Method for treating patients for ureteral stones

FIELD: medicine.

SUBSTANCE: method involves prescribing drinking radon-containing mineral water distinguished by radon activity of 185-370 kBq/l in the amount of 100 ml 3 times a day. Then, radon baths are given where radon activity is of 0.75-2.25 kBq/l, temperature is 36-37°C, procedure duration is 10-15 min. Then, vacuum depression of 4-9 atm with succession frequency of 15-25 pulses per 1 min and alternating sinusoid current of 100-200 Hz, current intensity of 20-40 mA and duration of 12-15 min is applied to kidney region and injured ureter segment region in everyday mode with 10-12 procedures long treatment course.

EFFECT: increased stimulated action to functional renal pacemaker and neuromuscular apparatus; higher percent of stone excretion.

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The present invention relates to medicine, in particular to urology, and can be used in hospital, clinics and sanatoriums.

As you know, currently urolithiasis occurs in up to 3-5% of the population. The mechanism of formation of urinary stones in the urinary tract remains largely unknown. Therefore, in most cases, the implementation of causal therapy and prevention of recurrent stone formation remains ineffective. Approximately 50-70% of patients undergoing surgical treatment for stones in the kidneys and ureters, there is a re-formation of urinary stones (Schmiedt E., Chaussy Ch. Extracorporeal Shock-Wave Lithotripsy (ESWL) of kidney and ureteric stones // Int. Urol., Nephrol. - 1984. - V.16, No. 4. - R-283.

In recent years in the treatment of patients with urolithiasis widely used extracorporeal shock wave lithotripsy (ESWL). The most frequent complication is the formation of a "stone paths" from the debris of the destroyed stone and urinary sand at different levels of the upper urinary tract, with complete or partial obstruction them with subsequent development of acute pyelonephritis, renal failure, etc. of the Above complications for their favorable resolution often require endourological manipulation or surgical interventions is (Libby J.M., Meacham R.B., D.P. Griffith The rote of silicone ureteral stents in extracorporeal Shock Wave lithotripsy of large renal calculi // J.Urol. - 1988. - V.139, no. 1. - P.15-17). Therefore, the most important step after ESWL becomes the postoperative period, during which is necessary to achieve complete removal of fragments of stone from the urinary tract, parallel conducting preventive measures against possible infectious-inflammatory complications (acute pyelonephritis and others).

Currently, there are few works on the conservative removal of stone fragments after ESWL of the upper urinary tract. In particular, recommend local vibrotherapy (Lopatkin N.A., Bykovsky AA, Dmitriev became popular Stimulation liturata when urolithiasis // VIII the age of three. the Congress of urology: Abstracts. - M., 1988. - S-201), the ingestion of large quantities of liquid (up to 2.5-3 liters per day) (Chaussy Ch., Schmiedt e, Jocham D. Nonsurgical Treatment of Renal Calculi with Shock Waves Stones: clinical management of Uroiithiasis // Ed. by R.A.Roth, B.F.Finlayson. Baltimore-London. - 1983. - P.461-476), intravenous infusion of glucagon and levulose (N. Minkov, Shumleva V., Pironcov A. et al. A new method for the management of ureteral colic after extracorporeal shock wave lithotripsy // Int., Nephrol. - 1988. - V.20, No. 3. - P.251-255), drinking radon water and radon in water baths (Korova V.M. Healing properties of Khmilnyk for the treatment of patients with urological // Radon: Proceedings of scientific-practical use. proc. - Khmilnyk, 1966. - P.93-96; Whether AA and other treatment Method is Aulnay with ureteral stones. - RF patent №2183109 from 10.06.2002, bull.№16). However, the above methods of treatment provide a relatively low percentage removal of stone fragments from the upper urinary tract, In particular, 3 months after ESWL fragments of stones in the upper urinary tract were detected in 25-36% of patients (J. Rassweiler, Gumpinger R., Bub P. et al. Wolf piezolith 2200 versus the modified Dornier HM3. Efficacy and range of indications // Europ. Urol. - 1989. - V.16, No. 1. - P.1-6; Vallancien G., Defounnestraus N., Leo J. P. et al. Outpatient extracorporeat lithotripsy of kidney stones: 1200 treatments // Europ. Urol. - 1988. - V.15, No. 1-2. - P.1-4).

