Method of treating myelopathy

FIELD: medicine.

SUBSTANCE: method involves the intravenous and/or intramuscular introduction of the drugs used in myelopathy, balneotherapy in the form of baths. Acupressure and manual therapy are applied in addition. The manual therapy requires such techniques, as ischemic compression, release phenomenon, fascial broach, postisometric relaxation of the muscles involved in a pathological process. Discontinuous therapeutic plasmapheresis is applied with using either Baxter, or Bekman, or Haemophoenix apparatuses, and/or extracorporal ultraviolet blood irradiations is ensured by the apparatus Isolda MD 73 M. The apparatus Cryo-Jet is used for cryotherapy with cooled dry air at the level of degenerative dystrophic changed vertebral motor cervical segments and muscle attachment points.

EFFECT: method improves clinical effectiveness due to fast pain management, enlarged range of active and passive motions, normalised muscular tonus, increased muscular strength and corrected vegetovascular disorders.

6 cl, 3 ex

 

The invention relates to medicine, namely to neurology: treatment of myelopathy due to degenerative changes of the cervical spine.

The analysis of the sources on this issue (1-9) allowed to identify the main directions of the leading maxims of neurological schools on the classification, etiopathogenesis, clinical presentation and methodology of restorative treatment of patients with polymorphic myelopathy.

According to Vasiljevich (6), one of the ideologists of modern transformation of medical tactics rehabilitative treatment of patients with instability of the cervical spine, which is primarily characteristic of patients with polymorphic myelopathy, when myelopathy in recovery and rehabilitation measures being used more and more conservative methods of treatment and less - operative methods. Unambiguous treatment of such patients has not to date been developed. Patients with myelopathy are severe somatic patients, forced to take large doses of the hormone. Currently, the treatment of polymorphic myelopathy is a complex problem, which requires the efforts of physicians of multiple specialties: rheumatologists, neurologists, orthopedists, neurosurgeons, rehabilitation specialists, etc.

Known standard is tons of inpatient care polymorphic myelopathy, approved by order of the health Ministry of the Russian Federation No. 594 dated 09.08.2006 year, consisting of diagnosis and treatment based on 24 days, including intravenous medications, intramuscular medicines, prescription and diet therapy in diseases of the peripheral and Central nervous system, the purpose of the exercise physiotherapy, massage in diseases of the Central nervous system.

Used in the present period of the medication regimens of patients polymorphic forms myelopathy, leave some therapeutic dissatisfaction with the results of this treatment and oblige us to seek opportunities for local natural physical resort factors for the rehabilitation of these patients. There are Medical indications and contraindications for sanatorium-resort treatment of adults and adolescents (except TB), approved by the Ministry of health of the Russian Federation 22.12.1999, No. 99/227.

The main disadvantages in the direction of patients for sanatorium-resort treatment are usually the following:

- lack of examination of patients by doctors immediately before the direction of the sanatorium;

error diagnostics, the underestimation of the stage, the degree of the pathological process, Sopot is adequate disease, the General condition, age of the patient and others;

- lack of knowledge of doctors sending patients for treatment, rules of sanatorium-resort selection, location resorts with these or other health factors, mechanism of action of these factors, indications and contra-indications for referral of patients in sanatorium-resort treatment, insufficient consideration of climatic and seasonal conditions. Along with the inclusion of a special section devoted to the General contraindications for referral to the resorts and local sanatoria, for each class of diseases listed contraindication, which facilitates the physician's decision regarding the selection of patients for sanatorium-resort treatment.

The closest analogue, i.e. a prototype, the claimed method is a method of treatment of myelopathy caused including degenerative changes of the cervical spine, including intravenous and/or intramuscular drugs, mud therapy, balneotherapy baths (see "Diagnosis and treatment of dorsopathy"guidelines. Voronezh state medical Academy, compiled by doctor of medical Sciences Sporkin. Voronezh, 2005, p.1-12, published online on the website www.voed.ni/diagn_n_cure_dorsopatia.htm 14.07.2005 found 17.12.2009,). The specified method does not allow to achieve the desired Ter the non-therapeutic effect and stable remission of the pathological process.

