Method of treating and increasing quality of patients with gallbladder dyskinesia

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to gastroenterology, physiotherapy, rexlexotherapy. Method includes carrying out drug therapy. Additionally, taking into account degree of expression of anxiety-depressive disorders by Hamilton scale data, antidepressant asaphen is introduced. In case of clinically expressed disorders asaphen is introduced in dose 75 mg per day, in case of subclinically expressed affective disorders - in dose 50 mg per day. Intake of asaphen is realised during 30 days. Taking into account individual peculiarities of vegetative balance state magnetic laser puncture is performed. For this purpose used is wavelength 1.3 mcm, modulated mode, frequency 2.4 Hz, magnetic-acupuncture nozzle 50 mT. Impact is carried out during 10-30 s per one biologically active point. In case of sympathicotonia point Gl 4 is sedated and points E 25, E 36, MC 6 are toned up. In case of vagotonia point Gl 4 is toned up and points E 25, E 36, MC 6 are sedated. Course includes 10-12 procedures.

EFFECT: method increases patients' life quality, reduces treatment terms, increases remission duration, reducing number of recurrences due to correction of state of day chronobiorhythms, psychoemotional sphere and vegetative balance.

2 ex, 2 tbl

 

The invention relates to medicine, namely to a gastroenterologist, and can be used in the treatment of dyskinesia of the gallbladder (JP).

There is a method of treating JP, consisting of drug therapy using agents that affect the tone of smooth muscles - antiholinergiceski substances, choleretic, holekinetikam, antispasmodics and prokinetics (Grigoriev PA, Yakovenko EP Diagnosis and treatment of diseases of the digestive system. - M., 2005, 463 C.). For this purpose, use, for example, teston in a dose of 200-400 mg 3 times a day for 1-3 weeks (Yakovenko EP, Grigoriev PA Chronic disease extrahepatic ways. Diagnostics and treatment. Methodological manual for doctors. - M.: Medicine, 2001. - 31 S.). There is information about the use of duspatalin (mebeverine) at a dose of 200 mg 2 times a day for 2 weeks (Cholecystitis: an algorithm for diagnosis and medical tactics. Manual for doctors. / A Handbook edited by EverEve. - Moscow. Necr MH and CF of the Russian Federation, 2006. - 64 S.).

But this therapy does not affect obeazatelino system of the patient JP, in particular, mental status, autonomic balance, daily chronobiology, does not ensure elimination of violations of the contractility of the gallbladder, no significant impact on the prolongation of the remission, reduction of recurrence, quality of life of patients. In the same lie is known, what in the regulation of motor activity biliary system involves the sympathetic and parasympathetic divisions of the autonomic nervous system (ANS) (minushkin on. / A Handbook for physicians. - M., 2006 - 28 C.)that patients JP frequently detected non-psychotic mental disorders (Raskin V.I. Peculiarities of the psychological status of patients with chronic cholecystitis / Viglasky, Auvsi // Russian journal of gastroenterology, Hepatology, Coloproctology: Annex 15. Materials of the 7th Grew. Gastroenterological Week, Moscow, 2001 - C, No. 5. - S). Most authors attribute the tendency of an individual to anxiety and fear with a predominance of the sympathetic nervous system tone (Romanov V.V. cardiovascular system specialists carrier profile in the process of continuous operation. Way // human Physiology. 1981. - V.7, №2. - S-213.), but in some cases was shown that for chronic anxiety-depressive States is characterised by the long predominance of parasympathetic tone (Nabiullina P.P. Comparative evaluation of the efficacy of tranquilizers different chemical groups at somatogennye neurosis-like disorders: author. Diss. ... candles. the honey. Sciences / Run. - Kazan, 1977. - 22 C.). State regulatory systems, psychovegetative balance largely determines the power of therapeutic measures, rate of recurrence and prognosis in JP.

Objective: to develop a method for correcting mental status, daily chronobiotic and state of autonomic balance in patients with dyskinesia of the gallbladder in the treatment process, allowing to extend periods of remission, reduce the frequency of relapses, to improve the quality of life of patients.

The technical result is achieved by the fact that patients JP after the standard survey is conducted additional evaluation of the severity of anxiety and depressive disorders, daily monitoring of heart rate variability, evaluate the contractile function of the ha and the patient's quality of life; based on the obtained additional survey results opt comprehensive treatment.

