What type of current is used in the galvanization method. Progress of the treatment procedure. Indications for use

The areas of skin on which the electrodes will be applied should be examined first. In the place of violation of the integrity of the skin (presence of abrasions, cracks, irritation, pustules), due to a decrease in its resistance to current, the current lines of force here become denser and pain and morphological changes may appear; subsequently the tissue dies here. The presence of hair on the skin prevents the uniform distribution of current. When galvanizing, skin defects should be covered with a piece of oilcloth thickly greased with Vaseline, and the hair should be moistened generously with water.

The skin to be galvanized should be wiped with cotton wool soaked warm water, to remove flaking products and fat that impede the passage of current. Moistened hot water and well-pressed hydrophilic pads, on top of which metal electrode plates are placed.

There are transverse and longitudinal arrangement of electrodes. With a transverse arrangement, the electrodes are placed opposite each other, that is, on opposite parts of the body; in this case, the impact extends to the entire thickness of the area. With a longitudinal arrangement, the electrodes are placed in the same plane; in this case, tissues located in shallow areas are mainly affected. When using electrodes of different areas, an electrode with a smaller area is called active, since per 1 cm 2 of its area there is a greater current strength, i.e., the current density on it is greater. More than two electrodes can be used simultaneously.

After each procedure, the pads should be rinsed well with running water, boiled separately depending on the medicinal substances used and dried.

During galvanization, the patient should be in a comfortable and free lying or sitting position (depending on the procedure and the patient’s condition).

Before applying the electrodes, you must make sure that the potentiometer slider is in the zero position, the shunt switch handle is in accordance with the intended current strength, and the milliammeter needle is at zero.

After applying the electrodes, connecting the wires to them and fixing them, the wires are connected to the corresponding terminals of the galvanizing apparatus. When the device is turned on, the signal light lights up, indicating that current is flowing into the device. After this, wait 1/2-1 minute for the kenotron cathode to heat up, and then slowly begin to move the potentiometer slider clockwise. As the potentiometer is gradually moved out, the current gradually increases; The current strength is determined by the readings of a milliammeter.

The patient should be warned that he should feel a tingling sensation at the sites where the electrodes are applied, which may subside during the procedure. If the patient is bothered by a burning sensation in a limited, small area of skin, this indicates a technically incorrect procedure. The cause of the burning sensation may be the presence of abrasions and other defects on the skin, where the current flows, as a result of which the current density here increases. In such cases, slowly move the potentiometer slider knob to reverse side turn off the device and check the procedure technique. The current density during galvanization is dosed within the limits of current tolerance by the patient, but not more than 0.05-0.1 mA/cm 2 of the spacer area active electrode. In children, depending on age, the current density should not exceed 0.03-0.08 mA/cm2. Procedures are also used (galvanic collar, etc.) in which the current density is very low (0.001-0.03 mA/cm2).

As the stratum corneum is moistened (from the wet pad), the skin resistance decreases and the current strength may itself increase a few minutes after the start of galvanization.

With high current strength, especially with certain diseases nervous system When the sensitivity of the skin is reduced and the patient does not feel irritation from the current, a sharp hyperemia of the skin may appear. Sometimes skin burns occur, and most common reasons are: the metal plate of the electrode or wire clamp touching the skin, too thin, uneven thickness or a defective gasket. When a burn occurs, the patient must provide first aid and find out the cause. If there is severe hyperemia and pain, the area of redness is lubricated with boric vaseline or fish oil.

With a more severe burn, blisters also appear, which, when opened, lead to the formation of ulcers, which are subsequently covered with a scab. With an anode burn, a dry, dense, dark-brown scab appears; with a cathode burn, a gray-brown, soft, easily bleeding, slowly healing scab appears. The cause of skin burns are electrolysis products, for example, Na, Cl, etc. ions, which, under the influence of direct current, reaching the corresponding poles, give up their charges to them, turning into atoms. At the same time, they react with a water molecule, and therefore a burn from acid (HCl) is formed on the area of the skin adjacent to the anode, and from alkali (NaOH) on the area adjacent to the cathode. If a burn occurs, galvanization of the damaged areas is stopped.

During direct current treatment, some patients may experience dry skin, itching, and sometimes cracks at the electrode locations. If these phenomena are not clearly expressed, the irritated areas are lubricated with glycerin or castor oil, half diluted with water. If skin irritation does not stop after the procedures and even intensifies, galvanization should be abandoned.

During the procedure, the patient should not talk or read, but should lie or sit quietly in order to correctly orientate nurse about your feelings. If the patient falls asleep during the procedure, the current is turned off, giving the patient the opportunity to sleep for a while. At the end of the procedure, slowly return the potentiometer slider to its original position, turn off the current, disconnect the wires from the terminals of the device, remove the electrodes and inspect the galvanized areas.

During galvanization, especially during electrophoresis, the polarity of the current plays an important role. The polarity markings on the terminals available on the panel of the galvanizing device are not always correct, and therefore periodic (in particular, after repair of the device) check of the polarity using one of the given methods is required.