The objective of the invention is to solve the problem of continuity of regenerative medical treatment of patients with myelopathy, development of a unified methodology of restorative treatment of this contingent of patients on the phase-clinic sanatorium.

The invention consists in the fact that after therapy is prescribed manual therapy (i.e. treatment methods: ischemic compression, release phenomenon, stretching the fascia, acupressure active trigger points (ATP), postisometric relaxation of muscles involved in the pathological process), perform intermittent therapeutic plasmapheresis devices Baxter, Bekman or, Gemofeniks and/or in vitro method of ultraviolet irradiation of the blood on the device MD 73 M "Isolde". Number, the multiplicity of procedures of plasmapheresis and deleted the volume of plasma per session when performing intermittent plasmapheresis each patient depending on the duration, severity, shape of the flow of the studied disease, often practiced by the standard scheme for intermittent plasmapheresis, which includes 3-5-7 procedures when removing each procedure 500-800 ml plasma in 1-2-3 days, local cryotherapy device "Cryo-jet" at the level of degenerative and dystrophic changes of vertebral motor segments (PDS). Often the spine, use the method of local cryotherapy (LKT) interested vertebral motor segments of the cervical spine and places of attachment of muscles using chilled dry air at t°=-30°C duration of 3-4 min, 7-10 procedures for the course of treatment.

As components of balneotherapy patients myelopathy used white turpentine baths that complement medical tactics when expressed cervicalcheck syndrome. Turpentine baths have good analgesic, relaxing, improves peripheral circulation effect. Feature when their purpose is the higher temperature of the water in the tub 37-39°C, the duration of the procedure for 10 to 15 minutes, use a white turpentine emulsion in the amount of 30 ml per 200 l of water, the treatment consists of 12-15 treatments after a day or two days in a row with a break on the third day, and in the presence of contraindications apply the General bromine baths with iodine content of 5 mg/l and bromine 25 mg/l (t=36°C for 15-20 min, No. 10, h/day). After the correction cervicalcheck syndrome recommended pelotherapy in thin-layer technology applications muds Tambukan field (salinity up to 435 g/l, beats. weight 1,43) to 2-3 cm thick on the projection interested segments of the spine, the area of application not less than 50-70 cm2and greenwaste 20-25 min, at t=40-42°C, No. 8 h/day. Aqua aerobics in the pool designate the days free from baths, individual modes aimed at increasing mobility and local stretching interested spine.

Example 1

Patient agadzhanov AA, born in 1956, has been treated in the neurological Clinic of neurology were diagnosed with "Chronic vertebral cervicobrachialgia. Relapsing course, protracted stage of exacerbation. Osteochondrosis C3-C4, C4-C5, C5-C6. Servicecontracts. Protrusion of disks C3-C4, C4-C5, C5-C6. Cervical myelopathy".

Was admitted with complaints: weakness, fatigue; periodic dizziness when turning, and the drooping of the head to the side, a sharp rise; noise, stuffiness in the ears; stiffness, soreness in the neck with irradiation in the head and hands, numbness in the tips of the fingers and feet, burning sensation in the extremities, paleness of the skin of the hands and feet, "crawling", the weakness in the hands.

Objective: pupils d=s; palpebral fissure d>s. The tongue in the midline. The expression is weakened. Melcorazmashisty horizontal nystagmus when looking to the left. Coordinatorsee sample performs with intentsionnogo component. In the Romberg shakiness without storenote. The reflexes of the upper and lower extremities increased with the expansion of reflexogenic zones. Achilles reflex the s with clonic component. The sensitivity is lower conductive type, ( + )-m Rossolimo with two sides, Babinski from two sides, Pussep with two sides, a positive test Panova from two sides.

During the examination of the cervical spine: the restriction of mobility in the lateral tilting and turning your head to the right. Palpation minor pain at the ERB's point to the right, over-Arlovski point to the left, decrease in muscle strength in wrists up to 2 points. Hypotension tenure, getutent from two sides.

