RU2146916C1 - Method for treatment of children with secondary pancreatitis - Google Patents

Abstract

FIELD: medicine, physiotherapy. SUBSTANCE: method involves drinking mineral water of low mineralization, taking baths of carbon dioxide and hydrogen sulfide, and application of low-intensity laser beam to point VC13. Procedures are taken every day. EFFECT: persistent remission. 3 ex, 3 tbl

Description

 The invention relates to medicine and relates to the treatment of children by physical methods.

Closest to the claimed method is a method for the complex treatment of secondary pancreatitis with mineral water, including drinking Slavyanovskaya water, diet, sparing regimen, exercise therapy and mineral baths (Novozhilova L. I. Diss. Doctor of Medical Sciences. 1980. - P. 48) . Prescribe mineral baths with a temperature of 37 ^o C, a duration of 15 to 20 minutes every other day, 8 to 10 baths per course. However, the known method does not ensure the achievement of stable remission.

The essence of the invention lies in the fact that they carry out complex treatment with mineral water using low-intensity laser radiation at point V _with 13 (LLLT).

The method is as follows. Patients are prescribed a drink of low-carbonate chloride-bicarbonate-sulfide calcium-sodium water of average mineralization of 100 ml per reception 3 times a day, 40 ^o C, before meals, carbon dioxide baths lasting 10 - 15 minutes, t ^o = 37 ^o C, every other day, on a course of 8 - 10 baths in combination with laser puncture on point V _from 13 daily N 10.

 The treatment method is illustrated by the following examples.

 I observation (the proposed method).

 Patient Pavel G., 7 years old, medical history N 63. He was admitted to the clinic on May 1, 1995, complaining of constant abdominal pain after eating, poor appetite, and rapid fatigue. Sick for 3 years. For the first time in 1995 he was examined at the Republican Children's Clinical Hospital in Moscow.

 From the anamnesis: a child from the 3rd pregnancy, was born on time with a weight of 3,950 g, length 57 cm. Breast was fed 1 year 1 month. At an early age he developed well. Past diseases: chickenpox, SARS, chronic sinusitis. Upon admission: general condition is satisfactory, nutrition is sharply reduced (type II-III malnutrition). There is a stoop, asymmetry of the shoulder blades. All groups of peripheral lymph nodes are enlarged.

 In the lungs and heart without features, the tongue is densely covered with a dirty brown coating. The abdomen is moderately swollen, painful at the point of Kera, the left hypochondrium.

Functional research:
EGDFS - common gastritis, bulbitis, duodenitis
Ultrasound - a sharp deformation of the gallbladder, reactive changes in the pancreas, its parenchyma is heterogeneous.

 Paraclinic data: PAT in feces 1:40, coprogram - pH 5.0, expressed amilorrhea, steatorrhea, creotorrhea, absorption by a sample with D-xylose 3.2, 5.0, 4.1% is sharply impaired (normal 28- thirty%). Intolerance to sucrose was expressed 4.6, 7.95, 6.1 mm / 1, a flat curve with a load of lactose - (4.15, 4.15, 3.6) and glucose (4.5, 4.6, 4 , 8), blood lipase 0.5 units.

 General analysis of blood and urine without pathology.

 Clinical and paraclinical data gave reason to make a diagnosis: biliary dyskinesia, secondary pancreatitis, type II-III malnutrition dystrophy. , secondary lactose deficiency, glucose intolerance, chronic gastroduodenitis, intestinal dysbiosis.

In the clinic, the child received: diet therapy (table No. 5 according to Pevzner) with the exception of milk and sweets, chloride-bicarbonate-sulfate-sodium-calcium mineral water t = 40 ^o C before meals, 100.0 per reception, 3 times a day, during the month, NIL in t. V _with 13, 10 procedures per course, daily for 1 procedure, and mineral baths (SPM) with a temperature of 37 ^o C, lasting 10 minutes, per course of 8 baths.

