. When viewed pale skin, the periorbital cyanosis. Appetite is reduced. Tongue coated at the root. The stomach is the correct configuration, soft, pain in the epigastric and piloroduodenalnoy region, the point of the gall bladder, the area Yanover, symptoms Ortner, Kera positive. The edge of the liver is 2.0 cm in the midline, soft-elastic consistency, sensitive. The spleen is not enlarged. Chair regular feature. In neurological status: broken "soft" signs, insomnia, anxiety. Conclusion neuropsychiatrist: asthenoneurotic reaction.

The examination revealed: clinical and biochemical blood tests - without pathological changes. The study of the secretory function of the stomach by means of fractional sensing using histamine test showed higher accumulation of acid in the basal and stimulated phase secretion. 3 days after admission was held esophagogastroduodenoscopy, which revealed superficial duodenitis, confirmed by morphological examination of biopsy specimens slizisty of the abdominal cavity with conducting functional tests with cholagogue Breakfast detected increased motor function of the gallbladder /75,0%/. These rheoencephalography indicate signs of a small decrease in the intensity of the blood vessels of the investigated regions: the effects of standard and hypertonicity.

With a 4 day stay in the hospital were assigned to the pulse currents are sinusoidal pulses of alternating directions, for which the child was laid on the couch in a specially equipped classroom, on the closed eyelids and the area of the mastoid processes impose special electrodes of the device, "Electrosleep" change plug the device in relation to the apparatus Amplipulse-4". Impact conducted by sinusoidal modulated currents from device "Amplipulse-4" in AC mode, III is a native of operation with a frequency of 100 Hz, a modulation depth of 25%, duration parcels of pulses and pauses of 1-1 .5 s, the power current of 0.8 mA for 8 minutes, at the rate of 8 daily procedures.

Already after a single exposure was noted improvement in rheoencephalography: increased the intensity of the blood vessels of the studied areas, the lability of the tone remained with the trend toward normalization was determined individual phenomena hypertonicity. In the course of treatment after 4 treatments the condition has improved, disappeared complaints about the drugs. By the end of the treatment condition was satisfactory, disappeared palpation pain and dyspeptic symptoms, decreased to normal size of the liver, normalized sleep /night and day/, significantly decreased neurological "soft" signs.

During the examination after the course of therapy the positive dynamics of the secretory function of the stomach, which was confirmed a significant reduction in the rate of an hour of free hydrochloric acid in the basal phase /from 37.3 to 21.7 mg/ and in stimulated phase secretion /from 92.8 to 77.7 mg/. When the control endoscopic examination showed a subsidence of the inflammatory process of the upper parts of the gastrointestinal tract, indicating that the improvement of the morphological status gastroduodenal mucosa in the form of the disappearance of lymph plasmocytomas infiltration. The analysis of the dynamics of immunological parameters set expressed immunocorrective effect, the reduction factors of autoagressive and improving mechanisms for local protection in the normalization of serum concentrations of immunoglobulins and decrease in saliva secretory immunoglobulins. Ultrasound study of the functional state of the gallbladder revealed normalizes Inoi hemodynamics: the intensity of the blood was within the age norm, fully normalized vascular tone regions.

Follow-up observations showed that the remission of the disease increased to 1 year, there were no complaints of abdominal pain, nausea, boy hurts less colds, increased physical activity, improved sleep.

Example 2. Smirnova Elena 13 years was admitted to the gastroenterology Department of the Institute of Pediatrics of Russian Academy of medical Sciences with a diagnosis of chronic gastroduodenitis, aggravation, duodenoplasty reflux, biliary dyskinesia and intestines, alimentary Allergy.

When entering a state of moderate severity. Complaints on a daily attacks of abdominal pain, nausea, occasionally vomiting, sudden loss of appetite, delayed stool for 2-3 days, weakness, irritability, poor sleep. When inspecting the skin pale, dry. The language of "geographic", densely totally white furred. Abdomen slightly swollen, with painful palpation in the epigastric and piloroduodenalnoy region, in the course of the sigmoid colon, "gallbladder" positive symptoms. Liver at the edge of the costal arch, the spleen is not enlarged. Stool - constipation. In neurological status: emotional lability as rastitelnostina, sedative therapy and treatment with drugs that normalize peristalsis.