The closest (prototype) the technical nature of the present invention is a method of treatment of patients with ureteral stones by drinking radon water with a radon concentration of 185 kBq/l, 100 ml (of 18.5 kBq) 2-3 times per day after a meal followed by a reception, after the first drinking radon treatments, radon baths with a radon concentration of 1.5 kBq/l, a temperature of 37°s With a duration of 10-15 minutes in a complex impact on the region of the kidneys and the affected Department of the ureter sinusoidal modulated currents (SMC) II a native of work, frequency of 30 Hz, a modulation depth of 100%, pulse duration and pause 4-6, duration 14 min, treatment of 10-12 procedures (I. Karpukhin, Whether A.A., A.I. Gusarov and other Application of sinusoidal modulated currents and radon patients with stones in the upper urinary tract // Matters. a resort., seater. and exercise therapy. - 2003. No. 5. - Pp.33-34).

Using this method (prototype) concretions from the upper urinary tract departed in 22 (73.3 per cent) of the 30 patients ureterolithiasis after a single course of treatment (I. Karpukhin, Whether A.A., Gusarov, I. I. and others, ibid.).

The disadvantages of the prototype are:

a) weak stimulating effect of this complex on the functional renal pacemaker and neuromuscular apparatus of the smooth muscles of the upper urinary tract with subsequent low contractile function;

b) a relatively low rate of discharge of the stones of the upper urinary tract (73,3%).

The technical result of the proposed method of treatment is a highly effective treatment and reducing treatment time.

This technical result is achieved by the fact that patients with ureteral stones carry drinking radon water with a radon concentration 185-370 kBq/l 100 ml 2-3 times a day after meal followed by a reception, after the first drinking radon procedure, first radon baths with a radon concentration of 0.75 to 2.25 kBq/l, temperature of 36-37°s With a duration of 10-15 minutes and then simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression 4-9 ATM with a repetition rate of 15-25 pulse/min and alternating sinusoidal current of frequency 100-200 G is, the current intensity of 20-40 mA, duration of the procedure 12-15 min, treatment of 10-12 procedures, daily.

The advantages of the proposed method of treatment is the observance of the normal hydration (fluid intake to 1.5-2 liters per day), high efficiency of treatment and reducing treatment time.

In the proposed method of treatment were used drinking radon water, radon in water baths (I. Karpukhin, Whether A.A., Kiyatkin, VA, A.I. Gusarov, Dubovsky AV Radon patients with chronic pyelonephritis: a Manual for physicians. - M., 2004. - 12 S. Approved by the RF Ministry of health), as well as simultaneous impact on the region of the kidneys and the affected Department of the ureter (the level of localization of ureteral stones in it) pulsed vacuum depression and low frequency alternating sinusoidal current (using a combine harvester, comprising a device for vacuum massage with rational electrodes for stimulation "Neocell 824" Siemens AG, Germany // GOS. the register of medical products health Ministry (additional No. 1-2). - M., 1999. - s - Reg. No. 96/428) and apparatus physiotherapy low-frequency electric pulse "Neuroton 827" Siemens AG, Germany // GOS. the register of medical products health Ministry (additional No. 1-2). - M., 1999. - P.185. - Reg. No. 96/424).

Radon (Rn222) is an inert gas resulting from the decay of radium (Ra26 ). Radon is soluble in vegetable oils, worse in biological environments, even worse in the water. Half-life (T1/2) radon is 3,823 days. During the decay of radon sequentially formed a short-lived subsidiary products: RaA (T1/2was 3.05 min), RaB (T1/2and 26.8 min), RaC (T1/2is 19.7 min) and RaC (T1/2- 1,63·10-4min). The number formed by the further decay of radon isotopes At218Rn218and RaC (TI210) is negligible and practical does not matter (A.I. Gusarov Radon - M., 1974).

When applying radon procedures major therapeutic effect of alpha-irradiation of the body, formed by the decay of radon and its short-lived daughter products (RaA-RaC). The share generated alpha particles account for more than 90% of all energy radiation of these isotopes.

1. Receiving artificially prepared drinking radon water with a radon concentration 185-370 kBq/l, 100 ml (18,5-37 kBq) 2-3 times a day 20-30 minutes after eating, the temperature of 20-22°With, has a direct effect (due to alpha radiation from radon and its daughter products) on the adrenal glands, the kidneys and the urinary tract, increases diuresis, reduce spasms of smooth muscle, edema, inflammation in the upper urinary tract and stimulates the frequency and intensity of reflex impulses that originate in the pelvis-ochlockonee zone (renal pacemaker) and propagating along the smooth muscle of the ureter, increasing contractility his smooth muscles, increasing peristalsis and accelerating the discharge of the stone from him. In a single course offered by way of treatment doses so-called "critical organs (stomach and kidneys) are respectively 7-15 mSv and do not go beyond the permissible limits, components respectively 41,7-100 mSv/year (Guidance on radon in the military sanatorium. Clinical radon / Under. edit Imeja, ISA. - M., 1994. - part 2. - P.17, table 3).

