Method of treating patients with epicondylitis
SUBSTANCE: invention refers to medicine, namely to traumatology and orthopaedics, and can be used for treating patients with epicondylitis. That is ensured by applying a complex of measures, in particular a restraint of motions in the involved segment, physiotherapy and drug treatment. A pain syndrome is pre-evaluated by a visual analogue scale (VAS). A proximal forearm is immobilised with an epicondylic bandage in the daytime for 7-10 days in sportsmen, and for 2-3 weeks in common patients. Therapeutic exercises (TE) are prescribed from the first day of treatment. The first part of TE consisting of isometric and static exercises aiming at strengthening arm muscles is done before noon. The second part of TE comprising relaxing exercises is performed in the late afternoon or after any physical loads. The patient continues with the therapeutic exercises after the bandage is removed and to be used for professional or sports loads only. Electric stimulation is conducted daily for 7-10 days with using TENS apparatus or its analogues generating electrical signals covering the enthesis and the involved forearm muscles. Arthrofoon is administered with underlying electric stimulation. If the pain syndrome value according to the VAS is less than 4 points, the preparation is administered as a monotherapy in a dose of 4 weeks a day for three months. If the pain syndrome according to the VAS is more than 4 points, Arthrofoon is administered in a dose of 8 tablets a day in a combination with a selective non-steroid anti-inflammatory preparation in a therapeutic dose for no more than 10 days. The therapeutic regimen also contains Sirdalud 2-4 mg one hour before bedtime for 2 weeks. There are also administered vasodilators improving microcirculation of the involved segment, intramuscularly for 10 days. The therapeutic complex is also added with Milgamma B 2 ml, 5 injections, and another 5 injections triduan. Wobenzyme is administered for 3-4 weeks. Calcemine or Calcemine-advance, the preparations of calcium are administered for six months. The therapeutic course according to the presented regimen is repeated half a year later. The physical exercising for the arm muscles strengthening are to be further done two or three times a week on the average for min. 30 minutes for the life term if suffering high loads or doing any top-class sports for the purpose of maintaining the forearm tonus. The segment of interest is fixed with an orthesis when suffering a load. The therapy with the TENS or similar apparatus of the forearm muscles of interest and the enthesis follow a pronounced load 2-3 hours before bedtime and shall be accompanied with a session of relaxing exercises.
EFFECT: method provides the evident and stable clinical effect characterised by the complete recurrence-free recovery by the physical restoration of the tissue structure within the inflammation with the high quality of life and a surgical intervention avoided.
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The invention relates to medicine, namely to traumatology and orthopedics, outpatient pioneering of cosmetic surgery, and can be used for the treatment of patients with epicondylitis.
Epicondylitis is a common disorder in outpatient practice. Epicondylitis (tennis elbow, elbow porter) is a clinical syndrome aseptic inflammation of the periosteum and tendons-ligaments in the area of the inner (medial) or outer (lateral) namyslow shoulder, manifested by pain in the elbow joint, first motions, and then constant with irradiation in the course of the muscles of the forearm tenderness to palpation of namyslow in the area of attachment of muscles. Develops when muscle tension due to monotonous repetitive movements of the elbow in connection with sports (tennis, baseball, Golf) or professional activities (e.g., the musicians); is considered as a kind of tendinopathy. The disease occurs on a background of repetitive repetitive loads. In the risk group comprises the following occupations: computer users, milkmaids, installers, painters, seamstresses and others
The treatment includes restriction of movements in the elbow joint (in the acute period of immobilization bus), local injections of glucocorticoids.
The imperfection of the conservative Le is placed epicondylitis shoulder was noted since the description of this disease, it requires not only a long time, but not always leads to a stable recovery of the patient. Depending on what seemed etiopathogenesis of the disease, surgeons have proposed various operations, treating them as the "last resort", valid only long after unsuccessful conservative treatment.
Known methods of treatment of patients with epicondylitis often do not provide a permanent remission, especially with the constant monotonous sports or professional workload, when the patient may not refuse these loads, not wanting for many reasons to change the profession or leave the sport.
There is a method of treatment of patients with epicondylitis (A. Belenky, Local injection therapy in degenerative diseases of the musculoskeletal, M., 2003, pp. 28-29), including the introduction of corticosteroids with anesthetic - hydrocortisone, kenalog, diprospan in the area of greatest pain syndrome, with a needle carried out as deeply as possible until it stops in the bone, and the drug is injected under high pressure. The course shall 2-3 injections at weekly intervals.
However, this method has some significant drawbacks, which are technically difficult to perform injection, which is noted by the authors of the method, there is a risk of damage the nerves. With the introduction of corticosteroids is often rough skin atrophy, depigmentation, worsening degeneration in the subsequent spontaneous breaks tendon. In addition, with the introduction of hydrocortisone occurs rapid microcrystalline reaction. Secondary injection of corticosteroids does not allow to achieve initial remission: frequent relapses, and ultimately, the pain starts to wear chronic persistent nature, the COP-the drugs don't bring therapeutic effect.
The known method of conservative treatment of patients with epicondylitis (R. F. Akhmetianov, E. N. Lukyanov with co-authors, "in Vitro VIPs degenerative and inflammatory diseases of musculoskeletal system". Traumatology and orthopedics: the present and the future. Proceedings of the international Congress, Moscow, 7-9 April 2003 Publisher PFUR. pages 19-20) by shock wave therapy physiotherapy treatment based on the use of acoustic shock waves. Developed in the clinics of Germany and Switzerland. The basis of this method lies on the damaged structure of high energy ultrasound power. The duration of the session leaves 15 minutes for each anatomical area. Therapeutic shock waves, without hesitating, distributed in soft tissues and without damaging them, have a direct per the op perate on bone and cartilage tissue, bone spikes, growths and other education with a high acoustic impedance. The procedure restores the natural metabolism, triggers the processes of regeneration and cell renewal, improves metabolic processes in the tissues.
The disadvantage of this method is the presence of pain arising in the course of the session, which can have very high intensity, which does not allow to apply the method in individuals with low pain threshold. As in the previous method, often relapse, and the method repeated application also is not effective.
There is a method of treatment of patients with epicondylitis (Orthopedic aspects of epicondylitis, current views on the pathogenesis and treatment of epicondylitis shoulder (Shishov S. C.: In the book. Selected issues English language. - M - 1993. - T. 1. - S. 25-29), including surgical intervention. The indication for it is the absence of effect from conservative treatment within 1 year. The most frequently used operation according to the method of C. B. Ulzibata: partial anthesis - dissection of the tendon of the extensor tendon at the site of attachment.
However, such surgical intervention, of course, is crippling in nature and in case if you are athletes or people with certain professional characteristics motor mode can privest the loss of professional opportunities or loss of sporting achievements. In any case, the decreased functionality of the limb is too high a price for the reduction of pain.
