RU2186595C2 - Method for correcting phagocytosis with the help of leukocytes in patients with postradiation syndrome - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: phonophoresis of biologically active lipid tincture from tambukan curative mud is conducted for area of the upper third of a sternum. EFFECT: higher efficiency of correction. 7 ex, 2 tbl

Description

 The invention relates to medicine and relates to methods for correcting disorders of the immune system by physical methods.

 Closest to the claimed is a method for the correction of immunological disorders in individuals exposed to small doses of ionizing radiation (decision to grant a patent dated 06/25/96 to invention 93046186/14/046054) - "Method for the correction of violations of the immune status".

The known method consists in the fact that patients were prescribed a sparing-training regimen of motor activity, diet, internal intake of carbonate-hydrogen carbonate-sulfate sodium-calcium mineral water 200 ml 3 times a day 40-60 minutes before meals, carbon dioxide mineral baths temperature 37 ^o С, exposure time 10-15 minutes, 8 procedures per course and exposure to the sternum area by ultrasound with an intensity of 0.05 W / cm ² according to the labile method for 30-60 s, every other day, 5-6 procedures per course. According to indications, intestinal procedures and massage were prescribed.

 However, the known method does not ensure the normalization of the most inhibited as a result of irradiation of immune function - phagocytosis and is not clinically effective enough.

 We have developed a new therapeutic technique for phonophoresis of biologically active extraction of Tambukan mud lipids into the zone of an immunocompetent organ - the thymus, which is used in a complex of spa treatment.

The proposed method is as follows. Patients are prescribed a gentle-training regimen of motor activity, dietary nutrition according to schemes 1 and 5 of the Institute of Nutrition of the RAMS, internal intake of carbonic acid-bicarbonate-sulfate sodium-calcium mineral water 200 ml 3 times a day 40-60 minutes before meals, carbonic acid mineral baths 37 ^o C, exposure 10-15 minutes, on the course - 8 procedures. According to indications, intestinal procedures and massage are prescribed.

Phonophoresis was carried out as follows. The patient is laid on his back. The impact is produced from the ultrasound therapy apparatus (UZT-101) on the area of the upper third of the sternum according to the labile technique (ultrasound intensity 0.05 W / cm ² , single exposure - 30-60 s). Contact medium - biologically active extract of lipids of Tambukan mud, temperature 38-40 ^o C. Procedures are carried out every other day in the amount of 5-6 per treatment course.

 The theoretical justification of the method is the position that the effect of lipid phoresis by low power ultrasound is carried out locally on the area of the immunocompetent organ - the thymus. According to hormesis theory, such an effect on one of the central organs of hematopoiesis and immunogenesis - the bone marrow should lead to stimulation of the function of the target organ (S.V. Andreev, V. S. Zelenetskaya. - The concept of hormesis in the problem of the stimulating effect of small doses of physical factors. - Issues of balneology - 1989. - 6. - S. 68-75).

The method is illustrated by the following examples:
1. Patient P., aged 45, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from December 4 to 25, 1998 (medical history 1939).

Diagnosis: Chronic gastroduodenitis with increased secretory function in the phase of incomplete remission. Hypertensive neurocirculatory dystonia. Complaints at admission: hungry pain in the epigastric region, heartburn, belching, dizziness, general weakness, periodic aching pain in the heart, palpitations, high blood pressure. He participated in the aftermath of the Chernobyl accident in 1987, after which he immediately began to note the appearance of these complaints. The documented radiation dose is 20 BER. It was treated on an outpatient and inpatient basis (annually) without any particular effect. Objectively: HELL d 160/90 mm RT. Art., blood pressure s - 150/90 mm Hg. Art., distal hyperhidrosis, red diffuse dermographism, instability in the Romberg position. Pulse - 86 in 1 min, respiratory arrhythmia. Palpation of the abdomen - pain in the epigastric region. Liver - along the edge of the costal arch, painless. On the ECG: signs of left ventricular hypertrophy, impaired myocardial repolarization of the posterior wall of the left ventricle. Complete blood count: Red blood cells 3.2 • 10 ¹² / l, white blood cells 4.5 • 10 ⁹ / l (e - 2, p - 5, s - 62, l - 22, m - 9), platelets 230000, reticulocytes 0 , 3%. Neutrophil phagocytosis data: FAL - 59%, PHIL - 1.3 units, Em-ROCK - 7%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 1 of the Nutrition Institute of the RAMS, internal intake of carbonic acid hydrocarbonate-sulfate sodium-calcium mineral water of the Slavyanovsky source 200 ml 3 times a day 60 minutes before meals, carbonic mineral baths from the same water temperature 37 ^o C, exposure 15 minutes, the course of treatment - 8 procedures. The patient was prescribed phonophoresis of the lipid extract of tambucan mud (ultrasound intensity - 0.05 W / cm ² , exposure 60 s) to the area of the sternum handle at a dirt temperature of 38-40 ^o C, every other day, for treatment 6.

