Method for correcting immunological disorders in patients with aftereffects of cranio-cervical trauma

The invention relates to medicine, in particular to neuropathology, namely the treatment of cranio-cervical trauma, and can be used in the health clinics.

Currently, the problem of injuries is one of the most important in medicine, and damage to the skull and brain are more than one-third of all injuries, but at the same time, occupy the first place among the causes of death of victims and their disability (Aspropotamos, 1986; Lubriderm et al., 1993; You et al., 1994; Untain et al., 1996).

The absolute majority of patients after brain injury, in the first months formed the different consequences in different clinical variants observed in 70% of victims (Aspropotamos, 1991; Antonopoulou et al., 1994; Assetsof, 1994), which is explained by the frequency of lesions of the hypothalamic-stem parts of the brain, the reticular formation of the cortical-subcortical interactions, i.e. those anatomical structures that form the multilevel system of the relationship of the organism with the external environment - adaptation-regulatory system. Accordingly, patients have been violations of the functional state of the brain and the interaction between the neuroendocrine and immune systems (V.V. Abramov, 1988), develops the syndrome of posttraumatic dysregulation that leads to d is Lenasia progression of disease (NR. Aivazov, 1999), due to transformation of neuroendocrine regulation and disorders of the Central regulation of immunogenesis (A.P. Romodanov et al., 1991; Say et al., 1997).

The closest to the technical nature of the claimed method is a method of treatment of the late effects of cranio-cervical trauma method of use of naso-oral venopuncture (a positive decision on granting of the patent “METHOD of TREATMENT of PATIENTS WITH CONSEQUENCES of CRANIO-CERVICAL TRAUMA (naso-oral venopuncture) Authors: L.A., Charuvastra, NR. Aivazov, A.A. Barashkova, NN. Waders on October 21, 2002, No. 2001110254).

This method requires the effects of ultrasound on the naso-oral region in impulse (1:10) mode via the contact medium: jelly, gel, labile, the intensity of 0.05-0.1 W/cm²for 6-8 minutes On a course of 10-12 treatments.

Irritation ultrasound points in the naso-oral region is accompanied by the activation of a significantly larger number of neural elements than irritation points of the body, as in reflex relationships involved more differentiated and numerous neural structure of the higher functions of the Central nervous system. Is an indirect effect on the autonomic nuclei of the brain stem, hypothalamus, optic tubercle, the reticular formation of the mid-brain, other education lim is practical complex. Thus, this method of treatment is pathogenic, leading to the normalization of body systems in General.

At the same time, the method has several limitations. So when brain injury often occur disturbances in the immune system of the body, accompanied by the development neuroautonomic reactions that are involved in the pathophysiological processes in the brain in early and late phase of injury. Found that patients with brain injury develops neurogenic secondary immunodeficiency, which is formed with the participation of violations of regulatory and effector-immunity, and stored sensitization to neuronal and glial brain antigens (VA Rudenko et al., 1988; A.I. of Mintenko et al., 2000). The way the prototype does not have immunocorrective properties.

The method is as follows: the patient is in sitting position ultrasonic emitter set via the contact medium (vaseline gel) on the side surface of the nose (at the level of the inner corner of the eye) and a slow spiral motion emitter move the wing of the nose to the nasolabial crease, corner of the mouth and upper lip. Then the same conduct on the opposite side. The exposure time for one field is¹/₂from the time of the whole procedure. Thus, in 1 box, the exposure time is 3-4 minutes. Por the procedures carried out daily, in the course of 10-12.

USED in the IMPACT ZONE

The outer lateral surface of the nose (at the level of inner corner of eye), the wings of the nose, nasolabial fold, the area above the upper lip. Zone symmetrical.

The technical result of the proposed method of treatment of patients with immunological disorders is the normalization of immunological parameters, and consequently, increases the effectiveness of treatment in these patients.

This technical result is achieved by the fact that in the beginning the patient takes little or moderately mineralized mineral water in the amount of 200-300 ml, then 30-40 followed by Breakfast, after which 2 hours is the impact of ultrasound on the naso-oral region in impulse (1:10) mode via the contact medium: jelly, gel, labile, the intensity of 0.05-0.1 W/cm²for 6-8 minutes, and 4 hours after it is water radon baths concentration of 1.5 kBq/l, temperature 37°With, exposure of 10-15 minutes At a rate of 8-10 cycles.