As the closest analogue of the adopted method for the treatment of patients with epicondylitis". (J. Murtha. Handbook of General practitioner. TRANS. from English. PRACTICE. M. P. 570-572), including the limitation in motor mode for the affected limb: - "not to do movements that cause pain. Perform bandaging elbow, bring the limb in an elevated position. From the first days appoint an active physical therapy (physical therapy) with overcoming any pain. The effectiveness of physical therapy assessed after 6 weeks. In the painful area twice with an interval of 2-4 weeks, introduce a solution corticosteroids. The ineffectiveness of treatment, surgery - excision in the area of pain scar tissue mobilization of the proximal ends of the muscles of the forearm. According to the author of the effectiveness of surgical treatment is 70%. Athletes should be encouraged before training "tight bandage forearm slightly below elbow elastic bandage
However, the method is not without disadvantages. As a rule, medical help treat people with pain already has a long history and despite the gentle tired of waiting for self-recovery. In addition, it is known, Thu the treatment of athletes has its own characteristics. One of them is the inability to take breaks in training. The above complex treatment also does not guarantee against the occurrence of relapses. Tight bondage causes disturbance of microcirculation and so modified muscle and it is hard to imagine the training of an athlete with tightly bandaged forearm. Introduction glucocorticoids is fraught with many complications: septic infectious, local (worsening local destructive process), and General (a rise in blood glucose level, impaired immune function, changes of blood rheology, exacerbation of pancreatitis). The application of the method does not prevent relapses in the future.
The objective of the invention is to provide a highly efficient method for the treatment of patients with epicondylitis, allowing you to get a pronounced and persistent clinical effect, to prevent the recurrence of the disease and possible complications.
The invention consists in that in the method of treatment of patients with epicondylitis, including the following measures: limit motor mode of the affected segment, physiotherapy and pharmacotherapy, pre-assess the level of pain syndrome according to the Visual Analogue Scale, the proximal part of the forearm immobilized epicondylar bandage during the day for 7-10 days patients-athletes or 2-3 weeks is normal patients from the first day of treatment prescribed physical therapy, the first part of which, consisting of an isometric or static exercises aimed at strengthening the hand muscles, hold in the first half of the day, and the second part consisting of a relaxing exercise in the afternoon or after any loads, while physical therapy continue after removing the bandage, using it only during professional or sports activity, in parallel daily for 7-10 days of conducting the electrical stimulation with the use of the instrument tens or its analogues by electrical signals in the area anthesis and interested muscles of the forearm, on the background of electrical stimulation conduct complex medical therapy, which includes anti-inflammatory and reparative therapy drug Arthrofoon, and when the value of the level of pain, not to exceed 4 points, it is prescribed as monotherapy at a dose of 4 tablets per day for three months, and when it is above 4 points in the dose of 8 tablets per day in combination with selective non-steroidal anti-inflammatory drug in therapeutic dose of no more than 10 days in treatment include muscle relaxant Sirdalud 2-4 mg one hour before bedtime for 2 weeks, vasodilators, improves microcirculation of the affected segment: injection that is injected intramuscularly daily within 1 days preparation Milgamma, containing a complex of vitamins of group In 2 ml of 5 injections, and then another 5 injections over two days on the third, the enzyme preparation Wobenzym for 3-4 weeks, and calcium Calcemin or Calcemin-advance, which is prescribed for a period of six months, a course of treatment under the scheme may be repeated in six months later the patient is recommended when a heavy load or on a background of professional sports for life to maintain the strength of the tone of the muscles of the forearm exercise aimed at strengthening the muscles of the hand two or three times a week on average for at least 30 minutes the fixation orthosis interested segment during load handling device tens or its analogue interested muscles of the forearm and zone anthesis expressed after loads for 2-3 hours before bedtime and conducting the session relaxing exercises.
The use of the invention allows to obtain the following technical result.
The proposed method is highly effective. It allows you to get a pronounced and persistent clinical effect, characterized by a complete relapse-free recovery, including patients with high professional or sports activity.
If all methods are practiced lightweight work in the future, especially in surgical treatment, the proposed method is about who has a high quality of life: a return to their former way of life and work or sport loads.
The method provides high treatment outcome without complications. The high efficiency of selected schemes of pharmacotherapy is accompanied by a high degree of safety treatment. Habituation does not occur.
The method provides physiological restoration of tissue structure in the area of inflammation and receiving consistently good long-term results, thus precluding unnecessary surgical intervention.
The method has practically no contraindications in addition to the General knowledge in the use indicated in the circuit of drugs.
The technical result is achieved due to the developed by the authors of the new technologies in the treatment of epicondylitis, providing treatment and rehabilitation activities carried out in sequence and aimed at the treatment of pathology of achieving disease-free result.
In the heart of the new technologies are installed to the authors of the facts.
Clinic epicondylitis is determined by the formation of a "vicious circle" with the continued prolonged tension is not strong enough muscles to perform individual loads. Is irritation of the insertion of the muscles of the forearm to nadasaka humerus : periostitis, anthesis, formed a vicious circle involving chronic lo the social inflammatory process, the microcirculation disorder, neuropathic syndrome, the occurrence of a trigger zone with morphological changes of the tendons and muscles.
First aid is the withdrawal from the process load of the affected area. This is achieved by imposing a special bandage which contains viscoelastic insert that provides directional effect on the insertion of the muscles of the forearm, which contributes to the load redistribution in the first place - with the transposition of the point of attachment of muscles. This option prevents irritation of the periosteum namesake shoulder - pain stopped, a vicious circle is broken.
During the first two weeks of the regular load is reduced (professional athletes) or completely removed (non-athletes)that allows you to support the break the "vicious circle". Begun exercise physiotherapy (physical therapy) developed by the author of the scheme against this background allows the muscles and prepare them for loading.
As a local therapy affect the area anthesis and stakeholder muscles of the forearm apparatus tens (or its analogues: SCENAR, DENAS and DIADENS). The action of these devices is completely harmless to the body due to the fact that the signal of the apparatus is as close to whitefish is Alam nervous system of the patient and the treatment effects operate primarily on superficial skin receptors. Heat the same or some other type of radiation from devices does not proceed, therefore, the apparatus can be applied even to treat cancer patients without fear of worsening their condition.
Electro-stimulation therapy device using devices like tens is a method of non-drug, non-invasive, i.e., undamaged therapeutic effects on the human body and is aimed at activation of the internal forces of the body, regulation of metabolism, blood circulation, normalize the functioning of the nervous system. Effects of electro-stimulation therapy: General regulating, normalizing metabolism, the conductivity of the nerve fibers, autonomic function, vascular tone, stimulating repair processes, including tissue regeneration. Local stimulation provides analgesic and anti-inflammatory effects.
In the use of technology impulse dynamically changes when exposed by dynamically adjusting the impedance of the skin: the shape and duration of the acting impulse close in characteristics to the momentum after distortion of skin, fatty tissue, muscle tissues, etc. will be close to the nerve impulse. Treatment is carried out adjustment dynamics changes its signal to the dynamics of state changes "zone of pain". In response, it increases and the response of the organism to restore, as artificially increased pathological signal he perceives as real. This causes the body to produce more powerful reaction to combat the "pain". Technology units DENAS and SCENAR helps restore the body's functions to the level on which he operated until the occurrence of disease. SCENAR restores homeostasis to premorbid levels. When a patient has a pacemaker electrical stimulation apparatus tens or other electrical appliances do not apply.
The key point in the algorithm of the complex treatment of epicondylitis in addition to local electrical stimulation of muscles of forearm and zone anthesis is the inclusion into the scheme of drug therapy aimed at eliminating chronic inflammation, optimize functional status of the concerned segment, the repair of tissues anthesis, prevention of relapse.
Drug therapy epicondylitis, make use of a complex selected by the author of the drugs of the developed scheme.