By the end of treatment, there was a positive dynamics of the subjective symptoms of the disease: blood pressure returned to normal, tachycardia and pathological dermographism, instability in the Romberg position, dizziness, and pain in the stomach disappeared. Dyspepsia, general weakness, headaches decreased. Complete blood count: red blood cells - 4.8 • 10 ¹² / l, white blood cells 6.5 • 10 ⁹ / l (e - 1, p - 2, s - 63, l - 27, m - 7), platelets - 290000, reticulocytes - 0.7%. Neutrophil phagocytosis data: FAL - 82%, PHIL - 4.5 units, Em-ROCK - 11%. The effect of treatment is regarded as an improvement.

2. Patient A., 58 years old, was in the Zheleznovodsk Clinic of the State Research Institute of Balneology for treatment from June 24 to July 17, 1998 (medical history 939). Diagnosis: gastric ulcer in the phase of incomplete remission. Persistent chronic hepatitis. Chronic stoneless cholecystitis in the phase of incomplete remission. Mixed neuro-circulatory dystonia. Complaints at admission: persistent headaches, dizziness, darkening in the eyes, sometimes fainting, severe general weakness, stitching pains in the heart, jumps in blood pressure from 100/60 to 150/90 mm Hg. Art., a feeling of heaviness in the epigastric region and in the right hypochondrium, bitterness in the mouth, skin itching, pain in the knee and ankle joints. He participated in the aftermath of the Chernobyl accident in February-May 1987, six months later, these complaints appeared. The documented radiation dose is 15 BER. Treated on an outpatient and inpatient basis without much effect. Spa treatment for the first time. Objectively: the skin is paleish, subicteric sclera, blood pressure d - 130/90 mm RT. Art., blood pressure s - 120/80 mm RT. Art., red diffuse dermographism, distal hyperhidrosis, instability in the Romberg position, tremor of outstretched fingers. Pulse - 78 in 1 min, respiratory arrhythmia. The abdomen on palpation is moderately painful in the epigastrium and in the right hypochondrium, at the point of the gallbladder. Liver +2.5 cm, soft, painless. On the ECG - a violation of intraventricular conduction and repolarization of the posterior wall of the left ventricle. Complete blood count: red blood cells 3.3 • 10 ¹² / l, white blood cells 4.5 • 10 ⁹ / l (e - 6, p - 4, s - 57, l - 25, m - 8), platelets 227000, reticulocytes 0 ,4%. Neutrophil phagocytosis data: FAL - 48%, PHIL - 0.68 units, Em-ROCK - 16%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 5 of the Nutrition Institute of the RAMS, internal intake of carbonic acid-bicarbonate-sulphate sodium-calcium mineral water 200 ml 3 times a day 40 minutes before meals, carbonic mineral baths from the same water, temperature 37 ^o C, exposure 15 minutes, 8 treatments per treatment course. The patient was prescribed phonophoresis of the lipid extract of tambucan mud (ultrasound intensity - 0.05 W / cm ² , exposure 60 s) to the area of the sternum handle at a dirt temperature of 38-40 ^o C, every other day, for treatment 6.

