A method for the treatment of dumping syndrome
(57) Abstract:The invention relates to physical therapy and is intended for treatment of dumping syndrome in patients undergoing surgery for ulcer. Patients assigned to the complex of therapeutic and preventive measures, including health resort health-protective mode, clinical nutrition, physical therapy, internal reception of mineral water, carbonic mineral baths, as well as electrophoresis of dalargin sinusoidal modulated current with a modulation frequency of 150 Hz, the depth of 25%, amperage 6 - 10 mA, the first 5 min I come from, the next 5 min - IV is a native of work, duration of parcels 3 c in 1.5-2 hours after eating, in the course of 10 treatments in alternation with baths. The proposed method of treatment contributes to the inhibition of motility of the gastrointestinal tract, reduces the reflex excitability of the sympathetic nervous system, reduces the severity of autonomic and hormonal reactions of the heart, blood vessels, brain. table 1. The invention relates to medicine and can find application in the treatment of patients operated on for stomach ulcer duodenal ulcer (abdc), have developed dumping syndrome (DS).In the treatment of DS isaku physical factors (mineral water, peloids, methods of physiotherapy - and pulsed galvanic currents, electrophoresis of novocaine, hexane and others). However, existing methods of treatment DS is not effective enough.There is a method of treatment of DS patients YAB after gastrectomy, the application of therapeutic mineral waters, mineral baths and electrophoresis of philodina sinusoidal modulated currents (SMC). The impact of ITC in continuous mode, bipolar, amperage of 20 mA, a frequency of 100 Hz, for 5 minutes I come to work and for the next 5 minutes IV come when the modulation depth of 50% (L. I. Novozhilova, N. With.Molchanov, I. C. buhtoyarov of authorship N 1169668, registered in the State. register of inventions of the USSR 01.04.1985 year ). The method allowed to reduce the main clinical manifestations of dumping syndrome and positive dynamics of indicators of vascular reactions, ECG, blood glucose, but this effect was developed only to the end of treatment and was not expressed.The rationale for the development of the proposed method was evidence of the ability of the synthetic analogue of enkephalins - dalargin and sinusoidal modulated currents (SMC) used in the mode is the least irritating destist in the ganglion system, to reduce the reflex excitability of the sympathetic nervous system and smooth muscles of the stomach and intestines.The essence of the proposed method lies in the complex influence of physical factors in combination with chemotherapy on the main pathogenetic mechanisms of dumping syndrome: increased speed of evacuation of food masses of the operated stomach into the small intestine, increased reflex excitability in the asthma of cholinergie, hyperactively "anterointernal axis with severe autonomic and hormonal response of the heart, blood vessels, brain.The method is as follows. Patients assigned to the complex of therapeutic and preventive measures, including SANATORNO-resort treatment, therapeutic nutrition (diet with restriction of carbohydrates, the fractional power), physical therapy, internal reception moderately mineralized carbon dioxide chloride-hydrocarbonate sodium mineral water from the calculation of 3.0-3.5 ml per 1 kg of patient's body weight 3 times a day for 45-60 minutes before meals, carbonated mineral bath temperature 36-37oC through the day, 8-10 procedures for the course, and electrophoresis of dalargin sinusoidal modulated the particular patient), the first 5 minutes I come from, the next 5 minutes IV kind of work, duration of parcels 3 sec. At the anode raspolagaet in pyloro-duodenal region, the gasket put 4 ml of working solution of dalargin (1mg drug dissolved in 4 ml of distilled water). The procedure is carried out in 1.5-2 hours after a meal, in the course of 10 treatments, in alternation with baths. We have chosen for the injection of dalargin mode CMT gives easy undulating surface modulation, low irritant effect while maintaining the analgesic actions.Observations were carried out on 20 patients suffering from dumping syndrome after gastrectomy for ulcer. Among the observed male patients was 15, 5 women, aged mostly between 30 and 50 years. Severe dumping syndrome occurred in 5, moderate in 12, light 3. Hypoglycemic syndrome was diagnosed in 7, gastritis