 After the treatment, the positive dynamics of the clinical symptoms of the disease was noted: appetite improved, abdominal pain disappeared, and symptoms of chronic intoxication decreased. The child gained 1.5 kg in 30 days. The coprogram normalized, the proteolytic activity of trypsin in feces increased from 1:40 to 1:80, signs of inflammation in the pancreas disappeared on ultrasound, blood lipase increased 0.5 to 1.0 units.

 Thus, a single treatment of the patient in the clinic with the use of diet therapy, internal administration of therapeutic mineral water, low-intensity laser radiation, mineral baths contributed to the onset of complete remission. After a year, the long-term results were studied (the child was called to the clinic again). Within a year, the boy was not ill, there was no exacerbation of the disease.

 II observation (control).

 Patient Olya T., 8 years old, medical history N 11, 1995. She was admitted to the hospital on 01.29.95 with complaints of abdominal pain, belching, nausea, sometimes vomiting, rumbling in the intestines, fatigue, headaches.

 From the anamnesis: the patient has been ill for 3 years, the disease began acutely with severe pain in the abdomen of herpes zoster, acute surgical disease was excluded. She was examined at the Republican Children's Clinical Hospital in Moscow, diagnosed with pancreatitis.

 Upon admission: satisfactory condition, the skin is pale. In the lungs and heart without features, the tongue is densely overlaid, the stomach is painful in Comrade Kera, epigastrium, right hypochondrium. The chair is normal.

Paraclinical data:
Load tests with sugars: with sucrose - 4.5, 7.2, 4.5, with lactose - 4.7, 5.5, 4.7, with glucose - 4.6, 5.85, 4.3. Blood lipase 0.6 units

 Diastasis of blood and urine is normal, ultrasound - the pancreas is heterogeneous, the parenchyma is condensed, the gall bladder - the wall is sealed.

 FGS - the mucous membrane of the esophagus in the lower third nest is hyperemic, edematous, granular, the cardia does not close completely, there is a lobbying of the gastric mucosa into the esophagus. In the stomach, the mucous membrane of the nest is hyperemic. Flat bulging. The gatekeeper closes. Swelling in the bulb. In the post-bulbar departments, there is a “hoarfrost” raid.

 Based on clinical and paraclinical data, the diagnosis was made: chronic gastroduodenitis, reactive or secondary pancreatitis, biliary dyskinesia, secondary lactase deficiency, intolerance to sucrose.

The child received the following treatment in the clinic: mineral water for 30 days, diet therapy (table No. 5 without sweets), laser puncture in volume V _from 13 daily No. 10.

 After the treatment, the girl’s condition improved, the pain syndrome disappeared, dyspeptic symptoms (belching, nausea, vomiting) became less frequent, headaches disappeared.

 Paraclinical indicators basically did not change. Ultrasound did not show any dynamics.

 In this case, the dynamics of the disease after treatment was less positive, and the paraclinical data remained practically unchanged.

 The girl’s remission lasted only 3 months.

 In order to ensure the reliability of the study, we conducted treatment for 31 children in a known manner (carbon dioxide baths and mineral water inside).

We give our observation (III):
Patient Vika G., 14 years old, medical history 118. Was admitted to the hospital on June 19, 1995 with complaints of recurrent pain in the abdomen, heart, joints.

 From the anamnesis: sick for 8 years, the disease began with pain in the joints, then there were pains in the abdomen and heart. She was treated many times on an outpatient basis and in a hospital at the place of residence without effect. Only in 1995 she was examined and treated at the Republican Children's Clinical Hospital in Moscow, after which she was sent for spa treatment.

 At admission: general condition is satisfactory, asthenic physique, low nutrition. In the heart, the muffling of heart tones. In the lungs without features, the pharynx is a sharp hypertrophy of the tonsils, the tongue is densely coated. The abdomen is soft, painless, defansion in Comrade Kera. Liver, spleen not enlarged, stool normal.