By the end of treatment, there was a positive dynamics of subjective and objective symptoms: general weakness and headaches decreased, syncope, pain in the region of the heart, skin itching disappeared, pain in the right hypochondrium, bitterness in the mouth decreased, pulse arrhythmia, and asymmetry of blood pressure disappeared. Complete blood count: red blood cells - 4.8 • 10 ¹² / l, white blood cells - 5.8 • 10 ⁹ / l (e - 2, p - 2, s - 59, l - 33, m - 4), platelets - 297500 reticulocytes - 0.7%. Neutrophil phagocytosis data: FAL - 68%, PHIL - 2.5 units, Em-ROCK - 22%. The effect of treatment is regarded as an improvement.

 3. Patient T., 55 years old, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from March 18 to April 10, 1998 (medical history 412).

Diagnosis: Chronic gastroduodenitis with preserved secretory function in the phase of incomplete remission. Ischemic heart disease. Angina pectoris I f. class But. Mixed neuro-circulatory dystonia. Complaints at admission: general weakness, shortness of breath, headaches, constricting pains in the heart during physical exertion, numbness and pain in large joints of the arms and legs, aching pain in the epigastric region, heartburn. Participated in the aftermath of the Chernobyl accident in May - June 1986, after which a year later he began to note these complaints. The documented radiation dose is 25 BER. It was treated on an outpatient and inpatient basis (annually) without any particular effect. Objectively: blood pressure ds = 130/80 mm RT. Art. , persistent red dermographism, instability in the Romberg position, hyperhidrosis of the skin. Pulse - 80 in 1 min. Heart sounds are muffled. On palpation of the abdomen, moderate pain in the epigastric region. On the ECG: left ventricular polytopic extrasystoles, impaired myocardial repolarization of the posterior wall of the left ventricle. Complete blood count: red blood cells - 4.5 • 10 ¹² / l, white blood cells 4.0 • 10 ⁹ / l (e - 4, p - 3, s - 60, l - 25, m - 8), platelets - 230,000, reticulocytes - 0.5%. Data of phagocytosis of neutrophils: FAL - 68%, PHIL - 1.53 units. , EM-ROCK - 21%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 1 of the Nutrition Institute of the RAMS, internal intake of carbonic acid, hydrocarbonate-sulfate sodium-calcium mineral water 200 ml 3 times a day 40 minutes before meals, carbonic mineral baths from the same water temperature 37 ^o C, exposure 15 minutes, the course of treatment - 8 procedures every other day. The patient was prescribed phonophoresis of the lipid extract of the Tambucan mud (ultrasound intensity - 0.05 W / cm ² , exposure 30 s) to the area of the sternum grip at a mud temperature of 37 ^o C, every other day, for treatment 6.

By the end of treatment, general weakness and pain in the epigastric region decreased, the remaining complaints were the same. Complete blood count: red blood cells - 4.0 • 10 ¹² / l, white blood cells - 4.0 • 10 ⁹ (e - 4, p - 3, s - 58, l - 27, m - 8), platelets - 210,000, reticulocytes - 0.5%. Neutrophil phagocytosis data: FAL - 84%, PHIL - 2.0 units, Em-ROCK - 18%. The treatment effect is regarded as a slight improvement.

 4. Patient G., 60 years old, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from March 10 to April 2, 1999 (medical history 364).

 Diagnosis: peptic ulcer of the duodenum in the phase of incomplete remission, neurocirculatory dystonia of a mixed type. Common osteochondrosis. Complaints at admission: headaches, pain in the epigastric region on an empty stomach, heartburn, pain in the muscles of the arms, legs and spine. He participated in the aftermath of the Chernobyl accident in 1986, a year later he began to note the appearance of these complaints. The documented radiation dose is 25 BER. Treated on an outpatient and inpatient basis without any particular effect, spa treatment for the first time.

