Method of treating peritoneal adhesions

FIELD: medicine.

SUBSTANCE: placenta hydrolyzate 1 ml mixed with lanolin 30 g before the procedure is applied on an anterior abdominal wall of a patient lying on his/her back in the projection of adhesions. That is followed by phonophoresis generated by UZT-1.07F ultrasonic therapeutic apparatus and sounded by an emitter of the diameter of 4 cm of the intensity of 0.4-0.6 W/cm2. The exposure mode is continuous; an emitter velocity is 1-1.5 cm/sec. The length of procedure is 5-7 minutes. The therapeutic course is 10 procedures.

EFFECT: reduced progression of abdominal adhesions and their manifestations by evident anti-inflammatory effect, reduced pain syndrome, higher adaptive body reserves.

3 tbl, 2 ex

 

The invention relates to medicine, in particular physiotherapy in the treatment and prevention of adhesive disease in patients operated for abdominal organs.

Adhesive disease (morbus adhaesivus) is a condition which is characterized by the formation of adhesions in the abdominal cavity and the pelvic connective tissue fibers. Recently the prevalence of adhesive disease in surgery and gynecology greatly increased. It is associated with many risk factors of modern adhesive disease pathogenesis.

The development of adhesive disease is preceded by appendicitis, inflammatory diseases of the pelvic organs, intestinal obstruction, peritonitis. The emergence of adhesive disease contribute to mechanical damage to the peritoneum and the serous membranes of the abdominal cavity, exposure to iodine, alcohol, antibiotics and antiseptics, talc. Adhesions formed after hemorrhage into the abdominal cavity during infection streamed blood, around foreign bodies, nasal packing, drainage. With long-term paresis of the intestine after injury abdominal adhesions are formed in the contact damaged the serosal surfaces of the abdominal organs and the parietal peritoneum. Especially severe adhesions happens after suffering peritonitis.

Among operations, leading vpos is estii for adhesive obstruction and intra-abdominal adhesions to the binding, the majority of authors have noted appendectomy - from 7 to 45% [Beburishvili A.G., Mihin IV, A. Vorobyev, Acinic A.N. // The Bulletin of the surgery. I.I. Grekov - 2004. - T, No. 2. - Ñ.38-40. Aglow CENTURIES, Prilepskaya V.N., 2007, Rudakova, E.B. et al., 2008].

Studies on the pathogenesis of adhesions formation showed that the main cause of adhesions - decreased levels of plasminogen activator within damaged peritoneum. Organization of fibrin occurs by the end of the first three days after exposure to traumatic agent, and if during that time have depression plasminogen activity and inhibition of local fibrinolysis, the formation of adhesions. Ischemic tissue damage during surgical exposure or when the inflammatory reaction of the peritoneum is a powerful factor depressing fibrinolysis tissue. Study of the parameters of the fibrinolytic activity in the portal vein and cubital veins showed that the intestine under physiological conditions is itself a modulator fibrinolytic activity. Therefore, the formation of adhesions of peritoneum also promote ischemic tissue damage organs, covered by the peritoneum associated with gross manipulation during operation [A. Vorobyev, Shaburishvili A.G. Surgical anatomy of the operated stomach and laparoscopic surgery for adhesions. - Volgograd: Publisher, 2001. - 24 S., Jancevski R.A. Adhesive disease. - M.: Medicine, 1989. - 192 S., Chekmazov I.A. Adhesive disease of the peritoneum. - M.: GEOTAR-Media, 2008. - 160 S.].

Also found that increased intracolonic pressure of more than 30 mm of water. Art. can be considered critical for microcirculation disorders of the intestinal wall. At the same time at the Central and splanchnic hemodynamics affects intra-abdominal pressure: increasing it to 200 mm Vogt significantly reduces the blood flow to the intestinal wall, and 400 mm Vogt is a critical figure pressure. This explains the possibility of adhesions when less invasive and traumatic laparoscopic interventions in the abdominal cavity [Beburishvili A.G., A. Vorobyev, main I.V., Popov I.S. // Endoscopic surgery - 2003. No. 1. - P.51-63., Beburishvili A.G., Mihin IV, A. Vorobyev, Acinic A.N. // The Bulletin of the surgery. I.I. Grekov - 2004. - T, No. 2. - Ñ.38-40].

Morpho-functional changes that occur when the adhesive process, which significantly affects the quality of life of patients, which makes the task of diagnosis and treatment of inflammation in a number of not only medical, but also an important social problems. Patients complain of pain in the abdomen, most often in the lower divisions, rarely in the epigastrium. Pains are constant and strong, less aching, iradionet in the lumbar region and the rectum. In women operated for about gin is oncologic pathology in the face of adhesions, impaired reproductive function, formed secondary infertility [I.V. main, A.G., Beburishvili, A.V. Gushul. - The treatment of pain forms adhesive disease of abdomen laparoscopically. - Bulletin of the Volgograd scientific center of Russian Academy of 2/2010. - p.40-44]. In gynecological practice is still relevant search highly effective means of influence on adhesions. It is known that the sclerotic process in the connective tissue is a consequence of immune inflammation in type hypersensitivity reactions of the delayed type. If the acute inflammatory process in the first place are alterative and vascular and exudative changes, when chronic, proliferative, culminating in the formation of connective tissue, i.e. sclerosis [ADO ROAD, Ishimov L.M., 1980]. One of the key elements in the formation of a productive process of inflammation in the connective tissue is to stimulate the function of fibroblasts macrophage cytokines [Smirnova LI, 2006; Streltsov O.S, Krupin, VN, 2008]. Factor that activates macrophages and their production of various cytokines, including fibroblast growth factor, is an endotoxin produced in the process of life and especially in death of opportunistic gram-negative microorganisms [Sidorov, I.S., Sheshukova A, 2003; Sidorov, I.S., Ovsyannikova T.V., 2006]. Obviously, for the treatment of sclerotic process in the abdominal cavity requires a complex effect on the formed connective tissue for the purpose of its resorption and inflammatory process, causing its formation.