To assess the severity of anxiety and depressive disorders use questionnaires for the following test questionnaires: the Hamilton depression rating scale to determine anxiety (HARS), the Hamilton depression rating scale to determine depression (HDRS). When interpreting the data take into account the total score for all questions, which were determined by the severity of the disorders: 0-7,0 on a scale HARS and 0-8,0 points on the scale HDRS - absence of symptoms of anxiety and depression; 7,1-16,0 scale HARS and 8.1 20.0 points on a scale HDRS - subclinical expressed signs of anxiety and depression; more 16.0 points on a scale HARS and more of 20.0 points on a scale HDRS - clinically you the Agen anxiety and depression.

To assess the autonomic balance conduct daily monitoring of the heart rate variability device, for example, "Cardio Tens 01" ("Meditech", Hungary) taking into account the recommendations of the ESC/NASPE (Standards of Heart rate Variability. Circulation. Vol.93. No. 5, March 1, 1996) and subsequent cosinor-analysis (Fearow, Seaport. Chronobiology and the bases of bioenergetics. - Moscow: "Triada-X", 2000, - 488 S.).

To assess contractile function ha perform ultrasound ha with functional breakdown (trial Breakfast - 2 raw egg yolks). Contractility assessed by changes in percentage terms of the volume of ha on an empty stomach.

To assess quality of life using a questionnaire SF-36.

When assigning a course of antidepressant azafena consider the following possible variants, obtained by processing the test questionnaires:

if the patient has clinically expressed anxiety and depression azafen administered in the dose of 75 mg per day;

if the patient has subclinical expressed anxiety and depression azafen administered in the dose of 50 mg per day

When assigning course magnetothermopower consider the following possible options:

if the patient has the original sympathicotonia (RMSSD less than 15, LF/HF less than 3.5), foot reflexology, the impact of consistently seatrout point GI 4 and tone point E 25 E 36, 6 MS;

if a patient in a vegetative status of robledal vagotonic (RMSSD more than 35, LF/HF is less than 1), when magnetothermopower consistently tone up the point GI 4, and seatrout point E 25 E 36, 6 MS.

The choice of points for the correction of vegetative balance based on literature data (non-traditional methods of diagnosis and therapy / edited Issueswe. - Kiev: Health, 1994. - 142 C.). The exposure time per one BAHT: when sedation is 30 seconds, while toning - 10 seconds. In the course of 10-12 daily procedures.

After further examination and selection magnetic effects carry out comprehensive treatment, including in addition to standard medical therapy: taking antidepressant azafena dose of 50 or 75 mg per day for 30 days; holding 1 per day in a single session course of 10-12 procedures magnetothermopower wavelength of 1.3 μm in the modulated mode, a frequency of 2.4 Hz minidocumentary nozzle 50 MT 10-30 with one biologically active point, and if sympathicotonia consistently perform sedation point GI 4 and toning points E 25 E 36, 6 MS; if vagotonia consistently tone up the point GI 4 and seatrout point E 25 E 36, MS.

For laserpuncture used vehicles physiotherapy laser exposure, for example, LTA "Moth-reflex".

Conducted examination and treatment by the proposed method, the analysis of relapses and remissions during the year in 28 patients On The P. The control group consisted of 20 patients treated by known standard method of treatment, comprising duspatalin at a dose of 200 mg 2 times a day for 2 weeks. The results are presented in table 1.

Table 1
Analysis of the results from this method of treatment (study group) compared with standard therapy (control group).
IndexThe group of patients
maincontrol
The number of patients2820
The terms of relief of clinical symptoms (days)2,3±0,44,6±0,8
Normalization contractility of the gallbladder (%)90%30%
Normalization of autonomic balance after treatment (%)93%7%
Restore daily chronoligical after treatment (%)93% 7%
The lack of affective disorders100%25%
Relapse within one year (%)0%75%
Remission during the year (%)100%25%

