Method of treating patients suffering from cholelithiasis following gall bladder surgeries

FIELD: medicine.

SUBSTANCE: method involves a dietary therapy, taking mineral water in an amount of 100-150 ml, 3 times a day and exposure to a physical factor. What is used is the Pevzner's diet No. 5. Karachinskaya chloride-hydrocarbonate sodium gas-free mineral water of total mineralisation up to 3 g/dm3, at a temperature of 38-40°C is taken 30-40 minutes before a meal. The physical factor represents a magnetic laser therapy and an EHF therapy. The contact magnetic laser therapy covers three zones sequentially at a frequency of 5 Hz: an epigastric zone and the right and left upper hypochondria along the midclavicular lines, for 4 minutes for each zone within the course of 10 procedures. The EHF therapy involves combined exposure on two projection zones: in the right hypochondrium and on the sternum generated by a broadband noise emitter at an emission frequency of 40-63 GHz, for 20 minutes, every day within the course of 10 procedures.

EFFECT: method provides more effective rehabilitation treatment following endoscopic cholecystectomy ensured by the early integrated therapeutic exposure.

2 ex, 4 tbl

 

The invention relates to medicine, namely to physical therapy and gastroenterology, and can be used for prevention and complex treatment of patients with gallstone disease in the early postoperative period after endoscopic cholecystectomy.

At the present time will not be excessive exaggeration to admit that the world is experiencing an epidemic of gallstone disease (ICB). Every fifth woman and every tenth man in the gallbladder revealed concretions.

Among patients with complaints characteristic of biliary dyspepsia, incidence of biliary sludge reaches 24,4%to 55%. Removal of the gallbladder does not relieve patients from metabolic disorders, including hepatic cell dasholi, changes in the chemical composition of bile (lithogenicity); in the postoperative period violated the passage of bile into the intestine may develop dyskinesia sphincter of Oddi, excessive bacterial growth in the intestine syndromes maldigestion, malabsorption. Continuing dyslipoproteinemia and biliary hypertension, according to PA Grigorieva, AP Yakovenko, N.A. Agafonova with co-authors (2004) do not exclude recurrence of the disease.

Closest to the proposed method is a method of treating conditions after cholecystectomy (as laparotomic and endoscopic (EN 2204980 C1 2705.2003)), including the appointment of a diet Pevzner, internal reception of mineral water in 100-150 ml 3 times a day, and the impact of physical factors, carry out electrophoresis. However, the known method is applied in the later postoperative period, because technically run at kapitalizirovana wound process does not impact on all stages of pathogenesis of postoperative States, does not provide a systematic approach in the appointment of physiotherapeutic methods of correction. The reduction of coverage patient rehabilitation activities after cholecystectomy is a prerequisite for the development of late post-operative complications and secondary cholelithiasis.

Oral litolitic therapy is the only effective pathogenetic therapy treatment JCB as during camminatiello, and after removal of the gall bladder. For dissolution of stones used drugs bile acid, ursodeoxycholic acid and chenodeoxycholic acid. However, strict criteria for the selection of patients make this method available for approximately 15% of patients. All this causes some dissatisfaction with the results and contributes to finding new treatments for patients with this pathology.

New technical problem - increasing the effectiveness vosstanovitelnoj the treatment of patients with GCB after endoscopic cholecystectomy due to prevention of recurrence of stone formation through the use of medical facilities in the early stages after surgery.

To solve the problem in the treatment of patients with gallstone disease after surgery of the gallbladder, including clinical nutrition, appropriate diet №5 Pevzner, internal reception of mineral water in 100-150 ml, 3 times a day and the effect of the physical factor, as mineral water will hold the reception chloride-hydrocarbonate sodium mineral water Karachinsky, General mineralization of up to 3 g/DM3, degassed, the temperature of 38-40°C for 30-40 minutes before meals, as well as the physical exercise factor the impact of magnetic therapy and EHF-therapy, while magnetic therapy effect with a frequency of 5 Hz, contact, successively into three zones: zone epigastria and on the right and left hypochondrium for crenelations lines, 4 minutes each, for a course of 10 treatments, and EHF-therapy is carried out by simultaneous exposure to two projection zones: in the right hypochondrium and on the sternum area broadband noise oscillator with frequency radiation 40-63 GHz, for 20 minutes, every day, for a course of 10 treatments.

