Method of treatment of climacteric syndrome

 

(57) Abstract:

The invention relates to medicine, physical therapy, and can be used to treat patients with climacteric syndrome. Realize the impact of interference currents from device "Stereoliner-728" Siemens (Germany) fronto-mastoid technique. Use three pairs of electrodes, allowing the interference of three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range of 0-200 Hz for 25-30 with until you feel a light vibration duration 10-15 min each. The course is 10-12 daily procedures. The method allows to increase the efficiency of treatment of patients with climacteric syndrome.

The invention relates to medicine, in particular to physiotherapy, namely the treatment of patients with climacteric syndrome, and can be used in hospital, clinics.

Menopausal syndrome - syndrome complicating natural course of menopause is the physiological period, during which on the background of General age-related changes in a woman's body develop involutional processes in the reproductive system. The clinic study and development maniam life expectancy, respectively, and a period of perimenopause, increased social activity of women, as well as the importance of various aspects that determine the quality of life of women in this age group.

Menopausal healthy women reduce ovarian steroidogeneza, as a rule, leads to the development of degenerative changes and dysfunction estrogenzawisimy bodies.

The leading role in the pathogenesis of menopausal syndrome is attached dysfunction of hypothalamic structures, ensuring the coordination of cardiovascular, vascular, and emotional and behavioral reactions. One of the significant factors in the pathogenesis of the pathological manifestations of the climacteric syndrome is a deficiency of oestrogen influences, which entails the formation of a complex of symptoms characteristic of the so-called disease "estrogen deficiency". Due to the complexity and ambiguity of the mechanisms of occurrence and diversity of clinical manifestations treatment of menopausal syndrome represents a significant challenge. Research results E. M. Wiseway and co-authors (1997) imply that therapeutic "intervention" at a relatively early stages of the P> One of the main methods of treatment of climacteric disorders is hormone replacement therapy of various analogues of sex steroid hormones (C. I. Kulakov, and coauthors, 2001).

However, hormone therapy, as one of methods of drug therapy, has significant drawbacks, both economic (the high cost of the drug) and physiological (a large number of side effects and a huge number of contraindications).

The closest in technical essence to the proposed method of treatment of patients with climacteric syndrome is a method of treatment, which is transcerebral using rectangular pulse currents according to the method of electrosleep. Procedures are performed through the use of a rubber cuff with a forked electrodes in the socket which is inserted moistened with water hydrophilic spacers (cotton swabs) with a thickness of 1 see Eye electrodes placed on closed eyelids and is connected to a cathode of the occipital electrodes fixed on the mastoid processes of the temporal bones and attached to the anode. When conducting a classic use of electrosleep rectangular pulse currents with a frequency of 10 Hz (I. F. Perfilieva, E. M. Smith,ngroom. Proceedings Of Tniikip. Volume XI. 1978, S. 48-51).

The prototype disadvantages are that this method of treatment in patients with climacteric syndrome, despite a rather pronounced sedative effect, the lack of effect on the vegetative component of the disease, in particular not reduced the number of tides that is one of the leading complaints in this category of patients. This, in turn, reduces the effectiveness of the treatment and reduces the period of remission.

The technical result of the proposed method of treatment of patients with climacteric syndrome is to increase efficiency, reduce treatment time, increasing the period of remission.

This technical result is achieved by the impact of the interference currents on fronto-mastoid technique using three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range of 0-200 Hz for 25-30 with until you feel a light vibration in the course of 10-12 daily procedures with a duration of 10-15 minutes each.

The rationale of these parameters.

In the clinical studies it was found that the impact of interferenceavoidance, has a marked effect on the anterior and posterior hypothalamus, thalamus, reticular formation of the mid-brain, thus having a positive effect on the vegetative nervous system.

It was also found that interference currents in this range cause a pronounced sedative effect due to significant activation of limbic structures with the release of endorphins and other opioid amines.

Description of method of treatment.

The procedure is performed in the position of the patient lying on his back. The impact of the interference current is conducted from the apparatus "Stereoliner-728" Siemens (Germany) fronto-mastoid technique using three pairs of electrodes, allowing the interference of three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range of 0-200 Hz to feel a light vibration. For the procedure uses an electrode device (mask) for the application of interferential currents according to the method of electrosleep, representing 3 pairs of electrodes embedded in a rubber cuff. Procedures carried out daily, the duration of one procedure 10-15 min, treatment of 10-12 procedures.

Examples of OS is Edna severity with vascular manifestations. Arterial hypertension.