As an anti-inflammatory drug therapy drug use Arthrofoon, the treatment regimen which is correlated with the severity of pain syndrome, what is it used for known Visual analogue scale (VAS).
Arthrofoon modulates the production and functional activity of the CN is ogandaga of tumor necrosis factor alpha (α) in rheumatoid arthritis, osteoarthritis, osteochondrosis. Anti-inflammatory and analgesic action. By reducing the production of several proinflammatory cytokines, mediators of inflammation prevents the progression of inflammatory lesions of tissues and organs with inflammatory-degenerative diseases. Practically has no contraindications and side effects.
The preparation is extremely important in the treatment of chronic degenerative diseases of the musculoskeletal system, since in this case the basis of the disease is sluggish, poorly manifested by inflammation. However, it can occur with almost any elements of the musculoskeletal system: muscles, tendons, ligaments, cartilage, etc. have a Gross effect of corticosteroids or long massive intake of nonsteroidal anti-inflammatory drugs (NSAIDs) exacerbates the dystrophic processes and on the background of the analgesic effect of pathological changes in the joint continues to grow.
Ultra-low doses of antibodies to tumor necrosis factor-alpha (TNF-α), the drug Arthrofoon exercises aimed pathogenetic therapy of degenerative process in antisite. Special technology of preparation of solutions of ultra-low doses of antibodies gives them a biological activity comparable with non-steroidal protivovospalitel is a recreational drugs. However, for the manifestation of the high activity of the drug requires a long reception.
Arthrofoon take sublingual without chewing.
When receiving Arthrofoon reduces the need for symptomatic anti-inflammatory remedies, therefore, when the level of pain, not to exceed 4 points (on YOUR), a drug prescribed as monotherapy.
The drug safe for long term use.
When assigning Arthrofoon in combination with a short course of nonsteroidal anti-inflammatory drugs (NSAIDs) and chondroprotective action of the latter increases, and by NSAIDs decreases the level of side effects. Because the inflammatory process when epicondylitis usually is chronic, drug-based ultra-low doses of arthrofoon ensures soft, proper action on inflammation, especially when pain syndrome, not to exceed 4 points on YOUR. When epicondylitis it comes to suppressing inflammation in a very small volume of the structure, therefore, prolonged use of NSAIDs in which the distribution of the drug throughout the body, it is impractical. In comparative studies, the efcacy of oral administration of NSAIDs by patients with epicondylitis practically did not differ from the placebo effect.
In case of persistent pain is the first syndrome, when pain syndrome, reflecting the level of inflammation in the lesion exceeds 4 points, additionally conduct a short course of NSAIDs.
As vasodilator use of nicotinic acid and /or trental, complamin etc. Vasodilators spasms microcirculation, which leads to circulatory hypoxia of the tissues concerned zone (in this case anthesis) and is one of the leading factors in the pathogenesis of pathological disorders in degenerative-dystrophic pathology of the musculoskeletal system.
As a preparation containing a complex of vitamins of the b group: assign Milgamma. It includes the drugs group and lidocaine. Drugs groups are of great importance for the normal functioning of the nervous tissue. Vitamins Milgamma promote the regeneration of nerve and muscle tissue, improve circulation, analgesic and positively affect the conductivity of neuromuscular impulses. The solution for injection contains vitamin B1 - thiamin, vitamin B6 - pyridoxine, vitamin B12 is cyanocobalamin. Thiamine affects synaptic transmission, thereby improving the conductivity of the nerve. Its deficiency causes accumulation in nervous tissue degradation products of carbohydrates. Pyridoxine is necessary for the formation of different active neurotransmitters - dopamine, adrenaline, Geest is in, tiramina, serotonin. Also this vitamin is involved in the processing of amino acids by the body. After phosphorylation of pyridoxine gets into the blood plasma, after which you can hit him in a cage. Exerts a powerful influence on the functioning of the muscular system. Cyanocobalamin is involved in the synthesis of creatinine, nucleic acids, choline, methionine, prevents anemia and takes part in metabolism. He is also analgetika.
Indication when epicondylitis is the presence of pain and neuropathy dystrophic, muscular-tonic syndromes.
As enzyme preparations used: Wobenzym or its analogue, which is a combination of highly active enzymes of plant and animal origin. Has immunomodulatory, anti-inflammatory, fibrinolytic, anti-inflammatory, antiplatelet and secondary analgesic effect. Wobenzym has a positive effect on the inflammatory process, limits the pathological manifestations of autoimmune and immune processes has a positive effect on performance and immunological reactivity of the organism. Stimulates and regulates the functional activity of monocytes-macrophages, natural killer cells, stimulates anti-tumor immunity, cytotoxics the e T-lymphocytes, phagocytic activity of the cells.
Under the influence of Wobenzym reduces the number of circulating immune complexes and removal of membrane deposits of immune complexes from tissues. Wobenzym reduces infiltration interstitial plasma cells. Increases elimination of protein debris and deposits of fibrin in the area of inflammation, accelerates lysis of the toxic products of metabolism and dying tissue; improves resorption of hematomas and edema; normalizes permeability of vascular walls. reduces the concentration of thromboxane and platelet aggregation. Regulates the adhesion of blood cells, increases the ability of cells to change their shape by adjusting their elasticity, normalizes the number of normal discocytes (platelets) and reduces the total number of activated forms of platelets, normalizes blood viscosity, reduces the total number microaggregates, thus improving microcirculation and blood rheology, as well as the supply of tissues with oxygen and nutrients. Normalizes lipid metabolism, reduces the synthesis of endogenous cholesterol, increases the content of HDL, reduces the level of atherogenic lipids, improves the absorption of polyunsaturated fatty acids. Increases the effectiveness of antibiotic therapy, increasing the concentration of antibiotics in the blood plasma and inflammation, as well as Enset a side effect of as dysbiosis. Reduces the severity of side effects associated with hormonal drugs, including hypercoagulation. Regulates the mechanisms of nonspecific protection stimulates the production of interferons, thereby exhibiting antiviral and antimicrobial effects. Secondary analgesic effect of Wobenzym is manifested through the impact on the causal factors of acute inflammatory process.
In complex drug therapy include Sirdalud - muscle relaxant Central action.
The main point of application of its action is in the spinal cord. Stimulating presynaptic α2receptors, tizanidine inhibits the release of excitatory amino acids that stimulate the receptors that are sensitive to N-methyl-D-aspartate (NMDA receptors). As a consequence, at the level of intermediate neurons of the spinal cord occurs suppress polysynaptic excitation transfer. Because this mechanism is responsible for excessive muscle tone, with its suppression of muscle tone decreases. In addition to the muscle relaxant properties of tizanidine has a Central moderately pronounced analgesic effect. Sirdalud effective in acute painful muscle spasm and chronic spasticity of spinal and cerebral origin. Reduces spastic is here and clonic convulsions, resulting in reduced resistance to passive movements and the volume of active movements, which allows you to optimize therapeutic exercises and accelerate therapeutic effect of combination therapy.
To improve the quality of bone tissue, which always suffers in the area of the tendon to the periosteum and is expressed as an area of resorption on the radiograph, improve muscle-nerve conduction and improve the quality of the connective tissue, prescribe calcium-D3-containing preparation of the third generation - Calcemin. The choice of drugs because Calcemin will have a positive influence on bone structure to a greater extent than other calcium preparations due to the content of an osteo-trace elements and prepares the skeleton to the increased load in the postoperative period. In addition, the drug improves neuromuscular conduction, providing moderate relaxing effect.