Drinking radon water with a radon concentration of less than 37 kBq per day has a slight stimulating the smooth muscles of the ureter action, and drinking radon water with a radon concentration of more than 110 BCF per day of undesirable due to the possibility of its inhibitory effect on peristalsis of the ureter that would prevent the timely discharge of the stone from him. It is known that high concentrations of radon radon in drinking water inhibits the motor function of the smooth muscles of internal organs (Leites FL, Ruser PS Morphological and dosimetric studies with the introduction of the gastrointestinal tract radon water in the experiment // the. a resort., fizioter., LFC. - 1961. No. 1. - S-15).

When drinking radon water part of radon and its daughter products from the stomach is diffused into surrounding organs (with linic, spleen, adrenal glands, kidneys, liver, pancreas), and the other part is absorbed into the blood. In the contents of the stomach and its wall is formed depot radon, from which it gradually enters the blood and is excreted mostly via the lungs, to a lesser extent through the kidneys, and about 1% through the skin. Therefore, drinking radon water 20-30 minutes after eating significantly slows down the removal of radon from the body through the lungs and kidneys. The full decay of radon and its daughter products in the body is almost within 3-4 hours after its oral administration. Before this time after ingestion of radon water by direct laboratory study of various portions of urine, selected patients with ureteral stones, daughter decay products of radon are usually elicited in her.

Drinking radon water has anti-inflammatory, diuretic, stimulating the smooth muscles of internal organs, desensitizing, sedative and analgesic action (A.I. Gusarov Radon. - M., 1974). Potable use of radon water also increases renal blood flow (Yasnohorodska VG, Olefirenko V.T., Whether A.A. and other physical factors in the treatment of patients with chronic nonspecific pyelonephritis and cystitis (adults and children): Method. recommendations. - is., 1984) and appears to be a related increase in the daily urine output in patients with calculous pyelonephritis. In addition, it helps increase the activity of redox enzymes in tissues (succinate, malate, glucose-6-phosphate and lactate dehydrogenase). After taking a course of radon water, there is also a long delay it (up to 30 days), contributing to further reduction of the inflammatory process in the upper urinary tract and reduce the swelling of their mucous membrane, which accelerates the discharge of the concretions.

2. Radon water bath with a radon concentration of 0.75 to 2.25 kBq/l have a more active action on the contractile function of the upper urinary tract compared with other concentrations. The influence of radon baths with a radon concentration of less than 0.75 BCF/l is manifested in poorly pronounced stimulating effect on smooth muscles of the ureter, and the activity of radon more than 2.25 kBq/l may cause negative reactions on the part of organs of the urinary system, including the reduction of contractile function of muscles of the ureter, the decrease in daily urine output and other

Radon water bath at a temperature of 36-37°With a positive effect on patients with increased excitability of the nervous and cardiovascular systems, reducing spasm of smooth muscles of the upper macavinta is their ways.

Radon water bath with a temperature of less than 36°With unwanted urolithiasis, as the latter increase muscle spasm of the ureter, improve its tone, disrupt the activities of the Central thermoregulatory mechanisms. Radon baths with temperatures above 37°also undesirable due to the high diffusion of radon from the water bath into the air.

The optimal condition for exposure to radon baths in the above parameters is the duration of the procedure for 10-15 min and treatment - 12-15 procedures (A.I. Gusarov Radon. - M., 1974).

Radon water baths have a marked vasoconstrictor effect on the capillaries of the skin, which leads to reflex vasodilatation of the internal organs. Formed in the tissues under the action of radiation of radon and its daughter products, free radicals and other biologically active substances, such as DOPA, dopamine and other), acting on skin receptors and affecting mediated reflex-humoral through the centers of the neuroendocrine regulation of the adrenal glands, kidneys and ureters, reduce spasms of smooth muscles, swelling and inflammation in the upper urinary tract and stimulate the frequency and intensity of reflex impulses that originate in the pelvis-ureter zone (renal pacemaker) and propagating along the ureter is, increasing its peristalsis and speeding up the passage of ureteral stones.

When receiving a radon water bath with a radon concentration of 0.75 BCF/l, with a duration of 20 min, a temperature of 36-37°radon enters the body mainly through the skin, but not more than 0.5% of its content in the bath. When receiving radon baths subsidiary products, settling on the skin to form on her so-called "active plaque". At the exit of the patient from the water active plaque is held firmly on the skin and is not removed even after wiping with a towel, and then for 2-3-4 hours completely falling apart. After the procedure is quite intensive removal of radon from the body through the lungs (about 60%) and skin (about 40%) for 3-4 hours. With urine after ingestion of radon baths allocated about 0.25% of the penetrated the body of radon. Formed in the body of radon progeny also completely disintegrate within a specified time.