There is a method of treatment of adhesive disease by electrophoresis lidz. With the patient lying on the back electrode area of 150-250 cm2placed in the area of projection of adhesions in the abdominal cavity and connected to the positive pole "+". The second electrode have in relation to the first cross on the back, similar to the first square, and connect to the negative pole "-". The dry preparation Lidz 64 UNITS dissolved in 30 ml of acidic buffer solution and applied to filter paper with the positive electrode. Current is 10-15-20 mA, duration of treatment 20 minutes [of the Techniques and methods of physiotherapeutic procedures. - A Handbook, edited by V.M. hierarchy. - Moscow. - 2009. - p.32-33].

This method has anti-inflammatory effect, reduces the proliferative activity of mesenchymal tissue and has a resolving effect. However, this method has a weak absorbing effect, which is manifested only in a slight decrease of pain syndrome, adhesive p is ocess continues to spread to the surrounding tissue, procedures must be repeated many times.

The closest in technical essence is a method of treating adhesive disease using phonophoresis of hydrocortisone. Take 1% hydrocortisone ointment or emulsion of the following composition: 5 ml suspension hydrocortisone, 25 g of vaseline and lanolin. The ointment is applied to the anterior abdominal wall above the projection of adhesions. The position of the patient is lying on his back. Scoring is conducted by the intensity of 0.2-0.6 W/cm2, continuous or pulsed. The procedure 5-7-10 minutes. The course consists of 10-15 procedures, which are conducted three times with an interval of 3 months [Clinical physiotherapy. - Sosin I.N., Tondi L.D., Sergiani E.V., Palamarchuk, A. and others - Kiev. - Health. - 1996 - str]. This method improves the metabolism and the blood supply to the underlying tissues, reduces perineurally swelling, thereby decreasing pain. Ultrasound prevents fibroplastic the transformation of the tissues, preventing the formation of adhesions, reducing the exudative extra - and intracapillary processes. As a result, reduces inflammation, suppressed immunopathological reaction that leads to pain. In the tissues improves protein metabolism and enzymatic processes.

However, this method has drawbacks:

as a representative of the group of glucocorticoids hydrocortisone have the t pronounced immunosuppressive effect, contributing to the appearance of purulent complications (especially in conditions of inflammation of the peritoneum) and the decrease of the degree of reparative processes;

- adhesions in the abdominal cavity does not disappear;

- pain is stored in the form of chronic pain, which is renewed under provoking circumstances: colds, heavy physical labor, intercurrent diseases;

- impact methodology 6-12 months after diagnosis of adhesive disease do not achieve positive clinical dynamics.

The objective of the invention

Improving the efficiency of treatment of adhesive disease of the abdominal cavity by reducing the development of fibrous connective tissue changes and restoration of adaptive reserves of the patient.

This object is achieved by a method for the treatment of adhesive disease after surgical interventions on the organs of the abdominal cavity, including the application to the anterior abdominal wall drug and the conduct of phonophoresis.

As a drug take 1 ml of the placentae, which before the procedure is mixed with 30 g of lanolin. With the patient lying on the back put the tool on the anterior abdominal wall above the projection of adhesions. Spend phonophoresis from the ultrasonic therapy apparatus UST-1.07 F. with the sound from the transducer diameter is 4 Ohm cm intensity of 0.4-0.6 W/cm 2the continuous mode, the speed of the emitter 1-1 .5 cm/sec, the procedure for 5-7 minutes, in the course of 10 treatments.

The novelty of the method

First proposed the use of a solution of placentae for holding phonophoresis with adhesive disease.

The technical result

The method allows to reduce the progression of adhesive disease and its manifestations, to prevent its formation in the early recovery period after surgery in the abdominal cavity. To eliminate the pain.

The proposed method prevents the development of clinical manifestations of adhesive disease due to:

- reduce inflammation at the site of the surgical field or chronic inflammation in the abdominal cavity;

- the elimination of adhesions, which is confirmed by ultrasound examination;

- improve the adaptation of the patient.