First way. The bare ends of the wires connected to the terminals of the device are lowered into a glass of fresh water. When a direct current is passed around the immersed end of the wire connected to the cathode, hydrogen bubbles will be intensely released; Fewer oxygen bubbles will form at the anode.
Second way. The bare ends of the wires connected to the terminals of the galvanizing apparatus are applied to a piece of cotton wool moistened with a solution of potassium iodide. When a current is passed at the point of contact with the wire connected to the anode, a brown color appears, indicating that iodine ions, which have a negative charge, having reached the positive pole, turned into iodine atoms and accordingly colored the cotton wool.
Third way. When a direct current is passed through a strip of blue litmus paper moistened with water, you can see its pinkness at the electrode on the anode, which is due to the formation of hydrochloric acid here; The blueness of the pink paper on the cathode is due to the formation of alkali here.

Galvanization is a method in which continuous direct current with a voltage of 60-80 V is used for therapeutic purposes.

Distinguish the following techniques exposure to direct current: local, reflex-segmental and general.

From reflex-segmental galvanization techniques well known, for example:

1) galvanization of individual zones (galvanic collar, galvanic belt, galvanic pants);

2) galvanization of the cervicofacial area;

3) nasal galvanization.

Under the influence of these physiotherapy procedures, excitability changes sympathetic nodes border trunk, the excitability of the diencephalic centers decreases.

General methods of exposure include general galvanization according to S. B. Vermeule. Direct current is used when medicinal electrophoresis; the latter is a method of combined exposure to direct current and ions or particles of medicinal substances introduced into the body through the skin and mucous membranes.

To carry out the galvanization and electrophoresis procedure, electrodes are used consisting of sheet lead or staniol with a thickness of 0.3-0.5 mm and, in order to avoid electrolysis phenomena, from a hydrophilic gasket (baize, paper, flannel) in 6-8 layers (its thickness should not be less than 1 cm). The area of the hydrophilic gasket should be larger than the metal plate and extend beyond its edges on all sides by at least 1-2 cm. The electrodes are connected to the galvanizing apparatus with a special wire with a clamp; The pads for the procedure are moistened with warm tap water.

There are transverse and longitudinal arrangement of electrodes.

With a transverse arrangement, the electrodes are placed parallel to each other or diagonally so that the area to be affected is in the interelectrode space, with a longitudinal arrangement - in the same plane. If it is necessary to concentrate the current on a certain area of the body, an electrode of a smaller area is placed here; this is the so-called active electrode. In electrophoresis, the electrode whose gasket is wetted is called active. medicinal solution. Second electrode larger area, is called indifferent.

Baths with tap water in the form of four-, three-, two- and single-chamber baths are often used as electrodes for limbs (with the latter, one conventional electrode is also used).

To carry out the electrophoresis procedure, the same electrodes are used as for galvanization, but the active electrode gasket is moistened with a solution of the corresponding medicinal substance. It is advisable to moisten the medicinal solution not with the gasket, but with one layer of filter paper or 1-2 layers of gauze corresponding in size to the electrode gasket; they are placed on an electrode pad moistened with warm tap water, and the entire electrode is placed on the area of the body to be affected. The medicine is administered from the pole whose charge it has. Thus, anions (negatively charged ions) are introduced from the cathode, cations (positively charged ions) from the anode.

Direct current is dosed according to the milliammeter readings on the galvanizing apparatus in milliamperes (mA). In this case, the so-called current density must be taken into account, i.e. the number of milliamps per 1 cm2 of the area of the electrode pad. The permissible current density during galvanization and electrophoresis should not exceed 0.1 mA/cm2 (for children 0.05 mA/cm2); As the electrode area increases, this current density should be reduced rather than increased. Knowing the area of the active electrode and permissible density current, you can determine in advance the permissible current during the procedure. So, for example, with an electrode pad area of 12 cm2, the current strength should be no more than 1.2 mA (12x0.1). Nevertheless, when determining the required current strength, one should take into account the sensitivity of the patient, who during the procedure at the site where the electrodes are applied, other than a slight tingling sensation, should not experience any discomfort, burning, pain, etc.

The duration of the galvanization and electrophoresis procedure is from 10-15 to 40-60 minutes. As a rule, the first 4-6 procedures are carried out every other day, the subsequent ones - depending on the patient’s reaction, either every other day or daily; a course of treatment usually ranges from 10-12 to 20-25 procedures. In general, it should be borne in mind that the strength of the current, the duration of the procedures, the sequence of their implementation, and their total number per course of treatment depend on the nature, stage (phase) of the disease, general condition the patient and his individual reactivity.

Some galvanization techniques

Nasal galvanization technique. Gauze turundas, well moistened with warm tap water or an appropriate medicinal solution, are inserted into both nostrils. The turundas are inserted as deeply as possible, filling them with the anterior fossa of the wings of the nose; they should fit tightly to its mucous membrane. On upper lip place a piece of oilcloth on which the extended ends of the turunda are placed, covering them with a lead plate (2X3 cm) with a wire soldered to it. The lower edge of the oilcloth is folded onto a lead plate and fixed in this form with a few turns of the bandage; a second indifferent electrode with an area of 80 cm2 (8x10 cm) is placed on the back of the neck. If the electrode on the back of the neck needs to be connected to the cathode, then it is placed in the area of the lower cervical vertebrae, and if it needs to be connected to the anode, then it is placed in the area of the upper cervical vertebrae.

The duration of the procedures and the current strength depend on the nature of the disease and the drug used. With electrophoresis of vitamin B1 (0.5% solution), the current is from 0.5 to 2 mA, the duration of the procedure is 10-30 minutes, for a course of treatment up to 20-25 procedures, with calcium electrophoresis (2% solution) the same duration of procedures, but the current is 0.2-0.7 ma.

