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GASTROENTEROLOGY
INVENTION
Patent of the Russian Federation RU2150974

METHOD FOR TREATMENT OF PATIENTS WITH PULMONARY DISEASE OF THE TWELFTH DIAGNOSTIC

METHOD FOR TREATMENT OF PATIENTS WITH PULMONARY DISEASE OF THE TWELFTH DIAGNOSTIC

The name of the inventor: Minenkov AA; Filimonov RM; Serebryakov SN; Volkova Т.V.
The name of the patent holder: Russian Scientific Center for Rehabilitation and Physiotherapy
Address for correspondence: 121099, Moscow, Novy Arbat 32, RRC Rehabilitation and Physiotherapy
Date of commencement of the patent: 1996.01.15

The invention relates to gastroenterology and is intended for the treatment of duodenal ulcer. Impact infrared laser radiation on the projection zones of cervical sympathetic nodes. The method allows to achieve a clinical effect without taking antacids, shorten the treatment period and prolong remission.

DESCRIPTION OF THE INVENTION

The invention relates to the field of medicine, in particular gastroenterology, and can be used in institutions of practical public health in the treatment of duodenal ulcer, which continues to be one of the central problems of modern gastroenterology.

A method of medicamentous treatment of duodenal ulcer is known, which includes astringent and enveloping drugs, antacids, anticholinergics, H 2 -blockers that actively suppress the secretory activity of the stomach and cause "medicamentous vagotomy", anti-inflammatory drugs and vitamins / Vasilenko VK, Grebenov A . "Peptic ulcer" - M .: Medicine, 1987, Mashkovskiy MD Drugs: in 2 volumes - M .: Medicine, 1988. The disadvantage of the drug treatment method is that the nature of this disease requires a long-term use of medicines with further resistance to them and subsequently the need to increase the dose and the development of all sorts of complications (allergic and toxic reactions). In addition, the intake of a number of drugs is limited by the presence of contraindications to their use, for example, in glaucoma, a tendency to bleeding, hypotension, constipation, tachycardia, etc. The effectiveness of drug therapy is on the average 55-70%, in terms of 4-8 weeks / Vasilenko V.K., Grebenov A.D. Peptic ulcer disease. - Moscow: Medicine, 1987.

The method of treatment of patients with peptic ulcer disease using resort factors is known: mineral water, mud, etc. However, their appointment is possible only in the conditions of sanatoria, resorts that have these stocks, and patients who do not have contraindications for balneotherapy / Olefirenko VT Water-heat therapy. - M .: Medicine, 1978. Vygodner EB Physical factors in gastroenterology. - M .: Medicine, 1978.

A method of treatment using various physical factors is also known, for example, exposure to a continuous electric field of UHF, sinusoidal-modulated currents, ultrasound, low-frequency pulsed current (by the method of electrosleep), alternating magnetic field / Vygodner EB, 1987, Yasnogorodsky V.G. . Electrotherapy. - Moscow: Medicine, 1987. A common disadvantage of these treatments is their low effectiveness (according to the data of a catamnesis, cicatrization of ulcers is observed in 28-35% of cases), insufficient resistance of the therapeutic effect, inability to use them to patients with low blood pressure, various concomitant diseases and severe allergies.

One of the close analogues to the proposed method of treatment is the use of monochromatic laser radiation with a wavelength of 0.6328 μm. Considering the penetration depth of NLI from 20 to 30 mm / Koshelev VN Laser therapy of gastroduodenal ulcers. - Saratov, 1986, Pletnev SD Lasers in clinical medicine. - М .: Medicine, 1981 /, a technique of so-called endoscopic laser therapy using endofibroscopes is used. This method has a number of advantages in comparison with other physical factors, such as a reduction in the duration of treatment to 20 days compared with 38 days in traditional methods of treatment / Korochkin IM, Poslavsky MV Clinical application of LI with different wavelength for the treatment of chronic gastroduodenal ulcers. In: Application of lasers in medicine. Tez. Doc. Kiev, 1985. Healing of ulcers occurs by epithelization or the formation of tender scars, long-term remission to 2 years or more. However, this method of treatment is contraindicated in severe deformation of the bulb of the duodenum, poor intragastric procedures, sharp narrowing of the esophagus, widening of the esophagus, aortic aneurysm, decompensated state of the cardiovascular system, etc.