The selection criteria of ultrasonic treatment on the anterior abdominal wall above the projection of adhesions was the mechanism biophysical impact factor and anatomical proximity of the peritoneum, where you can enter the medicinal substance. Ultrasonic vibrations penetrate to a depth of 6-9 cm, reaching the peritoneum and the abdominal region under the emitter. The mechanical vibrations are transferred to the cells and tissues in the form of a micro-massage due to the cavitation effect. In the area in which the effects dilate the blood vessels, in them increases blood flow, increases the intensity of biochemical and metabolic processes, the local temperature. Significantly increases lymph circulation in the tissues, accelerates regeneration processes, immunological activity due to cavitation ("cellular massage") component of therapeutic mechanism of action of ultrasound. In subject bodies-rich fluids (blood, lymph, muscle tissue), amplification of diffusive processes, the rate of biochemical reactions that cause temperature gradients, resolve edema, infiltrates, exudates, hemorrhages. Are resorption of scar tissue. With the introduction of ultrasound medicinal substance will produce a greater analgesic and anti-inflammatory effect [V.S. ulaschyk. - Physiotherapy / universal medical encyclopedia / Book house. - Minsk. - 2008 - 488-481 C.]. Pathological changes in the tissues are eliminated primarily congestion, reduced perifocal edema, reduced inflammatory and autoimmune reactions, strengthens the barrier function of lymphoid tissue. At the same time amplification enzyme and free radical processes, increases the content of bioactive compounds in free form. Shifts in transcapillary exchange, pronitsaemostyami barriers, metabolism of biologically active compounds, including cyclic amp and prostaglandin, which positively affects the course of regenerative and immune processes, functions immunocompetent tissue, oxidation-reduction reactions, tissue respiration, and oxygen homeostasis, inhibiting inflammation [Mgorobets, GN. Ponomarenko. - Handbook on electromagnetotherapy. - Hippocrates. - 2002. - s-185].

Procedures were released from the ultrasonic therapy apparatus UST-1.07 F. generating mechanical vibrations frequency 0,88 MHz in the performance of compliance to technical specifications 92-0482101.012-90, 1992 issue No. 1129, , Maloyaroslavets.

The criterion for selecting a solution placentae steel properties of the drug, accessibility and ease of use. Thus, sterile 100% solution of the hydrolyzate of the placenta contains:

peptides - high biological properties of the placentae are largely determined by the presence of short-chain peptides with unique structure, which play an important role in maintaining homeostasis (tissue biochemical equilibrium) and the regulation of many vital processes of the General nature such as growth, differentiation and regeneration of cells. Mucopolysaccharides - polymer carbohydrate-protein complexes with carbohydrate content part (70-80%). The most is its widely represented in the connective tissue and certain body fluids.

The main representatives of mucopolysaccharides, hyaluronic acid, heparin, keratolytic, chondroitinase acid (part of the cartilage).

Due to its ability to bind and retain water mucopolysaccharides determine the elasticity of the connective tissue joining ligaments. Mucopolysaccharides perform locomotor function, have antibacterial properties.

The main functions of mucopolysaccharides - supporting, protective and regulatory.

Hyaluronic acid. Has the ability to attract and hold around a large number of water molecules. Concentrating, water gives extra volume. As "swaps" cells from the inside, making them more strained and taut.

Amino acids are the structural chemical units or "building blocks"that make up proteins. The importance of amino acids is determined by the enormous role played by proteins in all life processes. In humans, many amino acids are synthesized in the liver. However, some of them cannot be synthesized by the body. These essential amino acids are histidine, isoleucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine.

Histidine protects the structure of the mucous membranes from the damaging effects of radiation, contributes to the evegeniu heavy metals.

Isoleucine is necessary for hemoglobin synthesis, stabilizes and regulates blood sugar levels, restores muscle tissue.

Lysine promotes the absorption of calcium is involved in the synthesis of antibodies, hormones, enzymes, collagen formation and tissue repair, has an antiviral effect.

Methionine helps the processing of fats, preventing their deposition in the liver and in the walls of arteries, destroys toxic metals, reduces muscle fatigue, protects from the effects of radiation necessary for synthesis of nucleic acids of collagen. Phenylalanine is necessary in the treatment of metabolic disorders. Threonine helps to maintain normal protein metabolism in the body. Important for the synthesis of collagen and elastin, helps the liver and is involved in the metabolism of fats, stimulates the immune system.

Valine is required for repair of damaged tissues of the abdominal region and to maintain normal metabolism of nitrogen in them.

Liposomes are artificial education, intended for use as a unique carriers (vectors) of drugs. In many cases, the medicinal substance entered traditionally, does not provide the desired action due to low bioavailability. Liposomes containing the medicinal substance, deliver it to the exact address that the warranty is no maximum therapeutic effect.

These components of the placenta is cellular nutrition, which normalizes the transmission of nerve impulses, increases blood circulation and lymph flow, stimulates cellular respiration, i.e. activates every cell in the body, restoring its functional state to normal [Deriglazova N.A., 2006, L.G. Kozyreva, 2005]. The drug placentae obtained from the placenta of cattle, developed by a team of creators and scientists on the basis of production "Company yalma when overflowing with subsequent laboratory and clinical testing center of plastic surgery and cosmetology MOH of Russia (certificate No. SSES. EN. The CSCS. 158 State register № ROSS RU. 0001.510346. Protocol No. 46 dated 19.09.2003. Cover letter from 26.08.2003, San. the epidemiological. the bookmark. No. D. from 01.10.2001, the Conclusion of the Institute of plastic surgery and cosmetology MOH of Russia dated 19.09.2003).

The use of the exposure method of phonophoresis solution of placentae in patients with peritoneal commissures allowed to obtain new result:

By the end of treatment was stopped pain syndrome in patients of the main group (tables 1 and 2), while the patients of the control group, there was only a decrease (p<0,001).

- The disappearance of signs of adhesions on ultrasound examination of abdominal cavity organs (table 3) after a course of therapy for the implemented method, while in the control group were detected signs of preservation of adhesions (p<0,001).

- Absence within 2 years of the adhesive disease manifestations in patients of the main group, in contrast to relapse several times a year in patients of the control group.