G alvanization of the collar area(galvanic collar according to A.E. Shcherbak). An electrode in the form of a shawl collar with an area of 1000 cm2 is placed on the “collar” zone ( top part back, supraclavicular areas, upper shoulders) and connect it to the anode of the galvanization apparatus; the second electrode with an area of 400 - 600 cm2 is placed in the lumbosacral region and connected to the cathode of the galvanization apparatus. Procedures lasting from 6 to 16 minutes with a current strength of 6 to 16 mA are carried out every other day (daily), for a total of up to 20-25-30 per course of treatment.

Orbital-occipital galvanization technique. Two round electrodes with spacers round shape 10-12 layers of gauze, each with a diameter of 5 cm, are placed over closed eyes and connected to one pole of the galvanizing apparatus, the third electrode with a spacer of 50 cm2 is placed on the back of the neck and connected to the second pole of the galvanizing apparatus; if this electrode is connected to the anode, then it is placed in the area of the upper cervical vertebrae; if it is connected to the cathode, then it is placed in the area of the lower cervical vertebrae. Current 4 mA; procedures for 20-30 minutes are carried out daily or every other day, for a course of treatment there are 10-15 procedures.

General galvanization technique. An electrode with an area of 300 cm2 (15X20 cm) is placed in the interscapular area and connected to one pole of the galvanizing apparatus, two other electrodes with an area of 150 cm2 (15X10 cm) are each placed in the area of both calf muscles and connect them to the second pole of the galvanizing apparatus. Procedures lasting 10-60 minutes at a current density of 0.03-0.05-0.06 mA/cm2 are carried out every other day (daily), for a course of treatment there are 15-20 procedures.

This technique has been proposed for electrophoresis; In this case, usually the electrode gasket in the interscapular region is moistened with a solution of the medicinal substance and the electrode is connected to the corresponding pole of the galvanizing apparatus, depending on the polarity of the injected substance.

Galvanization is the use for therapeutic purposes of continuous direct current of low strength (up to 50 mA) and low voltage (30-80 V), supplied to the body contactally, through electrodes.

Direct current causes complex biophysical processes in tissues associated with a violation of the quantitative and qualitative ratio of ions.

The multilayered nature and different electrical conductivity of body tissues determine the passage of current not in a straight line, but along the path of least resistance - through the intercellular spaces, blood and lymphatic vessels.

A specific feature of the action of direct current is the directional movement of positively or negatively charged ions contained in complex tissue solutions that are located between the electrodes. Negative ions move towards the positive pole (anode), and positive charges- to the negative pole (cathode). Approaching a metal electrode, the ions lose their discharge as electrolysis occurs and turn into chemically active atoms that react with water and form electrolysis products on metal plates (Fig. 2.2).

The positive electrode produces acid, and the negative electrode produces alkali. These electrolysis products can cause chemical burns to tissues that come into contact with the metal electrode. Inside the tissues located between the electrodes, the concentration of ions near the membranes changes. Cell membranes, with their protein substance, under the influence of direct current change their permeability, while the processes of diffusion and osmosis intensify, and exchange occurs more intensely.

When current passes through the tissues, biologically active substances are formed: under the cathode, the content of histamine and acetylcholine in the tissues increases and the activity of cholinesterase decreases, which increases the excitability of tissues (especially neuromuscular), causes more pronounced hyperemia of the skin, and increases the permeability of cell membranes.

In the skin under the anode, the amount of histamine and acetylcholine decreases and the activity of cholinesterase increases, which leads to a decrease in tissue excitability, as cell membranes become denser. This phenomenon finds practical use and is taken into account when applying electrodes to reduce pain.

Galvanic current irritates skin receptors. This irritation is transmitted to the cerebral cortex and returns from there in the form of a certain reflex, most often a vasodilator. As a result, hyperemia forms under the electrodes, which lasts from 30 minutes to 1.5 hours - the effect after the procedure.

The action of galvanization causes not only a local reaction. Thus, an example of the emergence of predominantly general reaction the body in response to the influence of galvanic current is galvanization of the collar zone, in which the response through irritation of the cervical sympathetic nodes is involved the cardiovascular system, blood circulation improves in organs innervated from the corresponding segment spinal cord, are improving metabolic processes.

When electrodes are placed in the head area, reactions may occur that are characteristic of irritation not only of the skin analyzer, but also of others: taste (sensation metallic taste in the mouth), visual (appearance of phosphenes), etc.

When the electrodes are placed transversely in the temple area, dizziness may occur as a result of irritation of the vestibular apparatus.

Direct current does not only act at the point of application. Its influence extends to other organs and tissues, primarily to those innervated by the corresponding segment of the spinal cord.

Galvanization stimulates the regulatory function of the nervous and endocrine systems, helps normalize the secretory and motor functions of the digestive organs, stimulates trophic and energy processes in the body, increases the body's reactivity, resistance to external influences, in particular, increases protective functions skin.

With general galvanization, the number of leukocytes in the blood increases, the ESR increases slightly, hemodynamics improve, the number of heartbeats decreases, and metabolism increases (especially carbohydrate and protein).

Low-intensity direct current (at a density of up to 0.05 mA/cm 2) helps accelerate coronary circulation, increase oxygen absorption and glycogen deposition in the myocardium. However, higher current strength causes the opposite effect.