The closest in nature, i.e. Prototype, the proposed method is a method of treatment of patients with peptic ulcer disease using pulsed low-energy infrared laser radiation with a wavelength of 0.89-0.90 microns (IR NLI), a noninvasive method with an effect on the epigastric region under the xiphoid process. "Fundamentals of laser therapy." - M., 1992. The time of exposure to one field is up to 2 minutes, the pulse generation frequency is 200-1000 Hz, the power is minimal, and the treatment course is 10-15 daily procedures.

However, the disadvantage of this method of treatment is that with the initial hyperacid state, laser therapy should be accompanied by the intake of additional drugs, in particular antacids.

The technical result of the proposed method of treatment of patients with duodenal ulcer is cicatrization of a ulcerative defect without taking antacids, shortening the duration of treatment and prolonging the period of remission.

The essence of the invention is that the action of pulsed infrared low-energy laser radiation with a wavelength of 0.89-0.90 μm produces a paravertebral sympathetic node C 2 -C 4 , with the radiation dose per procedure for each zone 0.02-0, 13 J with a gradual increase in the procedure time from 2-5 minutes for the first 4 days, and from 5 procedures for 4-5 minutes before the end of the course of treatment, daily 10-15 procedures.

A distinctive feature of this method of treatment is a new localization of the effect of laser radiation on the upper cervical sympathetic nodes.

The choice of localization is justified by the fact that the upper cervical sympathetic nodes are directly related to the regulation of acid formation and motility of the gastroduodenal system, and are associated with the hypothalamus, pituitary gland and thyroid gland, whose role in the regulation of trophic processes is unquestionable. Mosin VI Hormonal aspects of pathogenesis - Stavropol , 1981, Pasechnikov VD The content of STH, cortisol and thyroxine in the blood in patients with peptic ulcer of the duodenum. Stavropol, 1980.

Use in treatment of irradiation dose below 0.02 J did not have a sufficient effect on the dynamics of clinical symptoms, objective signs and endoscopic picture of the disease, but also on the acid-forming function of the stomach. Use in the treatment of radiation doses above 0.13 J in patients showed an increase in the clinical symptoms of the underlying disease and characteristic disorders of the secretory function of the stomach.

The most optimal results of treatment were obtained using an irradiation dose of 0.02 to 0.13 J.

DESCRIPTION OF THE METHOD OF TREATMENT

After a preliminary examination, which includes the collection of anamnesis, clinical and laboratory methods of research, esophagogastroduodenoscopy (EHDS) and pH-metry, begin treatment.

The treatment is performed using serial physiotherapeutic devices ALT "Uzor", "Mustang", "Elat" and others / radiation wavelength 0.89-0.90 microns, pulse duration 7 h 10 -8 s /. The dose of irradiation for one procedure when acting on the cervical sympathetic nodes 0.02-0.13 J, the contact radiator is labile, paravertebrally irradiate the area of ​​the projection of the upper cervical sympathetic nodes C 2 -C 4 . The duration of irradiation during the first 4 days of each zone individually increases from 2 to 5 minutes, and from 5 procedures for 4-5 minutes before the end of the course of treatment. Only 10-15 daily procedures. Treatment of patients is carried out while observing an antiulcer diet according to the scheme of the Institute "Nutrition" - table 1 on the background of taking multivitamins.

An example of implementing the method

Example 1 : The patient T-ova, born in 1955, was treated in the gastroenterological department of the RSC MPIFT with the diagnosis: peptic ulcer of the duodenum in the stage of fading exacerbation. Entered the institute with complaints about the "hungry" aching nature of pain in the epigastric region, the pain was stopped by eating, heartburn and belching after eating, a general weakness. With EGDD, a duodenal ulcer 0.5 cm was found on the anterior wall of the bulb, an oval shape. PH-metry data: body of the stomach - 1,1; Antral department of the stomach - 2,8; Cavity of the bulb of the duodenum - 3.8. The following treatment has been prescribed: exposure to pulsed infrared low-energy laser radiation from the ELAT apparatus / wavelength 0.89-0.90 μm / paravertebral to the projection of cervical sympathetic nodes C 2 -C 4 , irradiation dose 0.02 J, procedure labile, duration The first four procedures from 2-5 minutes per field, and then 5 minutes before the end of the course of treatment. A total of 12 daily procedures on the background of dietary intake and multivitamins. The tolerability of the procedures was good. As a result of the treatment, the patient's well-being improved, the pains decreased to 4 procedures, and stopped by 7 procedures. Dyspeptic syndrome decreased to 3 procedures, stopped by 7 procedures.