The method is as follows

For the treatment of adhesive disease after surgical interventions on the organs of the abdominal cavity is performed on the area of adhesions phonophoresis of placentae over the projection of adhesions in the abdominal cavity from the ultrasonic therapy apparatus UST-1.07 F. Take 1 ml of concentrated solution of placentae and mixed with 30 g of lanolin before the procedure. The ointment is applied to the anterior abdominal wall above the projection of adhesions. The position of the patient is lying on his back. Sound is conducted from the emitter with a diameter of 4 cm intensity of 0.4-0.6 W/cm2the continuous mode. The speed of the emitter 1-1 .5 cm/sec. The procedure for 5-7 minutes. The course consists of 10 sessions.

The study included 75 patients diagnosed with peritoneal commissures in age from 28 to 67 years of age, treated by the present method, which formed the core group (of which 56 women and 19 men). All patients were operated on earlier in the abdominal cavity: 9% about calculous cholecystitis, 17% about the injuries of the abdomen, 5%regarding gastric ulcer, 39% regarding caesarean section, 30% regarding inflammatory diseases of the pelvic organs in women.

The control group consisted of 75 people (49 women and 26 men), the same age with the same diagnosis who received treatment according to the prototype. All patients were operated on earlier in the abdominal cavity: 12% about calculous cholecystitis, 11% about the injuries of the abdomen, 9% about stomach ulcers, 41% regarding caesarean section, 27% about inflammatory diseases of the pelvic organs in women.

All patients were examined before and after treatment, ultrasound examination of abdominal cavity organs. Ultrasonography was performed on the ultrasonic Honda HS-2000, equipped with multifrequency transducers linear and convex, operating at frequencies respectively 6,0-7,5-9,0 MHz and 2.8 to 3.5-5.0 MHz. When ultrasound was assessed primarily echogenicity (tissue density), echoes and level of vascularization (supply of blood vessels) bodies. Recorded signs of adhesions in the abdomen, the pelvis: the deviation of the uterus, dystopia ovary (smartness, pripadnost to the edge of the uterus) and blurring its outline, visualization adhesions, inflammatory infiltrates.

The purpose of objectification dynamic assessment of pain severity of pain was assessed by the visual the second analog pain scale (VAS). YOUR is the length of 100 mm in length, depicted on a clean sheet of paper, where the start point of the segment (indicated by the "0"means the absence of pain, the end point of the segment (marked "100") means the unbearable intensity of pain.

Patients were asked to evaluate pain, making a mark on a piece. Pain intensity is measured in mm: mild pain in YOUR segment corresponds to 20 mm (1-2 points), discomfort from 20 to 40 mm (3-4 points), annoying pain - cut from 40 to 60 mm (5-6 points), more than 60 to 80 mm - severe pain (7-8 points), more than 80 mm - unbearable level of pain (9-10 points) [Brevik N., et al., 2008]. Given that this assessment of pain requires from the patient's visual-figurative thinking, was also used verbal rating scale of pain, so that patients the best to objectify pain. Verbal rating scale contains a number of words describing the power of pain: no pain (1), lightweight (2), uncomfortable (3), annoying (4), heavy (5), intolerable (6). Rating strength pain is the ordinal number of the selected definitions [Pavlenko, S. and coauthors, 2002]. Both scales are comparable with each other.

The immediate efficacy of treatment was evaluated according to the following criteria: reduction in abdominal pain (10-point visual analogue scale and a 5-point verbal rating scale), CTE is Yeni severity of inflammation and adhesions in the abdominal cavity by ultrasound. To determine the tolerability of physiotherapy was carried out diagnosis of the type of adaptive response by L. Garkavi [Garkavi LH anti-stress response and activation therapy: Part 1. / LH Garkavi, E.B. Cucina, I.E. Kuzmenko, A.I. salanova - Ekaterinburg, RIA "Philanthropist". - 2002, 196 S.].

The results showed that the proposed method has a pronounced positive effect on the reduction of adhesions and inflammation in the abdominal cavity with an adequate response to treatment of adaptation reserves patients.

As can be seen from tables 1, 2, 3, under the effect of phonophoresis solution placentae over the projection of commissural changes of the abdominal cavity in patients with adhesive disease is a resorption of solderings, liquidated inflammatory process, docked pain syndrome, which proves the high therapeutic effect of the proposed method.

Control Group (n=75)
Table 1
The intensity of the pain in YOUR patients of two groups before treatment and after treatment (X±Δ)
Indicator of painBefore the treatmentAfter the treatment
The main Group (n=75)The main Group (n=75)Control Group (n=75)
Points4-74-703-4

Table 2
Verbal rating scale in patients of the two groups before and after treatment (X±Δ)
Indicator of painBefore the treatmentAfter the treatment
The main Group (n=75)Control Group (n=75)The main Group (n=75)Control Group (n=75)
Points3-43-402-3

Before the treatment
Table 3
The performance of ULTRASONIC research of organs of the abdominal cavity before and after treatment in two groups (X±Δ)
IndexAfter the treatment
The main Group (n=75)Control Group n=75)The main Group (n=75)Control Group (n=75)
Visualization of adhesions++-+
EchoLocally raisedLocally raisedOkayLocally raised
The presence of infiltratesDefineDefineNot definedDefine

The type of adaptive response by L. Garkavi on the background of phonophoresis of placentae in patients of the main group met response training (number of lymphocytes within the lower limit of normal: 24-26%, segmented leukocytes in the upper half of zone regulations: 58-63%, the total number of leukocytes, eosinophils, stab, monocytes - normal). At the same time in the control group, the type of adaptive response by L. Garkavi appropriate what was esteval acute stress, which is characterized by leukocytosis, reasinable, lymphopenia, neutrophilia. (Lymphocytosis less than 20%, leukocyte count of more than 9000, eosinophils - 0, stab - norm and more segmented, more than 65%), which retains the prerequisites for the formation of adhesions.