How to dose energy?

There is the concept of “current density” (CT). Current density is the current divided by the electrode area. The unit of current density is mA/cm2.

1 mA/cm 2 is a current equal to 1 mA acting on an active electrode area equal to 1 cm 2.

Therapeutic current density - small values: from 0.01 to 0.1-0.2 mA/cm 2.

PT 0.5 mA/cm 2 or more causes irreversible changes in tissues.

For energy dosage in medicine, a therapeutic current density corridor is used in 3 ranges:

I. Low therapeutic current density: from 0.01 to 0.04 mA/cm 2 (current strength is from 1 to 4 mA). Used for acute processes, pain syndromes in children under 4 years of age.

II. Average therapeutic current density: from O.04 to O.08 mA/cm 2 .

III. High therapeutic current density: from 0.08 to 0.1 (0.2) mA/cm 2 . Used for local influence: long-term and chronic diseases.

The dosage of procedures is also carried out according to exposure (exposure time): from 10 to 30 minutes. The optimal effect occurs after exposure for 10 minutes.

Galvanization techniques

Galvanization techniques can be divided into three groups:

1. Are common - use a small therapeutic dose, for example, a four-chamber hydrogalvanic bath (Fig. 2.3).

2. Segmental - use a small and medium therapeutic dose (for example, endonasal galvanization, galvanization of the spine).

3. Local - use the entire corridor of therapeutic effects.

Indications and contraindications

Main indications for galvanization:

Diseases internal organs(stages I and II hypertension, bronchial asthma, gastritis, colitis, pancreatitis, gastric and duodenal ulcers, scleroderma);

Diseases of the nervous system (plexitis, neuritis, radiculitis, neuromyositis, injuries: peripheral nerves, brain and spinal cord, neurosis, migraine, solaritis).

Galvanization is also used for a number of diseases of the skin, female genital organs, eyes, etc.

Contraindications:

1. Individual intolerance to current.

2. Violation of the integrity of the skin at the site of localization (eczema, hyperkeratosis).

3. Severe vegetotrophic disorders.

4. Malignant diseases.

5. Increased blood pressure above 180/100 mmHg. Art., frequent vascular crises.

6. Atrial fibrillation.

7. Polytonic extrasystole.

8. Circulatory disorders II -III degree.

9. Feverish conditions.

Galvanizing equipment

Direct current is obtained using galvanizing devices. For galvanization, in particular, the following devices are used: AGN-1, AGN-2, Potok-1, Potok-01M, Potok-Br, Elfor-Prof .

As an example, let's describe one of the devices.

Therapeutic device Elfor-Prof designed for galvanization and electrophoresis procedures. It is an improved functional analogue of the physiotherapeutic device for electrophoresis Potok-1.
made on a modern element base using a microcontroller. This made it possible to expand the functionality of the device, making it at the level of modern medical technology.

The device uses a multi-turn current regulator, which does not have stops in the extreme left and extreme right positions. With such a decision in Elfor-Prof device Firstly, the current value is always automatically set to zero when the device is turned on, which is an important electrical safety measure. Secondly, adjusting the current value during operation occurs more smoothly and accurately.

IN Elfor-Prof device There is a built-in timer, which greatly simplifies monitoring the time of the procedure. The operator has the ability to set one of the following discrete time values: 10, 15, 20, 25 and 30 minutes. after the set time interval has expired, the procedure stops automatically.

IN Elfor-Prof device A current stabilization mode has been implemented, in which the set current value is automatically maintained throughout the entire procedure. More than 150 types of medications can be administered in electrophoresis mode.

Technical characteristics of the Elfor-Prof device

Name	Meaning
AC supply voltage, V
AC supply frequency, Hz
Power consumption, W, no more
Maximum current in the patient circuit, mA
Current adjustment ranges, mA
Procedure execution timer, min.
Timer setting resolution, min.
Overall dimensions of the case, mm, no more
Weight without packaging, kg, no more

During procedures, current is supplied to the patient through electrodes along current-carrying wires. The electrodes consist of lead plates 0.3-1 mm thick, damp hydrophilic fabric gaskets and cord.

Gaskets made from 12-16 layers of white flannel. They should be warm enough to open the skin pores. To avoid the danger of contact of the patient's skin with the metal plate, it is necessary that the gasket protrudes from all sides beyond the edges of the plate by 1.5-2 cm. The purpose of the gasket is to create uniform density of contact between the electrode and the patient's body, reducing high skin resistance.

Electrodes there are various shapes and sizes. Most often, rectangular electrodes are used, but sometimes a special form of electrode is needed, for example, a half mask for galvanizing the face, a “collar” for galvanizing the upper back and shoulder girdles, a funnel for galvanizing the ear area, a tray for galvanizing the eye area. In gynecological practice, special cavity electrodes are used - vaginal, in surgery (proctology) - rectal, etc. The area of the electrodes is different, therefore the area of the pads is also different.

Lead plates are used as electrodes, since they are very flexible and easily take the shape of the areas of the body on which they are applied. The plates must be smooth, without sharp corners, so that the current density is uniform.

The cathode and anode electrodes can be of the same area, or one of them can be smaller - the so-called active electrode. The current density per 1 cm 2 of spacer at the active electrode turns out to be greater because the field lines become thicker. During the procedure, the active electrode is applied to the area where it is necessary to ensure the maximum effect of the current.