Calcium, which is part of the drug, is a building component for bone tissue, regulates the permeability of blood vessels, is involved in regulation of conductivity in the synapses and neuromuscular junctions, is involved in the contractile activity of skeletal and smooth muscles, is a necessary component for the process of blood clotting. Calcium is presented in the drug carbonate and CIT is atoi salts. Calcium carbonate contains the highest amount of elemental calcium. Calcium citrate decreases the dependence of the process bioavailability of calcium from the state of the mucosa of the gastrointestinal tract, prevents continentalnature in the urinary system, even in case of prolonged use, reduces the excessive production of parathormone.
Vitamin D (cholecalciferol) in the composition of calamine encourage adequate absorption of calcium, participates in the processes of regeneration and build bone.
Zinc is an integral component of various enzymes of the body (over 200 species), which synthesize proteins and nucleic acids. Also provides gene expression, regeneration and growth of cells. Positively affects the activity of the enzyme alkaline phosphatase.
Manganese promotes the synthesis of substances that are components of bone and cartilage (glycosaminoglycans). Potentiates baltisberger the ability of vitamin D.
Copper is involved in the formation of elastin and collagen. Helps to stop the phenomenon of demineralization of bone structures.
Bor normalizes the activity of parathyroid hormone - parathormone. The latter is involved in the metabolism of calcium, cholecalciferol, phosphorus, magnesium. Effect on mineral metabolism of parathormone is not dependent on the receipt is itamin D3.
Thus, the algorithm of complex treatment in a concise form can be defined as follows: mild pain syndrome - interrupt pathological impulsaria in the trigger zone - strengthening hand muscles (and, first of all, forearms) - ensuring the regeneration of tissues anthesis.
The authors first proposed a method for the treatment of epicondylitis, including the complex of therapeutic measures aimed at improving the trophic degenerative tissue damage, interrupt the "vicious circle". The authors first proposed a method for the treatment of epicondylitis, including the complex of therapeutic measures aimed at improving the trophic degenerative tissue damage, interrupt the "vicious circle", the rapid relief of pain, prevention of relapses, disability of patients with epicondylitis.
A method of treating epicondylitis is aimed at all pathogenic components of the degenerative process: provides simultaneously an adequate analgesic, anti-inflammatory, angioprotective, regenerative effect, breaks the vicious circle of disease pathogenesis.
Timely comprehensive treatment of epicondylitis with emphasis on the most complete and rapid relief of pain and creating muscle sheath upper limb, sufficient to ensure that t is boamah loads (imposed work requirements limbs), improvement of metabolic processes in the tissues of the affected segment can prevent the chronicity of the condition of high load and recurrent disease as fully as possible to restore the function of the affected limb.
Application of the proposed method in 100% of cases to avoid the use of corticosteroids, and surgery for pathologically altered segment, to increase the rehabilitation potential of the patient and the patient's quality of life.
Despite the apparent success of sports medicine continuing introduction of corticosteroids and mutilating surgical treatment of intesion, for example, when epicondylitis.
The author first established the following. Adverse treatment outcome is determined primarily by the fact that when operative treatment nadrejena modified tendon or ligament ever leaves defective scar tissue, further complicating the return of the patient to normal life and still loads. There may be relapses, because the pressure is not aimed at the cause and the consequence. Conservative treatment, including injections corticosteriods, leads to degenerative changes and a high risk of spontaneous ruptures of the tendon or ligament. In addition, improper use immobilizers elbow joint means supports rivet irritation of the zone of attachment of anthesis and relapsing forms of the disease.
Chronic inflammatory process forms a stagnation of lymph, violates the separation of Pro-inflammatory factors, which, in turn, increases degenerative dystrophic changes in the tissues concerned segment.
A complex process of structural changes in paraartikulyarnye tissues, in turn, leads to reduced muscle balance and risk of formation of encomiendas contracture. With progression of degenerative-dystrophic process in the pathological process involves the whole upper limb, leading to severe disability of the patient.
Thus, in the postoperative period or after conservative treatment with corticosteroids amid the temporary relief of pain of the patients and after completing a full course of standard rehabilitation cannot stand still increased loads. Further, when the load increase above normal, there is a relapse.
The application of the proposed treatment algorithm allows to achieve a high positive treatment effect without the risk of the above complications.
The method is as follows.
Conduct a physical examination to confirm the diagnosis of epicondylitis". Assess the level of pain syndrome according to the Visual Analogue Scale (the ASH).
From the first day of treatment to complex therapeutic measures.
The affected segment of the proximal part of the forearm immobilized epicondylar tyre company Bauerfeind (Fig.1) during the day for 7-10 days patients-athletes or 2-3 weeks of normal patients. As part of the bandage has a viscoelastic insert that allows directed to unload the insertion of the muscles of the forearm and to minimize external loads on the segment. After that, the brace is worn only at loads. When this occurs, the transfer point of muscle attachment in the area of the pressing its special rubber pad of the bandage. This ensures full discharge zone of the tendon of the muscle to the periosteum of the humerus.
From the first day from the start of treatment prescribed physical therapy (physical therapy). And its first part, consisting of an isometric or static exercises aimed at strengthening the hand muscles, hold in the first half of the day, and the second part consisting of relaxing exercises conducted in the afternoon or after any loads. During the first two to three weeks of exercise therapy is carried out in the fixed position of the limb, and then moving on to physical therapy without the brace, using it only during professional or sports activity. The criterion of possible loads etc the LFC is the complete lack of pain when you exercise.
Concurrently daily for 7-10 days of conducting the electrical stimulation by electrical signals in the area anthesis and interested muscles of the forearm, what is it used for instrument tens or its analogs - DENAS, SCENAR, etc.
Against the background of stimulation spend pathogenic anti-inflammatory and reparative pharmacotherapy the scheme developed, aimed at tissue regeneration zone anthesis.
When the level of pain, not to exceed 4 points on YOUR prescribed anti-inflammatory medication Arthrofoon in monotherapy at a dose of 4 tablets per day for three months. When the level of pain syndrome 4 points and above Arthrofoon administered in the dose of 8 tablets per day in combination with selective nonsteroidal anti-inflammatory drugs: NISE, or Nimesulide, or NIMULID at a dose of 100-200 mg for 7-10 days.
Relaxation of tense muscles of the forearm prescribed medication, muscle relaxant Sirdalud 2-4 mg one hour before bedtime for 2 weeks.
In the body of the patient is given drugs that improve the microcirculation of the affected segment, vasodilators, which are used nicotinic acid or trental or complain and other injections that are injected intramuscularly, 1-2 ml daily for 10 days.
The treatment regimen includes the introduction into the organism of the patient is Reparata Milgamma, contains b vitamins to 2 ml of 5 daily injections, and then another 5 injections over two days on the third.
Appoint enzyme preparations: Wobenzym or Phlogenzym dose of 3 tablets three times a day for 3-4 weeks.
To restore the entire complex of tissues, including bone, tendon, muscle, in addition to the scheme of medical treatment administered calcium Calcemin or Calcemin-advance, which is prescribed for a period of six months.
The treatment by the proposed scheme is repeated after six months as the prevention and consolidation of initial treatment and exclusion of relapse.