Under the action of radon water baths is the mobilization of uric acid from the tissues into the blood, followed by active excretion her urine (Mezernitsky p. g the Use of radium emanation in uric acid diathesis // Russian doctor. - 1910. No. 51. - P.12-18).

Radon water baths have a desensitizing, anti-inflammatory, sedative, analgesic and stimulant socratically the ability of smooth muscles of the upper urinary tract action.

When using the proposed method for the treatment of alpha particles of radon and its daughter products has a complex effect on the patient's body with a stone in the ureter as indirectly, reflex-humoral through the centers of the neuroendocrine regulation of the adrenal glands, kidneys, and ureters (the radon baths)and directly (by drinking radon water) on the tissues of these organs, improving the overall diuresis, reduce spasms of smooth muscle, edema, inflammation in the upper urinary tract and stimulating frequency and intensity of reflex impulses that originate in the pelvis-ureter zone (functional renal pacemaker) and propagating along the ureter, increases its motility and accelerates the removal of calculus from it.

When applying radon water baths are of primary importance reflex-humoral path stimulation of the sympathoadrenal system from receptors in the skin. When drinking radon procedures more significant role is played by the direct influence of alpha radiation from radon and its daughter products, circulating blood, and to a lesser extent - reflex-humoral path. It is known that drinking radon procedures adrenal glands are exposed to ionizing radiation alpha radiation is 20 times greater than with radon baths.

therapeutic effect of radon is o water treatment influence on the organism of low doses of ionizing radiation, virtually no presenting somatic and genetic risk (S.V. Andreev TO risk assessment of radon // Matters. kurortol., fizioter., LFC. - 1993. No. 3. - P.29-34; Gusarov I.I. Radon. - M.: Medicine, 2000; Henry H.F. Is all nuclear radiations harmeul // Health Phys. - 1982. - V.43. - P.767-789; Hanson G.P., E. Komarov Health effects in residents of high background radiation regions//Biological effects in low-level radiation. - Vienna: IAEA, 1983. - P.211-231), but play an important role in enhancing the immunoreactivity of the body, the elimination of the inflammatory process in the upper urinary tract, relieve spasm of smooth muscles, increased peristalsis of the ureter and other

3. Simultaneous impact on the region of the kidneys and the affected Department of the ureter (the level of localization of ureteral stones in it) pulsed vacuum depression (vacuum) less than 4 bar, with a repetition rate of less than 15 pulses/min (pulses in minutes) and alternating sinusoidal current of frequency less than 100 Hz, the intensity of the current less than 20 mA, a duration of less than 12 min, leads to insufficient stimulation of the contractile function of the upper urinary tract in urinary stones. And the combined effect of pulsed vacuum depression over 9 ATM with a repetition rate of more than 25 pulses/min and alternating sinusoidal current of a frequency greater than 200 Hz, the current intensity of more than 40 mA, a duration of more than 15 min reduces motor activity p is expressed in the ureter and, therefore, inhibition of removing stone from him.

Therefore, the optimal condition for removing concretions or their fragments from the upper urinary tract is a simultaneous impact on the region of the kidneys and the affected Department of the ureter (the level of localization of ureteral stones in it) pulsed vacuum depression (vacuum) 4-9 ATM with a repetition rate of 15-25 pulse/min and alternating sinusoidal current of frequency of 100-200 Hz, the current intensity of 20-40 mA, a duration of 12-15 min, daily, for the treatment of 10-12 procedures. Thus the simultaneous effects of these physical factors (in the background drinking radon water and radon water bath) to set forth to the electrodes areas of skin with subcutaneous tissue and skeletal muscle contributes not only directly, but also reflex stimulation (through zone Zakharyin - Ged) contractile function of smooth muscles of the kidney and upper urinary tract and expedited removal of concrements of them.

DESCRIPTION of METHOD of TREATMENT

1. Patients with ureteral stones carry drinking radon water with a radon concentration 185-370 kBq/l 100 ml 2-3 times a day after meal followed by a reception, after the first drinking radon procedure, first radon baths with a radon concentration of 0.75 to 2.25 kBq/l, temperature of 36-37°With, a long is inetu 10-15 min and then simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression 4-9 ATM with a repetition rate of 15-25 pulse/min and alternating sinusoidal current of frequency 100-200 Hz, the current intensity of 20-40 mA, a duration of 12-15 min, daily, for the treatment of 10-12 procedures.

When half the drinking of radon water, in addition to the morning, the patient repeats drinking radon water after dinner, and at three times the acceptance - drinking radon water also repeat after lunch and dinner.