At admission the patient complained of frequent flushing of weak and moderate intensity from 10 to 15 times per day with heavy sweating, headache, unstable blood pressure. Along with complaints vegetososudistaja character had complex emotional disorders as depression, irritability, decreased vital interests, insomnia, tearfulness. These symptoms the patient was noted in 9 months. Despite periodic treatment by a neurologist and gynecologist medicines, these violations progressed.

From the anamnesis revealed that during the years of menstruation began to come regularly, with delays of up to two to four months. Pregnancies were 4, one delivery, three artificial termination of pregnancy without apparent complications. When hormonal examination revealed: decrease in sex steroid hormones, whereas the level of luteinizing (LH) and folikulostimuliruyuschego (FSH) hormone in the serum remained within normal limits. It was also revealed deviation lipid spectrum, in particular haemoglobin rate was higher than normal (3,1).

Assessment of emotional lichi personality questionnaire (RESINS), health - activity - mood (SAN), short-term verbal memory, etc.

In clinical neurological picture of the patient prevailed in the first place, the phenomenon of stem-cerebellar disease (unstable gait, discoordination in the finger-nose test, nystagmus, diplopia, and so on) and the initial manifestations of the pyramid deficit (entrelace, the elements of violation of praxis, and so on). Dominated zerebrosteniceskie symptoms: decreased physical and mental health, fatigue, impaired memory cycle "sleep-Wake" and expressed affective disorder.

According to the ultrasonic dopplerography (USDG) main arteries of the head (MAG) have been identified organic obstacles blood flow: a stenosis in the basins of the carotid arteries. Signs of venous discirculatory in the vertebrobasilar system, the tendency to angiospastic reactions in the basins of the carotid arteries.

The results of the test RESINS have allowed to reveal mainly improvements on the scale "psychasthenia". Data test SAN was characterized by lower values for all scales. Comprehensive data evaluation psychological testing indicates preobladayushchego well-being.

Along with the above studies have calculated the index of Kuperman assessment of symptoms (hot flashes, sweating, sleep disturbance, neuronet, impaired concentration, depression, headaches, arthralgia, tachycardia). In this patient the index of Kuperman consistent with 23 points, which corresponds to the climacteric syndrome of moderate severity.

Analysis of initial immunological parameters showed a disturbance in T-cell immunity.

Given the history of the disease, patient complaints, clinical data and special methods of investigation, and the lack of effect from a previously conducted therapy medicines as hormonal and non hormonal stimulants, the patient was treated by interference currents on fronto-mastoid technique using three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range from 0 to 200 Hz for 30 s until you feel a light vibration in the course of 10 daily treatments lasting 15 min each.

The tolerability of therapy interferential currents was good. 1-3 procedures mentioned changes, the characteristic value for the minute). There was a sense of tide heat, which declined for the fifth procedure. During and after the procedure occurred programmnoe status, blood pressure and heart rate stabilized.

After treatment was observed regression in the first place, zerebrasteniceski manifestations: reducing irritability and fatigue, improve short-term memory functions, positive shifts in a series of "sleep-Wake" (the increase in the total duration, improve sleep quality, reduce the frequency of night awakenings, and others). Along with this, at the end of treatment was a decrease in the frequency and duration of the tides.

Index score of Kuperman showed a positive trend and a reduction in the number of points to 14, which corresponds to mild severity of menopausal syndrome.

At the end of treatment and during the period of observation the patient within 6 months of assessment of menstrual function showed that the duration of intermenstrual period ranged from 40 to 45 days under normal values of the volume of lost blood and the duration of menstruation.

According to the data of hormonal inspection, there was a trend to higher values of steroid hormones, whereas the level of luteinizing (LH) and FD is x norm (2,1).

According to the data of Doppler ultrasound was noted improvement in cerebral hemodynamics due to the significant reduction in the phenomenon of arteriospasm and venous discirculatory. There were signs of development of collateral circulation in the basins of the carotid arteries, reducing venous discirculatory in the vertebrobasilar system.

Given electroencephalography (EEG) had distinct General changes, dysfunction formations limbic-reticular complex phenomena of irritation. As shown by the analysis of EEG data in dynamics, the state of the bioelectrical activity of the brain, in response to transcerebral interferential electrotherapy currents were unchanged in the majority of observations. This fact is important, as it indicates no negative reactions on the part of the Central nervous system (CNS) when applying transcerebral physiotherapy. The positive trend was more pronounced in rheoencephalography (REG): marked improvement in blood, decrease symptoms of dystonia cerebral vessels and improving the outflow of venous blood.