Control esophagogastroduodenoscopy. Compared with the previous study, there is a pronounced positive dynamics: complete scarring of the ulcer of the bulb of the duodenum.

PH-metry data: body section of the stomach - 1,7; Antrum stomach - 3,4; The cavity of the bulb of the duodenum is 5.2, which testifies to the suppression of acid-forming and stimulation of the acid neutralizing function of the stomach and duodenum. A reliable normalization of the parameters of the immune and neuroendocrine systems was observed.

Example 2

Patient P-va, born in 1927, was on treatment in the gastroenteric department of the Institute with a diagnosis: duodenal ulcer, stage II, moderate severity, recurrent course, in the phase of fading exacerbation. IHD-angina pectoris, II functional class. At admission, she complained of intense "hungry" pains in the epigastric region, calming down after eating. An eructation of air and heartburn after a meal.

It is sick since 1990, when after the nervous overstrain for the first time there were pains of a dull and aching character in the epigastric region. The patient was examined, with EHDS was revealed chronic gastroduodenitis. At the place of residence, outpatient treatment was provided. In 1992, the patient began to worry about "hungry" pains in the epigastric region, which were calmed down by the ingestion of food. When endoscopic examination revealed duodenal ulcer up to 0.5 cm in diameter, an oval shape along the anterior wall of the bulb of the duodenum, with a bottom covered with a whitish coating on the background of focal bulbit. In-patient treatment was conducted in 67 mountains. Hospital with the use of solcoseryl IV, Almagel, Vicair and spasmolytics. With control endoscopy 39 days after the start of treatment, the ulcer was healed. The duration of remission after the treatment was 6 months. Outpatient medication prophylactic antiulcer treatment was performed in the spring-autumn periods, which gave clinical improvement for some time. In the autumn of 1993, with a control endoscopic examination during an exacerbation, an ulcer was found in the bulb of the duodenum. Outpatient, medication

The last exacerbation since the end of April 1994, when again after a nervous overexertion the patient began to be troubled by "hungry" pains in the epigastric region, heartburn and belching were added by air. The patient was sent to the gastroenterological department of the Institute for consultation and treatment. When endoscopic examination of April 28, 1994, a duodenal ulcer measuring 0.5 × 0.7 cm was detected on the background of pronounced bulbit. After that the patient was hospitalized in the department of RNC MR and FT.

At an objective inspection it is revealed: a skin pure, the thyroid gland is not increased, lymph nodes without features. In the lungs, the breath is vesicular, there is no wheezing. Boundaries of the heart within the limits of age norms, heart rhythmical sounds, no noise, arterial pressure 120/80 mm Hg. St., Pulse 73 beats per minute, satisfactory filling and tension. The abdomen is of regular shape, evenly participates in the act of breathing, with trembling palpation the expressed tension in the epigastric region and behind the paravertebral at the level D 6 -D 12 is determined. With deep palpation, there is local soreness in the pyloroduodenal region. Symptoms of Orner and Ker are weakly positive. The liver is not enlarged, palpation along the thick intestine is painless. Dysuric phenomena do not occur, the symptom of Pasternatsky is negative on both sides. From the side of the nervous system, no changes were detected.

The treatment was performed by pulsed infrared low-energy laser radiation from the ELAT apparatus / wavelength 0.89-0.90 μm / per projection of the cervical sympathetic nodes, with an irradiation dose of 0.13 J. The duration of the first 4 procedures is from 2 to 5 minutes for each Zone, subsequently up to 5 minutes before the end of the course of treatment. Only 10 impacts, daily. Dietary nutrition (curative) according to the scheme of the Institute of Nutrition. Multivitamins 1 tablet 3 times a day after meals.

The tolerability of the effects of IR NLI was satisfactory, hemodynamic parameters both before and after treatment remained unchanged.

As a result of the treatment, the patient's condition improved significantly, the pain in the epigastric region disappeared to the 3rd procedure, heartburn and air belching decreased to 4 the effects of IR NLI, and completely disappeared to 6 procedures. In an objective study, muscle tension and local soreness were not determined to 4 exposures.

The laboratory data changed as follows (Table 1)

Study of the level of hormones in the pituitary-thyroid-adrenal system (Table 2).