EXAMPLE No. 1. Patient R., 31 year history No. 004315, clerk, was admitted to outpatient treatment in physiotherapy in may 2009 with a diagnosis of adhesive disease. The syndrome of chronic pelvic pain. Secondary infertility. Syndrome fetal loss. Complaints at admission: moderate intensity dragging pain in the abdomen and lumbosacral region, without irradiation, more to the right, with a duration of about one year, score YOUR pain - 40 mm; verbal rating scale - 4 points, fatigue, headaches, meterability, reduced emotional background, tearfulness, insomnia. Illness: NDC hypotonic type with puberty. Chronic tonsillitis, chronic sinusitis for about 10 years, without exacerbation. Heredity: maternal uterine fibroids without indications for surgery. Menstrual cycle: menstruation for 12 years, was installed immediately, 5-6 days, moderate, painful on the first day. Gynecological history: sexuality with 22 years of marriage I, the husband of 32 years. In September 2005 stood pregnancy on term of 5-6 weeks for the next abrasion. Chronic endometritis and chronic oophoritis diagnosed with this time without signs of acute onset process and clinical deterioration. In August 2006 - apoplexy ovarian conducted conservative treatment. In June 2007 ectopic pregnancy, performed laparoscopy, tubectomy the left pipe. During laparoscopic surgery were identified pelvic peritoneal adhesions, including perfumania seam. Conducted with the greatest possible excision of adhesions, intraoperative installed patency of the right fallopian tube. In August 2008 stood pregnancy on term of 8-10 weeks followed by scraping. On the stages of rehabilitation since 2005 to November 2008 the patient was carried out repeated courses of antibiotic therapy and physical treatment: electrophoresis lidz, phonophoresis of hydrocortisone, (area effect). Objectively: the patient is in satisfactory condition, the shape correct. HELL 90/60 mm Hg, pulse satisfactory filling and voltage, 84 beats per minute. The chest without features, determined by palpation of the changes in the mammary glands no. The abdomen is soft, EPI - and mesogastric painless. Bimanual examination of the body of the uterus in retroflexio, normal size and consistency, with smooth contours, the tour is limited to spikes in papadimitrou p is stranstvo and painful. Right appendages slightly increased soldered to the uterus, palpation their painful area. Palpation of the walls of the pelvis is also painful to the right. When ULTRASOUND done on day 7 of the cycle, set: the shape and volume of the uterus is common, and the structure of the myometrium homogeneous, the structure of the endometrium is not changed, the thickness of the M-echo of 4.5 mm, the Size of the ovaries is not enlarged, distinct contours. Near the right ovary lazerette fallopian tube with thickened walls to 2.91 mm, in the form of "twisted strand" length 50,86 mm is Defined a small amount of fluid in the fallopian tube adhesions visualized. The pressure of the ULTRASONIC sensor when detecting the area right appendages painful. ULTRASOUND diagnosis of Chronic endometritis. Adhesive disease. Were assigned to the treatment according to the proposed method: the area of adhesions phonophoresis of placentae in the abdominal wall above the projection of adhesions in the pelvic area from the ultrasonic therapy apparatus UST-1.07 F. Took 1 ml of placentae and was mixed with 30 g of lanolin before the procedure. The ointment was applied to the anterior abdominal wall above the projection of adhesions in the pelvic area. Position the patient is lying on his back. Scoring was performed from a transducer with a diameter of 4 cm intensity of 0.4 W/cm2the continuous mode. The speed of the emitter 1-1 .5 cm/sec. The procedure time is 5 minutes. The course is standing out of 10 procedures. The pain has been fully and firmly docked after 7 treatments. Control tests were conducted on the 7th day of the next cycle. Complaints the patient did not show. Bimanual examination revealed a pronounced resolving and protivospaechnyj the proposed method: increased excursion of the uterus, there was no pain on palpation of the right-wing appendages, vaults and pripadnost appendages. These data were confirmed by ultrasound dynamics: pain at locations not mentioned, the right fallopian tube was not visualized, which indirectly may indicate the absence of pathology, the thickness of the endometrium was 7.1 mm Score from YOUR was 0 points; verbal rating scale - 0 points. The type of adaptive response by L. Garkavi match reaction training. In September 2009, there was a planned pregnancy, keeping pregnant was based burdened obstetric history. The pregnancy proceeded normally and ended urgent delivery. A girl was born (weight 3100 g, height 50 cm).