10-30 min after administration of the first portion of the radon water the patient takes radon baths, and 10-15 min after the bath conduct simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression and alternating sinusoidal current.

The proposed method for the treatment of patients with stones in the ureter is in compliance background normal drinking behavior during the day.

EXAMPLES of the METHOD

Example 1. Patient I., 56 years of age, with a diagnosis of stone lower third of the right ureter, chronic pyelonephritis, oxaluria. When receiving the complaints of pain in the right iliac region. Objective: the abdomen is soft, painless on palpation. The kidney is enlarged, the symptom of Pasternacki to the right is positive. When finger vaginal examination shows tenderness in the lower point of the Tour on the right. On the overview and the excretory programma - the shadow stone size 7×5 mm at the level of the lower third of the right ureter. Right - modest growth CLS kidney and mochet is cnica to the level of calculus. Left - CLS kidney and the ureter is not changed, the passage of contrast through the ureter is not broken.

Blood biochemistry: urea - 4,2 ml, creatinine - 0,05 ml, uric acid - 0,38 ml, phosphorus - 1,0 ml, calcium - 3,7 ml, ALT - 6, ACT - 12, LDH - 141.

Urine analysis: reaction of acid, leucocytes - 25-35 in the p/SP., erythrocytes - 7-10 p/SP. Urine calcium - 12 mm/s, oxalates - 680 μm/s In the urine culture: revealed epidermal staphylococci 4×104CFU/ml

Patient 9 h 30 min lunch and then after 20 min (9 h 50 min) take 100 ml of 18.5 kBq) drinking radon water temperature 20-22°C. In 10 hours, the patient takes the first radon water bath with a concentration of 0.75 BCF/l, temperature 36°duration 10 minutes, then after 10-15 minutes after a bath for carrying out physiotherapy one of the two rounded metal electrodes with a diameter of 4 cm (harvester, comprising two devices "Neocell 824 and Neuroton 827")fixed to the inner surface of the rubber cups with a diameter of 6 cm, moistened with warm tap water fabric strips of the appropriate size is placed in the right lumbar region (the projection area of the right kidney), and the other electrode is on the right iliac region (the area of projection of the level of localization of ureteral stones in the lower part of the right ureter) with subsequent fixation of the vacuum depression. Then p is avodat simultaneous impulse vacuum depression 4 ATM with a repetition rate of 15 pulses/min and alternating sinusoidal current of a frequency of 100 Hz, the current intensity of 20 mA, a duration of 12 min, daily.

Patient 20 h 20 min (20 min after the meal) takes 2 times 100 ml of 18.5 kBq) drinking radon water.

The proposed method of treatment was carried out for 6 days (see table 1). After 6 treatments drinking radon in water, radon baths, and concurrent exposure to a pulse depression and alternating sinusoidal current went calculus without attack of renal colic. In addition antimicrobial and antispasmodic drugs the patient was not taken in the course of treatment.

After treatment - pain in the right iliac region disappeared. Objective: the abdomen is soft, painless on palpation. The kidney is enlarged, the symptom of Pasternack negative on both sides, pain in the lower point of the Tour is missing.

Control review programme - shadows of ureteral stones along the right ureter not.

Blood biochemistry after treatment: urea 2,5 ml, creatinine - 0,05 ml, uric acid is 0.15 ml, calcium - 3,0 ml, phosphorus - 1,0 ml, ALT - 6,0, ACT - 12, LDH - 140, C-reactive protein was negative. Urine analysis: reaction of acid, specific gravity 1010, leukocytes - 3-5 p/SP., erythrocytes - 0-1 in the p/SP. In urine - calcium - 8,6 mm/s, oxalates 250 µm/s In the urine culture: selected epidermal staphylococci in quantity - 2×102CFU/ml

Primer. Patient C., 55 years of age, with a diagnosis of stone middle third of the left ureter, chronic pyelonephritis, benign hyperplasia (adenoma) of the prostate I-II century

When entering the patient complaints of pain in the left lumbar region. Objective: the abdomen is soft, painless on palpation. The kidney is enlarged, the symptom of Pasternack positive on the left. Pain in the upper and middle points of the Tour. When finger rectal examination both lobes of the prostate elastic consistency, painless, enlarged. Magdalena groove smooth. Paraphrastically cellulose is not infiltrated.

On the overview and the excretory programma - the shadow stone, size 7×4 mm, at the level of the third lumbar vertebra in the left ureter. Left - modest growth CLS kidney and the left ureter to s/h, up to the level of localization of ureteral stones in it.