Table 2
The dynamics of quality of life on this method of treatment (study group) compared with standard therapy (control group)
Scale SF-36Before the treatmentAfter the treatment
the main groupthe control group
Physical functioning (PF)68,2±6,496,0±14,2*65,7±7,0
Physically-role functioning (RP)54,1±5,690,0±13,8*52,1±8,9
Physical pain (BP) 69,3±6,7of 89.7±13,1*58,3±9,7
General health (GH)39,2±3,8*73,2±11,6*44,2±5,4
Vitality (VT)54,9±5,262,2±9,2of 58.9±6,0
Social functioning (SF)61,1±7,185,0±12,868,2±6,3
Emotional role functioning. (RE)63,3±6,065,0±10,064,5±6,1
Mental health (MH)63,3±9,582,3±7,870,8±3,9

Example 1. Patient B., 24, went to the polyclinic at the place of residence to the doctor-gastroenterologist 3.04.2009, with complaints of pain in the right hypochondrium, shooting character, radiating under the right shoulder that occurs after eating that occurs periodically, lasting at least six months with breaks.

Survey data: General analysis of blood, urine - without a pathology. EGD - without a pathology. Ultrasound of the gastrointestinal tract, gall bladder irregular shape.

Weg is consultative balance, including the daily monitoring of heart rate variability: RMSSD=11,4, LF/HF=6,4, testified sympathicotonia. Daily chronobiotic - offset acrophase, a decrease in the amplitude and mesara.

Data test questionnaires: HARS=15,8, HDRS=19,3. Quality of life (according to the questionnaire SF-36) is reduced by 1, 3, 4, 7, 8 scales.

Ultrasound ha with options. the breakdown. Conclusion - the signs of gallbladder dyskinesia in hypermotor type

The diagnosis of dyskinesia of the gallbladder on hypermotor type.

The patient received standard therapy duspatalin, and 1 time a day for 30 days azafen dose of 50 mg per day and magnetothermopower wavelength of 1.3 μm in the modulated mode, a frequency of 2.4 Hz minidocumentary nozzle 50 MT: sedation point GI 4 (30), toning (10) points E 25 E 36, 6 MS according to HRV about sympathicotonia) for 10 days.

Survey data after treatment. Clinical symptoms disappeared on the 3rd day.

Autonomic balance: RMSSD=26,2, LH/HF=1,5 (indicating that normotone); daily chronobiotic - normalization.

Data test questionnaires: HARS=3,8, HDRS=6,2. Quality of life according to the questionnaire SF-36 improved in all 8 scales.

Ultrasound ha with options. the breakdown. Conclusion - the contractile function of the gallbladder within the physiological norm.

During the year surveillance of recurrence was not.

Example 2. Patient K., 31, went to the polyclinic at the place of residence to the doctor-gastroenterolo is the 22.01.2009, with complaints of pain in the right hypochondrium, stabbing character, associated with food intake that occur periodically over 1.5 years.

Survey data: General analysis of blood, urine - without a pathology. EGD - without a pathology. Ultrasound of the gastrointestinal tract, gall - bladder with the bend in the neck.

Autonomic balance, including the daily monitoring of heart rate variability: RMSSD=12,1, LF/HF=5,8, testified sympathicotonia. Daily chronobiotic - offset acrophase, a decrease in the amplitude and mesara.

Data test questionnaires: HARS=15,2, HDRS=19,8. Quality of life (according to the questionnaire SF-36) is reduced by 1-4 and 8 scales.

Ultrasound ha with options. the breakdown. Conclusion - the signs of gallbladder dyskinesia in hypermotor type.

The diagnosis of dyskinesia of the gallbladder on hypermotor type.

The patient received standard therapy (duspatalin),

Survey data after treatment. Clinical symptoms disappeared on the 5th day.

Autonomic balance: RMSSD=12,6, LH/HF=5,6 (testified sympathicotonia); daily chronobiotic is unchanged.

Data test questionnaires: HARS=14,8, HDRS=18,6. Quality of life according to the questionnaire SF-36 is unchanged.

Ultrasound ha with options. the breakdown. Conclusion - the signs of gallbladder dyskinesia in hypermotor type.

After 3 months, the patient relapsed.

Thus, the application of the proposed method for the correction obiazatelen systems of the body, in particular, mental status, autonomic balance, daily chronobiotics, accompanied by persistent normalization contractility ha, promotes edema clinical manifestations of the disease, lengthen remission, reducing the frequency of relapses, improve the quality of life of patients during treatment, JP.