PRIMER No. 2. Patient S., 48 years old. The diagnosis of adhesive disease. Operated three years ago about calculous cholecystitis method of endoscopic access. After surgery notes epigastric pain, more in the right upper quadrant of different intensity, especially on the background of physical exertion in stressful situations. Often concerned about nausea, diarrhoea symptoms. Up to four times per year refers to the surgeon about the expressed pain in the abdomen. It was held ultrasound of the abdominal cavity, where the signs of adhesions in the form of a local increase of echogenicity in the epigastric region, the presence of foci of infiltrates, visualization adhesions. Score YOUR pain is 60 mm; the verbal rating scale with 5 points. At objective inspection palpation of the abdomen sharp pain in the epigastric region, marked local tenderness to the right of the middle line of the abdomen, as well as at the level of the umbilical ring. Were assigned to the treatment according to the methods on the epigastric region phonophoresis of placentae in the abdominal wall over the projection of the adhesions from the ultrasonic therapy apparatus UST-1.07 F. Took 1 ml of placentae and was mixed with 30 g of lanolin before the procedure. The ointment was applied to the anterior abdominal wall above the projection of adhesions in the epigastrium. The position of the patient is lying on his back. Scoring was performed from a transducer with a diameter of 4 cm intensity of 0.4 W/cm2the continuous mode. The speed of the emitter 1-1 .5 cm/sec. The procedure time is 7 minutes. The course consisted of 10 treatments. Control tests were carried out one month after the end of treatment. During the examination the patient had no complaints. From ECAL, in the course of a month never worried about the pain in his stomach. Score YOUR was 0 points; verbal rating scale - 0 points. The type of adaptive response by L. Garkavi match reaction training. Palpation of the anterior abdominal wall showed no pain or local changes on the part of organs of the abdominal cavity. Ultrasound signs of adhesions were observed, local increase of echogenicity or the presence of infiltrates were not found. Surveillance for 2 years stated no signs of adhesive disease, maintaining health and quality of life of the patient.

Thus, from the use of the proposed method obtained the effect, which are as follows:

the way relieves pain syndrome on the background of adhesive disease;

the method prevents the development of manifestations of adhesive disease;

the method has a pronounced anti-inflammatory effect;

the method improves the adaptive reserves of the body of the patient.

A method of treating adhesive disease, including the application to the anterior abdominal wall drug and holding phonophoresis, characterized in that as a drug take 1 ml of the placentae, which before the procedure is mixed with 30 g of lanolin, with the patient lying on the back put the tool on Perigny the abdominal wall above the projection adhesions, spend phonophoresis from the ultrasonic therapy apparatus UST-1.07 F. with sound from a transducer with a diameter of 4 cm intensity of 0.4-0.6 W/cm2the continuous mode, the speed of the emitter 1-1 .5 cm/sec, the procedure for 5-7 minutes, in the course of 10 treatments.



 

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1 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and gastroenterology, and can be applied in treatment of patients with acute gastroduodenal bleedings. For this purpose on the 2-nd - 3-rd day after stabilisation of hemostasis a monitor purification with rinsing water is carried out. Temperature of water constitutes 30-32°C, and an intracolonic pressure is 20-25 mm Hg. Adsorbent polyphepan is added into rinsing water in a dose 10 g per 1500 ml of chemically pure decontaminated water of drinking water supply. Speed of supply and exhaust of rinsing water constitutes 1.0-1.6 l/min.

EFFECT: method ensures fast recovery of peristalsis and temperature normalisation, induced by development of endotoxicosis, due to effective purification of intestine from products of blood decay and microbial insemination as a result of selection of optimal parameters of the monitor intestine purification and required adsorbent.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: feeding a medical solution is combined with an exposure to low-frequency ultrasound generated by a low-frequency ultrasonic cavitator that is AUZKh-100 PHOTEK apparatus. The medical solution is presented by a solution of metrogyl and dioxydine in ratio 5:1 or 1:1 respectively. The exposure involves feeding the solution at 0.2-0.5 ml/s. The cavitator is placed at 0.2-0.5 cm from a defect surface. First, the defect is exposed to an average-density ultrasonic flow of power 1.6-3 Wt/cm2 for 1-2 min. Then, the exposure is characterised by average-density ultrasonic power 3.1-8 Wt/cm2 for 4-10 min. The therapeutic course is 3-15 sessions every second day.

EFFECT: method provides the maximum mechanical debridement of the purulent-fibrinous impositions and the qualitative wound disinfection ensured by selecting the cavitation mode for specific drug preparations and deep penetration of the above drug preparations into the lesion.

3 cl, 1 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to therapy, purulent surgery, and may be used for treating chronic wounds. That is ensured by implementing the versions of the methods of treating chronic wounds involving removing a portion of necrotic or other devitalised tissue from the wound with healthy tissue coated with a solvated system of an extracellular polymeric substance. The above system contains an aqueous solution of an agent isolating metal ions, a surfactant and a buffer substance. An osmolarity of the solvated system makes from approximately 1000 to approximately 4000 mOsm of the dissolved substance per one litre. What is also presented is a device for treating the given pathology comprising a wound cleansing instrument, a container for the solvated system of the extracellular polymeric substance, and an aspirator. What is presented is a kit for care for the patients suffering chronic wounds, comprising a tray, a syringe, a vessel with the solvated system of the extracellular polymeric substance, and printed application instructions.

EFFECT: presented group of inventions provide the effective treatment of chronic wounds by introducing the solvated system of the extracellular polymeric substance biocompatible with healthy tissues containing the ingredients preventing the binding of polymer chains in the extracellular polymeric material of a biofilm matrix and promoting transferring them into the solution for more complete removal from the wound.

67 cl, 2 tbl, 1 ex, 3 dwg

FIELD: medicine, pharmaceutics.