According to the test RESINS as a result of the treatment there is a decrease show the tension, the reduction of anxiety, anxiety, anxiety, enhance adaptive capacity. Also there has been some decline in the scale of hypochondria (52,9 before treatment and 46.6 points after treatment), indicating that the reduction of excessive fixation on the manifestations of the disease, the reduction of such phenomena "flight into illness", the emergence of a more positive attitude to life. According to test SAN, there is some increase in the scale of activity (5,4 before treatment 5,9 after), indicating that the increase in actual energy potential of life.

I.e., according to psychological testing, the results of treatment in this group of patients is the weakening of emotional tension, increase vitality, improve psychological adjustment.

Analysis of immunological parameters showed that after treatment was observed a significant reduction of T-lymphocytes, as in percent (24,41,9% to 18,91,3%) and in absolute value (269,236,0 to 170,612,7).

Data ultrasonic research of organs of a small pelvis showed the absence of negative trends in the state organs of the female reproductive system.

Example 2. The patient is and manifestations. Arterial hypertension.

At admission the patient complained of frequent flushing of weak and moderate intensity from 12 to 18 times per day with heavy sweating. Headache, unstable blood pressure. Along with complaints vegetososudistaja character had complex emotional disorders as depression, irritability, decreased vital interests, insomnia, tearfulness. Despite periodic treatment by a neurologist and gynecologist medicines, these violations progressed.

From the anamnesis revealed that during the two years of menstruation began to come regularly, with delays of up to two to four months. Pregnancies were 2, one delivery, one artificial interruption of pregnancy without apparent complications. When hormonal examination revealed: decrease in sex steroid hormones, whereas the level of luteinizing (LH) and folikulostimuliruyuschego (FSH) in serum remained within normal limits. It was also revealed deviation lipid spectrum, in particular haemoglobin rate was above the norm (3,8).

Assessment of the emotional and personal and intellectual-mental sphere was carried out on about is the Artin sick prevailed, first of all, the phenomenon of stem-cerebellar disease (unstable gait, discoordination in the finger-nose test, nystagmus, diplopia, and so on) and the initial manifestations of the pyramid deficit (entrelace, the elements of violation of praxis, and so on ). Dominated zerebrosteniceskie symptoms: decreased physical and mental health, fatigue, impaired memory cycle "sleep-Wake" and expressed affective disorder.

According to the ultrasonic dopplerography (USDG) main arteries of the head (MAG) have been identified organic obstacles blood flow: a stenosis in the basins of the carotid arteries. Signs of venous discirculatory in the vertebrobasilar system, the tendency to angiospastic reactions in the basins of the carotid arteries with reduced linear blood flow velocity (BFV).

The results of the test RESINS have allowed to reveal mainly improvements on the scale "psychasthenia". Data test SAN was characterized by lower values for all scales. Comprehensive data evaluation psychological testing confirms the prevalence psihasteniceskie changes, reducing actual energy potential of life index of Kuperman assessment of symptoms (hot flushes, sweating, sleep disturbance, neuronet, impaired concentration, depression, headaches, arthralgia, tachycardia). In this patient the index of Kuperman corresponded to 25 points, which corresponds to the climacteric syndrome of moderate severity.

Analysis of initial immunological parameters showed a disturbance in T-cell immunity.

Given the history of the disease, patient complaints, clinical data and special methods of investigation, and the lack of effect from a previously conducted therapy medicines as hormonal and non hormonal stimulants, the patient was treated by interference currents on fronto-mastoid technique using three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range from 0 to 200 Hz for 25 with until you feel a light vibration in the course of 10 daily treatments lasting 15 min each.

The tolerability of therapy interferential currents was good. 1-3 procedures mentioned changes, characteristic of increased emotional stress (in the period of adaptation increase AD 15-20 mm RT.art., increased heart rate on 10-18 beats per min is about programmnoe state, The blood pressure and heart rate stabilized.

After treatment was observed regression in the first place, zerebrasteniceski manifestations: reducing irritability and fatigue, improve short-term memory functions, positive shifts in a series of "sleep-Wake" (the increase in the total duration, improve sleep quality, reduce the frequency of night awakenings, and others). At the end of treatment was a decrease in the frequency and duration of the tides.

Index score of Kuperman showed a positive trend and a reduction in the number of points to 15, which corresponds to mild severity of menopausal syndrome.