The method is illustrated by the following examples:

Patient L., 48 years old, medical history, No. 456, was treated in the neurology Department of GNIIT with 16.08.2002 on 08.09.2002,

Upon receipt complained of headaches, mostly the right half of the head, the compressive nature, worse when the weather changes, per the fatigue, stressful situations; system dizziness, buzzing, ringing, flashing “flies” before the eyes, fatigue, irritability, memory loss, pain in the cervical spine, feeling the crunch in the same Department, numbness of the fingers, stabbing pain in the heart area. From the anamnesis it is known that 3 years ago was the injury - hit his head on the bar. Loss of consciousness was not. There were headache, nausea. The treatment was carried out at the dispensary with a neurologist is not. Before the injury above complaints are not disturbed. Objectively in somatic status without pathology. In the neurological examination: clear consciousness, emotionally labile, tearful, intellectually saved. Cranial nerves intact. Muscle strength is good, tendon and periosteal reflexes evenly quickened, without convincing differences of the parties. Pathological signs. In the Romberg - resistant. Tremor of the eyelids, fingers outstretched hands. Coordinatorsee sample performs satisfactorily. On the REG - reduced blood, arterial hypotension, difficulty of venous outflow. On EEG paroxysmal activity: sporadic irregular waves, the focus of pathological activity in the midbrain. When carrying out functional tests - signs of moderate dysfunction of median structures. Echo-encephalography: the data for the presence of stable signs of hypertensive-hydrocephalic character. On radiographs of the cervical spine in two projections with functional tests - osteochondrosis of the cervical spine. ECG without pathology. Ophthalmological status is normal. Final diagnosis: long-term consequences of cranio-cervical trauma syndromes: vegetative-vascular dystonia, astheno-neurotic. Osteochondrosis of the cervical spine syndrome cervicalgia.

After conducting a comprehensive treatment using the naso-oral venopuncture, receiving water radon baths and mineral water - a condition of the patient improved: reduced pain in the cervical spine, significantly decreased the frequency and intensity of headaches, stopped dizziness, improved overall health. Palpation of the spinous processes, paravertebral points painless. Repeated EEG and Echo-ES - without a pathology. On REG: improved blood circulation and vascular tone. In immunological status a statistically significant positive changes - the decline of the CEC in blood (from 28.6±1,88 to 21.4±1,99%; P<0,01). When this was determined a distinct tendency to normalization of phagocytosis - FAL and PHIL and phenotypic parameters (E-ROCK with 70,28±1,35 to 67,32±1,34; P<0,05) (see table 1).

Patient S., aged 40, case history No. 1041, was treated in the neurological Department of the hospital with 07.07.2002 on 30.07.2002,

Upon receipt complained of headaches in the frontal area, system dizziness, poor sleep, irritability, fatigue, weakness, memory loss, fluctuations of blood pressure. From the anamnesis it is known that in 1997 he got in the car accident. Was a short-term loss of consciousness, then headache, nausea, vomiting. Was admitted to hospital with a diagnosis of concussion. Discharged with improvement. The neurologist observed irregularly, receives treatment in the outpatient setting. The above complaints appeared after trauma. Last year's General condition deteriorated somewhat: frequent headaches, pain in the cervical spine. In neurological status: the patient is emotionally labile, focused answers the questions correctly. Cranial nerves: nystagmoid movement when looking to the right, weakened the act of convergence. Tendon and periosteal of refl is XY evenly quickened. Disorders of sensitivity is not revealed. In the Romberg - tingling, in the complicated unstable. Limited range of motion in the SHOP in all directions. On the REG - blood pressure is reduced, arterial and venous tone is increased. On EEG moderately expressed human diffuse nature. Signs of severe paroxysmal activity with a focus in the right fronto-temporal region. ECG within age norms. ECHO-ES - signs of hypertensive-hydrocephalic character. On radiographs SHRP in two projections with functional tests - osteochondrosis of the cervical spine. Final diagnosis: long-term consequences of cranio-cervical trauma syndrome encephalopathy. Osteochondrosis of the cervical spine, vertebral artery syndrome, syndrome cervicalgia. After treatment with the use of naso-oral puncture treatment 10 treatments, the patient's condition has improved: reduced headache intensity, but they did not fully stopped. Survived pain in the cervical spine, General fatigue. Statistically significant positive changes in immune status is not followed. On re-REG and EEG data of the previous one (see table 2).

The immune status in patients with long-term effects of combined cranio-cervical trauma

In the remote period of the cranio-cervical trauma (APCTT) of great interest is the study of changes of specific immunity and nonspecific resistance of the organism, because the immune response is an essential component of the consequences of cranio-cervical trauma (Ihemelu, 1984; Vigorous et al., 1996). For this purpose we studied 100 patients with APCTT and 22 healthy volunteers in the control. The objective of this stage of the research was the creation of “immunological image” patients with cranio-cervical trauma.

