RU2277920C2 - Method for treating children in case of chronic viral hepatitis at applying sulfide baths and low-carbonate mineral water - Google Patents

Abstract

FIELD: medicine, pediatrics.

SUBSTANCE: children should take sulfide baths and for inner intake - warm low-carbonate chloride-hydrocarbonade sodium-calcium water of low mineralization per 100-200 g depending upon patient's age, for 30 d. The innovation provides improved clinical and paraclinical values due to combined intake of sulfide baths, that stimulate nervous centers through vast cutaneous receptor fields, and drinking water of concrete ionic composition and mineralization degree that decreases activity of all enzymatic systems of gastro-intestinal tract, hepatic among them.

EFFECT: higher efficiency of therapy.

2 ex, 3 tbl

Description

The invention relates to medicine, namely to children's balneotherapy. Closest to the claimed is the well-known use of sulfide baths in combination with drinking sulfide water of source No. 16, where the content of hydrogen sulfide is exactly 10 mg / l. (in. letter to help practitioners of resorts, Pyatigorsk, 1990). These studies concerned the rehabilitation of patients after hepatitis A. Our studies have shown that the combined use of sulfide baths and sulfide water for drinking is not indicated for children with CVH, even in the phase of minimal activity. In sulfide baths, where the content of hydrogen sulfide is minimal, hydrogen sulfide is rapidly destroyed and therefore does not have a harmful effect on the liver. The use of sulfide water inside children with CVH causes the activity of all enzyme systems of the gastrointestinal tract, including the liver, in children, alkaline phosphatase, ACT, ALT increase. The essence of the invention lies in the fact that children with CVH are assigned sulfide baths with a minimum content of hydrogen sulfide and slightly carbonic chloride-bicarbonate-sodium-calcium water ist. No. 24, warm (Pyatigorsk narzan). It is known that when applied externally, sulfide waters have a multilateral effect on the human body. When bathing, mineral water comes into contact with the skin, which has an extensive receptor field through which the stimulation of the external environment is transmitted to the corresponding nerve centers. In addition, the ingredients of mineral water through the skin and respiratory tract penetrate into the internal environment of the body and cause irritation of the interoreceptors of internal organs. Chemical and thermal factors determine the body's response to these irritations.

Our proposed method is carried out as follows: against the background of the intake of mineral water, low carbonate chloride-bicarbonate sodium-calcium low salinity - 4.5 g / l. (Pyatigorsk source. No. 24), diet, exercise therapy. The child takes sulfide baths (Pirogovskie with a hydrogen sulfide content of 10 mg / l).

In the last decade, chronic viral hepatitis deserves close attention, because leads to disability of the population. Recent scientific literature claims that 1/3 of the globe is sick with viral hepatitis B, C, D, and therefore the urgency of the problem came in first place, ahead of AIDS. Every year, 1 million people die from hepatitis.

Treatment with interferons allows to achieve temporary remission in 30-40% of patients, combined treatment with lamivudine and ribovirin prolongs remission in 60% of patients. Treatment is extremely expensive and inaccessible to the bulk of the population. In connection with the foregoing, our studies are quite significant.

The method is illustrated by the following examples.

Observation 1. S. Magomed, 15 years old, medical history 213/815, go to the clinic on January 29, 2003, was discharged on February 27, 2003. Complaints of pain in the right upper quadrant before eating, nausea, constipation, loss of appetite, fatigue . Sick since 7 years old, was treated in an infectious diseases hospital, Botkin’s disease was diagnosed. He was first examined for hepatitis markers, carriage of viral hepatitis B + D was detected, received symptomatic therapy. In 2002, he was treated in a children's sanatorium in Essentuki with a positive result. Early analysis without features. On admission: general condition is average, symptoms of chronic intoxication are expressed, pale, ipteric hard palate and sclera, traces of scratching are visible on the skin. The tongue is covered with a dirty white coating. The abdomen is soft and painful in the right hypochondrium, T. Kera. The liver protrudes from the hypochondrium by 3 cm, painful. The thyroid gland was visually enlarged to I-II art. From other organs and systems, there is no visible pathology.

Ultrasound from 18 / II-2003 - the liver increased 142-51 mm, mosaic.

Rheographic examination of the liver before and after treatment without dynamics - blood vessels are reduced, vascular tone on the right is increased, ECG without pathology.

Prothrombin time to treatment 87.9% after 78%. Total bilirubin 23.0 μm / L, ALT 0.218 μm / L, ACT 0.112 μm / L, thymol sample 4.8, total bilirubin after treatment 16.1, ALT 0.299, ACT 0.124, thymol sample 3.7.