The survey: 1. To tion of a neurologist, a chiropractor; 2. OAK; 3. OAM; 4. Biokhimicheskii blood; 5. Radiography of the cervical spine in two projections, FRIES; 6. REG; 7. USDG brachiocephalic vessels; 8. ENMG upper and lower extremities; 9. MRI of the cervical spine

Treatment: 1. Mode 1. 2. Diet - table No. 15. 3. LFC individually. 4. Drinking regime "Slavyanovskaya" 1 tbsp 3 times a day for 40 minutes before eating. 5. Massage Vorotnikova zone, upper limbs, No. 10. 6. Manual therapy in adequate (PERM, MB) №5. 7. White turpentine baths, 37-38°C, 10-15 min, No. 12 (scheme). 8. Electrophoresis Caribana on the cervical spine, No. 12. 9. Laser therapy MILTA" (under the scheme) on the cervical spine, No. 10. 10. Intermittent therapeutic plasmapheresis devices Baxter, No. 3, deleting each procedure 500-800 ml plasma in 1-2-3 days according to the respectively. 11. Local cryotherapy device "Cryo-jet", t=-30°C for 3-4 min, No. 10. 12. Pharmacotherapy:

The pharmacological/drip 4 mg of the drug per 200 ml of physiologic R-RA 200 ml, No. 10.

Actovegin/inkjet 5 ml №10.

Cortexin/m, No. 10.

Milgamma 1 tab. 3 times a day, every day.

The patient is discharged with improvement: under the supervision of a neurologist on a residence.

Recommended: Dynamic observation at the Department of neurology with a repeated course of treatment at the clinic of neurology in 4 months.

Example 2

Sick of Bagashvili IA, born in 1938, was treated at the Clinic of neurology were diagnosed with "Chronic vertebral cervicalgia. Humeroscapular periastron on the right. Musculo-ligamentous form. Relapsing course, the stage of exacerbation. Osteochondrosis C3-C4, C4-C5, C5-C6. Servicecontracts. Herniated disc C4-C5, C5-C6. Cervical spondylogenic myelopathy".

Was admitted with complaints: headaches compressive nature, dizziness, flashing flies before the eyes, emotional lability, irritability, fatigue, weakness. Pain, stiffness in the neck, radiating to neck, right shoulder, accompanied by a pronounced restriction of mobility, pain between shoulder blades back pain, numbness in the tips of the fingers and toes, feeling the freezing limbs, redness to the author of the skin of the hands and feet, "crawling", the weakness in the hands, insecurity when walking.

Objective: pupils d=s; palpebral fissure d<s. Deviate language right. The weakness of convergence and accommodation. Nystagmus when the extreme abstraction of the eyeballs from two sides. Coordinatorsee samples from the upper extremities performs satisfactorily, with the lower extremities is unclear. In the Romberg shakiness without storenote. The reflexes of the upper extremities on the right is reduced. The reflexes of the lower extremities is increased with the expansion of reflexogenic zones. The phenomenon of hypesthesia right along the locus C6, C7, C8. The phenomenon of differentials between the distal upper limb (d<s), ( + )-m oral automatism, Rossolimo with two sides, Babinski from two sides, Kadoka with two sides, weakly positive test "rings", Panova from two sides.

During the examination of the cervical spine: the restriction of mobility in the lateral tilts and turns his head to the side. Palpation tenderness in the ERB's point to the right, over-Arlovski points on both sides, at the point of the vertebral artery on the right, the projection of the spinous processes of C2-C4. Positive symptom Fence, "axial load", positive symptom Popeljanskij, more to the right. Pain and marked limitation of mobility (up to 50% of N) in the right shoulder joint, decrease in muscle strength in the hands, hypotension tenure, getutent Ref is. During the examination of the thoracic spine: FB level Tn-Tn, local tenderness, positive symptom "sticking", the defense of muscle rectifiers back more to the right. ATP in muscle-rectifiers back in the rhomboid muscle, skeletal muscle, levator scapulae right, the functional block of the right scapula.

The survey: 1. To tion of a neurologist, a chiropractor; 2. OAK; 3. OAM; 4. Biokhimicheskii blood; 5. Radiography of the cervical spine in two projections, FRIES shoulder, right; 6. REG, RVG upper extremities; 7. USDG brachiocephalic vessels; 8. ENMG upper and lower extremities; 9. MRI of the cervical spine.