The method is as follows: on the background of gently-training mode and therapeutic limited supply of products, providing chemical, thermal and mechanical irritation of the mucous recommended by the Institute of nutrition the Russian Academy of medical Sciences (corresponding to a diet №5 Pevzner), assign: internal reception mineral chloride-hydrocarbonate water, total mineralization of up to 3 g/DM3(Karachinsky), degassed 3 times a day for 30-40 minutes before eating a temperature of 38-40°C 100-150 ml on admission for treatment; laser therapy apparatus "MILTA-f" consistently for 3 zones: zone epigastria, left and right hypochondrium on crenelations lines of contact, with a frequency of 5 Hz, for 4 minutes on each zone, for a course of 10 treatments; EHF-therapy apparatus "SEM-TESN-BF" performed by simultaneous exposure to 2 projection zones in the right hypochondrium and the sternum area broadband noise emitter frequency 40-63 GHz (emitters marked: No. 4), 20 minutes daily for a course of 10 treatments.

Physical factors used in the implementation of treatment method, ensure the restoration of the functional state of the biliary tract, while increasing the adaptive capacities of the organism, have a powerful reparative action, anti-inflammatory and analgesic effect.

A distinctive feature of the proposed method is the use of two factors in the early postoperative period. The technical result of the proposed method is an improvement in functional activity hepatosis is the prison system, elimination or reduction of the signs of disadapted.

The mode method is based on the analysis of the results of clinical observations.

The proposed method has been applied in clinical practice 50 patients aged 54,7±3.7 years, the ratio of the floor 4:1 (women/men). The comparison groups were matched for sex, age and clinical laboratory values.

The main group (1 gr.) consisted of 25 patients treated with the inventive method of complex treatment. As a control group were patients (n=25)received a similar core group treatment, but without the use of EHF-therapy (2 g.).

Before treatment all patients in the study of General and biochemical blood tests, liver ultrasound, ECG, the study of emotional tolerance tests Luscher and SF-36 for indicators of changes of personal-emotional, autonomic nervous system health and availability of stress.

Tolerability and therapeutic efficacy of the complex was estimated on the basis of the dynamics of clinical symptoms, indicators of functional activity of the liver and biliary system (laboratory data), the level of reactivity of the organism (Garkavi LH et al.), psychological testing. The immediate effectiveness of the treatment, expect what was the number of patients with positive treatment outcomes ("improvement" and "significant improvement") according to clinical and laboratory research.

The main complaints of the patients were pain or heaviness in the right hypochondrium and epigastrium, bitter taste in the mouth, heartburn, violations of the chair, weakness, emotional lability.

The research results presented in table 1 show that in the group of patients treated by the claimed method marked with higher efficiency compared to the control, indicating a positive impact of the ongoing rehabilitation activities.

Thus, all patients of the first group there was a positive dynamics of clinical symptoms. In the control group dynamics of clinical complaints were similar, but the importance of reducing the intensity of clinical symptoms was lower (p=0.006).

On the background of the treatment was noted positive dynamics of laboratory indicators: decreased to normal levels of AST, Alt, GGT and alkaline phosphatase (table 2), with more pronounced trend was observed in the study group (p=0,005-0,001)compared with the control group (p=0,05-0,01).

The analysis of the dynamics of indicators of psychological status (table 3) according to the test (test SF 36) showed improvement on scales "physical functioning", "social functioning", "General health", "mental health", "vitality" (p<0,05).

When analyzing the dynamics of adaptati is the R of the body revealed the following: increase in the number of patients with a high level of reactivity after treatment in the main group was 23.7%, in the control group was 17.7% (table 4).

The immediate effectiveness of the treatment, the calculation of which takes into account only the indicators of "significant improvement" and "improvement"in the main group was 90.5 per cent, which was higher than in the control group (76,4%). Analysis of the structure efficiency also revealed differences. So, in the main group the number of patients with "significant improvement" was 64.5 per cent in the control group - 47,7%. This indicated a more favorable prognosis for the ongoing rehabilitation activities in the main group.

In the available scientific and medical and patent literature information about the popularity of the treatment for patients in the early postoperative period after endoscopic cholecystectomy about GCB the claimed method no. Thus, the claimed invention meets the criterion of "novelty".