When prescribing galvanization, the permissible current strength is set according to the area of the active electrode With taking into account the characteristics of the area of the body exposed, and most importantly, taking into account the condition of the patient.

There are transverse and longitudinal arrangement of electrodes. With a transverse arrangement, the electrodes are placed opposite each other on opposite parts of the body (the effect is provided on deeper tissues). With a longitudinal arrangement, the electrodes are located on one side of the body (superficially located tissues are exposed).

Progress of the procedure

Before applying electrodes, it is necessary to carefully examine the relevant areas of the skin. The skin should be clean. Areas with damaged epidermis are smeared with Vaseline and covered with pieces of cotton wool, thin rubber or oilcloth.

During the procedure, it is necessary to monitor the patient’s sensations and the device’s readings, ensuring that the specified current strength is not exceeded. Galvanization, carried out in compliance with the specified rules, usually causes a tingling sensation, “crawling goosebumps” on the areas of the skin located under the electrodes, with a sharp burning sensation or pain, even; on small areas of skin, it is necessary to smoothly turn off the device and establish the cause of the adverse reactions. They may depend both on technical conditions and on the state of the body.

During a course of galvanization, it is recommended to lubricate the skin with Vaseline to avoid peeling of the track and the appearance of cracks. After the procedure, the pads should be washed and boiled.

To remove addiction to the procedure, use degabituiru reception : turn off the device or change the polarity for 2 minutes.

It must be remembered that after 5-7 procedures there may be physiotherapeutic reactions slight exacerbation of the disease (worsening of the condition), which indicates a positive therapeutic effect appointments.

The use of direct current for therapeutic purposes for galvanization is currently gradually narrowing, giving way to electrophoresis - the introduction of medicinal substances into the body through the skin or mucous membranes.

Types of rehabilitation: physiotherapy, physical therapy, massage: textbook allowance / T.Yu. Bykovskaya [and others]; under general ed. B.V. Kabarukhina. - Rostov n/d: Phoenix, 2010. - 557, p.: ill. - (Medicine). pp. 34-40.

Clinical picture

Laboratory and instrumental research methods

Treatment

Prognosis and complications

12. Cardiomyopathies: classification, etiology, pathogenesis, clinical picture of various variants, their diagnosis. Treatment.

Classification

13. Atherosclerosis. Epidemiology, pathogenesis. Classification. Clinical forms, diagnosis. The role of the pediatrician in the prevention of atherosclerosis. Treatment. Modern antilipidemic drugs.

2. Results of an objective examination with the aim of:

3. Results of instrumental studies:

4. Results of laboratory tests.

15. Symptomatic arterial hypertension. Classifications. Features of pathogenesis. Principles of differential diagnosis, classification, clinic, differentiated therapy.

16. Coronary heart disease. Classification. Angina pectoris. Characteristics of functional classes. Diagnostics.

17. Urgent rhythm disturbances. Morgagni-Edams-Stokes syndrome, paroxysmal tachycardia, atrial fibrillation, emergency treatment. Treatment. Vte.

18. Chronic systolic and diastolic heart failure. Etiology, pathogenesis, classification, clinical picture, diagnosis. Treatment. Modern pharmacotherapy of CHF.

19. Pericarditis: classification, etiology, features of hemodynamic disorders, clinical picture, diagnosis, differential diagnosis, treatment, outcomes.

II. Etiological treatment.

VI. Treatment of edematous-ascitic syndrome.

VII. Surgery.

20. Chronic cholecystitis and cholangitis: etiology, clinical picture, diagnostic criteria. Treatment in the phase of exacerbation and remission.

21. Chronic hepatitis: etiology, pathogenesis. Classification. Features of chronic drug-induced viral hepatitis, main clinical and laboratory syndromes.

22. Acute liver failure, emergency therapy. Process activity criteria. Treatment, prognosis. VTE

23. Alcoholic liver disease. Pathogenesis. Options. Features of the clinical course. Diagnostics. Complications. Treatment and prevention.

24. Cirrhosis of the liver. Etiology. Morphological characteristics, main clinical

27. Functional non-ulcer dyspepsia, classification, clinic, Diagnosis, differential diagnosis, treatment.

28. Chronic gastritis: classification, clinical picture, diagnosis. Differential diagnosis with stomach cancer, treatment depending on the form and phase of the disease. Non-drug treatment methods. Vte.

29. Peptic ulcer of the stomach and duodenum

30. Nonspecific ulcerative colitis and Crohn's disease.

31. Irritable bowel syndrome.

32. Glomerulonephritis

33. Nephrotic syndrome: pathogenesis, diagnosis, complications. Kidney amyloidosis: classification, clinical picture, course, diagnosis, treatment.

35. Chronic pyelonephritis, etiology, pathogenesis, clinic, diagnosis (laboratory and instrumental), treatment, prevention. Pyelonephritis and pregnancy.

36. Aplastic anemia: etiology, pathogenesis, classification, clinical picture, diagnosis and differential diagnosis, principles of treatment. Indications for bone marrow transplantation. Outcomes.

Differential diagnosis of hemolytic anemia depending on the location of hemolysis

38. Iron deficiency conditions: latent deficiency and iron deficiency anemia. Epidemiology, etiology, pathogenesis, clinical picture, diagnosis, treatment and prevention.

39. B12 deficiency and folate deficiency anemia: classification, etiology, pathogenesis, clinical picture, diagnosis, therapeutic tactics (saturation and maintenance therapy).