gastric stump 6, afferent loop syndrome in 4, enterocolitis, adhesive disease, cholecystitis, hepatitis, pancreatitis, iron deficiency anemia, respectively, 6, 5, 3, 4, 4, 5 patients.Patients in addition to detailed clinical examination were determined: blood count, blood glucose, amylase, bilirubin, hall is and the height of the dumping of the reaction was determined by heart rate, blood pressure (BP), ECG, blood glucose. These studies were conducted at the beginning and end of treatment. After treatment, most patients have disappeared or decreased clinical symptoms of dumping syndrome and other-post gastro-resection disorders, there is a favourable dynamics of the vascular manifestations (table). Significant improvement noted in 7, the improvement in 13 patients. It should be noted that the positive dynamics of clinical symptoms appear in patients after receiving II-III procedures.Comparative analysis of treatment results for the proposed method and the known method prototype (electrophoresis of philodina sinusoidal modulated currents, drinking mineral water and mineral baths) allowed us to identify distinct advantage of the proposed method before known as clinical indicators (clinical symptoms of dumping syndrome and other-post gastro-resection disorders), and indicators of vascular manifestations, data of blood glucose and ECG.The effectiveness of the treatment of dumping syndrome proposed method: significant improvement of 33%, an improvement of 67%; in a known manner: a significant improvement of 10%, ulovane CMT-phoresis of dalargin 4-5 days the method of the prototype 20-24 days.When using CMT-phoresis of dalargin for patients while maintaining an objective signs of dumping syndrome (increased heart rate, increased blood pressure, glycemia) disappeared subjective symptoms - weakness, sweating, palpitations, dizziness, nausea. Patients could eat, which is explained by the increased sensitivity of the Central nervous system to visceral influences (in this case with the receptors of the small intestine in response to stimulation with a large amount of food quickly evacuated from the operated stomach into the small intestine).The proposed method is illustrated by the following example.Patient S. , 42 years (history N disease N 483) was treated in the conditions of the Essentuki clinic Pyatigorsk, GNIIT in September-October 1999 When entering complained of General weakness, fatigue, particularly pronounced on an empty stomach and with long breaks in meals, pain in the epigastric region after a meal, periodically vomiting bile. After the meal, adopted even in a small amount, says the attacks of acute weakness, drowsiness, palpitations, feeling hot, prodoljayushie the ka method Billroth-II ulcer, complicated by stenosis of the pylorus.Sick right physique, adequate nutrition (height - 158 cm, weight - 60,5 kg). Skin and visible mucous net, pink, peripheral lymph nodes are not enlarged. In the lungs - vesicular respiration, percutane - pulmonary sound. Pulse 56 in 1 minute, rhythmic, satisfactory properties. Blood pressure 100/60 mm RT. Art. heart sounds clean, regular rhythm. Tongue moist, coated with white bloom. The belly of the correct form, in the act of breathing participates evenly. On the middle line of the belly - postoperative scar from the xiphoid process to the umbilicus. The abdomen is soft, with painful palpation in the epigastric region and in the region of the descending and sigmoid colon. Liver and spleen are not enlarged. Analysis of clinical blood: hemoglobin 135 units , leukocytes 6,2 109/l, eosinophils 2, band 3, segmented 63, lymphocytes 30, monocytes 2. Erythrocyte sedimentation rate of 4 mm/h blood Glucose 3.6 mmol/L. ECG sinus bradycardia.After ingestion: pulse 88 1 min, BP 135/80 mm RT. Art. blood Glucose of 7.4. ECG acceleration of heart rate, ST depression, and SoBilirubin in the blood 16 Ám/l (indirect), cholesterol 6.4 mmol/L. ultrasound - moderately expressed diffusely about ulcer and 12 duodenal ulcer): reactive reflux gastritis, hypoglycemic and dumping syndrome moderate, afferent loop syndrome, reactive hepatitis, pancreatitis, enterocolitis.After treatment, including therapeutic nutrition (diet 2-R with the restriction of carbohydrates, the fractional power), therapeutic physical culture, vnutrenniy receiving moderately mineralized carbon chlorinehydrocarbons sodium source water Essentuki N 4 150 ml 3 times a day for 40 minutes before a meal, platekompaniet baths, electrophoresis