When ultrasound of the bladder shadow prostate size 5×4×3.8 cm juts out into the cavity of the bladder, pathological seal is not revealed. After emptying to 40 ml of residual urine in the bladder.

Blood biochemistry: urea - 5,33 ml, creatinine - 0,08 ml, uric acid - 0,46 ml, phosphorus - 0,8 ml, calcium - 3,6 ml, ALT - 11, ACT - 10, LDH - 170, C-reactive protein - 2+. Urine analysis: reaction of acid, specific gravity 1010, leukocytes - 20-30 p/SP., erythrocytes and 12-15 in the/SP. In urine - calcium -12,3 mm/s, oxalates - 540 µm/s and salt urates. In urine cultures: selected gram-negative cocci in quantity of 104CFU/ml

9 h 30 min patient has Breakfast and then after 30 min (10 h) the patient receives 100 ml (37 kBq) of drinking radon water temperature 20-22°C.

At 10 h 30 min patient takes first radon water bath with a radon concentration of 2.25 kBq/l, a temperature of 37°duration 15 min, and then after 15 minutes (11 hours) after the bath, spend a combined effect on the area of the left kidney and the middle division of the left ureter (harvester, comprising two devices "Neocell-824 and Neuroton-827" (Siemens, Germany). One of the two rounded metal electrodes, with a diameter of 4 cm, attached to the inner surface of the rubber suction cups, diameter 6 cm, with a damp cloth strips, place a skin in the left lumbar region (the area of projection of the left kidney), and the other on the left hypochondrium (the projection area of localization of the concrement in the middle third of the left ureter), with subsequent fixation of the electrodes with the help of vacuum. This is followed by a simultaneous impulse vacuum depression (vacuum) 9 ATM, with a repetition rate of 25 pulses/min and alternating sinusoidal current of frequency 200 Hz, the current intensity of 40 mA, a duration of 15 min, daily.

the day the patient takes drinking radon water, in addition to her morning portion of 100 ml (37 kBq), the temperature of 20-22°13 h 00 min (30 min after lunch) and 20 h 30 min (30 min after dinner).

The proposed method of treatment was performed to the patient for 11 days (see table 2). On the 11th day went calculus without attack of renal colic. The patient was not assigned additional antibacterial and anti-inflammatory drugs in the treatment process.

After treatment - no complaints. The abdomen is soft, painless on palpation. The kidney is enlarged, the symptom of Pasternack negative on both sides, pain in the upper and middle points of the Tour is missing. On the overview control programme shadows of concrements in the course of the left ureter was not detected.

With repeated finger rectal examination and ultrasound of the bladder - signs of further increase in prostate cancer was not detected. Residual urine in the bladder - 30 ml

Table 2
The treatment algorithm patient C., 55 years old, with stone middle third of the left ureter, chronic pyelonephritis, benign hyperplasia (adenoma) of the prostate, the I-II century
12345679101112131415
NamemonWcfThuFrisatsumonWcfThuFrisatsumon
procedures
Drinking radon+++++--+++++--+
water 100 ml (31 kBq)×3 times a day
The radon +++++--+++++--+
baths (2,25 kBq/l)
Simultaneous+++++--+++++--+
impact on the region of the left kidney and the middle third of the left ureter pulsed vacuum depression (vacuum) 9 ATM, with a repetition rate of 25 pulses/min and alternating sinusoidal current of frequency 200 Hz, the current intensity of 40 mA with duration of 15 min
Note: "+" - day admission procedures " - " - a day of rest from treatment.

Blood biochemistry: urea - 3,60 ml, creatinine - 0,09 ml, uric acid and 0.28 ml, phosphorus - 0,8 ml, calcium - 3,00 ml, ALT - 6, ACT - 9, lactate dehydrogenase - 122, C - reactive protein was negative. Urine analysis: reaction sour, share - 1016, leukocytes - 5-7 p/SP., erythrocytes - 2-3 p/SP. In urine - calcium - 8.2 mm/s, oxalates 250 µm/s In the urine culture: no growth of microorganisms.

The proposed method for the treatment of patients with ureteral stones tested in the Department of urology of the Russian scientific center for restorative medicine and balneology health Ministry. The study included 60 patients with ureteral stones or fragments in the different departments of the ureter. Of these, 40 were found concretions and 20 - stone fragments after suffering a shock wave lithotripsy (ESWL) in the different departments of the ureter. From accompanying diseases - benign hyperplasia (adenoma) of the prostate stage I-II was observed in 5 out of 60 patients.

At admission, the patients complained of pain in the lumbar region, podrebarac and iliac regions. After removal of stones from the urinary tract these symptoms in patients was not recorded.