The way to improve the quality of life and treatment of patients with dyskinesia of the gallbladder, including medication, characterized in that additionally taking into account the severity of anxiety and depressive disorders according to the scale of Hamilton to assess anxiety HARS and scale of Hamilton, to assess depression HDRS prescribed antidepressant azafen when clinically defined disorders in a dose in the dose of 75 mg per day, expressed in subclinical affective disorders in a dose of 50 mg per day for 30 days and taking into account individual peculiarities of vegetative balance are magnetothermopower wavelength of 1.3 μm in the modulated mode, a frequency of 2.4 Hz minidocumentary nozzle 50 MT 10-30 with one biologically active point for 10-12 procedures; and in the case of sympathicotonia seatrout point GI 4 and tone tocha E 25 E 36, 6 MS; if vagotonia tone up the point GI 4 and seatrout point E 25 E 36, 6 MS.



 

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6 cl, 19 ex, 1 tbl

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2 ex

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6 cl, 3 ex, 3 dwg

FIELD: medicine.

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1 ex, 2 tbl

FIELD: medicine.

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1 ex, 2 dwg

FIELD: medicine.

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EFFECT: method ensures evident and permanent clinical effect with no thyroid tissue destruction with minimum tissue injures, provides achieving gradual regress of pathological process in tissues and its replacements by normal thyroid epithelium with no destructive changes, reducing risk of specific postoperative complication in the form of bleeding.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, also can be used in treating patients with solid tumours. For this purpose, 1-2 days prior to the initiation of chemotherapeutic procedures, a preparation of marrow mesenchymal stem cells coated with perfluorocarbon nanoparticles produced by incubation in a medium containing a pharmaceutically acceptable aqueous perfluorocarbon nanoemulsion of a particle diameter 300 nm and less is introduced to a patient intravenously in dose 0.5-10·106 cell/kg. Then the chemotherapeutic procedures follow with underlying oxygenated gas mixture inhalations at normal or high pressure.

EFFECT: method provides effective growth inhibition and reduced tumour size, including ensured by increasing tumour cell sensitivity to chemopreparations.

9 cl, 4 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely devices for temperature control of skin surface and biotissue subcutis. The device comprises a laser emitter, a working chamber and a gas system, a fluid tank and temperature regulation system, a mixing chamber, a fluid injection system into the mixing chamber, fluid supply channels into the injection system, a suction system, withdrawal channels for gas and fluid pumped-out by the suction system from the working chamber. A gas flow is supplied into the mixing chamber from the gas system for atomisation and formation of a gas-drop mixture supplied into the working chamber. On top, the chamber is formed by an optical window transparent for working radiation in a laser pathway, by a skin surface at the bottom and by walls on each side. A gap thickness between an internal surface of the optical window and a skin surface is d≥4 λ\α, while fluid temperature in the chamber is specified as Tf≥Tsur[1+λe/(αδe)]-[λe/(αδe)]T0, where λe, δe are a heat conduction coefficient and a skin surface thickness respectively, α is a skin surface thermal conductivity coefficient, T0 is initial skin surface temperature, Tsur is required skin surface temperature. Gas temperature in the working chamber is 5-20°C higher than fluid temperature. The fluid is skin neutral and has a boiling point exceeding body temperature.

EFFECT: use of the invention enables more efficient and uniform cooling of a skin surface area and improving result stability of temperature control of a skin surface.

2 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: method involves dietotherapy that is M.I. Pevzner's diet No. 5, therapeutic exercises and oral administration of the preparation Enterosan. Enterosan is dosed one capsule 5 times a day after meals for 2-3 weeks. The administration is combined with general magnetotherapy. That is ensured by exposure to low-frequency traveling pulse magnetic field of frequency 100 Hz and magnetic induction gradually increasing within 10 % to 80 % from the maximum value 3.5 mT. The magnetic field is directed forward - backward - forward. Exposure time is 20-25 minutes. 4-5 procedures are performed every week. The therapeutic course is 8-10 procedures.

EFFECT: method provides intensification of general and hepatic haemodynamics, improvement of bile production and secretion processes, elimination of inflammatory process, normalisation of a gastric and pancreatic secretory function, correction of motor-evacuation and microbiotic intestinal disorders, lower lipid peroxidation activity and stimulation of antioxidant system activity.

2 ex

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