SUBSTANCE: invention refers to medicine, particularly to traumatology, orthopaedis, maxillofacial surgery, dentistry, neurosurgery, namely to osteoplastic formulation of biocomposites for treating human bone diseases and injures, and can be used as a material fully degradable in the body and replaceable by new bone tissue, for bone cell regeneration, as a biological filler for bone tissue defects, as an osteoconductive and osteoinductive biological frame for bone tissue regeneration. The hardened biocomposite for bone defect replacement on the basis of calcium phosphate contains magnesium phosphate, calcium hydrophosphate, amino acid; calcium phosphate is biological hydroxyapatite in the following proportions, wt %: hydroxyapatite - 45-47, magnesium phosphate - 32-34, calcium hydrophosphate - 16-19, amino acid - 1-5, as a binding agent - casein.

EFFECT: implementing the expansion of the biocomposites for bone defect replacement and endoprosthesis fixation.

1 cl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly coloproctology, and may be used for treating chronic anal fissure. The method involves an anal fissurectomy with a graduated sphincterotomy and a drug-induced therapy. A patient's preoperative psychoemotional status is assessed by questionnaire survey according to the Hospital Anxiety and Depression Scale (HADS). If the disorders have been shown by the questionnaire survey, namely 8-10 points "subclinical anxiety/depression" or 11 points and more "clinical anxiety/depression", a psychopharmaceutical therapy with Grandaxin or Tianeptine. The preparations are administered in common doses for 4 weeks.

EFFECT: method provides the effective treatment of the disease with comorbid psychoemotional disorders, exposure on the additional mechanisms of the anal fissure pathogenesis in this case.

3 ex

FIELD: medicine.

SUBSTANCE: before the implantation, a demineralised bone graft (DBG) is kept for 2 hours in 0.9% chloride solution at room temperature. Thereafter, the DBG is exposed for 10 minutes to ultrasound at frequency 44±4.4 kHz and vibrational amplitude 30 to 50 mcm in 0.9% sodium chloride solution heated to 36°C.

EFFECT: method enables accelerating the repair processes in grafting a fragment of the demineralised bone graft of the pre-set shape in experimental animals and increasing substantially post-grafting osteogenesis rate in a segment of a skull flat bone.

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to prevention of purulent-septic inflammatory complications in obstetric patients of a high infectious risk group. A device comprises an ultrasonic generator with a monitor control, a piezoceramic radiator with a terminal wave guide and an intravenous medication system with a control valve, a pivotally connected system of equally spaced support nuts, supplementary ultrasonic generators with monitor controls and piezoceramic radiators built into the nuts; with a quantity of the piezoceramic radiators matching a quantity of the nuts laid on a spacer, a programmed microcontroller and an indication panel. The piezoceramic radiators are fixed on the support nuts of the pivotally connected systems, flow through spacer holes and are connected to outputs of the respective ultrasonic generators the monitor controls of which are connected to matched outputs of the programmed microcontroller which are simultaneously connected to matched inputs of the indication pane and the control valve of the intravenous medication system.

EFFECT: providing individual spatial characteristic of the effect and higher reliability.

3 cl, 2 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medical equipment, namely to ultrasound therapeutic apparatuses. An ultrasonic transducer contains at least one ultrasonic radiating element with ultrasonic wave front sets radiated by the element representing spherical surfaces of the same radius, while the ultrasonic radiating element performs a function of ultrasound reflection and forms a spherical resonant cavity. If using more than one ultrasonic radiating element, they are configured to form a combined spherical resonant cavity. An internal space of the spherical resonant cavity is shaped as a full spherical envelope or a truncated spherical envelope with a sphere centre inside, while the ultrasonic waves generated by at least one ultrasonic radiating element are focused in the area which comprises the sphere centre of the spherical resonant cavity.

EFFECT: using the invention provides an ultrasonic focus energy gain, as well as eliminated working frequency influence of an ultrasonic source.

15 cl, 11 dwg

FIELD: medicine.

SUBSTANCE: area of inflammation is exposed to ultrasound generated by the Sonoca 185 apparatus. The exposure power gradually grows within the range of 20 to 40-80 W depending on age. The palatal tonsils are alternately sanitised with octenisept dissolved in 0.9% sodium chloride in a ratio 1:8 with an octenisept flow rate gradually increasing within the range from 20 to 180 ml/s, an exposure time of 2-5 seconds for 3-5 minutes. The therapeutic course is 8-10 sessions, either daily or every second day.

EFFECT: method involves the integrated effect of ultrasound and antiseptic on the oropharyngeal mucosa in the developed regimen that enables providing the higher therapeutic effectiveness, including that in children suffering from chronic tonsillitis, reducing a probability of complications, improving an acceptability of presented therapy.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to energy transmission systems. The energy transmission system involves an energy source for ultrasonic energy supply into a circumferential region adjoining a patient's blood vessel with a circumferential nerve plexus found within the above region. The energy source is configured to use the blood vessel as a support point for energy supply to the nerves surrounding the blood vessel, and for ultrasonic energy supply for generating an annular region of a nerve inhibition around the blood vessel with the annular region arranged along the length of the blood vessel.

EFFECT: using the invention enables more effective targeted energy supply.

22 cl, 30 dwg

FIELD: medicine.