Treatment: 1. Mode 1. 2. Diet - table No. 15. 3. Water aerobics. 4. Drinking regime "Slavyanovskaya" 1 tbsp 3 times a day for 40 minutes before eating. 5. Massage lymphatic drainage "hivamat 200" neck area and lower extremities, No. 10. 6. Manual therapy in adequate (PERM, MB) No. 7. 7. CMT phoresis with Aminophylline on cervical-collar zone, No. 10. 8. Laser therapy MILTA", No. 12 (scheme). 9. White turpentine baths, 37-38°C, 10-15 min, No. 12 (scheme). 10. Intermittent therapeutic plasmapheresis devices Baxter, No. 5, deleting each procedure 500-800 ml plasma after 2 days. 11. Local cryotherapy device "Cryo-jet", t=-30°C, 3-4 min, No. 10. HB, No. 8, hD. 12. Pelotherapy, "gloves", "socks", 20-25 min, at t=40-42°C, N 8, the/day, alternate with LKT. 13. Pharmacotherapy:

Cerebrolysin/drip 5-10-15-20-25 ml per 200 ml of physiologic R-RA 200 ml, No. 10.

Milgamma 2 ml/inkjet, No. 10.

Cerebrum compositum 2.2 ml, V/m, h/o day, No. 10.

Coenzyme compositum 2.2 ml, V/m, h/o day, No. 10.

Cogitum contents 1 capsules 2 times a day (morning and afternoon), daily, No. 20.

Application of DMSO, novocaine, dipyrone on the shoulder area, No. 5.

Infiltration of the right shoulder joint, No. 3 (hydrocortisone 1 ml (30 mg), 0,5%novocaine -10) hC the third day.

The patient was discharged in satisfactory condition with pronounced positive dynamics under the supervision of a neurologist on a residence.

Recommended: Dynamic observation at the Department of neurology with a repeated course of treatment at the clinic of neurology in 4 months.

Example 3

Patient Borisov, V.N., 53 years old, was hospitalized in the neurology Department of the Clinic of neurology of SSMU with the diagnosis of Endogenous spondylodiscitis. Chronic vertebral cervicobrachialgia with pronounced vestibulocochlear disorders. Symptom of vertebral artery. Relapsing course. Stage prolonged aggravation. Osteochondrosis C3-C4, C4-C5, C5-C6. Servicecontracts. Herniated disc C5-C6, protrusion of disks C3-C4, C4-C5, C6-C7. Cervical myelopathy".

P is stepped with complaints of weakness, fatigue, emotional instability; stiffness, pain in the neck radiating to the occipital, parietal and frontal region predominantly left; dizziness, worse when turning, and the drooping of the head to the side (more to the left), sometimes accompanied by nausea; severe headache squeezing, constricting nature; noise in the ears, flashing flies before the eyes, numbness in the tips of the fingers and feet, burning sensation in the limbs, "crawling", the weakness in the hands.

On examination: the patient emotionally labile, estensione, oriented in time and space. Pupils d=s, palpebral fissure d>s. The expression relaxed somewhat. Melcorazmashisty horizontal nystagmus when looking to the side, deviate language right. The complication of the Romberg shakiness, when performing coordinatory samples are marked elements intentions. Peripheral Acrocephalus. The reflexes of the upper and lower extremities increased with the expansion of the reflex zones, Achilles reflexes with clonic component with two sides. The sensitivity is lower conductive type, ( + )-m Rossolimo with two sides, Babinski from two sides, Pussep with two sides, Oppenheim with two sides, a positive test Panova from two sides.

During the examination of the cervical spine: a limitation of the evaluation is gnosti for lateral tilting and turning your head to the right. Palpation minor pain at the ERB's point to the right, over-Arlovski point to the left, decrease in muscle strength in wrists up to 2 points. Hypotension tenure, getutent from two sides.

The survey: 1. To tion of a neurologist, a chiropractor; 2. OAK; 3. OAM; 4. Biokhimicheskii blood; 5. Radiography of the cervical spine in two projections, FRIES; 6. REG; 7. USDG brachiocephalic vessels; 8. ENMG upper and lower extremities; 9. MRI of the cervical spine.