According to the data of hormonal inspection, there was a trend to higher values of steroid hormones, whereas the level of luteinizing (LH) and follicle-stimulating (FSH) has not changed. Haemoglobin rate at the end of treatment was within the normal range (2,3).

According to the data of Doppler ultrasound was noted improvement in cerebral hemodynamics due to the significant reduction in the phenomenon of arteriospasm and venous discirculatory. There were signs of development of collateral circulation in the basins of the carotid arteries, decrease in the EG) marked marked total changes dysfunction formations limbic-reticular complex phenomena of irritation. As shown by the analysis of EEG data in dynamics, the state of the bioelectrical activity of the brain, in response to transcerebral electrotherapy pulse interference currents were unchanged in the majority of observations. This fact is important, as it indicates no negative reactions on the part of the Central nervous system (CNS) when applying transcerebral physiotherapy. The positive trend was more pronounced in rheoencephalography (REG), the improvement of blood, reducing the effects dystonia cerebral vessels and improve the venous blood.

According to the test RESINS as a result of the treatment is observed the decrease of the scale of psychasthenia (from 52.9 to treatment and 41.8 after treatment), indicating that the weakening of emotional tension, reducing anxiety, anxiety, anxiety, enhance adaptive capacity. Also there has been some decline in the scale of hypochondria (53,9 before treatment and 46,0 points after treatment), indicating that the reduction of excessive fixation on the manifestations of the disease, the reduction of such phenomena "the flight of the ve indicators on the scale of activity (5.3 to ensure 5,9 after), reflecting increasing current energy potential of life.

So, according to psychological testing as a result of treatment in this group of patients is the weakening of emotional tension, increase vitality, improve psychological adjustment.

Analysis of immunological parameters showed that after treatment was observed a significant reduction of T-lymphocytes, as in percent (24,21,9% to 18,11,3%) and in absolute value (267,236,1 to 171,612,0).

Data ultrasonic research of organs of a small pelvis showed the absence of negative trends in the state organs of the female reproductive system.

Long-term results of treatment testified to the saving achieved immediate results of treatment during 8 months of follow-up.

The proposed method for the treatment of patients with climacteric syndrome was applied 60 patients aged 42 to 58 (49,56,8) years.

As a result of treatment by the proposed method were observed regression in the first place, zerebrasteniceski manifestations: reducing irritability and fatigue, improving functions of short-term PA is iunie frequency of nighttime awakenings, and others).

The treatment time was reduced in comparison with the prototype up to 18-20 days (prototype - 28-32 days).

Long-term results of treatment testified to the saving achieved immediate results of treatment for 6-8 months of observation.

A method of treating patients with climacteric syndrome by physical impact factor, characterized in that the influence exercised by the interference currents from device "Stereoliner-728" Siemens (Germany) fronto-mastoid technique using three pairs of electrodes, allowing the interference of three sinusoidal currents in a rhythmically changing the frequency of the interference currents in the range of 0-200 Hz for 25-30 with until you feel a light vibration duration 10-15 min each, in the course of treatment 10-12 daily procedures.

 

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1 dwg

FIELD: medicine.

SUBSTANCE: method involves introducing photosensitizer in pharmaceutical water-soluble dosage form at a dose of 1.5-2.0 mg/kg * 0.7 during 40-60 min. Blood is concurrently exposed to laser radiation at a dose of 600-900 J/cm3. The wavelength is selected to match photosensitizer absorption maximum in the water-soluble dosage form. Chlorine row photosensitizer is introduced 3-3.5h later in liposome form at a dose of 1.5-2.0 mg/kg*0.3. 15 min later, laser radiation is applied all over the whole tumor perimeter in transpupillary mode with neighboring fields overlap by 5% of area with power density of 80-100 J/cm2. The wavelength is selected to match photosensitizer absorption maximum in the liposome form. Then the whole neoplasm surface is irradiated in transpupillary mode in laser radiation fields in circle moving from periphery to the center with neighboring fields overlap being equal to 5% of area. The wavelength is selected to match photosensitizer absorption maximum in the water-soluble dosage form. Power density of 80-100 J/cm2 in peripheral part is gradually increased when moving towards the center to 100-120 J/cm2. Two weeks later, localization is adjusted in diaphanoscopic transscleral way and electrochemical destruction of intraocular neoplasm is carried out with current intensity of 10-100 mA during 10-1 min.

EFFECT: enhanced effectiveness in achieving complete or partial tumor regress; reduced risk of metastatic complications.

4 cl

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