[Physical factors in the medical rehabilitation of patients with chronic cerebral ischemia in the outpatient stage]. / Fizicheskie faktory v meditsinskoi reabilitatsii patsientov s khronicheskoi ishemiei golovnogo mozga na ambulatornom etape.

Chronic cerebral ischemia is an urgent problem of modern medicine due to high disability of this contingent of patients and requires new approaches to the treatment and medical rehabilitation. OBJECTIVE: To develop a new technology for medical rehabilitation of the patients with chronic cerebral ischemia on an outpatient basis using therapeutic physical factors (such as ozone therapy and magnetic field in combination with endomassage) against the background of rational pharmacotherapy and psychocorrection. MATERIAL AND METHODS: There have been observed 122 patients with chronic cerebral ischemia stage I. They were divided into three groups by simple randomization. The patients of the group of comparison 1 (GC1) (n=39) had neurotropic pharmacotherapy (Cerepro and Mexidol) and a group psychotherapy; the rehabilitation programme of the patients of the group of comparison 2 (GC2) (n=41) included ozone therapy (intravenous infusions of ozone-oxygen mixture) in addition to the treatment program of GC1; the patients of the main group (MG) (n=42) received a combination of magnetic field exposure and endomassage in addition to the treatment program of GC2. Clinical monitoring, coagulation hemostasis, and cerebral vascular ultrasound were used to assess the treatment efficiency. RESULTS: The rehabilitation treatment performed on an outpatient basis with the inclusion of ozone therapy and the combined effect of magnetic field and endomassage in MG ensured the leveling of clinical symptoms in 91.2% of cases (p<0.01). The efficiency of rehabilitation in GC1 was 74.4%, with the additional use of ozone therapy in GC2 - 82.6%. CONCLUSION: The use of the new technology with the use of intravenous infusions of ozone-oxygen mixture and magnetic field in combination with endomassage against the background of rational pharmacotherapy and psychocorrection in medical rehabilitation of the patients with chronic cerebral ischemia on an outpatient basis provides a reliably significant increase in the effectiveness of rehabilitation measures.

[The substantiation of the application of the high-intensity pulsed magnetic field for the combined treatment of biliary sludge]. / Obosnovanie primeneniia vysokointensivnogo impul'snogo magnitnogo polia v kompleksnoi terapii biliarnogo sladzha.

Despite the considerable achievements in the field of gastroenterology, there is still high incidence of diseases of the organs of the hepatobiliary system which necessitates the development of new therapeutic techniques for their management. Nowadays, high-intensity pulsed magnetic therapy is considered to be a highly efficacious method characterized by well-pronounced and many-sided action on the processes proceeding in the organism as a new preformed factor producing neurostimulatory, vasodilatory, trophic, and hypoalgesic effects. It appears to be effective with respect to biliary sludge (BS) since it can promote depletion of stagnant contents of the gall bladder and also intensify its contractile function. AIM: The objective of the present study was to evaluate the effectiveness of the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy as the components of the combined treatment of biliary sludge. METHODS: The study included 117 patients presenting with biliary sludge (BS) who were randomly allocated to three groups. Group 1 was comprised of 38 patients and served as the control group. These patients received medicamentous therapy (hymecromone - 200 mg 3 times daily during two weeks and ursodeoxycholic acid at a dose of 10-15 mg/kg a day during a period from 3 to 6 months). The second group consisted of 40 patients and served as the group of comparison. The patients of this group received medicamentous therapy in the combination with the intake of 'Sernovodskaya' hydrocarbonate-chloride-sulphate sodium mineral water (from a spring in the Chechen republic). The third group was composed of 39 patients and constituted the main study group. These patients completed a course of therapy with the use of the high-intensity pulsed magnetic field applied to the gall bladder region. Each patient underwent 10 sessions of magnetic therapy after the completion of the treatment with hymecromone and 'Sernovodskaya' mineral water. The treatment was carried out with simultaneous monitoring dynamics of the clinical symptoms of biliary sludge, the ultrasound examination of the abdominal organs with the evaluation of the contractile function of the gall bladder, the level of bilirubin in the cystic bile, bile acids, cholesterol, and cholate-cholesteric coefficient. RESULTS: The combined treatment of the patients suffering from BS including the application of the high-intensity pulsed magnetic field alleviated the clinical symptoms of the disease much faster than medicamentous therapy combined with the intake of 'Sernovodskaya' mineral water. Moreover, it promoted the restoration of the motor activity of the gall bladder and accelerated the evacuation of the hyperechoic particles. CONCLUSION: The course of the combined treatment of the patients presenting with biliary sludge including the application of the high-intensity pulsed magnetic field in the combination with the intake of mineral water (MW) and rational pharmacotherapy significantly relieved abdominal pains, alleviated the symptoms of biliary dyspepsia, and improved the motor function of the biliary tract. These therapeutic effects persisted as long as 3 months. The results of the present study give evidence of the necessity of prescription of an optimum dose of ursodeoxycholic acid to the patients suffering from biliary sludge.