The Department conducted examination: fractional gastric intubation with the use of histamine test revealed normal secretory function. Esophagogastroduodenoscopy found a marked exacerbation of gastroduodenitis, rapid duodenoplasty reflux. The morphological examination of biopsy specimens was observed diffuse antral gastritis and chronic superficial duodenitis. The results of ultrasound abdomen revealed a deformation of the gallbladder, normokinetic type of biliary dyskinesia. According to rheoencephalography was observed lability of vascular tone regions /phenomena normo - and Hyper/ unstable signs of violations of hemicircular in vessels of average size, difficulty of venous outflow.

With 5 days of hospitalization were sinusoidal modulated currents from device "Amplipulse-4" in AC mode, III is a native of operation with a frequency of 150 Hz, a modulation depth of 50%, the duration of the parcels of pulses and pauses of 1-1 .5 s, the power current of 2 mA for 10 min, at a rate of 10 daily procedures. Pre-child laid on cosequential in a rubber mask of the device, "Electrosleep" change plug the device in relation to the apparatus Amplipulse-4".

Already after a single exposure according to rheoencephalography tended to improve venous outflow, though preserved lability of vascular tone. By the middle of the treatment the girl's condition has improved, gone are the symptoms of intoxication, increased appetite, disappeared complaints of abdominal pain, vomiting, decreased palpation tenderness in all departments of the abdomen, normalized sleep, the child became less excitable. To the end of treatment, the condition has stabilized, fully cleansed language, disappeared dyspeptic symptoms and pain, the chair became a regular, normalized night and daytime sleep, the girl has become less excitable and irritable.

A monitoring study noted positive dynamics of these special methods. Esophagogastroduodenoscopy revealed a decrease swelling, hyperemia of the mucous membrane and the normalization of the motor-evacuation disorders gastroduodenal zone. The morphological examination of biopsy specimens showed lower lymph plasmocytomas infiltration, increased regeneration of the mucous membrane of the stomach and duodenum. According to rheoencephalography significant improvement CEA lability of vascular tone, was determined only normal tonus, normalized venous outflow. Follow-up observations showed an increase of resistance of an organism of the child, the increase in remission for up to 6 months. Subsequent exacerbations were less pronounced, continued physical activity, restful sleep.

The proposed method of treatment was applied in the Department of gastroenterology, research Institute of Pediatrics of Russian Academy of medical Sciences in 60 patients with chronic gastroduodenitis in children aged 6 to 14 years. All children were identified exacerbation of chronic gastroduodenitis, most of them /75%/ noted conjugated disorders of the digestive system /biliary dyskinesia, chronic diagnostics, chronic constipation/. The comparison group consisted of 20 patients with /without physical therapy/. Was well tolerated procedure, no side reactions.

Under the influence of the treatment approach was opportune dynamics of the main clinical symptoms of the disease by the middle of the course of therapy. By the end of treatment in 81,7% of patients were relieved of pain syndrome, in 78.3% of children completely disappeared palpation tenderness, 73,3% - decreased diarrhoeal phenomenon, was significant reduction increased retrodisko syndrome in 91,7% children: decreased high level of irritability, anxiety, fear, improved night and day sleep. In the comparison group positive changes in clinical symptoms were less pronounced and occurred at a later date.

The results of fractional sensing of the stomach revealed the effectiveness of the proposed method both at elevated and reduced secretory function, it was found more pronounced by its inhibitory effect, which was characterized by a significant decrease in hypersecretion in both phases of digestion /63.3% of the children/ debit hours of free hydrochloric acid from 63.3% in the basal phase /40,52 3,78 up of 28.72 1,77 mg, P < 0,01/ and half of the patients in stimulated phase secretion /110,83 8,39 to 88,81 5,70 mg, P < 0,01/. In the comparison group, the positive dynamics of the secretory activity of the stomach was observed.