41. Malignant non-Hodgkin lymphomas: classification, morphological variants, clinical picture, treatment. Outcomes. Indications for bone marrow transplantation.

42. Acute leukemia: etiology, pathogenesis, classification, the role of immunophenotyping in the diagnosis of OL, clinic. Treatment of lymphoblastic and non-lymphoblastic leukemia, complications, outcomes, VTE.

44. Henoch-Schönlein hemorrhagic vasculitis: etiology, pathogenesis, clinical manifestations, diagnosis, complications. Therapeutic tactics, outcomes, VTE.

45. Autoimmune thrombocytopenia: etiology, pathogenesis, clinical picture, diagnosis, treatment. Therapeutic tactics, outcomes, follow-up.

47. Diffuse toxic goiter: etiology, pathogenesis, clinical picture, diagnostic criteria, differential diagnosis, treatment, prevention, indication for surgical treatment. Endemic goiter.

48. Pheochromocytoma. Classification. Clinic, features of arterial hypertension syndrome. Diagnosis, complications.

49. Obesity. Criteria, classification. Clinic, complications, differential diagnosis. Treatment, prevention. Vte.

50. Chronic adrenal insufficiency: etiology and pathogenesis. Classification, complications, diagnostic criteria, treatment, VTE.

I. Primary cnn

II. Central forms nn.

51. Hypothyroidism: classification, etiology, pathogenesis, clinical manifestations, therapeutic mask diagnostic criteria, differential diagnosis, treatment, VTE.

52. Diseases of the pituitary gland: acromegaly and Itsenko-Cushing’s disease: etiology, pathogenesis of the main syndromes, clinical picture, diagnosis, treatment, complications and outcomes.

53. Itsenko-Cushing syndrome, diagnosis. Hypoparathyroidism, diagnosis, clinic.

54. Periarteritis nodosa: etiology, pathogenesis, clinical manifestations, diagnosis, complications, features of the course and treatment. VTE, medical examination.

55. Rheumatoid arthritis: etiology, pathogenesis, classification, clinical variant, diagnosis, course and treatment. Complications and outcomes, VTE and medical examination.

56. Dermatomyositis: etiology, pathogenesis, classification, main clinical manifestations, diagnosis and differential diagnosis, treatment, VTE, clinical examination.

58. Systemic scleroderma: etiology, pathogenesis, classification, clinical picture, differential diagnosis, treatment. VTE

I. According to the course: acute, subacute and chronic.

II According to the degree of activity.

1. Maximum (III degree).

III. By stages

IV. The following main clinical forms of SS are distinguished:

4. Scleroderma without scleroderma.

V. Joints and tendons.

VII. Muscle lesions.

1. Raynaud's phenomenon.

2. Characteristic skin lesions.

3. Scarring on the fingertips or loss of finger pad substance.

9. Endocrine pathology.

59. Deforming osteoarthritis. Diagnosis criteria, causes, pathogenesis. Clinic, differential diagnosis. Treatment, prevention. Vte.

60. Gout. Etiology, pathogenesis, clinical picture, complications. Differential diagnosis. Treatment, prevention. Vte.

64. Exogenous allergic and toxic alveolitis, etiology, pathogenesis, classification, clinic, diagnosis, treatment, VTE.

65. Occupational bronchial asthma, etiology, pathogenetic variants, classification, clinical picture, diagnosis, treatment, principles of VTE.

68. Technogenic microelementoses, classification, main clinical syndromes for microelementoses. Principles of diagnosis and detoxification therapy.

69. Modern saturnism, etiology, pathogenesis, mechanism of the effect of lead on porphyrin metabolism. Clinic, diagnosis, treatment. Vte.

70. Chronic intoxication with organic solvents of the aromatic series. Features of damage to the blood system at the present stage. Differential diagnosis, treatment. Vte.

76. Vibration disease from exposure to general vibrations, classification, features of damage to internal organs, principles of diagnosis, therapy, VTE.

Objective examination

Laboratory data

80. Hypertensive crisis, classification, differential diagnosis, emergency therapy.

81. Acute coronary syndrome. Diagnostics. Emergency treatment.

83. Hyperkalemia. Causes, diagnosis, emergency treatment.

84. Hypokalemia: causes, diagnosis, emergency treatment.

85. Crisis in pheochromacytoma, clinical features, diagnostics, emergency therapy

86. Cardiac arrest. Causes, clinic, emergency measures

87. Morgagni-Edams-Stokes syndrome, causes, clinic, emergency care

88. Acute vascular insufficiency: shock and collapse, diagnosis, emergency care

90. Tela, causes, clinic, diagnosis, emergency treatment.

I) by localization:

II) according to the volume of damage to the pulmonary bed:

III) according to the course of the disease (N.A. Rzaev - 1970)

91. Dissecting aortic aneurysm, diagnosis, therapist tactics.

92. Supraventricular paroxysmal tachycardia: diagnosis, emergency treatment.

93. Ventricular forms of rhythm disturbances, clinical picture, diagnosis, emergency therapy.

94. Complications of the acute period of myocardial infarction, diagnosis, emergency treatment.

95. Complications of the subacute period of myocardial infarction, diagnosis, emergency treatment.

Question 96. Sick sinus syndrome, options, diagnosis, emergency measures.