Investigation of the effect on immunity indices (Table 3)



Thus, under the influence of the treatment, the patient has an improvement in the clinical symptoms of the disease, the functional state of the stomach and duodenum, the parameters of the neuroendocrine and immune regulatory systems, the normalization of the exocrine function of the pancreas, which ultimately leads to an improvement in trophic processes in the gastroduodenal zone and healing Ulcers.

The patient is observed for 16 months and up to the present time she has not had any exacerbations.

The proposed method of treatment was used in the gastroenterological department of the RSC MPIFT in 40 patients with duodenal ulcer, aged 21-64 years, with a disease duration from 1 year to 10 years, mainly from stage II of the disease, moderate severity, in the phase of fading exacerbation. The diagnosis was made on the basis of clinical and endoscopic survey data. Some of the patients had concomitant diseases. So in 14 patients, cardia deficiency was identified, of them in 6 with the presence of reflux esophagitis, in 3 dyskinesia of the gallbladder. The majority of patients had typical clinical signs of peptic ulcer disease: pain in the epigastric region, heartburn, belching of the air, propensity to constipation, etc. In addition, in 7 patients, osteochondrosis of the cervical-thoracic spine was diagnosed.

In an objective examination, in 29 patients, zones of cutaneous hyperesthesia in the epigastrium on the right, soreness at the site of the projection of the ulcer on the anterior-abdominal wall in all patients, muscle tension in 37 patients were determined. When studying the state of acid-forming and acid-neutralizing gastric function, increased basal secretion was revealed, it corresponded to low pH (1.49 ± 0.083) both in the body of the stomach and in the antrum (2.59 ± 0.09). This caused a constant acidification of the medium in the bulb of DPC, with a pH value of 4.3 ± 0.16. Violations of the neutroendocrine system were minor. In the study of the immune system, most patients had an initial bisbalance in the number of immunocompetent lymphocytes and a violation of their functional activity.

As a result of the treatment, complete disappearance of pain in 87% of patients, heartburn in 71%, eructation in 50%, in addition, in most patients there was a significant improvement in objective data (skin hyperesthesia zones, muscle tension, local soreness). Scarring occurred in 78% of patients, 2 of them had chronic ulcers and 30% of large sizes (up to 0.7 cm). In the majority of patients, an increase in pH in the antrum of the stomach and in the duodenal cavity was detected, according to the data after the treatment and at the end of the course of treatment.

There was a statistically significant normalization of the indicators of the functional state of the pancreas (amylase, trypsin, trypsin inhibitor), histamine and serotonin. Under the influence of the course of treatment, a significant increase within the norm of the thyroid-stimulating hormone content of the pituitary, thyroxine, triiodothyronine and intestinal hormone gastrin, a decrease in the level of cortisol was found. The normalizing effect of this method on the immune system was revealed. This effect is manifested in the stimulation of the T-cell link of immunity by increasing the immunoregulatory subpopulation of the carrier function of the helpers. The ratio of immunoregulatory subpopulations (T U and T m ) has improved, as evidenced by an increase in the index of the immunoregulatory index. An increase in the initially reduced number of B-lymphocytes and a normalization of the level of immunoglobulins I and A.

The remission period after the treatment was an average of 1-1.5 years, which is much longer compared to the prototype (see Table 4).

Thus, the proposed method of treatment contributes to cicatrization of the ulcerative defect within 22-25 days with a remission period of up to 1.5-2 years.

CLAIM

1. A method of treating patients with duodenal ulcer by exposure to pulsed infrared low-energy laser radiation, characterized in that the effect is performed on the projection zones of cervical sympathetic nodes.

2. A method according to claim 1, characterized in that the effect is carried out on the projection zones of cervical sympathetic nodes C 2 -C 4 .

3. A method according to claim 1, characterized in that the irradiation dose per zone is assigned in the range of 0.02 to 0.13 Joule.

4. The method according to claim 1, characterized in that the wavelength of the pulsed infrared low-energy laser radiation is set in the range of 0.89 to 0.90 μm.

5. The method of claim 1, wherein the effect is performed in a paravertebral manner.

6. The method according to claim 1, characterized in that the radiation dose is prescribed with a gradual increase in the procedure time from 2 to 5 minutes for 1 to 4 days, and from 5 procedures for 4 to 5 minutes before the end of the course of treatment, daily, 10 - 15 procedures.

7. The method of claim 1, wherein the additional effect on the epigastric region is performed by pulsed low-energy infrared laser radiation.

print version
Date of publication 28.03.2007gg