The method of treatment of peptic ulcer of the duodenum

 

(57) Abstract:

The invention relates to medicine, namely to a gastroenterologist. Transcutaneous effect of low-intensity infrared laser radiation of gallium arsenide nature on the projection area of the ulcer on the anterior abdominal wall. In patients with protein-energy malnutrition the first-second degree, and pain syndrome this zone is irradiated with a frequency of 150 Hz, then the frequency of 1500 Hz for the duration of the session. In the absence of pain syndrome is irradiated with a frequency of 80 Hz. Exposure dose by irradiation with each frequency is 0.1 MJ /cm2. In patients with protein-energy malnutrition third degree pain syndrome this zone is irradiated with a frequency of 150 Hz, then the frequency of 1500 Hz for the duration of the session. In the absence of pain syndrome is irradiated with a frequency of 80 Hz. Exposure dose by irradiation with each frequency is 0.01 MJ/cm2. The exposure time of each frequency calculated by the formula: , where D is the exposure dose for each frequency j/cm2; P - average pulse power of the beam, W; -pulse duration, s; f is the pulse frequency, Hz; t is the exposure time, s; S - area of exposure, cm2increases the efficiency and reduces the treatment time.

The invention relates to medicine, namely to gastroenterology and physiotherapy for the treatment of peptic ulcer disease (PUD) of the duodenum.

A prototype of the invention taken treatment YAB duodenum by multiple session transcutaneous effects of low-intensity infrared laser radiation of gallium arsenide nature with the aid of a laser therapeutic units on the area of projection of ulcers on the anterior abdominal wall and paravertebral region; the exposure region of the projection ulcers hold for 8 min with a pulse frequency of 80 Hz (if poorly expressed painful syndrome) or with a frequency of 1500 Hz (when strong pain syndrome), irradiation paravertebral areas are conducted at the level of Th 7-9 for 2 min with a frequency of 300 Hz (B. N. Kharchenko and other Treatment of gastroduodenal ulcers semiconductor laser apparatus “Pattern” // Sov. medicine. 1990. S. 54-57).

The disadvantage of the prototype is the lack of a dose of laser radiation based on the reserve capacity of the organism of the patient, which does not allow differentiation therapy for the duration of the exposure, the exposure dose and reduces the effectiveness of treatment YAB duodenum.

The technical result is achieved by including multiple session transcutaneous influence of low-intensity infrared laser radiation of gallium arsenide nature with the aid of a laser therapeutic units on the area of projection of ulcers on the anterior abdominal wall, the method of treatment YAB involves irradiation in addition to the projection of gastroduodenal ulcers during which the irradiator constantly move without interruption from the skin so that the exposure time of one point does not exceed 2 seconds, the duration of the session establish the expression of the protein deficiency in the clinical picture of the disease.

If the patient's pain syndrome irradiated gastroduodenal area first with a frequency of 150 Hz, then the frequency of 1500 Hz.

In the absence of the patient's pain syndrome irradiated gastroduodenal zone with a frequency of 80 Hz.

The duration of exposure (t) gastroduodenal calculated by the formula

where D is the exposure dose, j/cm2;

P - average pulse power of the beam, W;

- pulse duration, s;

f is the pulse frequency, Hz;

2. Thus, in patients with bn first-second degree, and pain syndrome exposure dose at the session of 0.2 MJ/cm2in the absence of pain syndrome of 0.1 MJ/cm2.

In patients with protein-energy malnutrition third degree exposure dose by irradiation with each frequency should be of 0.01 MJ/cm2. Thus, in patients with bn in the third degree and pain syndrome exposure dose at the session of 0.02 MJ/cm2in the absence of pain syndrome of 0.01 MJ/cm2.

It is known that infrared laser radiation of low intensity, a frequency of 50-100 Hz is most effective for stimulation of regenerative processes, the frequency interval 150-600 Hz have the highest anti-inflammatory activity, the frequency interval from 1,000 to 1,500 Hz possess analgesic properties and have influence on the course of reflex processes.