Esophagogastroduodenoscopy in 2/3 of patients showed a significant improvement in motor function and reduction of inflammatory activity of gastroduodenal zone in the form of reducing edema, hyperemia of the mucous membrane, which was confirmed by morphological examination of biopsy specimens. In the comparative group reduction of inflammatory reaction of the mucosa was not accompanied by favourable structural is a tendency to normalization of serum concentrations of immunoglobulins, and 63.3% of the patients were observed improvement in local immunity, which indicates a strengthening of the mechanisms for local protection. In the comparison group dynamics immunity was less pronounced.

On the basis of the conducted studies have established the beneficial effect of the proposed method on the functional state of the gall bladder, is more effective when the hyperkinetic type of dyskinesia /all children/ than hypokinesia /one-third of patients/. In the comparative group, the disappearance of functional disorders of the gallbladder was observed less frequently.

Qualitative analysis curves rheoencephalography showed a favorable trend in the effect of the proposed method. Already after a single exposure at 51.4% of children found a clear positive effect of sinusoidal modulated currents on the cerebral blood flow: a 4-fold reduction in the number of patients with hypertension, type, normostenichesky type was determined in 16 patients instead of 11, were reported more often combinations of standard and hypertonicity, there was a decline in high tone as a major cerebral arteries and arterioles. By the end of treatment positive changes were observed in 63.3% of the children, a 2-fold increase in the number of Benini was not observed.

Follow-up observations carried out in terms of 3, 6, 12 months, testified about the persistence of therapeutic effect of this method. Relapses of chronic gastroduodenitis after 12 months was observed in one third of patients.

Comparison of the prototype and the proposed method of treatment.

The prototype.

1. Pulse currents of rectangular pulses of constant direction

2. therapeutic efficacy of treatment 60,0%

3. Duration of treatment: daily procedure - up to 23 days, with the application through day - to 35 days

4. Remission of the disease after treatment is on average 3-6 months

5. Contraindications are acute and chronic inflammatory eye diseases, degenerative changes in the eye, oceanevery.

The proposed method.

1. Pulse currents sinusoidal pulses of alternating directions

2. therapeutic efficacy of treatment 75,0%

3. The duration of treatment with daily procedure - to 11 days, a reduction of treatment time to 12 - 14 days

4. Remission of the disease after treatment is on average 6 months - 1 year

5. The application of the proposed method with the changes in the eyes, oculonasal.

Thus, the proposed method for the treatment of chronic gastroduodenitis in children provides an opportunity to increase the body's resistance to infectious diseases, significantly reduce drug therapy, to reduce the treatment time for 12-14 days to improve the psycho-emotional state and social adaptation of the child, to prolong the period of remission of up to 1 year.

The method of treatment of chronic gastroduodenitis in children through exposure to pulsed currents, characterized in that the impact of conducting sinusoidal modulated currents in AC mode, III is a native of operation with a frequency of 150 Hz and 100 Hz, a modulation depth of 25 to 50%, the duration of the parcels of pulses and pauses 1 - 1.5 s current strength of 0.8 - 2 mA on closed eyelids and mastoid processes for 8 - 12 minutes depending on the age, daily, treatment of 8 - 10 treatments.

 

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FIELD: medicine.

SUBSTANCE: through puncture opening in proximal and distal directions one should perform osseous tunnels being coaxial to osseous log to connect, thus, the cavity of osseous cyst with medullary canal. Through the parts of healthy bone at the distance of 1-2 cm against cyst's edge in oblique direction one should implant rigid electrodes at the angle of 45 deg. against its center by applying beck's needles with dielectric covering. Subcutaneously one should implant elastic electrodes in projection of lesion focus and connect an electrostimulating unit to cutaneous ends of electrodes. Onto intraosseous electrodes one should supply impulse current of negative polarity, and onto elastic ones - of positive polarity at 10-20 mcA power and frequency of 0.5 Hz, of total duration and front of rectangular impulses cut being 200 mcsec, not more.. One should affect with impulse electric currents on the 24-h basis till complete covering the osseous defect observed.

EFFECT: higher efficiency of therapy.

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