[The role of the combined balneotherapeutic treatment as the 'add-back therapy' against the background of the anti-hormonal effects of the agonists of gonadotropin-releasing hormone in the women suffering from endometriosis genitalis externa]. / Kompleksnoe bal'neolechenie v kachestve terapii prikrytiia na fone antigormonal'nogo vozdeistviia agonistami gonadotropin-rilizing gormona u zhenshchin s naruzhnym éndometriozom.

BACKGROUND: The use of agonists of gonadotropin-releasing hormone (GnRH) for the rehabilitation treatment of the patients presenting with endometriosis genitalis externa is known to significantly enhance the risk of development of hypoestrogenism. The so-called 'add-back-therapy' is carried out as a preventive measure to eliminate hypoestrogenism caused by the intake of GnRH agonists without detriment to the effectiveness of anti-hormonal therapy. AIM: The objective of the present study was to estimate the effectiveness of the new method ('add-back hormone replacement therapy') in comparison with anti-hormonal therapy with the use of GRH agonists at the stage of the early postoperative medical rehabilitation based on the drinking of mineral waters (MW) and radon therapy (RT) in the patients who had undergone the laparoscopic interventions for the treatment of endometrioid heterotopies of the ovaries (1-3 months post-operatively). MATERIAL AND METHODS: To evaluate the effectiveness of the spa and health resort-based rehabilitation measures, the long-term effects of GnRH agonists have been studied in 2 groups of the patients formed by the of simple randomization method. The main group (MG) was comprised of 45 women received medical rehabilitation under conditions of a spa and health resort setting with the application of medium-salt water from the Pyatigorsk spring and radon therapy in the combination with triptorelin. The group of comparison (CG) was composed of 44 women given the treatment with the use of triptorelin under the out-patient conditions. The assessment of the results of the study included: the estimation of the intensity of pelvic pain syndrome, indicators of the hormonal status and the quality of life (QL), ultrasonic examination of the pelvic organs, and the occurrence of adverse effects of triptorelin. The duration of the study was 3 years (2014-2016). RESULTS: The analysis of the long-term results of the rehabilitative treatment has demonstrated that the rehabilitation activities under the spa and health resort conditions within 1-3 months after the surgical intervention including the application of MW and RT in the combination with an agonist of gonadotropin-releasing hormone (triptorelin) greatly contributed to the stability of the results of the treatment: specifically, only 2.5% of the patients suffered the recurrence of cystic ovarian endometriosis whereas 24.5% (p<0.001) reported the restoration of the reproductive function. The patients comprising the control group experienced the recurrence of the pathologic process in 7.5% of the cases and the restoration of the reproductive function in 15.8% of the cases (p<0.001). Simultaneously, the quality of life in the patients in the main group improved 3.4 times on the average in comparison with the initial level (p<0.001). The 2.2-fold improvement of the quality of life was documented in the control patients (p<0.001). At the same time, the frequency of adverse reactions to the treatment with triptorelin in the control patients was higher than in the main group including pain in the epigastric area, headache, irritability, hyperhidrosis, and instability of arterial blood pressure (ABP) that significantly deteriorated the life quality in these women. CONCLUSION: The comparative analysis of the results of the follow-up observations has demonstrated that the application of drinking mineral water and radon therapy for the treatment of the women suffering from endometriosis genitalis externa can be recommended as 'add-back therapy' against the background of anti-hormonal effects of agonists of gonadotropin-releasing hormone.

[The evaluation of the effectiveness of the application of bischofite-modified yellow clay (an experimental studi)]. / Otsenka éffektivnosti primeneniia zheltoi gliny, modifitsirovannoi bishofitom (éksperimental'noe issledovanie).