of dalargin sinusoidal modulated currents in the epigastric region, 10 sessions of treatment (in alternation with mineral baths), the patient significantly improved health, mood. Disappeared epigastric pain, weakness, fatigue, stopped hypoglycemic seizures and dumping syndrome, vomiting bile, normalized stool. Increased heart rate after eating did not exceed 6 in 1 minute, the AD - 5 mm RT. Art. Disappeared tenderness to palpation of the abdomen. The increase in weight was 1.5 kg, the treatment is regarded as an improvement. It should be noted that the weakening of the manifestations of syndromes-post gastro-resection was observed after administration of the first two procedures CMT-phoresis gave the program, including the use of CMT-phoresis of dalargin for the epigastric region in combination with therapeutic mineral waters, affecting the basic pathogenesis dumping syndrome reduces the reflex excitability of the receptor apparatus of the gastrointestinal tract, slowing the evacuation of food from the stomach and its subsequent passage through the intestines, the elimination or significant reduction of vascular and autonomic manifestations, can improve the effectiveness of Spa therapy-post gastro-resection disorders, to achieve a positive effect in a shorter time - 4-5 day (compared with the method of the prototype at 20-24 days). A method for the treatment of dumping syndrome in patients undergoing surgery for ulcer, including the effects of sinusoidal modulated current to the epigastric region in combination with the medical nutrition, healing mineral waters and mineral baths, characterized in that use electrophoresis synthetic analogue of enkephalins - dalargin sinusoidal modulated currents used in the mode is the least irritating with modulation frequency of 150 Hz, the depth of 25%, amperage 6 - 10 mA on IMI baths, in the course of 10 treatments.
FIELD: medical engineering.
SUBSTANCE: device has container for keeping product to be applied, dosing unit for distributing the product, power supply element placed near the dosing unit. The dosing unit is designed as rotating element and is apiece of felt. Container walls are flexible. The dosing unit is manufactured from electric conducting material and connected to the power supply element.
EFFECT: enhanced effectiveness in carrying out viscous product iontophoresis.
8 cl, 7 dwg
FIELD: medicine, juvenile surgery.
SUBSTANCE: the method is characterized by the fact that 3 wk before surgical dissection of adhesions due to laparoscopy one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily. Moreover, 7 d before surgical interference it is necessary to conduct 7 seances of electrophoresis with irucsol and prescribe smekta sorbent per 1 packet thrice daily. Then comes laparoscopic dissection of adhesions, and after surgical interference one should perform electrophoresis with irucsol for 7 d. After appearance of intestinal peristaltics it is necessary to apply smekta per 1 packet thrice daily for 7 d. Since the 8th after operation one should prescribe bifiform per 1 capsule and Hilak-Forte per 10-15 drops thrice daily for 1 mo. Then 1 mo after laparoscopy one should prescribe electrophoresis with collalysine up to 8-10 procedures at simultaneous abdominal massage and curative-physical culture complex for 8-10 d. The method enables to obtain antiadhesive effect in 92% cases of surgical dissection of adhesions due to complex impact upon pathogenesis of adhesive disease, at decreased number of relapses.
EFFECT: higher efficiency of therapy.
SUBSTANCE: method involves introducing oxybutinine solution into the urinary bladder via catheter in the amount of 5-10 mg per 20-30ml of sterile water once a day. Electrophoresis is concurrently carried out on the urinary bladder projection region using current intensity of 0.02-0.04 mA/cm2 during 15-20 min. The total treatment course is 10-12 daily procedures long.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves placing active electrode like metal conductor in canal and passive electrode on body surface zone and applying DC action. The metal conductor is coated with dielectric layer spread to its working part. The working part is brought close to impassable area through badly or well-passable zones of the root canal. Gap filled with electrolyte is left between the impassable area and electrode end. The active electrode is connected to electric current source plus terminal and the passive one to minus terminal.