At the same time, it is known that an active inflammatory process in YAB without the expressed disturbances of the nervous regulation and pain sensitivity I. Subsidence of the pain syndrome and its absence is usually observed in the period of epithelialization of the ulcer. In addition, YAB is characterized by chronic persistent inflammation. Therefore, the frequency selection corrects the leading pathogenetic links YAB, which allows to take into account individual peculiarities of the course of YAB.

Reserve capacity of the organism of the patient with peptic ulcer disease reflects the degree of protein deficiency (cada A. A. Protein deficiency and its correction in determining the indications for surgical treatment of patients with peptic ulcer....: Diss... K. M. N., Ivanov, 1985. - S. 108).

Therefore, the choice of the duration of irradiation corresponding to the severity of protein deficiency in a patient, provides the dose of laser radiation based on the reserve capacity of the organism.

Examples of practical implementation of the method.

1. Patient A., 42 years. Hospitalized with exacerbation of ulcerative diseases of the duodenum. Complains of severe pain in the epigastrium. If fibroesofagogastroduodenoscopia (peggs): pronounced hyperemia of the mucosa of the duodenum, ulcer bulb 1.2 cm in diameter, 0.2 cm depth, at the bottom of which is a layer of fibrin.

Therefore, the patient A. in accordance with the proposed method assigned daily session transcutaneous influence of low-intensity infrared laser radiation of gallium arsenide nature with the aid of a laser therapeutic settings “Spectrum”, the power output of 8 W, gastroduodenal area of 60 cm2in series with the pulse frequency of 150 Hz for 1 min 40 s, then with a frequency of 1500 Hz for 10 s with the constant movement of the feed within the zone without separation from the skin so that the exposure time of one point does not exceed 2 seconds. The treatment course is 10 sessions. Control faggs after completion of the course: in the duodenal bulb is a linear scar.

2. Patient M., 46 years old. Hospitalized with exacerbation of ulcerative diseases of the duodenum. Pain no ulcer detected fibroesofagogastroduodenoscopia (peggs): 1.3 cm in diameter, 0.2 cm deep.

Total protein - 70,0 g/l, albumin blood of 36.4 g/l, albumin-globulin ratio - 1,08, is l/kg, interstitial fluid - 125,1 ml/kg, i.e. the protein deficiency of the patient M corresponds to the third degree.

Therefore, the patient M in accordance with the proposed method assigned daily session transcutaneous influence of low-intensity infrared laser radiation of gallium arsenide nature with the aid of a laser therapeutic settings “Range” on the gastroduodenal area of 50 cm2with a pulse frequency of 80 Hz for 16 with constant movement of the feed within the zone without separation from the skin so that the exposure time of one point does not exceed 2 seconds. The course of treatment - 10 sessions. To control faggs (after the 10th session of irradiation): reducing the size of the ulcer to 5 mm

Results of treatment of patients YAB duodenum showed that the treatment according to the method of the prototype (98 people) full scarring to 10 session obtained from 52 patients (53.1 per cent), and in the treatment by the proposed method (89 people) - in 73 patients (82,02%), i.e., advanced to the way the prototype of 29.1%. In addition, no change was observed in 10.2% of patients treated according to the method of the prototype, and 1,12% of patients receiving treatment by the proposed method. Average duration , is ecivres by way of a prototype, and 11,50,94 days of the proposed method. Therefore, in the treatment by the proposed method increases the number of patients with complete cicatrization of the ulcer to 10 days of treatment while reducing treatment time.

Thus, the proposed method, involving the dosage of laser radiation based on the reserve capacity of the body for the duration of the session and the exposure dose increases the effectiveness of treatment YAB duodenum due to more rapid cicatrization of the ulcer in a larger number of patients.

An advantage of the invention compared to the prototype is to increase the effectiveness of treatment YAB.

The use of the invention is to reduce the duration of temporary disability, improve the quality of rehabilitation.