BACKGROUND: The topical problems in balneotherapeutics and health resort activities in general are the development of the yellow clay-based preparations enriched in the natural mineral bischofite and the investigation of their therapeutic effects with the purpose of improvement of their curative potential. AIM: The objective of the present study was to evaluate the effectiveness of the course of the experimental therapeutic applications of the yellow clay obtained by the open pit mining of its deposits located in the vicinity of Pyatigorsk and modified by the addition of bischofite. MATERIAL AND METHODS: The experiments were carried out with the use of 57 eugamic Wistar male rats with adjuvant arthritis. The yellow clay supplemented with bischofite in various concentrations was applied in 12 procedures each 15 minutes in duration every other or every two days beginning from the 38th day of experimentally-induced arthritis. The animals were allocated to five groups as follows: group 1 included the healthy animals that served as controls (n=5), groups 2-5 were comprised of the animals with adjuvant arthritis. The animals included in group 2 served as the experimental model of adjuvant arthritis (n=8), those comprising group 3 were treated by the applications of yellow clay without additives (n=14), group 4 was composed of the animals with adjuvant arthritis treated by the applications of yellow clay containing 10% of bischofite (n=15), the animals in group 5 having adjuvant arthritis were treated by the applications of yellow clay containing 20% of bischofite (n=15). RESULTS: The study has demonstrated the reduction of the reactively enhanced relative abundance of, activated T-cells, and B-lymphocytes down to the respective control values in the animals with adjuvant arthritis after the course of applications of the yellow clay preparations. Simultaneously, normalization of the immunoregulatory index, IRI, (the T-helpers to cytotoxic T-lymphocytes ratio) was documented. The treatment was associated with the strong dependence of the interleukin (IL-1ß) contents on the cortisol level and the well apparent relationship between the levels of interleukins and IRI. Specifically, the relation between IL-1ß and IRI following the application of non-modified yellow clay was characterized as (r=+0.8, p=0.03) in comparison with the relation between IL 6 and IRI (r=+0.8, p=0.03) after the treatment with yellow clay containing 10% of bischofite or between IL 6 and IRI (r=+0.8, p=0.004) after the application of yellow clay containing 20% of bischofite. CONCLUSION: The results of the study give evidence of the immunomodulatory action of yellow clay modified by the addition of bischofite. They suggest the promising opportunities for the application of these preparations for the management and rehabilitation of the patients presenting with the diseases of the musculoskeletal system in the future.

[Mental, autonomic and neurophysiological disturbances in patients with obesity and their treatment with transcranial stimulation].

Authors studied 85 patients, aged from 45 to 68 years, suffered from obesity (stage I and stage II) for more than 5 years with concomitant arterial hypertension and atherosclerosis. Patients were randomized into two groups. Patients of the main group received transcranial stimulation (TS) along with standard treatment with antiaggregant vascular drugs and hypocaloric diet. Patients of the control group received placebo TS procedures with turned-off electrodes. The TS treatment was carried out using frontal-mastoid recording with the by-turn stimulation of the right and left hemispheres (frequency = 10Hz, number of daily sessions = 10-12). Psychometric scales, rhythmocardiography, EEG and evaluation of lipid peroxidation activity were used to assess the patient's status. Positive changes for most of the parameters used in the study were noted in the main group compared to the control one. The body-mass index was decreased by 9.8% in the main group.

The potential of transcranial magnetotherapy in color and rhythm therapy in the rehabilitation of ischemic stroke.

A total of 116 patients with ischemic stroke were studied during the early recovery period. The patients were divided into four groups - three experimental groups and one control group. Of these, 87 patients in the first three groups received transcranial magneto- and/or color and rhythm therapy (TcMT, CRT) along with traditional treatment, while the 29 patients of the control group received basal treatment only. TcMT was performed using a bitemporal method, with a running field regime with a modulation frequency of 1-10 Hz. CRT consisted of an alternating scheme of stimulation of the left and right eyes with green and/or blue light with a period of 2-4 sec and an on time of 1 sec. Each of the three experimental groups (group 1 received TcMT, group 2 received CRT, and group 3 received TcMT + CRT) received two courses of treatment separated by 1.5 months. After treatment, all experimental groups, particularly group 3, showed more marked improvements than the control group. Regression of neurological symptomatology on the Lindmark scale in group 3 was 9.5% greater than that in controls; improvements in impairments to activity and self-care ability on the Barthel scale were greater by 8.8%; memory and intellectual changes were also seen on the MMSE and the Luriya and Schulte tests. Rheography and electroencephalography demonstrated significant improvements in hemodynamics and alpha-rhythm differentiation and a 14.6% reduction in the proportion of patients with dysrhythmia in group 3 compared with the control group. The best result on all measures were obtained in patients given the combination of TcMT and CRT; TcMT had the greater influence on hemodynamics, while CRT had the greater effect on psychoemotional status. Both treatments were well tolerated and produced no side effects.

[Possibilities of transcranial magnetic therapy and color and rhythm therapy in rehabilitation of ischemic stroke].