Further, the patient is recommended when a heavy load or on a background of professional sports for life to maintain the strength of the tone of the muscles of the forearm exercise aimed at strengthening the muscles of the hand two or three times a week on average for at least 30 minutes, fixation orthosis interested segment during load handling device tens or its analogue interested muscles of the forearm and zone anthesis expressed after loads for 2-3 hours before bedtime and conducting the session relaxation exercises.
Way passed clinical trials in the base clinic of the Department of traumatology of RMAPO GKB №15 of them. O. M. Filatov and city polyclinic №22 km South of Moscow. He applied for 19 bol is different (volunteers) with epicondylitis in age from 16 to 56 years, 7 women and 12 men.
As a result of treatment in all patients achieved a pronounced and persistent clinical effect without complications and side effects. While examining patients over three years have not revealed the presence of epicondylitis or recurrence of pathological process, even in those with professional heavy loads.
Example 1. Sick Hours, 16 years old, a professional athlete-tennis player turned about sharply expressed pain syndrome, inability to perform simple sports activity. This state lasted for 4 months. The patient is examined. Confirmed the diagnosis of right-sided lateral-medial epicondylitis. Pain syndrome corresponds alone 4 points on YOUR. The patient was repeatedly applied in various clinics of the city. It was proposed that the introduction of corticosteroids in the area anthesis and surgical treatment. The patient refused the proposed treatment (risk of loss sports career) and addressed to the Department of traumatology and orthopedics, RMAPO. The treatment by the proposed method.
The proximal part of the forearm immobilized epicondylar tyre company Bauerfeind for a period of 10 days during the day. From the first day of starting treatment started performing gymnastics. Its first part, consisting of an isometric or static exercises directed on strengthening of muscles of hands, about what odiles in the first half of the day, and the second part consisting of relaxing exercises in the afternoon. During the first three weeks of therapy the patient was carried out in a fixed position by the brace legs, then LFC conducted without the bandage on his hand, and a bandage was applied only during exercise and sports performances in the next two months.
Also from the first days in the week held local stimulation by electrical signals in the area anthesis and interested muscles of the forearm device CHENS.
On the background of electrostimulation held anti-inflammatory and reparative pharmacotherapy: appointed anti-inflammatory drug Arthrofoon in monotherapy at a dose of 2 tablets twice a day for three months.
Relaxation of tense muscles of the forearm assigned drug - relaxant Sirdalud 2 mg one hour before bedtime for 2 weeks.
The course of injection therapy: nicotinic acid 2 ml daily for 10 days and Milgamma, 2 ml of 5 daily injections, and then another 5 injections over two days on the third.
Appointed enzyme preparation Wobenzym dose of 3 tablets three times a day for 4 weeks.
The medication calcium Calcemin for a period of six months.
The treatment was successful. Achieved full recovery of the patient. Pain Otsu is there. Complaints not submitted. Complications and side effects are not identified.
The treatment by the proposed scheme is repeated six months later.
The patient is observed for 7 years: performs the advice of a doctor, continues to engage in professional sports. Recurrence of epicondylitis was not observed. Visual inspection once a year did not reveal complaints of the upper extremities.
Example 2. Patient M. B. 57 years complained about pain in the right elbow joint. Occupation: geologist, built a house in the country site. During the inspection identified area anthesis, sharply painful palpation of the medial namesake right shoulder. Diagnosis: right medial epicondylitis.
Pain syndrome corresponds to 6 points on YOUR.
Immobilized proximal part of the forearm epicondylar tyre company Bauerfeind for a period of 3 weeks. From the first day of starting treatment recommended physical therapy in the state of fixation of the forearm for two weeks, then without it. The bandage was applied only for the period of physical exertion.
Concurrently daily for 10 days local stimulation by electrical signals in the area anthesis and interested muscles of the forearm with the SCENAR.
On the background of electrostimulation held anti-inflammatory and reparative pharmacotherapy drugs is ω Arthrofoon dose of 8 tablets per day in combination with selective non-steroidal anti-inflammatory drug NISE at a dose of 100-200 mg for 7 days prescribed muscle relaxant sirdalud 4 mg one hour before bedtime for 14 days, Calcemin - advance 1 tablet 2 times a day, Wobenzym - 3 tablets 3 times a day for 2 weeks and 5 tablets 3 times a day for another 2 weeks.
The course of injection therapy: trental 2 ml daily for 10 days and Milgamma, 2 ml of 5 daily injections, and then another 5 injections over two days on the third. The treatment was repeated after six months.
Long-term results after 4 years - during the examination of complaints is not revealed, recurrence was not, the patient had returned to their former way of life and work. Performs the advice of a doctor.
Method for the treatment of patients with epicondylitis, including the following measures: limit motor mode of the affected segment, physiotherapy and pharmacotherapy, wherein the pre-assess the level of pain syndrome according to the Visual Analogue Scale, the proximal part of the forearm immobilized epicondylar bandage during the day for 7-10 days patients-athletes or 2-3 weeks is normal in patients with the first day of treatment prescribed physical therapy, in the first part of which, consisting of an isometric or static exercises aimed at strengthening the hand muscles, hold in the first half of the day, and the second part consisting of relaxing exercises - in Deuteronomy the second half of the day or after any loads, while physical therapy continue after removing the bandage, using it only during professional or sports activity, in parallel daily for 7-10 days of conducting the electrical stimulation with the use of the instrument tens or its analogues by electrical signals in the area anthesis and interested muscles of the forearm, on the background of electrical stimulation conduct complex medical therapy, which includes anti-inflammatory and reparative therapy drug Arthrofoon, and when the value of the level of pain, not to exceed 4 points, it is prescribed as monotherapy at a dose of 4 tablets per day for three months, and when it is above 4 points at a dose of 8 tablets per day in combination with selective non-steroidal anti-inflammatory drug in therapeutic dose of no more than 10 days in treatment include muscle relaxant Sirdalud 2-4 mg one hour before bedtime for 2 weeks, vasodilators, improves microcirculation of the affected segment: injection that is injected intramuscularly daily for 10 days, the drug Milgamma, containing a complex of vitamins of group In 2 ml of 5 injections, and then another 5 injections over two days on the third, the enzyme preparation Wobenzym for 3-4 weeks, and calcium Calcemin or Calcemin-advance, which is appointed for a period of six months, the course of treatment pattern repeat in six months, in the future, the patient is recommended when a heavy load or on a background of professional sports for life to maintain the strength of the tone of the muscles of the forearm exercise aimed at strengthening the muscles of the hand two or three times a week on average for at least 30 minutes, fixation orthosis interested segment during load handling device tens or its analogue interested muscles of the forearm and zone anthesis expressed after loads for 2-3 hours before bedtime and conducting the session relaxing exercises.
SUBSTANCE: invention proposes a molecule that is specifically combined with CD37 and that contains the following from N-end to C-end: (a) CD37-specific scFV containing the following from N-end to C-end: (i) humanized variable region of a heavy chain, which contains CDR1 GYNMN, CDR2 NIDPYYGGTTYNRKFKG and CDR3 SVGPFDS, (ii) linker having 5 to 30 aminoacids inclusive, and (iii) humanized variable region of an easy chain containing CDR1 RASENVYSYLA, CDR2 FAKTLAE and CDR3 QHHSDNPWT; (b) a link region; and (c) immunoglobulin regions CH2 and CH3. The following is described: The following is described: nucleic acid coding the above binding molecule; an expression vector containing the above nucleic acid; and a host cell for production of a binding molecule, which contains the above vector. The invention proposes use of the above binding molecule to obtain a medicinal agent to reduce the number of B-cells, treatment of a disease or an illness, which is related to abnormal activity of B-cells. Besides, the invention describes compositions containing effective number of the above binding molecule to reduce the number of B-cells, treatment of a disease or an illness related to abnormal activity of B-cells.