Treatment: 1. Mode 1. 2. Diet - table No. 15. 3. LFC individually. 4. Drinking regime "Slavyanovskaya" 1 tbsp 3 times a day for 40 minutes before eating. 5. Massage the neck area, upper limbs, No. 10. 6. Manual therapy in adequate (PERM, release phenomenon, stretching of the fascia, acupressure ATP, MB) №5. 7. White turpentine baths, 37-38°C, 10-15 min, No. 8 (scheme). 8. Calpain-CMT-phoresis on the cervical spine, No. 12. 9. Laser therapy MILTA" (under the scheme) on the cervical spine, No. 10. 10. Intermittent therapeutic plasmapheresis devices Baxter, No. 3, deleting each procedure 500-800 ml plasma in 1-2-3 days, respectively. 11. Local cryotherapy device "Cryo-jet", t=-30°C for 3-4 min, No. 10. 12. Pharmacotherapy:

Trental/drip 10 ml per 200 ml of physiologic R-RA 200 ml, No. 10.

Actovegin/inkjet slowly 5 ml №10.

Cortexin/m, No. 10.

Milgamma 1 tab. 3 p is for a day, daily.

Adaptol 500 mg 2 times a day, every day, No. 48 (with subsequent continuation of the medication at home for one month).

The patient is discharged with improvement: under the supervision of a neurologist on a residence.

Recommended: Dynamic observation at the Department of neurology with a repeated course of treatment at the clinic of neurology in 4 months.

The technical result of the invention

With the improvement of objective health indicators and subjective well-being discharged from 77,69% to 88,05% patients: the relief of pain in the neck and shoulder belt, increasing the volume of active and passive movements, normalization of muscle tone of the upper and lower extremities, increased muscle strength, correction of vegetative-vascular disorders (phenomenon differentials between, hyperhidrosis), the reduction or disappearance of paresthesia.

Literature

1. Voloshin PV, cyclin VI Treatment of vascular diseases of the brain and spinal cord. - M.: Knowledge, 1999, - 557 S.

2. Geinitz A.V. et al. To the question of the classification of myelopathy. // New Notepad neurologist. - 2003. No. 1. - P.23-25.

3. The thick S.A., Shevelev I. Pathogenetic substantiation of principles of treatment and rehabilitation of patients with degenerative-dystrophic lesions of the cervical spine. // Actual problems of medical neurorehabil the promotion. J. struct. Dokl. the third scientific and practical conference dedicated to the 30th anniversary of GB No. 10. - M., 1996. - P.95-96.

4. Charles VA Therapy for neurological diseases: Guide for physicians). - M.: "Step", 1996. - 653 S.

5. Markin, S. p. Diagnosis and treatment of dorsopathy. Methodical recommendations, approved. The academic Council of the Voronezh state medical. Academy. - Voronezh, 2005. - 22 S.

6. Miscavige VA Instability of the cervical spine. // Russian scientific journal. - 2005. No. 1. - P.64-68.

7. Petelin PS, Smirnov UD, Akhmedov TERMS Landmark rehabilitation of neurological disorders in the lumbar osteochondrosis in adolescents. // Step recovery treatment of vertebrogenic diseases of the nervous system. - Stavropol, 1987. - P.223-226.

8. Skvortsova V.I., Levitsky G.M. current views on the etiology and pathogenesis of vascular myelopathy. // Scientific Herald of the Russian state medical University. - 2005. No. 2 (see app. 16). - P.29-33.

9. Trefilov P.P. Comprehensive physiotherapy treatment of patients with cervical myelopathy. // Physiotherapy practice. - 2004. No. 1. - P.77-79.

1. A method for the treatment of myelopathy due to degenerative changes of the cervical spine, including intravenous and/or intramuscular drugs used myelopathy, balneotherapy baths, characterized in that it further conduct of manual therapy,including techniques such as ischemic compression, release phenomenon, stretching the fascia, acupressure, postisometric relaxation of muscles involved in the pathological process of muscles, perform intermittent therapeutic plasmapheresis devices Baxter, or Bekman, or, Gemofeniks, and/or in vitro ultraviolet irradiation of blood on device MD 73 M Isolde, local cryotherapy device "Cryo-jet" with chilled dry air at the level of degenerative-dystrophic modified vertebral motor segments of the cervical spine and places of attachment of muscles.