One hundred and sixteen post-stroke patients were studied in the early rehabilitation period. All patients were divided into 4 groups: 3 main and 1 control groups. Three main groups (87 patients) received transcranial magnetic therapy (TMT) and/or color and rhythm therapy (CRT) along with traditional treatment and the control group (29 patients) received only basic therapy. TMT was conducted using bitemporal technique, running regime with modulation frequency 1-10 Hz. In CRT, the alternating stimulation of the right and left eye with green and/or blue color with a period of 2-4 s and duration of luminescence 1s was applied. Each of 3 main groups received 2 treatment sessions with an interval of 1,5 month (1st - TMT, 2nd - CRT, 3rd - TMT + CRT). After the treatment, the marked positive changes were seen in all main groups, in particular in group 3. The improvement of neurologic symptoms on the B. Lindmark scale was higher by 9,5% in group 3 compared to the control one, on the Barthel index - by 8,8%, on MMSE and A. Luria and Schulte test - by 5,4 and 14,3%, respectively. Rheographic and encephalographic study revealed the significant improvement of hemodynamics and alpha-rhythm differentiation, decrease of patients with dysrhythmia by 14,6% in group 3 as compared to the control group. The best results were seen in the combination of TMT and CRT, TMT exerted a higher effect on the hemodynamics and CRT - on the psychoemotional state. Both therapies were well tolerated and had no side-effects.

[Posttraumatic disturbances in patients with light craniocerebral injury and their correction via various variants of dynamic magnetotherapy].

Examination of 90 patients in intermediate period of slight craniocerebral injury before and after use of curative technologies with including of dynamic magnetotherapy suboccipitally or transcranially. It is established, that choosing rehabilitation methods, it is necessary to take into consideration clinical manifestation of disease, state of cerebral blood circulation, vegetative nervous system, bioelectrogenesis of cerebrum.

[The vegetative status in patients with vertebrogenic vertebral artery syndrome, and its correction with health resort treatment].

According to statistics, osteochondrosis is one of the most prevalent diseases resulting in changes in the musculoskeletal, nervous, and cardiovascular systems. In vertebral artery syndrome, the irritation of sympathetic plexuses around this artery results in vasomotor changes in the vertebrobasilar system and determines the clinical picture of the syndrome, i.e. its vegetalgic and angiodystonic components. Pathology of central regulatory mechanisms and suprasegmental divisions of the vegetative nervous system appears.

[Effects of combined action of radon baths and transcranial magnetotherapy on cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma].

The authors propose combined therapy improving cerebral circulation in patients in an intermediate period of a mild craniocerebral trauma. The combination consists of radon baths and transcranial magnetotherapy which raise blood volume filling, relieve vascular resistance, improve venous outflow.

[Effect of sanatorium treatment on hormonal disorders in patients with sequelae of craniocervical trauma]. / Vliianie kurortnogo lecheniia na gormonal'nye narusheniia u bol'nykh s posledstviiami kraniotservikal'noi travmy.

Craniocervical trauma brings about pathology of the central regulatory mechanisms, functional insufficiency of which persists for many years and is responsible for specific features of traumatic disease of the brain with development of the syndrome of posttraumatic regulatory disorders of the nervous-endocrine-immune system. The authors propose methods of differential therapy of posttraumatic hormonal disorders in sanatorium.

[Clinico-immunological disorders in the late sequelae of craniocervical trauma and their correction at the health resort stage]. / Kliniko-immunologicheskie narusheniia pri otdalennykh posledstviiakh kraniotservkal'noi travmy i ikh korrektsiia na kurortnom étape.

The examination of 30 patients with late aftereffects of craniocervical trauma has determined clinico-neurophysiological characteristics of the late trauma period and immunopathological reactions. Combined use of radon baths and ultrasound applied to the region of adrenal projection is suggested to correct the above aftereffects.

[The syndrome of posttraumatic deregulation of the neuroendocrine-immune system and the tasks of health-resort therapy]. / Sindrom posttravmaticheskoi dizreguliatsii neiroéndokrinno-immunnoi sistemy i zadachi kurortnoi terapii.

Examination of 150 patients with syndrome of immunoendocrinonervous system dysregulation (SIENDR) caused in 70% of cases by trauma has shown that this syndrome is characterized by hormonal disorders, immunodeficiency followed by visceral pathology (gynecological and gastroenterological, in particular). Anatomical substrate of the syndrome is impairment of hypothalamohypophyseoadrenal complex. Recognition of SIENDR is important for physiotherapist as it allows to treat combined diseases with mineral baths, drinking mineral water and inhalations.

[Radon baths and laser therapy in the rehabilitation of patients with the late sequelae of joint trauma to the head and neck]. / Radonovye vanny i lazerterapiia v reabilitatsii bol'nykh s otdalennymi posledstviiami sochetannoi travmy golovy i shei.

The study of combined effects of radon baths and laser irradiation of some cranial zones in therapy of 60 patients with late sequelae of craniocervical trauma has shown that the highest response can be achieved in vegetovascular dystonia, asthenoneurotic syndrome, vestibulopathy, spinal artery syndrome. Pathogenetic therapy with laser radiation and radon baths is validated in management of late sequelae of craniocervical trauma.