Question 97. Atrial fibrillation. Concept. Causes, options, clinical and ECG criteria, diagnosis, therapy.

Question 98. Ventricular fibrillation and flutter, causes, diagnosis, emergency therapy.

Question 99. Stopping breathing (apnea). Causes, emergency assistance.

102. Infectious-toxic shock, diagnosis, clinic, emergency therapy.

103. Anaphylactic shock. Causes, clinic, diagnosis, emergency care.

105. Poisoning with alcohol and its substitutes. Diagnosis and emergency treatment.

106. Pulmonary edema, causes, clinic, emergency care.

107. Asthmatic status. Diagnostics, emergency treatment depending on the stage.

108. Acute respiratory failure. Diagnostics, emergency therapy.

110. Pulmonary hemorrhage and hemoptysis, causes, diagnosis, emergency treatment.

112. Autoimmune hemolytic crisis, diagnosis and emergency treatment.

113.Hypoglycemic coma. Diagnostics, emergency care.

114.Hyperosmolar coma. Diagnostics, emergency care.

2. Desirable – lactate level (frequent combined presence of lactic acidosis).

115. Ketoacidotic coma. Diagnostics, emergency treatment, prevention.

116. Emergency conditions for hyperthyroidism. Thyrotoxic crisis, diagnosis, therapeutic tactics.

117. Hypothyroid coma. Causes, clinic, emergency treatment.

118. Acute adrenal insufficiency, causes, diagnosis, emergency treatment.

119. Stomach bleeding. Causes, clinical picture, diagnosis, emergency therapy, therapist tactics.

120. Indomitable vomiting, emergency treatment for chloroprivate azotemia.

121) Acute liver failure. Diagnostics, emergency therapy.

122) Acute poisoning with organochlorine compounds. Clinic, emergency therapy.

123) Alcoholic coma, diagnosis, emergency treatment.

124) Poisoning with sleeping pills and tranquilizers. Diagnosis and emergency treatment.

Stage I (mild poisoning).

Stage II (moderate poisoning).

Stage III (severe poisoning).

125. Poisoning with agricultural pesticides. Emergency conditions and first aid. Principles of antidote therapy.

126. Acute poisoning with acids and alkalis. Clinic, emergency care.

127. Acute renal failure. Causes, pathogenesis, clinical picture, diagnosis. Clinical pharmacology of emergency treatment agents and indications for hemodialysis.

128. Physical healing factors: natural and artificial.

129. Galvanization: physical action, indications and contraindications.

131. Diadynamic currents: physiological action, indications and contraindications.

132. Pulse currents of high voltage and high frequency: physiological effects, indications and contraindications.

133. Pulse currents of low voltage and low frequency: physiological effects, indications and contraindications.

134. Magnetic therapy: physiological effect, indications and contraindications.

135. Inductothermy: physiological action, indications and contraindications.

136. Ultra-high frequency electric field: physiological effects, indications and contraindications.

140.Ultraviolet radiation: physiological effects, indications and contraindications.

141.Ultrasound: physiological action, indications and contraindications.

142. Helio- and aerotherapy: physiological effects, indications and contraindications.

143.Water and heat therapy: physiological effects, indications and contraindications.

144. Main resort factors. General indications and contraindications for sanatorium and resort treatment.

145. Climatic resorts. Indications and contraindications

146. Balneological resorts: indications and contraindications.

147. Mud therapy: indications and contraindications.

149. The main tasks and principles of medical and social examination and rehabilitation in the clinic of occupational diseases. Social and legal significance of occupational diseases.

151. Coma: definition, causes of development, classification, complications, disorders of vital functions and methods of supporting them at the stages of medical evacuation.

152. Basic principles of organization, diagnosis and emergency medical care for acute occupational intoxication.

153. Classification of potent toxic substances.

154. Injuries by generally toxic substances: routes of exposure to the body, clinical picture, diagnosis, treatment at the stages of medical evacuation.

156. Occupational diseases as a clinical discipline: content, objectives, grouping according to etiological principle. Organizational principles of occupational pathology service.

157. Acute radiation sickness: etiology, pathogenesis, classification.

158. Military field therapy: definition, tasks, stages of development. Classification and characteristics of modern combat therapeutic pathology.

159. Primary heart damage due to mechanical trauma: types, clinic, treatment at the stages of medical evacuation.

160. Occupational bronchitis (dust, toxic-chemical): etiology, pathogenesis, clinical picture, diagnosis, medical and social examination, prevention.

162. Drowning and its varieties: clinic, treatment at the stages of medical evacuation.

163. Vibration disease: conditions of development, classification, main clinical syndromes, diagnosis, medical and social examination, prevention.

165. Poisoning by combustion products: clinical picture, diagnosis, treatment at the stages of medical evacuation.

166. Acute respiratory failure, causes, classification, diagnosis, emergency care at the stages of medical evacuation.

167. Basic directions and principles of treatment of acute radiation sickness.

168. Primary damage to the digestive organs during mechanical trauma: types, clinic, treatment at the stages of medical evacuation.

169. Principles of organizing and conducting preliminary (upon entry to work) and periodic inspections at work. Medical care for industrial workers.

170. Secondary pathology of internal organs due to mechanical trauma.

171. Fainting, collapse: causes of development, diagnostic algorithm, emergency care.

172. Acute renal failure: causes of development, clinical picture, diagnosis, emergency care at the stages of medical evacuation.