Objectively: blood pressure d - 150/90 ml RT. Art., blood pressure s - 130/90 mm Hg. Art., red spilled dermographism, instability in the Romberg position. Pulse - 88 in 1 min. On palpation of the abdomen - moderate soreness in the pyloroduodenal zone. On the ECG: signs of left ventricular hypertrophy, impaired repolarization of the posterior wall of the left ventricle. Complete blood count: red blood cells - 4.0 • 10 ¹² / l, white blood cells - 5.0 • 10 ⁹ / l (e - 1, p - 1, s - 61, l - 33, m - 4), platelets - 2,000,000 reticulocytes - 0.3%. Neutrophil phagocytosis data: FAL - 61%, PHIL - 1.74 units, Em-ROCK - 16%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 1 of the Nutrition Institute of the RAMS, internal intake of carbonic acid hydrocarbonate-sulfate sodium-calcium mineral water of the Slavyanovsky source 200 ml 3 times a day 60 minutes before meals, carbonic mineral baths from the same water temperature 37 ^o C, exposure 15 minutes, the course of treatment - 8 procedures every other day. The patient underwent phonophoresis of the lipid extract of the Tambucan mud (ultrasound intensity - 0.05 W / cm ² , exposure 60 s) to the area of the sternum handle at a mud temperature of 37 ^o C, every other day, for treatment 5.

By the end of treatment, general weakness, dizziness and heartburn decreased slightly, the remaining complaints persist. Complete blood count: red blood cells - 3.8 • 10 ¹² / l, white blood cells - 5.0 • 10 ⁹ / l (e - 1, p - 1, s - 56, l - 35, m - 5), platelets - 225000 reticulocytes - 0.4%. Neutrophil phagocytosis data: FAL - 67%, FIP - 1.8 units, Em-ROCK - 18%. The treatment effect is regarded as a slight improvement.

 5. Patient Z., 49 years old, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from May 10 to June 2, 1999 (medical history 710).

Diagnosis: Chronic stoneless cholecystitis in the phase of incomplete remission. Persistent chronic hepatitis. Hypertensive neurocirculatory dystonia. Complaints at admission: severe headaches, dizziness, tinnitus, memory loss, poor sleep, severe sweating. He participated in the aftermath of the Chernobyl accident in September-November 1986, after which he noted the appearance of these complaints. The documented radiation dose is 22 BER. Treated on an outpatient and inpatient basis, sanatorium-resort treatment for the first time. Objectively: blood pressure d = s = 160/100 mm Hg. Art., red diffuse dermographism, distal hyperhidrosis, severe tremor of the extremities. Pulse - 88 in 1 min. On palpation of the abdomen - moderate soreness at the point of the gallbladder, liver +2.5 cm, painless. On the ECG: left ventricular hypertrophy, impaired repolarization of the anterolateral and posterior walls of the left ventricle. Complete blood count: red blood cells - 4.8 • 10 ¹² / l, white blood cells - 4.5 • 10 ⁹ / l (e - 5, p - 3, s - 65, l - 19, m - 8), platelets - 180,000 reticulocytes - 0.2%. Neutrophil phagocytosis data: FAL - 45%, PHIL - 0.87 units, Em-ROCK - 12%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 5 of the Nutrition Institute of the RAMS, internal intake of carbonic acid hydrocarbonate-sulfate sodium-calcium mineral water of the Slavyanovsky source 200 ml 3 times a day 40 minutes before meals, carbonic mineral baths from the same water temperature 37 ^o C, exposure 15 minutes, the course of treatment - 8 procedures every other day.

The patient was prescribed phonophoresis of the lipid extract of tambucan mud (ultrasound intensity - 0.05 W / cm ² , exposure 90 s) to the area of the handle at a mud temperature of 42 ^° C, every other day, for treatment 6. In the 3rd procedure, a balneopathological reaction 2 degrees: 10 minutes after the procedure - a sharp headache, a jump in blood pressure up to 190/100 mm RT. Art., hyperemia of the face, palpitations. An emergency antihypertensive therapy (iv injection of dibazole, papaverine) was able to reduce blood pressure to 150/90 ml of mercury. Art. and partially stop these complaints.