SUBSTANCE: rehabilitation of children with chronic microbial-inflammatory urinary diseases with the low immune status is ensured by the staged rehabilitation treatment of patients in the stage of complete and partial clinical and laboratory remission. The first stage involves a complex whereat the patient is exposed to ultraviolet short-wave beams according to the standard technique including tonsils, and endonasally according to the standard technique every second day within the 16-21-day therapeutic course. That is followed by a helper stimulation of a chest by means of Helper apparatus with using 19, 20 and 21 sternal point for 3-5 minutes for each within the 7-10-day daily therapeutic course. Therapeutic exercises and phytotherapy are prescribed next with using essences, namely sage, or mint, or aniseed, or eucalypt essences, every second day within the 7-10-day therapeutic course. Thereafter, 3-4 months later at the second stage of rehabilitation, inhalations with immunopotentiating agents, namely 0.5% lysozyme, or sodium nucleinate, or aralia infusion, or ginseng infusion, or eleuterococcus infusion, or aloe extract are prescribed in the form of 10-15 minute daily procedures. The adrenal glands are stimulated with a low-frequency alternating magnetic field generated by Polus-1 stimulator, daily for 10-20 minutes within the therapeutic course of 10-20 procedures. That is followed by the helper stimulation of a thymus by means of Helper apparatus with using 19, 20 and 21 sternal point for 3-5 minutes for each within the 7-10-day therapeutic course. The patient does therapeutic exercises. At the 3rd stage 3-4 months later, the patient is subject to an extremely high frequency electromagnetic exposure covering the middle one-third of the sternum for 5-25 minutes within the therapeutic course of 8-10 procedures, daily or every second day; or the thymus helper stimulation is applied; or a splenin or interferon phonophoresis on the submandibular lymph nodes is alternated with a complex immune preparation on wings of nose with the length of exposure 2-3 minutes within the therapeutic course of 8-10 procedures daily or every second day. The complex certainly includes a halotherapy consisting in 12-25 daily session of the length of 30 minutes, a chest massage and therapeutic exercises. The final 4th stage involves cold water treatment as provided by standard techniques, helper stimulation of the sternum and feet, therapeutic massage, therapeutic exercises, swimming, pine baths or contrast shower. The length and therapeutic course are selected individually for each child.

EFFECT: higher effectiveness of the rehabilitation treatment, namely the recovery of the main disease, reduced intercurrent infections, normalised immunogram ensured by the staged rehabilitation program aiming at the non-invasive targeted effect on the immune system.

3 ex

FIELD: medicine.

SUBSTANCE: invention refers to devices for the non-invasive treatment of ocular pathologies. A device for treating the ocular pathologies comprises at least one eye ring with its proximal end being overlapped on an eyeball, and an ultrasonic beam generator rigidly fixed on a distal end of the eye ring. The ultrasonic beam generator is shaped as a concave segment with one curvature along one direction perpendicular to a rotation axis of the eyeball with the concavity shaped so that to be in line with the eyeball.

EFFECT: higher effectiveness of the non-invasive treatment of the ocular pathologies.

13 cl, 17 dwg

FIELD: medicine.

SUBSTANCE: abdominal ultrasonic examination is conducted to measure an area of longitudinal section of the liver along the abdominal midline, and along the right midclavicular line, and a lateral-lateral size of the liver to calculate by formula: volume of the liver = 604.3+L*(0.2474*S1+0.0879*S2) (cm3), wherein L is a width of the liver (cm), S1 is an area of the longitudinal section of a right lobe of the liver (cm2), while S2 is an area of the longitudinal section of a left lobe of the liver (cm2).

EFFECT: method provides more accurate determination of the volume of the liver as shown by the ultrasonic examination ensured by measuring the area of the longitudinal sections along the abdominal midline and midclavicular line, and the lateral-lateral size of the liver.

2 tbl, 3 dwg, 1 ex

FIELD: medicine.

SUBSTANCE: feeding a medical solution is combined with an exposure to low-frequency ultrasound generated by a low-frequency ultrasonic cavitator that is AUZKh-100 PHOTEK apparatus. The medical solution is presented by a solution of metrogyl and dioxydine in ratio 5:1 or 1:1 respectively. The exposure involves feeding the solution at 0.2-0.5 ml/s. The cavitator is placed at 0.2-0.5 cm from a defect surface. First, the defect is exposed to an average-density ultrasonic flow of power 1.6-3 Wt/cm2 for 1-2 min. Then, the exposure is characterised by average-density ultrasonic power 3.1-8 Wt/cm2 for 4-10 min. The therapeutic course is 3-15 sessions every second day.

EFFECT: method provides the maximum mechanical debridement of the purulent-fibrinous impositions and the qualitative wound disinfection ensured by selecting the cavitation mode for specific drug preparations and deep penetration of the above drug preparations into the lesion.

3 cl, 1 ex

FIELD: medicine.

SUBSTANCE: throat tonsil is treated with octenisept dissolved in 0.9% saline in ratio 1:10. The treatment involves right and left nostrils alternately for 3 seconds 30-40 times for 6-10 minutes. The treatment is combined with the ultrasonic exposure generated by Sonoka 180 at frequency 20-40 kHz. The therapeutic course is 6-7 sessions, either daily or every second day.

EFFECT: fast nasopharyngeal sanitation, reduced local inflammatory response, improved nonspecific resistance of the throat tonsil at enhancing the humoral immunity factors that in turn improves the quality of life of these patients.

3 ex

FIELD: medicine.

SUBSTANCE: allogenic multipotent mesenchymal stromal cells in the number of 6 million cells/kg are introduced intravenously in a dose of 3.0 Gy into rats suffered from radiation exposure. Additionally, haemopoietic stem cells recovered from umbilical blood in the number of 300 thousand cells/kg are introduced. The cells are transplanted in such a manner 60 min after radiation exposure.

EFFECT: higher mitosis count that leads to a substantial cryptal epithelium increase.

3 tbl

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