Alkaline phosphatase before treatment 209.9 U / L after - 1032 U / L, total protein before treatment 60 g / L, after treatment - 63.8 g / L, albumin, respectively, 61.2% - 59.3%.

Diagnosis: chronic viral hepatitis B + D, minimal degree of activity, euthyroidism I degree.

In the clinic, the child received diet therapy (table No. 5), sulfide water - sulfate-bicarbonate-calcium-sodium mineral water (mineralization 4.5 g / l, hydrogen sulfide - 10 mg / l), Pyatigorsk spring No. 16, exercise therapy, therapeutic tubing in during the month 2 times a week and basic therapy - sulfide baths (Pirogovskie), t = 37 ° C, lasting 15 minutes, every other day, on the course number 8.

After the treatment, the overall well-being of the child improved, appetite improved, emotional tone increased, abdominal pain disappeared, nausea, stool normalized, however, objective clinical data did not change: the liver remained the same size, the ultrasound data and the hematogram did not change. Prothrombin time decreased from 87.9 to 78%; ALT increased from 0.218 to 0.799, ACT from 0.112 to 0.124, alkaline phosphatase from 209.9 to 1032 U / L.

The total bilirubin and thymol test decreased slightly.

Thus, the known method is not shown to children with CVH, even with a minimal degree of activity, sulfide water is not shown inside, and therefore we have tested another method - sulfide baths and inwardly carbonic chloride-bicarbonate-sodium-potassium mineral water ist. No. 24 (mineralization 4.5 g / l).

Observation 2. S-va Zalina, 7 years old, medical history No. 1545/14. Was admitted to the hospital on August 3, 2003 with complaints of abdominal pain, loss of appetite, and lag in physical development. A child up to a year often suffered from various diseases, about which he received a lot of intravenous infusions. Mother considers her to have hepatitis since 2 years, when an enlarged liver was discovered.

From the anamnesis: was born on time with a weight of 3200 g. Up to a year, psychophysical development corresponded to age.

Past diseases: frequent acute respiratory viral infections, laryngotracheitis, 2 fractures of the extremities. The brother has hepatitis "B".

At admission: General condition is satisfactory, proper physique, low nutrition. The skin is pale, shadow under the eyes, lags in growth. Lungs and heart without features, the tongue is covered with a dirty white coating. The abdomen is soft, painless in the right hypochondrium. The liver protrudes from under the rib 3 cm, dense. Emotionally labile.

Paraclinical indicators: ultrasound scan dated 08.08.2003 - liver 8D 124 mm, SS - 31 mm., Fine-grained echostructure, gall bladder 52 × 19 mm, wall up to 4 mm, sediment - small amount. The pancreas is not increased. Conclusion: echoes of hepatitis, DZHVP hypomotor type.

Liver REG from 08.20 - blood supply to the vessels is reduced, the right is increased, the venous outflow is difficult.

On the ECG from 12.08. - severe sinus arrhythmia, impaired repolerization in the anterior septal region.

ALT 0.283 μm / L, ACT 0.226 μm / L, batch sublimate 96%, thymol 0.7 conv. units, serum cholinesterase 0.78 srvc. units, gamma - GTP 0.6 μkm / l; alkaline phosphatase - 495.2 U / L, cholesterol 4.26 mmol / L, total protein 69%, G - 54.1, α1 globulin 5.4%, α2-globulin 10.8%, B-globulins 12.6 %, G-globulins 17.1%.

PAG-0, creatorrhea, amylorrhea, steatorrhea, acid diarrhea.

A flat curve with a load of lactose was detected (3.61; 4.53; 4.46)

In the general analysis of blood and urine, there is no pathology. After treatment, the paraclinical parameters changed: the size of the liver decreased to 1.5 cm, venous congestion on REG disappeared, ECG did not change, ALT decreased from 0.283 to 0.126 μm / l, ACT from 0.226 to 0.146 μm / l, alkaline phosphatase from 495, 2 U / L to 437 U / L, albumin increased from 54.1% to 56.6%, the activity of trypsin in feces increased from 0 to 1:40 (dilution), creatorrhea, steatorrhea, amylorrhea disappeared.

Discharged after 30 days with an improvement in general condition - abdominal pain disappeared, appetite improved, symptoms of chronic intoxication disappeared - became more emotional, active. The liver was reduced from +3.0 to +1.5 cm. Venous stagnation disappeared on REG, symptoms of cytolysis, cholestasis, mesenchymal inflammation disappeared, pancreatic function improved (trypsin activity in feces increased). Digestion - creatorrhea, amylorrhea, steatorrhea disappeared.