The authors proved that a comprehensive rehabilitation treatment using laser and EHF-therapy in complex with mineral waters treatment provides improvement in functional activity of the hepatobiliary system, the processes of adaptation and emotional state. Thus, the claimed invention meets the criterion of "inventive step".

The proposed method is illustrated by the following clinically and examples.

Example 1.

Patient Z. 44 years old, he enrolled in the Department of rehabilitation Clinical hospital №81 with a diagnosis of JCB. Acute calculous flegmonoznih cholecystitis. Hydrops of the gallbladder. Condition after laparoscopic cholecystectomy.

From the anamnesis: considers himself to be the patient for more than 5 years, when ultrasound detected stones in the gall bladder. Clinic biliary dyspepsia if the errors in diet, physical activity. In the surgical hospital was admitted urgently to hospital biliary colic, ultrasound - fixed a stone in the neck of the gallbladder, perivesical thin liquid layer effusion.

Discharge from hospital on day 6 after surgery with the recommendations of the surgeon in the outpatient setting. The patient was worried about the pain and heaviness in the right hypochondrium, bitter taste in mouth, nausea, noted headaches, drops in blood pressure, total depression.

Biochemical blood test: Alat 84 u/l, AST 69 u/l, GGT 76 u/l, alkaline phosphatase 130 IU/L. Lymphopenia to 11%. HELL 150/100 mm Hg, BH 17 minutes

Were assigned to the treatment in accordance with the claimed method, namely: gently-training regime and healthy food with a limit of products, providing chemical, thermal and mechanical irritation of the mucous recommended by the Institute of nutrition of Russian Academy of medical Sciences (corresponding to a diet №5 Pevzner), internal pickup the mineral chloride-hydrocarbonate water, General mineralization of up to 3 g/DM3(Karachinsky), degassed, temperature +38 to+40°C, 3 times a day for 30-40 minutes before meals, 100-150 ml on admission for treatment; laser therapy apparatus "MILTA-f" consistently for 3 zones (zone epigastria, left and right hypochondrium on crenelations lines), contact with a frequency of 5 Hz, 4 min on each zone, for a course of 10 treatments; EHF-therapy apparatus "SEM-TESN-BF" through simultaneous exposure to 2 projection zones in the right hypochondrium and on the sternum area broadband noise emitter frequency 40-63 GHz (emitters marked: No. 4), 20 minutes daily for a course of 10 treatments; a break between the treatments was at least 40 minutes.

Treatment the patient was well tolerated, on the 3rd day from the start of treatment observed decrease in the severity of pain and dyspeptic syndrome, on the 7th day were relieved of pain in the right hypochondrium, bitter taste, nausea. By the end of the course the transaminase levels were determined in normal lymphocytes in the General analysis of blood increased to 27%, indicating that increasing adaptive capacity, decreased load on the cardiovascular system in the form of relief of symptoms and reduction of the index of the heart. Assessment criteria the treatment is consistent with gradation "value is positive improvement". Assessment of psychosomatic status revealed positive dynamics of indicators characterizing the level of well-being, physical activity, health and mood (p<0,05).

Example 2.

Patient D. 50 years old, he enrolled in the Department of rehabilitation Clinical hospital №81 with a diagnosis of JCB. Chronic calculous cholecystitis. Condition after laparoscopic cholecystectomy.

Was admitted with complaints of discomfort in the right hypochondrium in the last two years. Conducted routine cholecystectomy, postoperative nausea, flatulence, violations of the chair, not associated with an error of diet, severe asthenia.

Biochemical analysis of blood: bilirubin total 24 g/l, Alat 51 u/l, AST 47 u/l, GGT 40 u/l, alkaline phosphatase 128 IU/L. Lymphopenia to 15%. HELL 140/80 mm Hg, BH 16 in minutes

Were assigned to the treatment in accordance with the claimed method, namely: gently-training regime and healthy food with a limit of products, providing chemical, thermal and mechanical irritation of the mucous recommended by the Institute of nutrition of Russian Academy of medical Sciences (corresponding to a diet №5, Pevzner), internal reception mineral chloride-hydrocarbonate water, total mineralization of up to 3 g/DM3(Karachinsky), degassed, temperature +38 to+40°C, 3 times a day for 30-40 minutes before a meal 100-150 ml on admission for treatment; laser therapy apparatus "MILTA-f" consistently for 3 zones (zone epigastria, left and right hypochondrium on crenelations lines), contact with a frequency of 5 Hz, 4 min on each zone, for a course of 10 treatments; EHF-therapy apparatus "SEM-TESN-BF" through simultaneous exposure to 2 projection zones in the right hypochondrium and on the sternum area (Appendix 1) broadband noise emitter frequency 40-63 GHz (emitters marked: No. 4), 20 minutes daily for a course of 10 treatments; the break between the treatments was at least 40 minutes.