EFFECT: invention allows obtaining scFV molecule binding CD37, having orientation of variable regions VHVL, with high yield and efficiency in comparison to scFV molecule against CD37, which has orientation of variable regions VLVH.
31 cl, 17 dwg, 13 tbl, 12 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: present invention refers to biotechnology and represents a pharmaceutical composition applicable for treating a rheumatic disease and containing the humanised anti-CD4 antibody able to activate CD4+CD25+ regulatory T-cells, and methotrexat. The present invention also discloses a kit and a method of treating the rheumatic disease with using the above pharmaceutical combination and the above kit.
EFFECT: invention enables implementing more effective methods of treating the rheumatic diseases, including rheumatoid arthritis.
57 cl, 8 dwg, 2 tbl, 2 ex
SUBSTANCE: group of inventions refers to medicine. What is described is a biological material containing: a) a liquid carrier containing a viscous solution containing at least one natural and/or semisynthetic polysaccharide and having a dynamic viscosity measured at 20°C and at shear rate D=350 s-1, within the range of 100 to 250 centipoise and/or kinematic viscosity within the range of 99 to 248 centistokes (measured in the same environment); b) a autologous or heterologous mesenchymal cell culture and/or c) platelet rich blood product.
EFFECT: material in form of viscous liquid is particularly applicable for the therapy of osteoarthritis, ligament injuries and administered intra-articularly, intradermally or applied in situ without change of the properties of the mesenchymal stem cells and/or its platelets.
11 cl, 5 ex
SUBSTANCE: method involves a preclinical electroneuromyography (ENMG) of the neuromuscular apparatus of injured and intact lower extremities to measure a muscle response amplitude - an M-response. The findings are recorded. Starting from the second postoperative day, in the course of the drug-induced neuroprotective treatment and therapeutic exercises, the following therapy is additionally performed for 10-15 days. If the injured M-response amplitude is below 4.0 mV, while the respective intact value is more than 4.0 mV, the anti-inflammatory physical treatment covering the injured extremity is performed. If the injured M-response amplitude is more than 4.0 mV, while the respective intact value is below 4.0 mV, the stimulating passive physical treatment covering the intact extremity is performed. If the M-response amplitude of the injured and intact extremities is below 4.0 mV, the anti-inflammatory physical treatment covering the injured extremity and the stimulating passive physical treatment covering the intact extremity are performed. Three and six months following the surgical management, the repeated ENMG of the neuromuscular apparatus of the lower extremities to measure the M-response amplitude. If observing the preserving M-response amplitude below 4.0 mV on at least one lower extremity three months following the surgical management, the repeated complex of the drug-induced neuroprotective treatment and the stimulating passive physical treatment covering the neuromuscular apparatus of the hip with the M-response amplitude below 4.0 mV are performed. If observing the preserving M-response amplitude below 4.0 mV on at least one lower extremity six months following the surgical management, the repeated complex of the drug-induced neuroprotective treatment and the stimulating passive physical functional treatment covering the neuromuscular apparatus of the hip with the M-response amplitude below 4.0 mV are performed by walking electrical stimulation of the hip and shin.
EFFECT: method reduces the length of treatment and increases its effectiveness with decreasing a percentage of neurological complications by performing the individual complex exposure on the neuromuscular apparatus of the lower extremities taking into account the ENMG findings of the neuromuscular apparatus of the lower extremities.
2 cl, 3 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: invention refers to compounds of formula (I), wherein A means morpholinyl, 1,4-oxazepamyl, piperidinyl, pyrrolidinyl or azetidinyl which is bound to N; R1 means C1-C6-alkyl group; R2 means bicyclic aryl group specified in 1H-indolyl, 1H-pyrrolo[3,2-b]pyridyl, quinolyl, naphthyl, 1H-pyrrolo[2,3-b]pyridyl, 5H-pyrrolo[3,2-d]pyrimidinyl, 7H-pyrrolo[2,3-d]pyrimidinyl, benzo[b]thiophenyl, imidazo[1,2-a]pyridyl, benzo[b]thiazolyl, 5H-pyrrolol[2,3-b]pyrazinyl and quinoxalinyl which can be substituted by R4; R3 means hydrogen or halogen atom; R4 means C1-C6-alkyl group, C1-C6-halogenalkyl group, OR1A, halogen, -(CH2)aOH, CN, NHCOR1A, SO2R1A or NHSO2R1A; R5 means C1-C6-alkyl group, -(CH2)aOH, -(CH2)aOR1B, halogen or CONH2; provided p is a plural number, R5 can be identical or different, or R5 can be combined with another R5; each of R1A and R1B independently means C1-C6-alkyl group; a is equal to 0, 1 or 2; n is equal to 1 or 2; p is equal to 0, 1, 2, 3, 4 or 5. Besides, the invention refers to intermediate compounds of formulas (IA) and (IB) for preparing the compounds of formula (I), to a preventive or therapeutic agent containing the compounds of formula (I), pharmaceutical compositions, using the compounds of formula (I) and to a method for preventing or treating diseases.
EFFECT: compounds of formula (I) as selective 5-HT2B receptor antagonists.
11 cl, 1 dwg, 18 tbl, 88 ex
SUBSTANCE: what is described is a method for the cartilaginous, osseous, muscular tissue regeneration stimulation involving the setting of a long bone fracture and introduction of the prepared agent into the intramedullary canal and the surrounding muscular tissue; that is combined with the tissue regeneration stimulation by introducing a mixture of aqueous solutions of recombinant beta interferon (IFN-β) in the concentration of 1∙105 units/ml and polyethylene glycol with a molecular weight of 6,000 (PEG 6000) in the concentration of 0.03∙10-9 mole/ml in the relation of 1:4 respectively; that is followed by a retrograde intramedullary osteosynthesis of the long bone fracture.
EFFECT: agent enables providing higher clinical effectiveness in the long bone fractures, reducing injuries, simplifying preparation technology of the agent for the tissue regeneration stimulation within the fracture, and reducing a rate of pyoinflammatory complications.
SUBSTANCE: invention relates to novel inhibitors of human poly(ADP-riboso)polymerase-1 based on uracyl derivatives of general formula (I), (II), (III) and (IV). Inhibitors of poly(ADP-riboso)polymerase-enzymes take part in DNA reparation. In general formula and R1=H, Cl, Br, I, methyl, ethyl, propyl or isopropyl; R2, R3, R4, R5=H, methyl, ethyl, propyl or phenyl; R6=(CH2)n, where n=1-4; X=OR2 or NR2R3, R2, R3=H, methyl, ethyl, propyl, phenyl, 3-hydroxypropyl.
EFFECT: obtaining novel inhibitors of human poly(ADP-riboso)polymerase-1.