Thus, a single treatment in the clinic with the use of sulfide baths and drinking low-carbonate chloride-bicarbonate-sodium-calcium water during diet therapy helped to improve the general condition, clinical and paraclinical parameters.

Thus, the proposed method, i.e. sulfide baths and mild water, have an advantage over the previously described method and tested by us in children with CVH. This gives us reason to believe that patients with CVH in the phase of clinical and laboratory remission can be rehabilitated at the resort, the advantage of the proposed method over the known one is revealed. The peculiarity of the proposed method is that the sulfur contained in the baths could be a confirming factor for the liver, is destroyed in the first minute, and carbonic mineral water practically does not contain sulfur, as shown in the above examples (see Tables 1-3).

Table 1 Clinical characteristics of groups Sign The known method n = 24% The proposed method n = 10% Floor D 19 (80%) 7 (70%) M 5 (twenty%) 3 (thirty%) Disease duration 5 years 10 (40%) 5 (fifty%) more than 7 years fourteen (60%) 5 (fifty%) Degree of activity Inactive 2 (8.3%) one (10%) Minimum (I Art.) 22 (91.7%) 9 (90%) table 2 The dynamics of clinical indicators Signs of illness Famous
method n = 24 (points) Proposed
Method n = 10 D / l P / L R D / l P / L R Appetite 2.0 ± 0.73 0.6 ± 0.04 <0.05 4.0 ± 0.4 1.6 ± 0.3 = 0.001 Stomach ache 2.29 ± 0.2 0.45 ± 0.5 = 0.001 1.66 ± 0.4 0.6 ± 0.02 = 0.02 Heartburn 0.33 ± 0.01 0.04 ± 0.003 = 0.001 - - - Nausea 0.87 ± 0.17 0.5 ± 0.003 = 0.02 - - - Symptoms intoxication 6.0 ± 0.05 3.0 ± 0.01 0.05 6.5 ± 0.05 2.5 ± 0.01 <0.001 Language tightness 2.95 ± 0.9 0.29 ± 0.009 = 0.01 0.35 ± 0.03 0.01 ± 0.001 <0.001 SW liver 1.58 ± 0.06 1.13 ± 0.05 > 0.5 2.76 ± 0.47 1.25 ± 0.25 = 0.02

Table 3 The dynamics of paraclinical parameters in children with CVH during treatment. Indicator The known method n = 24 The proposed method n = 10 D / l P / L R D / l P / L R Cytolysis ALT 0.25 + 0.03 0.23 + 0.03 > 0.05 0.160 + 0.11 0.11 + 0.03 <0.5 ACT 0.18 + 0.01 0.17 + 0.01 > 0.5 0.161 + 0.02 0.136 + 0.005 <0.2 Mesench. vosp. HB 118.95 + 5.56 105.54 + 9.9 > 0.05 0.14.5 + 0.7 126.8 + 6.9 <0.05 ESR 5.83 + 0.07 4.08 + 5.5 > 0.05 - - - Thymol test 4.51 + 0.7 3.7 + 0.6 = 0.1 2.62 + 0.98 2.06 + 0.9 = 0.5 Cholestasis Click F 300.8 + 42.8 461.8 + 93.6 <0.05 411.98 + 38.4 301 + 0.15 = 0.1 Etc. beat. 2.08 + 0.9 1.23 + 0.5 = 0.1 1.24-0.08 1.1 + 0.5 = 0.5 β-lipopr. 1.09 + 0.2 1.11 + 0.09 = 0.5 3.0 + 0.22 3.6 + 0.1 = 0.02 Fosfol. 2.11 + 0.16 2.23 + 0.09 = 0.5 γ-GTP 0.31 + 0.04 0.37 + 0.63 = 0.5 - - - Hepatodepress. syndrome PTI 03.3 + 7.7 56.9 + 8.47 > 0.05 87.4 + 2.9 91.0 + 0.83 = 0.01 O. Beer. 17.95 + 1.4 14.53 + 1.7 = 0.1 17.8 + 9.07 20.1 + 0.5 > 0.5 Cholest. 4.49 + 0.24 3.75 + 0.48 = 0.2 - - - Albumen 54.2 + 2.4 49.64 + 3.9 = 0.5 55.9 + 1.14 56.5 + 0.56 = 0.5 D / l - before treatment P / l - after treatment P - significance of differences All groups are randomized.

Claims (1)

A method of treating children with chronic viral hepatitis, sulphide baths and mineral water, characterized in that the children take warm low-carbonated chloride-bicarbonate sodium-calcium water of low salinity of 100-200 g depending on age for 30 days as mineral water.