By the end of the course of treatment of patient complaints were not filed. Indicators of the biochemical analysis blood was determined in the normal range, the level of lymphocytes increased. Assessment criteria the treatment is consistent with gradation "significant improvement". Assessment of psychosomatic status showed a positive trend for all indicators (level of well-being, physical activity, health and mood (p<0,05)).

Thus, the claimed method of treatment shows a high therapeutic effect and pathogenetic validity due to the relief of clinical symptoms, improvement and normalization of the functional state of the hepatobiliary system, enhancing the adaptive capacity of the organism is, in the absence of complications and side effects.

Way to easily reproduce in medical and sanatorium establishments, not expensive and when used gives a good therapeutic effect.

Table 1
Dynamics of clinical parameters of the patients on the background of a course of treatment, scores (M±M)
The studied parameterThe main groupThe comparison group
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
Pain3,1±0,71,6±0,5*3,2±0,50,9±0,3*
Bitter taste in the mouth2,9±0,031,3±0,05*2,8±0,011,8±0,03*
Nausea2,4±0,11,0±0,10*2,5±0,11,3±0,05*
N is a violation chair 2,1±0,041,1±0,05*2,0±0,31,5±0,04*
Symptoms of asthenia3,0±0,051,2±0,04*2,8±0,71,8±0,04*
* The significance of the differences of the indices before and after treatment (p<0,05)

Table 2
Dynamics of laboratory parameters of patients on the background of a course of treatment (M±m)
The studied parameterThe main groupThe comparison group
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
AST32,3±2,531,5±2,821,1±2,3****20,6±2,3***
Alat31,2±3,432,2±3,123,9±3,1**24,8±2,6*
SEL is CNA phosphatase 64,9±3,363,1±2,763,5±3,262,6±2,8
GGT36,2±2,434,7±2,135,8±2,135,2±2,2
The significance of the differences of the indices before and after treatment (p<0,05; ** - p<0,01; *** p<0,005; **** - p<0,001

Table 3
The dynamics of the psychological state of patients on the background of a course of treatment
The studied parameterThe main groupThe comparison group
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
Physical functioning74,6±0,01and 82.2±0,03*of 74.3±0,0180,1±0,05*
General health58,3±0,0575,5±0,02*58±0,05 66,9±0,03*
Social functioningto 75.1±0,0283±0,04*to 74.7±0,03to 81.9±0,04*
Mental health52,2±0,0167,5±0,03*51,7±0,0466,1±0,05*
Vitality59,1±0,0477±0,04*57,5±0,03to 72.3±0,05*
* The significance of the differences of the indices before and after treatment (p<0,05)

Table 4
Dynamics of indicators of treatment effectiveness (%)
The studied parameterThe main groupThe comparison group
Before the treatmentAfter the treatmentBefore the treatmentAfter the treatment
The level of reactivity61,284,955,8 73,5
The immediate effectiveness of the treatment90,576,4

A method of treating patients in the early postoperative period after cholecystectomy, including clinical nutrition, appropriate diet № 5 Pevzner, internal reception of mineral water in 100-150 ml, 3 times a day and the effect of the physical factor, characterized in that the mineral water will hold the reception chloride-hydrocarbonate sodium mineral water Karachinsky, General mineralization of up to 3 g/DM3, degassed, the temperature of 38-40°C for 30-40 minutes before meals, as well as the physical exercise factor the impact of magnetic therapy and EHF-therapy, while magnetic therapy effect with a frequency of 5 Hz, contact, successively into three zones: zone epigastria and on the right and left hypochondrium for crenelations lines, 4 minutes each, for a course of 10 treatments, and EHF-therapy is carried out by simultaneous exposure to two projection zones: in the right hypochondrium and on the sternum area broadband noise oscillator with frequency radiation 40-63 GHz, for 20 minutes, every day, for a course of 10 treatments.



 

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2 cl, 4 ex

FIELD: medicine.