The method of treatment of peptic ulcer of the duodenum, including transcutaneous influence of low-intensity infrared laser radiation of gallium arsenide nature on the projection area of the ulcer on the anterior abdominal wall, characterized in that in patients with protein-energy malnutrition the first-second degree, and old ipecac syndrome - irradiated with a frequency of 80 Hz so that the exposure dose by irradiation with each frequency was 0.1 MJ/cm2and in patients with protein-energy malnutrition third degree pain syndrome this zone is irradiated with a frequency of 150 Hz, then the frequency of 1500 Hz during the session, in the absence of pain syndrome is irradiated with a frequency of 80 Hz so that the exposure dose by irradiation with each frequency was 0.01 MJ/cm2while the exposure time of each frequency calculated by the formula

where D is the exposure dose, j/cm;

P - average pulse power of the beam, W;

- pulse duration, s;

f is the pulse frequency, Hz;

t is the exposure time, s;

S - area of exposure, cm2.

 

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FIELD: medicine.

SUBSTANCE: method involves introducing 0.1-0.3 ml of photosensitizing gel preliminarily activated with laser radiation, after having removed neovascular membrane. The photosensitizing gel is based on a viscoelastic of hyaluronic acid containing khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-2% by mass. The photosensitizing gel is in vitro activated with laser radiation having wavelength of 661-666 nm during 3-10 min with total radiation dose being equal to 100-600 J/cm2. The gel is introduced immediately after being activated. To compress the retina, vitreous cavity is filled with perfluororganic compound or air to be further substituted with silicon oil. The operation is ended with placing sutures on sclerotomy and conjunctiva areas. Compounds like chealon, viscoate or hyatulon are used as viscoelastic based on hyaluronic acid. Perfluormetylcyclohexylperidin, perfluortributylamine or perfluorpolyester or like are used as the perfluororganic compound for filling vitreous cavity.

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FIELD: medicine.

SUBSTANCE: method involves making incision in conjunctiva and Tenon's capsule of 3-4 mm in size in choroid hemangioma projection to sclera 3-4 mm far from limb. Tunnel is built between sclera and Tenon's capsule to extrasclerally introduce flexible polymer magnetolaser implant through the tunnel to the place, the choroid hemangioma is localized, after performing transscleral diaphanoscopic adjustment of choroid hemangioma localization and size, under visual control using guidance beam. The implant has permanent ring-shaped magnet in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The permanent implant magnet is axially magnetized and produces permanent magnetic field of 2-3 mTesla units intensity. It is arranged with its north pole turned towards the choroid hemangioma so that extrascleral implant laser radiator disposition. The other end of the implant is sutured to sclera 5-6 mm far from the limb with two interrupted sutures through prefabricated openings. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. 0.1-1% khlorin solution is injected in intravenous bolus dose of 0.8-1.1 mg/kg as photosensitizer and visual control of choroid hemangioma cells fluorescence and fluorescent diagnosis methods are applied. After saturating choroid hemangioma with the photosensitizer to maximum level, transscleral choroid hemangioma laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm with total radiation dose being equal to 30-120 J/cm2. The flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, samarium-iron-nitrogen or neodymium-iron-boron system material. The photosensitizer is repeatedly intravenously introduced at the same dose in 2-3 days after the first laser radiation treatment. Visual intraocular neoplasm cells fluorescence control is carried out using fluorescent diagnosis techniques. Maximum level of saturation with the photosensitizer being achieved in the intraocular neoplasm, repeated laser irradiation of the choroid hemangioma is carried out with radiation dose of 30-60 J/cm2.

EFFECT: enhanced effectiveness of treatment.

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SUBSTANCE: method involves creating tunnel between sclera and Tenon's capsule in intraocular neoplasm projection. Intraocular neoplasm localization and size is adjusted by applying transscleral diaphanoscopic examination method. 0.1-0.3 ml of photosensitizing gel based on viscoelastic of hyaluronic acid, selected from group containing chealon, viscoate or hyatulon, is transsclerally introduced into intraocular neoplasm structure using special purpose needle in dosed manner. The photosensitizing gel contains khlorin, selected from group containing photolon, radachlorine or photoditazine in the amount of 0.1-1% by mass. Flexible polymer magnetolaser implant is extrasclerally introduced into the built tunnel in intraocular neoplasm projection zone under visual control using guidance beam. The implant has permanent ring-shaped magnet axially magnetized and producing permanent magnetic field of 3-4 mTesla units intensity, in the center of which a short focus scattering lens of laser radiator is fixed. The lens is connected to light guide in soft flexible envelope. The implant is arranged with its north pole turned towards the intraocular neoplasm so that implant laser radiator lens is extrasclerally arranged in intraocular neoplasm projection zone. The implant light guide is sutured to sclera 5-6 mm far from the limb with single interrupted suture. The implant is covered with conjunctiva and relaxation sutures are placed over it. Light guide outlet is attached to temple using any known method. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transscleral intraocular neoplasm laser radiation treatment is carried out via laser light guide and implant lens using divergent laser radiation at wavelength of 661-666 nm. The treatment course being over, the flexible polymer magnetolaser implant is removed and sutures are placed on conjunctiva. Permanent magnet of the flexible polymer magnetolaser implant is manufactured from samarium-cobalt, neodymium-iron-boron or samarium-iron-nitrogen. 0.1-1% khlorin solution as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is additionally intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg and repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2 15-20 min later during 30-90 s.