1 tbl, 19 ex
SUBSTANCE: invention refers to medicine, namely traumatology, orthopaedics, and can be used for supporting treatment in large joint replacement. That is ensured by determining a volume of involved joint contracture six months before the operation. That is followed by X-ray and magnetic resonant examination of the involved and collateral joints to specify their state. Besides, a quality of the bone tissue is assessed by osteodensitometry. If observing changes in the bone tissue quality, the complex of the drug therapy is added with the preparations Bivalos and Calcemin. A pain syndrome intensity is assessed by the visual analogue scale three months before the operation. That is followed by the complex therapy aiming at optimising the state of extremity joints with added local injection therapy (LIT). That is ensured by preliminary exposing the biologically active periarticular zones in the proximal and distal direction from the involved joint to the focused infrared laser light. A mixture containing solutions of the therapeutic preparations: chondroprotectors, Contrykal, Lidocaine, vitamin B12 is injected into the same zones. Besides, Arthrofoon is administered for the whole preoperative period. If the pain syndrome intensity is less than 4 points, Arthrofoon is administered in a dose of 4 tablets a day. If the intensity value is more than 4 points, the preparation is administered in a dose of 8 tablets a day in a complex with a short course of a non-steroidal anti-inflammatory preparations and a chondroprotector. The replacement operation is immediately followed by fixing a collateral joint with an orthesis for the period of 3 months. The complex of the postoperative supporting therapy started three weeks after the operation is added with a single intravenous introduction of the preparation Aklasta, the preparation Arthrofoon in a dose of 4 tablets a day for three months, alpha calcidole and Calcemin continuously. A pectoral girdle of the extremities is reinforced by means of an individually specified set of therapeutic exercises and electric walking myostimulation. The LIT of the collateral joint is performed three months after the operation. If observing a degenerative process in the adjacent joints, the LIT is performed alternatively in these regions. Vasodilators, chondroprotectors, and the preparation Milgamma are administered with underlying LIT. If observing psychoemotional changes in the patient, the preparation Tenoten is additionally administered. A postoperative medication regimen, including the LIT is repeated 3-4 times every 6 months.
EFFECT: method provides optimising the effect of the surgical management and preventing developing complications both in the operated joint, and in the adjacent and symmetrical joints after the replacement, preventing developing instability of the endoprosthesis components, preventing developing or aggravating degenerative process in the symmetrical and adjacent joints that reduces a risk of the recurrent operations.
SUBSTANCE: invention refers to medicine, namely to therapy, and can be used for treating arthritis in a mammal, involving administering N-(4-(4-((2-(4-chlorophenyl)-5,5-dimethyl-1-cyclohex-1-en-1-yl)methyl)piperazin-1-yl)benzoyl)-4-(((1R)-3-(morpholin-4-yl)-1-((phenylsulphanyl)methyl)propyl)amino)-3-((trifluoromethyl)sulphonyl)benzene sulphonamide (ABT 263).
EFFECT: invention provides treating arthritis by specific lymphocytic immune suppression in a patient caused by administering the above compound.
3 dwg, 1 ex
FIELD: medicine, pharmaceutics.
SUBSTANCE: group of inventions refers to treating arthropathies, such as arthrosis and inflammatory loss of cartilage, tendon disorders and/or degenerative spine diseases. What is presented is a pharmaceutical composition for the above application, containing a corticosteroid and a cytokine antagonist - a natural or recombinant protein of interleukin IL-1Ra antagonist, particularly orthokine or anakinra, and optionally a growth factor; the composition is injectable into an injured nerve root, or into an injured intervertebral disk, or into their local context, or for intraarticular injection. There are presented: a kit comprising the pharmaceutical composition with the above cytokine antagonist and optionally the growth factor, and the pharmaceutical composition with the corticosteroid; using the above cytokine antagonist and optionally the growth factor for preparing the pharmaceutical composition to be used in combination therapy together with the corticosteroid for the above application; using the corticosteroid for preparing the pharmaceutical composition to be used in combination therapy with the above cytokine antagonist and optionally the growth factor for treating the above arthropathies, tendon disorders and/or degenerative spine diseases.
EFFECT: clinical success of treatment manifested by apparent joint detumescence, pain reduction by 60-100%, functional improvement of the joint, with the effect persisting 8 months later and more after the treatment.
39 cl, 1 tbl
SUBSTANCE: invention refers to medical equipment, namely to external cardiac pacing devices. A cardiac pacemaker comprises input and output electrodes mounted by cross cables to a body with in-built bioelectric-potential amplifiers and a stimulation pulse generator, a control unit integrated into the body and connected to the stimulation pulse generator, control devices and the bioelectric-potential amplifiers. A power supply unit is connected to the cardiac pacemaker assemblies and separately uses each of them to form a number of operative voltages. A wireless device provides a wireless connection of the control unit with a computer and a printer. A charging unit is connected to external and internal power supplies. The control unit is connected to a data supplier, an operation lamp and an impedance meter connected to the stimulation pulse generator and enabling using the device as an intraoperative test gauge. The body is provided with separation mount holes for cross cables used to connect the input electrodes connected to read ECG signals, and the output electrodes, including the electrodes connected to perform an electrophysiological study, and the electrodes connected to perform endocardial stimulation, and the electrodes connected to perform percutaneous stimulation.
EFFECT: providing various cardiac stimulation modes.
8 cl, 3 dwg
SUBSTANCE: group of inventions relates to medicine. A device contains positive and negative electrodes, a power source and control means. The electrodes are installed or printed on a petal. The power source and the control means are located in a mould depression. The power source is connected to the electrodes by a conductive track. The conductive track of the positive electrode is separated from the negative electrode by an insulating strip. Insulating tracks are located on the petal edge. The method is realised with the application of the said device. In the process of its realisation stimulating electric impacts, sufficient to cause isometric muscle contraction, are supplied.
EFFECT: group of inventions increases the efficiency of a stimulating impact due to the prevention of electric current leakage and proportional increase of the blood flow in tissues.
7 cl, 2 tbl, 26 dwg
SUBSTANCE: invention relates to therapeutic devices for application in transcranial electrostimulation by the application of a respective electric impulse to ears simultaneously with playing music, which the patient hears. The device contains a generator of transcranial electrostimulation impulses, a generator of the sound signal, a control unit, a pair of audioearphones. The generator of transcranial electrostimulation impulses is made with a possibility of creating an electric impulse, which has such a frequency and duration as to provide the required microcurrent through the head. The control unit is made in the form of a microprocessor, controlling data of the electrostimulation impulse generator and the generator of the sound signal. Each audioearphone contains an electrode, transmitting electric current, for the application of the said impulses, produced by the impulse generator, into the area of the patient's ear. Each of the audioearphones and the respective electrode are combined into an electrode device, with the electrode of each electrode device being located on an external surface of the respective audioearphone, suitable for installation in an orifice of the auditory canal of the ear or inside it. The electrode of each electrode device has an area of electric contact for functional transmission of electric energy between the electrode and the patient's skin with the installed electrode device. The electrode devices are made with a possibility of installation in the orifice of the auditory canal of the respective ear of the said patient.
EFFECT: application of the invention increases convenience of carrying out electrostimulation and simplifies installation of the equipment on a patient.
6 cl, 6 dwg
SUBSTANCE: 12 postoperative days involve electric stimulation of a surgical suture region. For this purpose, an independent electrical stimulator is placed under the abdominal skin. The electric stimulation is performed with the use of platinum electrodes. A patient is exposed to rectangular electric pulses of the length of 6 ms formed as trains of 16 pulses. The pulse repetition period is 24 ms, the train repetition period and an alternative mark inversion is each 3 seconds, and current amplitude is 0.1 mA.