By the end of treatment, practically no positive dynamics were achieved in the subjective and objective status of the patient. Complete blood count: red blood cells - 4.5 • 10 ¹² / l, white blood cells - 5.0 • 10 ⁹ / l (e - 4, p - 1, s - 73, l - 20, m - 2), platelets - 210,000 reticulocytes - 0.27%. Neutrophil phagocytosis data: FAL - 43%, PHIL - 0.68 units, Em-ROCK - 13%. The effect of the treatment is regarded as "no improvement."

 6. Patient A., 49 years old, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from May 10 to June 2, 1999 (medical history 709).

Diagnosis: Peptic ulcer, 12 duodenal ulcer in the phase of incomplete remission. Chronic cholecystic pancreatitis in the phase of incomplete remission. Hypertensive neurocirculatory dystonia. Common osteochondrosis. Complaints at admission: headaches, dizziness, pain in large joints and spine, irritability, poor sleep, heartburn, nausea, bloating. He participated in the aftermath of the Chernobyl accident in 1987, after which he noted the appearance of these complaints. The documented radiation dose is 20 BER. Treated on an outpatient and inpatient basis, sanatorium-resort treatment for the first time. Objectively: blood pressure d = 160/100 mm RT. Art., blood pressure s = 150/100 mm Hg. Art., red diffuse dermographism, distal hydronephrosis, instability in the Romberg position. Pulse - 82 in 1 min. Palpation of the abdomen - pain in the pyloroduodenal zone and in both hypochondria. On an ECG: sinus tachycardia, impaired repolarization of the lateral and posterior walls of the left ventricle. Complete blood count: red blood cells - 4.2 • 10 ¹² / l, white blood cells - 4.5 • 10 ⁹ / l (e - 1, p - 1, s - 52, l - 44, m - 2), platelets - 230,000 reticulocytes - 0.3%. Neutrophil phagocytosis data: FAL - 59%, PHIL - 1.3 units, Em-ROCK - 10%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 1 of the Nutrition Institute of the RAMS, internal intake of carbonate-sulphate sodium-calcium mineral water of the Syavianovsky source 200 ml 3 times a day 40 minutes before meals, carbonate mineral baths from the same water temperature 37 ^o C, exposure 15 minutes, the course of treatment - 8 procedures every other day.

The patient was prescribed phonophoresis of the lipid extract of tambucan mud (ultrasound intensity - 30 s) to the area of the sternum grip at a dirt temperature of 38-40 ^o C, every other day, for treatment 5.

By the end of treatment, the patient’s initial complaint almost disappeared. Objectively: blood pressure d = 150/100 mm RT. Art., blood pressure s = 140/100 mm Hg. Art., pulse - 78 in 1 min. Complete blood count: red blood cells - 5.9 • 10 ¹² / l, white blood cells - 5.8 • 10 ⁹ / l (e - 2, p - 1, s - 57, l - 38, m - 2), platelets - 290000 reticulocytes - 0.6%. Neutrophil phagocytosis data: FAL - 89%, PHIL - 2.48 units, Em-ROCK - 18%. The treatment effect is regarded as a slight improvement.

 7. Patient L., 43 years old, was treated at the Zheleznovodsk Clinic of the State Research Institute of Balneology from April 5 to 28, 1999 (medical history 501).