EFFECT: enhanced effectiveness of treatment.
SUBSTANCE: method involves dropping 1% midriacyl solution into conjunctival cavity in postoperative period. Then, lidase electrophoresis is applied to orbicular muscle zones. Plaster wetted with Okovidit gel is applied to the lower eyelid.
EFFECT: accelerated treatment course.
FIELD: medical engineering.
SUBSTANCE: device has reservoir, containing medicament, with electrode fixed therein. The device is to be held with patient hand. Eye-bath end surface designed for making contact with orbit boundary is of oval shape having broad and narrow end approximating orbit form. The narrow eye-bath end is raised above its broad end. The electrode is removable and remountable. The eye-bath is manufactured from flexible biologically neutral thermosetting polymer stable with respect to temperature and medicament action.
EFFECT: improved adjacency to orbit in performing electrophoresis procedures.
FIELD: medicine, endocrinology.
SUBSTANCE: at the background of applying microdosages of iodine and/or levothyroxine one should conduct electrophoresis with 3%-sodium thiosulfate solution. The latter should be introduced with the help of a cathode placed onto thyroid area, an anode - onto interscapular area. The area of the interlayer corresponds to 5 x 10 cm at current power being 4-8 mA, exposure time being 15-20 min. Seances should be performed either daily or every other day, about 10-12 procedures/course.
EFFECT: higher efficiency of therapy.
FIELD: physiotherapy and health resort treatment.
SUBSTANCE: method envisages drinking mineral water, performing intragastric electrophoresis with mineral water, magnet-laser therapy, massage, and baths. Additionally, 2-3 days before physiotherapy and during physiotherapy, biologically active additive "succinic acid" is administered in daily dose 3 x 0.5 g after meal. Intragastric and magnet-laser therapy are performed every day consecutively without interval between them. Treatment course consists of 8-10 procedures. Method allows achieving stable remission in case of indicated diseases thanks to integrated positive effect produced on inflammatory process, velocity of epithelization of ulcerous and erosive defects, acid-forming, neutralizing, and motor functions in gastroduodenal region on the whole.
EFFECT: enhanced treatment efficiency.
5 tbl, 2 ex
FIELD: medicine; infectious therapy.
SUBSTANCE: device for plasma-dynamic treatment of infected wounds and cavities has high voltage electric pulse oscillator provided with low-sized high voltage pulse electric-charge unit housed inside carrier dielectric case. The case has co-axial electrode system which has ring-shaped and rod electrodes separated by dielectric insulator. Co-axial electrode system is placed inside optical-transparent quartz member made in form of flask which has perforated semispherical working end. Co-axial system is disposed to have space relatively inner surface of carrier case of unit. Part of internal surface of the unit - at the area of semispherical working end of flask - is made of material which is able to reflect radiation of visible and UF range of spectrum. Removable outlet union, provided with branch pipe connected to union, is mounted onto working part of carrier case of unit. Branch pipe is connected with member having perforated semispherical working end at the opposite side. Opposite edge part of carrier case has support sealing bushing with inlet pipe which is connected with ozone generator conjugated with vessel for containing oxygen. Inlet pipe communicates with space to inner surface of carrier case of the unit and outer surface of flask.
EFFECT: improved efficiency of treatment; improved reliability of operation.
10 cl, 2 ex
SUBSTANCE: method involves applying decompression cholecystostoma over the gallbladder. Gallbladder lavage is carried out using the cholecystostoma. Then gallbladder cavity is filled with antibacterial preparation. Electrophoresis is carried out directly in inflammatory changed area through electrodes mounted corresponding to preparation polarity in the gallbladder cavity and externally on patient skin in hepatobiliary organs projection zone.
EFFECT: accelerated treatment course.