EFFECT: complete destruction of neoplasm; excluded its further growth.

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SUBSTANCE: method involves applying transscleral diaphanoscopic examination method for adjusting intraocular neoplasm localization and size. Rectangular scleral pocket is built 2/3 times as large as sclera thickness which base is turned from the limb. Several electrodes manufactured from a metal of platinum group are introduced into intraocular neoplasm structure via the built scleral pocket. Next to it, intraocular neoplasm electrochemical destruction is carried out in changing electrodes polarity with current intensity of 100 mA during 1-10 min, and the electrodes are removed. Superficial scleral flap is returned to its place and fixed with interrupted sutures. 0.1-2% aqueous solution of khlorin as photosensitizer, selected from group containing photolon, radachlorine or photoditazine, is intravenously introduced at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, transpupillary laser radiation of 661-666 nm large wavelength is applied at a dose of 30-120 J/cm2. the operation is ended with placing sutures on conjunctiva. Platinum, iridium or rhodium are used as the metals of platinum group. The number of electrodes is equal to 4-8. 0.1-1% khlorin solution, selected from group containing photolon, radachlorine or photoditazine, is additionally repeatedly intravenously introduced in 2-3 days at a dose of 0.8-1.1 mg/kg. Visual control of intraocular neoplasm cells is carried out by applying fluorescence and fluorescent diagnosis methods. After saturating the intraocular neoplasm with the photosensitizer to maximum saturation level, repeated laser irradiation of the intraocular neoplasm is carried out with radiation dose of 30-45 J/cm2.

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SUBSTANCE: the present innovation deals with treating vascular cutaneous neoplasms, such as nevus flammeus and gemangiomas. Light-thermal impact at energy ranged 39-47 J/sq. cm should be performed in two stages, and between them, 2-3 wk after the onset of vascular resistance at the first stage one should perform beta-therapy daily for 2-3 d at single dosage being 20 g. Then, 3 wk later it is necessary to conduct the second stage of light-thermal impact by starting at energy value being 42 J/sq. cm, not less. The method enables to shorten therapy terms due to applying combined method to affect vascular cutaneous neoplasms.

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1 ex

FIELD: medicine.

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FIELD: medicine.

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6 cl, 12 dwg

FIELD: medicine, applicable for stopping of pains of various nature.

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EFFECT: quick and absolute anestesia.

2 ex, 1 dwg

FIELD: medicine.

SUBSTANCE: method involves administering laser radiation therapy once a day using low intensity pulsating radiation of wavelength equal to 890nmand power density of 0.03 mW/cm2. Injured organ projection to frontal abdominal wall is exposed to radiation at the first laser therapy stage in two fields acting upon each field for 2 min with radiation pulse succession frequency equal to 80 Hz in applying stable contact-type method. Total treatment dose on two fields is equal to 0.008 J/cm2. The second laser therapy stage begins immediately after having finished the first one in applying radiation along the large intestine path using labile contact-type method in a way that radiation pulse succession frequency equal to 80 Hz is applied first during 1 min and then frequencies of 600, 150 and 300 Hz are applied also during 1 min, respectively. Total treatment dose is equal to 0.032 J/cm2 at the second stage. Total treatment dose is equal to 0.04 J/cm2 at both stages.

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