EFFECT: method provides faster repair processes and remodelling phase transformation of the maturing connective tissue within the surgical suture.
SUBSTANCE: method involves retrobulbar administration of dexamethasone, intramuscular administration of cerebrolysin and proserine, intravenous administration of nootropil. The preparations are introduced for 10 days. Administration further is followed by a percutaneous transcranial pulse magnetic stimulation and an electric stimulation of the optic nerve once a day for 10 days. The magnetic stimulation is performed at the magnetic field strength 2 T, modulation frequency 1 Hz. The exposure covers four points in the projection of the optical nerve sequentially: eyes, temporal region, postaural region, inion - for 5 minutes on each point. The electric stimulation represents the exposure to negative train pulses a frequency of which is equal to a patient's pulse rate at an electrical characteristic not less than 10-15 mC per one session.
EFFECT: method prolongs the remission of optical neuritis in the patients suffering multiple sclerosis.
2 ex, 1 tbl
SUBSTANCE: invention relates to wireless monitoring of pH in oesophagus. Follow-up system incorporates internal transmitting hardware and external registration hardware. Note here that said internal transmitting hardware comprises pH-transducer, sampling circuit, first microprocessor, power supply, first module of wireless transceiver and first means. External registration hardware comprises second microprocessor, power supply, audio signal generator, memory, data interface, button switch, second module of wireless transceiver, light state indicator, housing and second means. Second means of external registration hardware can interact with the first means. If said interaction detects that internal registration hardware is no located at the preset body part then second microprocessor initiates audio signal generator and/it light state indicator. External registration hardware, in its turn, allows intermittent detection of the intensity of signal received by second module of wireless transceiver under control of second microprocessor. If signal intensity falls beyond preset range then second microprocessor actuates audio signal generator and/or light indicator for warning purposes. Method of positioning for wireless pH monitoring is realised with the help of follow-up system.
EFFECT: ruled out invalid measurements caused by unforeseen capsule departure.
8 cl, 7 dwg
SUBSTANCE: invention refers to medical equipment, namely to neurostimulation apparatuses. An apparatus comprises a device having a pulse generator for its supply on skin, a control unit, a probe with a number of electrodes connected to the control unit; the device is configured to determine a relative skin impedance, to localise an area of treatment on the basis of the relative skin impedance and to supply automatically a therapeutic pulse sequence on the basis of the pre-set relative skin impedance. According to the second version, the apparatus additionally comprises a gripping mechanism having a number of skin-contacting electrodes; the control unit is presented to determine a relative impedance of at least two of the whole number of electrodes for recording electrode-contacting skin impedance and to supply stimulation pulses to the electrodes on the basis of the recorded skin impedance. According to the third version, the probe comprises a number of spaced electrodes placed in a matrix; the matrix comprises a number of pairs of electrodes, and each pair of electrodes comprises neighbour electrodes having opposite polarities; the apparatus is configured to measure the skin impedance by the number of electrodes, to determine the relative impedance of the number of pairs of electrodes, to identify the area of treatment on the basis of the relative impedance, to transmit the pulse sequence into the area of treatment on the basis of the relative impedance of the pair of electrodes and to adjust the parameters of the pulse sequence in response to measuring the relative impedance of the pair of electrodes. According to the fourth version of the embodiment, the gripping mechanism comprises a number of electrodes comprising at least one first pair of electrodes mounted on the first probe to travel along the patient's skin to localise the active area on the basis of the skin impedance, and at least one second pair of electrodes mounted on the second probe to supply a pulse into the active area, while the control unit has at least one pre-set therapeutic parameter for setting variables of the generator to generate a pre-set pulse group and configured to provide a graphic selection of the above at least one pre-set therapeutic parameter by an operator by means of an interface.
EFFECT: using the invention enables to extend the range of technical aids for therapeutic neurostimulation.
35 cl, 49 dwg
SUBSTANCE: invention refers to medical equipment, namely to electrotherapeutic stimulators for muscle and nerve tissue The stimulator comprises a signal generator for generating alternating current of a certain frequency and amplitude, two electrodes for current stimulation of the muscle and nerve tissue The signal generator is configured to generate intermittently a simultaneous frequency and amplitude modulation in the rising frequency phase and in the falling frequency phase The generator performs a frequency modulation at a modulation frequency within the frequency range of 0.1 Hz to 200 Hz, with the modulated frequency within the frequency range of 2 kHz to 32 kHz varies at discrete quarter-tone pitches Besides, the generator is designed to take each quarter-tone pitch twice in the period of modulation and to decrease the rising frequency phase to the good of the falling frequency phase to zero.
EFFECT: using of the invention allows the therapeutic exposure continuous in terms of frequency coverage, and smooth muscular contraction and relaxation.
12 cl, 5 dwg
SUBSTANCE: invention refers to aids for facial nerve stimulation. A stimulation system comprises an electrode comprising a set of terminals placed in an individual's parotid region, and a processor stimulating each of the set of terminals separately to determine which contact or contacts activates a specific facial muscle or facial muscles, to identify the terminals enabling one or more nerve branches activating the required facial muscle, and to select the identified terminals to stimulate the nerve branches. The method for identifying one or more electrode terminals involves stimulating each of the set of terminals separately, measuring the motions of various facial muscles using sensors placed on the skin or implanted subcutaneously, and correlating the terminal stimulation data and the measured muscular motion data to determine which terminal or terminals has or have eventually activated the specific facial muscle or muscles.
EFFECT: using the invention enables providing higher accuracy of determining the terminals to activate the specific facial muscles, especially for the individuals having synkinetic re-innervated muscles.
19 cl, 11 dwg
SUBSTANCE: invention relates to field of medicine, namely to methods of functional diagnostics in cardiology. Stress-echocardiographic examination with application of transesophageal electrical stimulation of atria is carried out. Electric stimulation is carried out with step-by-step change of HR value in continuous mode. Stimulation starts from rate which is 20 beats lower than submaximal HR, with further increase of rhythm frequency by 10 p./min at each following minute until submaximal HR is achieved. After that electric stimulation continues at maximal HR within time period up to 3 minutes, when echocardiographic criteria of stress-induced ischemia of myocardium appear, electric stimulation is stopped.
EFFECT: invention makes it possible to increase diagnostic significance of the method in a reliable way with reduction of examination time.
2 cl, 1 ex, 2 tbl, 1 dwg
SUBSTANCE: effective amount of a chemotherapeutic agent and anti-VEGF antibodies (bevacizumab), wherein the agent represents either (a) capecitabine, (b) docetaxel or Abraxane, (c) or antracycline, and wherein the anti-VEGF antibody is administered at 15 mg/kg. No other chemotherapeutic agent has been administered into the individual for treating local recurrent or metastatic breast cancer, and/or the above individual has not undergone adjuvant pre-chemotherapy accompanying a recurrence for 12 months or less after the last dose administered. There are also presented the anti-VEGF antibody, using the anti-VEGF antibody and kits containing the anti-VEGF antibody in a combination with the chemotherapeutic agent for treating metastatic breast cancer.
EFFECT: prolonged individual's lifespan with no disease progression.
40 cl, 6 dwg, 5 tbl, 1 ex