After applying the proposed method of treatment was observed following main objective evidence: the good symptom of Pasternack - 3 of 30, tenderness in the upper point of the Tour - in 3 out of 30, at the midpoint is 4 out of 45, at the lowest point in 5 out of 50, high erythrocyturia - 2 of 45 and increased leukocyturia - 4 of 52 patients.

By the end of treatment there was a decrease pyuria (20±0,4)·103up to (6±0,5)·103and erythrocyturia with (8±0,5)·103up to (4±0,5)·103samples on Nechiporenko. There was also a decrease in the number of microorganisms (Escherichia coli, pathogenic epidermal staphylococci and gram-positive pathogenic cocci) in 1 ml of urine (20±0,4)·104up to (4±0,8)·102SOME, according to bacteriological tests midstream urine, after applying the proposed method of treatment. Reduction pyuria, erythrocyturia and bacteriuria after complex treatment indicates the reduction of the inflammatory process in the upper urinary tract.

Blood biochemical parameters are shown in table 3.

According to table 3, in the blood of patients after the application of the proposed method of treatment show increased levels of T-lymphocytes and a decrease in C-reactive protein, b-lymphocytes, immunoglobulin a, which indicates that the regression of the inflammatory process in the upper urinary tract and enhancement of cellular and humoral immunity is ETA. This suggests a General increase in the immunoreactivity of the body of patients in the application of the proposed method of treatment, apparently, due to the high percentage of elimination of stones from the urinary tract, reducing inflammation in them and improve the drainage of the ureter.

Daily urine after treatment, the proposed method has decreased excretion of oxalate with 523±13.0 to 289±11.0 mmol/day (P<0.001) and calcium (12.5±from 0.3 to 8.4±0.1 mmol/day (P<0,001).

Migration of stones in the upper urinary tracts shown in table 4.

According to the table. 4 in a single year of application of the proposed method of treatment, the discharge of the stone was observed in 56 (93,3%) of 60 patients with stones of various departments of the ureter. The size of the detached stones were in the range from 1 to 7 mm Stones up to 5 mm departed in all (100%) patients, 5 to 7 mm in 70% and more than 7 mm - 50%.

Table 4
The dynamics of promotion concretions in the upper urinary tracts in the application of the proposed method of treatment after a single course of treatment
Localization stoneJust sickThe number of cases
with the passage of stonemigration of stones in the distal ureterwithout migration stone
The upper part of ureter24204-
The average Department of ureter88--
The lower part of ureter2828--
TOTAL:6056 (93,3%)4 (6,7%)-

After applying the proposed method of treatment, according to the dynamic neprezentare was observed acceleration parameters of the Tmaxaccumulation in kidneys with 785±21 C to 540±22 C and T1/2excretion of the radiopharmaceutical from 1672±22 to 1469±20 C. This is apparently due to a reduction of the inflammatory process in the upper urinary tract, reduce swelling of the mucous, mucus concretions of them and improve their drainage function, which improves functionally what about the condition of the kidneys and upper urinary tract.

Consequently, the use of drinking radon water and radon in water baths in the complex while the impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression and alternating sinusoidal current increases the level of concentration of T-lymphocytes, reduces the content of b-lymphocytes, immunoglobulin a, C-reactive protein in the blood. Exposure to alpha radiation from radon and its daughter products in the adrenal glands, the kidneys and the urinary tract helps reduce pyuria, erythrocyturia and bacteriuria, and daily excretion of calcium and oxalate in the urine. When applying the proposed method of treatment bacteriostatic and anti-inflammatory effects were associated mainly with the increase in the immunoreactivity of the body. And the further reduction of calcium and uric acid in the blood, oxalates and calcium daily urine was associated with a normalizing action of radon on urate-oxalate-calcium metabolism in patients with calculous pyelonephritis. In addition, the proposed method of treatment accelerated the discharge of concrements in 56 (93,3%) of 60 patients with stones of various departments of the ureter.

According to Dudchenko M.A. (Dudchenko M.A. Treatment of urolithiasis in Truskavets. - Kiev, 1971), applying drinking mineral water, mineral baths,ozocerite appliqués on the lumbar region and antispasmodics elimination concretions were observed in 24 (14,5%) of 165 patients with ureteral stones. When you use drinking radon water and radon in water baths were observed discharge concretions from the ureter 33.3-66.7% of the observations (Korova V.M. Healing properties of Khmilnyk for the treatment of patients with urological // Radon: Proceedings of scientific-practical use. proc. - Khmilnyk, 1966. - P.93-96; I. Karpukhin, Whether A.A., A.I. Gusarov and other Application of sinusoidal modulated currents and radon patients with stones in the urinary tract // Matters. a resort., fizioter., LFC. - 2003. No. 5. - Pp.33-34). If using a prototype of the proposed method of treatment is the removal of calculus from ureter was observed in 73.3 per cent of cases (I. Karpukhin, Whether A.A., A.I. Gusarov and other Application of sinusoidal modulated currents and radon patients with stones in the upper urinary tract // Matters. a resort., fizioter. and exercise therapy. - 2003. No. 5. - Pp.33-34).