2. The method according to claim 1, characterized in that conduct white turpentine bath temperature of 37-39°C, containing 30 ml of white turpentine emulsion per 200 l of water, with a duration of 10-15 minutes, at the rate of 12-15 treatments after a day or two days in a row with a break on the third day, or total bromine bath temperature of 36°C at a concentration of iodine 5 mg/l and bromine 25 mg/l duration of 15-20 min, in the course of treatment 10 treatments every other day.

3. The method according to claim 1, characterized in that the local cryotherapy device "Cryo-jet" hold temperature -30°C duration of 3-4 min, treatment 7-10 procedures.

4. The method according to claim 1, characterized in that the intermittent treatment includes plasmapheresis 3-5-7 procedures when removing each of the procedures is at 500-800 ml plasma in 1-2-3 days.

5. The method according to claim 1, characterized in that it further conduct peloidoterapiya by mud Tambukan field on the projection interested segments of the spine thickness applications up to 2-3 cm square is not less than 50-70 cm2, temperature of 40-42°C for 20-25 min on a course of 8 treatments every other day.

6. The method according to claims 1 and 2, characterized in that it further in the days free from baths, perform aerobics.



 

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2 ex, 1 dwg, 3 cl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, specifically to combustiology and surgery. The technique involves preliminary abrasion of a wound and application of fibroblasts on the wound surface. The fibroblasts are distributed in a gel mixture. Said gel mixture contains a serum-free nutrient medium and methylcellulose in amount 1.0 - 3.0 wt %.

EFFECT: method prolongs viability of the cells applied on the wound, prevents occurrence of allergic reaction.

5 cl, 3 ex, 1 tbl, 5 dwg

FIELD: medicine.

SUBSTANCE: device contains lid for formation of chamber above wound, in which placed is at least one functional means for wound processing, which passes into chamber. Chamber is formed by at least one lower component, which is fastened to skin, and at least one upper component, made with possibility of detachment from lower component. At least one manipulator means of functional means represents electrode. There is film for skin protection, intended for placing between skin and lower component. In upper component made is opening, which is provided with air filter.

EFFECT: invention ensures processing of wounds and their accelerated healing.

15 cl, 7 dwg

FIELD: medicine.

SUBSTANCE: invention concerns an oligodynamic composite material representing a layer of polymer material with electret properties wherein there is one first discrete element coming on one working surface of the electret material and made of metal particles of various electronic work function and able to show oligodynamic action. The composite material can also contain the other discrete elements representing a drug dispenser or absorption aids.

EFFECT: composite material distinguishes itself with high efficiency ensured by synergy effect of the electret material and the metal showing oligodynamic action.

17 cl, 4 dwg, 1 tbl, 18 ex

Pelotherapy // 2377030

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to physiotherapy. Therapeutic technique involves heating of applicators containing pre-homogenised Tambukan mud to 36-38°C. The homogenised mud contains (wt %): crystal skeleton 15.0÷25.0, colloid complex 10.0÷20.0, the rest - mud solution. The heated applicators are placed on a projection of a diseased organ. Then electrodes are placed on applicators with a cathode on one, and an anode on the other. Direct current of density 0.03-0.07 mA/cm2 is supplied on the electrodes. In the first procedure the DC supply time is 10-20 minutes. In each following procedure, the DC supply time is two minutes more than in the previous one.

EFFECT: method improves clinical effectiveness ensured by higher activity of biological components of the mud.

7 cl, 4 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, oncology, and can be used for treatment of malignant lung neoplasms in experiment. For this purpose performed is extracorporal irradiation of autoblood with red incoherent light λ=0.67 mcm dose W=3.06 J/cm2 in continuous mode with exposition duration to three minutes. After that 15-20 minutes later into said blood added is cyclophosphane in dose 40 mg/kg and the mixture is incubated for 40 minutes at T=37°C. After that it is re-infused into subclavian vein of the animal.

EFFECT: claimed method allows to reduce terms of anti-tumour treatment, increase efficiency of cyclophosphane action, reduce its toxic manifestations, increase animals' life term, increase non-specific anti-tumour resistance, activate anti stressor mechanisms.

2 tbl

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