SUBSTANCE: method involves reflex therapy (RT) alternated with taking general baths every second day. The RT is conducted by inserting needles into corporeal points and microneedles into auricular points of the systemic effect on the 1, 5, 9, 13, 17, 21 procedures and executing the electric acupuncture of the paravertebral points on the 3, 7, 11, 15, 19 and 23 procedures. If the patients shows predominating psychoasthenic symptoms, iodine bromine baths are taken. The baths contains potassium iodide 50 mg/l and potassium bromide 125 mg/l. Water temperature is 36-37°C. If the vegetative imbalance predominates in the patients, radon baths with the radon concentration of 40-80 nCu/l are taken. Water temperature is 26-28°C. That is combined with the following laser therapy. The laser therapy is generated by Mlada apparatus. What is used is a continuous infrared light at wavelength 0.85 mcm, total output power of the two emitters 30 mWt. The patient is exposed by the standard procedure. The exposure covers 4 fields: a collar, an apex of heart, a middle one-third of chest and a left infrascapular region. The exposure length is 1 minute from 1st to 3rd procedure, 2 minutes from 4th to 6th procedures, and 3 minutes starting from the 7th procedure.

EFFECT: method improves the psychoemotional state of the patients thereby normalising the vegetative balance, and improves the working efficiency.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to paediatrics, namely to otorhinolaryngology, and may be used in treating chronic tonsillitis in children's health centres, in-patient hospitals, polyclinics. The low-power laser light covers projections of palantine tonsils, namely an anterior lateral neck surface below a mandibular angle to the right and to the left. The laser light is generated at wavelength 0.89 mcm, constantly variable frequency 10 to 1,500 Hz by AZOR 2K-02 apparatus in the contact, stable mode. The exposure length is 1 minute per a field at pulse power 2-3 Wt/pulse daily; the therapeutic course is 7-8 procedures in 5-10-year-old children. The exposure takes 2 minutes per a field at pulse power 4-5 Wt/pulse daily within the therapeutic course making 9-10 procedures. Each physiotherapeutic procedure is preceded by tonsillar lacunae irrigation with sterile 0.9% normal saline using a Hartmann cannula. The method is safe by selecting laser light conditions in the children of various age groups.

EFFECT: method enables higher clinical effectiveness in chronic tonsillitis, prolonging remission, reducing a recurrence and complication rate, lowering the need for medical treatment, improving the quality of life in children and adolescents.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to prostate exposure apparatuses. The prostate exposure apparatus comprises a bevelled end hollow cylindrical body for the contact of its tip with an exposure area; the tip of the apparatus adjoins a laser source, a heating element, a temperature sensing element, an active electrode, and an indifferent electrode, an electronic unit, an inductor coil, and an ultrasonic assembly representing a piezoelectric radiator with an ultrasound concentrator in the form of a metal core that is an active electrode simultaneously; one end of the active electrode is led on the tip of the apparatus, while the other end is mechanically coupled with the piezoelectric radiator and connected to the electronic unit; the indifferent electrode also connected to the electronic unit is brought out of the body, while the inductor coil is configured so that the active electrode extends along an axis of symmetry; the piezoelectric radiator, targeted laser source, heating element, temperature sensing element and inductor coil are connected to the electronic unit.

EFFECT: due to the inductor coil and ultrasound emitter, the apparatus as compared to its prototype enables additional ultrasonic and magnetic field exposure on the prostate that improves the therapeutic effectiveness.

1 dwg

FIELD: heating.

SUBSTANCE: invention refers to therapeutic systems for releasing energy into the target point. A therapeutic system comprises a therapeutic module for induction heating of the target zone which is made with the possibility of measuring the temperature in the measurement field of the target zone, and a control module for therapeutic module control which is made with the possibility of creating a prior estimate of the induction heating before the energy releases basing on the measured temperature, the successive energy releases are divided by a cooling period. The control module is additionally made with the possibility of prior estimating the cooling period basing on the estimate of the induction heating before the energy releases and with the possibility of adjusting the cooling period basing on the cooling period estimate. Machine readable medium of the system contains a computer programme which is saved on it and, when implemented, order the therapeutic module to perform successive energy releases and includes instructions to create a prior estimate, adjustment of the therapeutic module and creation of prior estimate of the cooling period before the energy releases.

EFFECT: invention allows for improved accuracy of energy releasing into the target zone.

10 cl, 2 dwg

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