In our opinion, we can assume the following working hypothesis of the mechanism of the accelerated removal of calculus from the upper urinary tract in the application of the proposed method of treatment. Drinking radon water, mainly through direct action of alpha radiation on the adrenal glands, kidneys and ureters, and radon water bath due to alpha radiation from radon and its daughter decay products and other biologically active substances from the irradiated areas of the skin (DOPA, dopamine and other),stimulating skin receptors, affecting mediated reflex-humoral through the centers of the neuroendocrine regulation on the same organs, increase diuresis, relieve abnormal spasm of smooth muscles, swelling and inflammation in the upper urinary tract. Radon also stimulates the frequency and intensity of reflex impulses emanating from the functional kidney of pacemaker (often localized in the pelvis, the lower group of cups kidney or pelvic-ureteric zone) and propagating along the smooth muscle of the ureter, increasing its peristalsis and accelerating the discharge of stones, or fragments of them. In addition, the simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression (vacuum) and alternating sinusoidal current, acting reflexively, and directly on the functional renal pacemaker and the neuro-muscular system of the upper urinary tract, increase their motor function and reinforces the positive effect of radon. Therefore, significantly improves contractile function of the upper urinary tract and consequently accelerates the excretion of stones, or fragments of them.

Testimony to the appointment of the proposed method of treatment are: calculus size up to 7 mm, the presence of normal or died, R anatomical and functional changes of the kidneys and upper urinary tract-side localization of the calculus, the absence of scar below the location of ureteral stones.

Contraindications: ureteral stones larger than 7 mm, acute infectious diseases and mental illness, often repeated bleeding, circulatory failure IIB-III stages, CHD III-IV functional class, all forms of blood diseases, malignant tumors and benign tumors, active tuberculosis, radiation sickness and other

Thus, drinking radon water, radon in water baths and simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression and alternating sinusoidal current anti-inflammatory, bacteriostatic, antispasmodic, increases the immunoreactivity of the patients body, stimulating the contractile function of smooth muscles of the upper urinary tract and improves the functional state of the kidney action. Therefore, when applying the proposed method of treatment for removal of stones from the ureter, there is no need for more inclusion (during treatment) in the medical complex antibacterial, stimulant and antispasmodic drugs to relieve abnormal spasm of smooth muscles, reduce inflammation, improve the overall diuresis and increased peristalsis of the upper urinary tract is Uta.

The development of a new effective method of non-drug therapy of patients with ureteral stones with minimizing potential complications is an important problem in modern urology. The creation of the proposed method of treatment of patients with the use of visibilization it is also important that when using known literature methods of treatment of patients with ureterolithiasis often accompanied by various complications associated with drug intolerance used for removing stones from the urinary tract medications. In addition, known methods of treatment used for removing concretions from the ureter, are characterized by the lack of efficiency of treatment.

The proposed method of treatment differs in comparison with the known simple methods, their good tolerance by patients and the possibility of its application in outpatient, inpatient and Spa facilities.

The proposed method for the treatment of patients with ureteral stones has compared to the prototype (73,3%) and other therapeutic techniques higher therapeutic efficacy (93,3%) and the relatively short treatment period (10-12 days).

Method for the treatment of patients with ureteral stones, including drinking radon water after eating, intake of radon is o water baths and exposure to low-frequency alternating sinusoidal current, characterized in that exercise drink radon water with a radon concentration 185-370 kBq/l 100 ml 2-3 times a day followed by a reception after the first drinking radon procedure first radon baths with a radon concentration of 0.75 to 2.25 kBq/l, temperature of 36-37°s With a duration of 10-15 minutes and then simultaneous impact on the region of the kidneys and the affected Department of the ureter pulsed vacuum depression 4-9 ATM with a repetition rate of 15-25 pulse/min and alternating sinusoidal current of frequency of 100-200 Hz, the current intensity of 20-40 mA, a duration of 12-15 min, daily, treatment 10-12 procedures.



 

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18 cl, 1 ex, 1 tbl

FIELD: medicine, physiotherapy, balneotherapy.

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1 cl, 1 ex, 3 tbl

FIELD: medicine.

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< / BR>
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1 ex, 1 tbl

FIELD: medicine.

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EFFECT: enhanced effectiveness of treatment.

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