The first difference of the immune status of patients with APCTT, in comparison with healthy individuals was reflected in a significant activation of the receptor function of immunocompetent cells: increase the number of common E-rosette cells in circulation by 23% (57,1±1.7 to 70,4±0,61%; P<0.0001)and theophylline-resistant E-ROCK - 91% (37,0±1.5 to 70,7±0,61; P<0.0001)and active E-ROCK - by 142% (from 27.5±1.7 to 66,7±0,60%; P<0,0001), sockets mouse erythrocytes - 61% (from 13.5±1.5 to 21,8±0,66%; P<0,001). The second difference comprising what about the decrease in the content of immunoglobulin G in the serum of 13% (from 13.8± 0,64 to 12.1±0.39 g/l; P<0,0001). The third difference was friendly reducing phagocytosis indices: FAL - 33% (84,0±3,07 to 56.1±1,00%; P<0,001), PHIL - 68% (with 3.56±at 0.42 to 1.13±0,04%; P<0,001), NRF - 29% (55,7±3,95 to 39.7±0,82%; P<0,0001). The concentration of circulating immune complexes in the serum increased by 112% (from 13.8±2.13 to 29,2±1,21%, P<0,001).

“Immunological” portrait of a patient with APCTT looks very peculiar: activation of cell reception, some decrease in the level of immunoglobulin G, a defect of phagocytic function parameters and an excess of circulating immune complexes in the blood. Apparently, increased receptor function of immune cells is associated with increased cellular sensitization as a result of injury. These changes can be caused by disorders of the blood-brain barrier and the possible defeat of the structures responsible for the Central regulation of immunogenesis (table 3). Related to this is a violation of the processes of phagocytosis, which leads to impaired elimination of immune complexes from the circulation and the increase of their content in the blood. The decrease in the level of immunoglobulin G in blood can be compensated in response to the activation of cellular immunity, or to determine intensified their involvement in the composition of the CEC.

Table 3

Immunological parameters in patients with distant consequences of cranio-cervical traumaIndicatorsThe arithmetic mean and its error (M±m)P Healthy volunteersPatients (n=100) Leukocytes 10⁹/l (n=15)6,5±0,75,59±0,14>0,2E-Poco, % (n=10)57,1±1,770,36±0,61<0,0001E-Rock/R, % (n=10)37,0±1,570,74±0,61<0,0001E-Rock, % (n=10)27,5±1,766,74±0,60<0,0001E-Rocm, % (n=10)13,5±1,521,80±0,66<0,001IgG, g/l (n=22)13,8±0,6412,08±0,39<0,05IgA, g/l (n=22)2,07±0,12,20±0,10>0,3IgM, g/l (n=22)1,62±0,161,87±0,19>0,3FAL, % (n=9)84,0±3,0756,10±1,00<0,001PHIL, % (n=9)3,56±0,421,13±0,04 <0,001NRF, % (n=9)55,7±3,9539,68±0,82<0,001CEC, ed (n=11)13,8±2,1329,24±1,21<0,001Lysozyme, µg/ml (n=10)7,18±0,226,98±0,14>0,4

The treatment by the proposed method was conducted in 50 patients with the consequence of cranio-cervical trauma and 50 patients with the same pathology (control group) received treatment in the prototype method, i.e. were exposed to ultrasound in the naso-oral region in impulse (1:10) mode via the contact medium: jelly, gel, labile, the intensity of 0.05-0.1 W/cm²for 6-8 minutes On a course of 10-12 treatments (tables 4 and 5).

Analysis of the results of the treatment proposed and known methods revealed positive changes in patients in the remote period of the cranio-cervical trauma, but more significant it appeared that patients who Leche is the n proposed method (table 5).

The analysis of the dynamics of immunological parameters during the course of treatment of patients with OPSCC revealed the dependence of these dynamics applied from the healing complex. Thus, with the use of naso-oral puncture was significantly activated the exit of leukocytes in circulation (with a total of 5.21±0.18 to 5,78±0,24×10⁹/l; P=0.05). A slight decrease in the level of immunoglobulin M in the blood (from 1.80±0.11 to 1,52±0.12 g/l; P<0,01). Phagocytosis indices, the level of the CEC in blood and phenotypic parameters has not changed. Therefore, isolated, naso-oral therapy does not provide the desired immune correction (normalization of phagocytosis and CEC-emii).

Drinking mineral water, radon baths in combination with ultrasonic treatment on the naso-oral region was accompanied by a significant decrease in the level of the CEC in blood (from 28.6±1,88 to 21.4±1,99%; P<0,01). When this was determined distinct ones is a tendency toward normalization of indicators of phagocytosis - FAL and PHIL and phenotypic parameters (E-ROCK).

Thus, according to the degree of immunocorrective effect applied medical complex with mineral water and outdoor radon baths is more effective.

A method of treating patients with distant consequences of cranio-cervical trauma through exposure to ultrasound on naturalnew region, wherein the first patient takes mineral water in the amount of 200-300 ml, then 30-40 min followed by Breakfast, then after 2 h by ultrasonic impact within 6-8 min, 4 hours after it is receiving water radon baths concentration of 1.5 kBq/l, and these cycles are carried out after 1-2 days, a total of 8-10.