Diagnosis: Chronic cholecystic pancreatitis in the phase of incomplete remission. Hypertensive neurocirculatory dystonia. Complaints at admission: general weakness, headaches, stitching pains in the heart area, nausea, bitterness in the mouth, bloating, pain in the muscles of the extremities. He participated in the liquidation of the consequences of the Chernobyl accident in 1937, after which he noted the appearance of these complaints. The documented radiation dose is 20 BER. Treated on an outpatient and inpatient basis, sanatorium-resort treatment for the first time. Objectively: blood pressure d = s = 150/90 mm Hg. Art., red diffuse dermographism, distal hyperhidrosis, instability in the Romberg position. Pulse - 78 in 1 min. Moderate soreness in the choledochopancreatic zone. On the ECG: left ventricular hypertrophy, incomplete blockade of the right leg of the bundle of His, a violation of the processes of repolarization of the lateral and posterior walls of the left ventricle. Complete blood count: red blood cells - 4.2 • 10 ¹² / l, white blood cells - 5.0 • 10 ⁹ / l (e - 5, p - 1, s - 50, l - 40, m - 4), platelets - 210,000 reticulocytes - 0.3%. Neutrophil phagocytosis data: FAL - 70%, PHIL - 1.86 units, Em-ROCK - 20%. The patient was assigned a sparing and training regimen of motor activity, dietary nutrition according to Scheme 5 of the Nutrition Institute of the RAMS, internal intake of carbonic acid hydrocarbonate-sulfate sodium-calcium mineral water 200 ml 3 times a day 40 minutes before meals, carbon dioxide mineral baths at a temperature of 37 ^o C, exposure 15 minutes, the course of treatment - 8 treatments every other day. Phonophoresis of the lipid extract of Tambukan mud was not prescribed to the patient (phonocontrol).

By the end of treatment, the initial complaints remained virtually unchanged. Objectively: blood pressure d = s = 140/90 mm Hg. Art., pulse - 74 in 1 min. Complete blood count: red blood cells - 4.0 • 10 ¹² / l, white blood cells - 5.0 • 10 ⁹ / l (e - 3, p - 2, s - 54, l - 36, m - 5), platelets - 200000 reticulocytes - 0.4%. Neutrophil phagocytosis data: FAL - 52%, PHIL - 1.4 units, Em-ROCK - 10%. The treatment effect is regarded as a slight improvement.

 The method was tested in the Zheleznovodsk clinic. There were 2 groups of patients - liquidators of the consequences of nuclear power plants (LPAH) - the main (40 people) and control (35 people), who received treatment according to the methods of the invention and prototype (table. 1).

 According to table 2, the positive dynamics of clinical symptoms (disappearance and reduction of symptoms during treatment) significantly prevailed in the main group (P <0.05 - 0.01). Thus, the disappearance of headaches in the main group was 75%, in the control group - 41% (P <0.01), dizziness - 89% and 67% (P <0.05), general weakness - 91% and 60% (P <0.05), cardialgia - 82% and 55% (P <0.05), bone pain - 77% and 43% (P <0.05), arthralgia - 82% and 50% (P <0, 05).

 In total, according to the criterion of signs, the clinical effect in the group of patients where phonophoresis of lipid extraction of dirt was prescribed was significantly higher than in patients of the control group (P <0.05).

 According to laboratory data, the frequency of normalization of the level of red blood cells, leukocytes, reticulocytes and platelets in the blood of patients of the main group was 40-65%, control - 26-42%.

 Neutrophil phagocytosis indices were studied in the examined patients (according to the method of A. I. Ivanov and B. A. Chukhlovin "On the methodology for determining the absorption and digesting ability of neutrophils." - Laboratory, - 1967, - 10. - P. 610-613).

 It was established that in patients of the main group, the initially reduced phagocytic activity of leukocytes (FAL) as a result of treatment significantly increased from 53.7 + 2.38 to 63.9 + 3.0% (Mp + mp = 8.65 + 2.18; p <0.01), phagocytic index (PHIL) - from 1.21 + 0.08 to 1.98 + 0.09 units. (Mp + mp = 0.72 + 0.25; p <0.05).

 In patients of the control group, the dynamics of these indicators was less significant (from 55.1 + 2.99 to 60.3 + 3.0%, from 1.08 + 0.17 to 1.22 + 0.11 units).

 Therefore, according to clinical, hematological and phagostimulating effects, the method of the invention had an advantage over the prototype method.

Claims (1)

 A method for correcting leukocyte phagocytosis in individuals with post-radiation syndrome by ultrasonic treatment of the upper third of the sternum, characterized in that a biologically active extraction of lipids from the Tambucan therapeutic mud is used as a contact medium.

Images