 Paraclinical data: general analysis of blood and urine without pathology. Diastasis of blood and urine is reduced. Lactose intolerance was detected, the proteolytic activity of trypsin in feces was reduced (1:40), and blood lipase was 0.4 units (decreased).

 Ultrasound investigation: before treatment, the gallbladder wall is thickened, the sediment in the neck, the duct is dilated, the pancreas is thickened, the capsule is thickened, the structure is heterogeneous, single foci are densified.

 Clinical and paraclinical indicators made it possible to make a diagnosis: biliary dyskinesia according to the hypotonic type, chronic cholecystitis, secondary pancreatitis, incomplete remission. Vegetovascular dystonia, cardiopathy.

The girl received the following treatment in the clinic: diet therapy (table N 5), healing mineral water for 30 days, mineral baths (SPM), temperature 37 ^o C, duration 10, every other day, for a course of 8 baths.

 After the treatment, the child's condition improved, her appetite returned to normal, abdominal pain, dyspeptic symptoms disappeared, and symptoms of chronic intoxication decreased.

 Paraclinical indicators and ultrasound data remained unchanged. Clinical remission lasted 6 months. In this case, the dynamics of the disease in the treatment process took place only according to clinical data, and objective indicators (laboratory, ultrasound) did not change.

 Testing of the proposed method was carried out in the conditions of the Pyatigorsk clinic GNIIK. The tests were carried out on 3 groups of patients - the main (proposed method), a known method and control for isolating the mechanism of action of laser puncture. In the main group there were 52 people, in control 22, in the prototype method - 31.

 The clinical characteristics of patients are presented in table 1.

 Patients of the main group received mineral baths and laser puncture, patients in group II (prototype method) respectively received mineral baths, in the third group (control) children received laser puncture.

 Patients of all three groups received mildly acid chloride-bicarbonate-sulphate calcium-sodium water for 4 weeks at an age-specific dosage.

 Statistical evaluation of three groups of patients was carried out. It was found that according to the main criteria of the initial clinical data, no significant differences between the groups were revealed. This allows us to justify the full clinical adequacy of these groups.

 Tables 2 and 3 show the dynamics of clinical and paraclinical data. The materials of table 2 show that the proposed method using mineral baths and laser puncture is clearly more effective. In 67 of 73%, abdominal pain disappeared, in 25 of 40%, stool returned to normal, and in 65 of 82%, dyspeptic symptoms disappeared. It should be noted that in the control, where patients received LLLT, the dynamics of clinical data was better than in group I (prototype method). This indicates that laser puncture in the reflexogenic zone in chronic pancreatitis has a specific anti-inflammatory effect, while mineral baths increase the general non-specific reactivity.

 Paraclinical data have confirmed the adequacy of the chosen method of treatment. The combined effect of mineral baths and LLLT against the background of drinking treatment increases the effectiveness of treatment with the selected method: all these patients have significantly improved pancreatic function. This is confirmed by an increase in the proteolytic activity of trypsin in feces, a highly reliable increase in blood lipase. They also significantly (p <0.05) reduced total edema of the pancreas, edema in the tail or head of the pancreas (p = 0.05), and the foci of sclerosis or fibrosis, of course, did not disappear.

 In groups I and III (prototype and control), the dynamics of clinical symptoms were less pronounced, pathology remained after treatment in a larger percentage of cases, paraclinical parameters did not change or were not reliable.

Claims (1)

A method of treating children with secondary pancreatitis, including drinking mineral water, diet therapy, mineral baths, characterized in that they prescribe an internal intake of low-carbonate chloride-bicarbonate-sulphate-calcium-sodium water of average salinity of 100 ml per dose 3 times a day, t = 40 ^o C, before meals, carbon dioxide-hydrogen baths lasting 10-15 minutes, t = 37 ^o C, every other day, on a course of 8-10 baths, in combination with low-intensity laser radiation to point V _from 13 daily, N 10.

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