173. Kidney damage due to mechanical trauma: types, clinic, emergency care at the stages of medical evacuation.

174. Radiation injuries: classification, medical and tactical characteristics, organization of medical care.

175. Occupational bronchial asthma: etiological production factors, clinical features, diagnosis, medical and social examination.

176. General cooling: causes, classification, clinic, treatment at the stages of medical evacuation

Galvanic current is a direct current characterized by a constant direction and amplitude in an electrical circuit. It was named after the physiologist Luigi Galvani, who observed an electrical discharge in the muscle of a frog when it came into contact with two dissimilar metals (1789). Soon, physicist Alexandro Volta discovered that a similar process occurs in the case of two dissimilar metals immersed in an electrolyte solution, and is the result of a chemical reaction between the metal of the electrodes and the solution. On this basis, Volta developed a source of electromotive force, which he named a galvanic cell in honor of the discoverer of the Galvani phenomenon. Since then, for many decades, the current of a galvanic cell has been used in medicine for physiological research and for medicinal purposes under the name "galvanization". This term has been preserved in medicine to this day, despite the fact that this type of current is already obtained from machine generators or by rectifying alternating current.

One of the common methods of using galvanic current is the method medicinal electrophoresis, proposed by V. Rossi in 1801.

Direct electric current in biological tissues causes the following physicochemical phenomena: electrolysis, polarization, electrodiffusion, electroosmosis.

Under the influence of an external electromagnetic field applied to human tissues, conduction current. Cations move towards the negative pole - the cathode, and anions - towards the positively charged pole - the anode. Directly approaching the metal plate of the electrode, the ions lose their charge and turn into atoms with high chemical activity (electrolysis). An alkali (KOH, NaOH) is formed under the cathode, and an acid (HCI) is formed under the anode.

Human skin has high resistance (low electrical conductivity), so current enters the body mainly through excretory ducts sweat and sebaceous glands, hair follicles, intercellular spaces of the epidermis and dermis. The maximum density of conduction current is observed in the liquid media of the body: blood, lymph, urine, interstitium, and neural spaces. The electrical conductivity of tissues increases with shifts in acid-base balance, which can occur as a result of inflammatory edema and hyperemia.

Most of the current energy is spent on overcoming the epidermis. Therefore, during galvanization, the skin receptors are irritated first, and the most pronounced changes are noted in it.

After overcoming the resistance of the epidermis and subcutaneous fatty tissue, the current further spreads along the path of least resistance, mainly through blood and lymphatic vessels, intercellular spaces, nerve sheaths and muscles, sometimes significantly deviating from the straight line, which can conditionally connect two electrodes.

Body tissues contain large amounts of electrolytes, mainly in the form of potassium, sodium, magnesium, calcium and other metal ions. As the number of monovalent potassium and sodium ions increases, tissue excitability increases in the corresponding areas; with the predominance of two valence ions, calcium and magnesium, it is inhibited.

Galvanization is characterized by increased activity of ions in tissues, which is due to their transition from a bound state to a free one. An important role among the primary mechanisms of direct current action is played by the phenomenon electric polarization, that is, accumulations of oppositely charged ions near membranes with the formation of additional polarization currents having a direction opposite to that from the outside. Polarization leads to changes in cell hydration, membrane permeability, and affects the processes of diffusion and osmosis.

Depending on the current parameters, the functional state of the patient and the galvanization technique, local, segmental - metameric or generalized reactions occur in the body. Physico-chemical changes that occur in the tissues of the body lead to the formation of a complex set of reactions that develop according to the neurohumoral mechanism. As a result, there is a change in the functional state of the nervous system, improvement in blood and lymph circulation, trophic, metabolic and regenerative processes, increased immunological reactivity.

Indications for galvanization

Indications for galvanization: consequences of injuries and diseases of the central and peripheral nervous system; vegetative dystonia, neurasthenia and other neurotic conditions; diseases of the digestive system (chronic gastritis, colitis, cholecystitis, biliary dyskinesia, peptic ulcer); hyper- and hypotensive diseases, coronary heart disease, atherosclerosis in the initial stages; chronic inflammatory processes in various organs and tissues; some dental diseases (periodontal disease, glossalgia, etc.); eye diseases (keratitis, glaucoma, etc.); chronic arthritis and periarthritis of various origins, bone fractures, chronic osteomyelitis.

Contraindications

Contraindications: individual intolerance to current, skin sensitivity disorders, violation of the integrity of the skin at the sites where electrodes are applied, acute purulent inflammatory processes, eczema, neoplasms or suspicions of them, systemic blood diseases, pronounced atherosclerosis, cardiac decompensation, fever, pregnancy, cachexia.

130. Electrophoresis medicinal a method of physiotherapy that involves simultaneous exposure of the body to a direct electric current and ions of medicinal substances administered to it (through the skin or mucous membranes). With E. l. the sensitivity of receptors to medicinal substances increases, which fully retain their pharmacological properties.

Main features of E. l. - pronounced and long-lasting therapeutic effect of small doses of medicinal substances due to the creation of a kind of skin depot of the drugs used, as well as the ability to provide a local effect in certain pathological conditions (for example, local vascular disorders) that make it difficult for the drug to enter the pathological focus from the blood. With E. l. simultaneous use of several drugs is possible. In some cases for E. l. also used impulse current constant direction, which increases the therapeutic effect of the method. For E. l. both electrodes with pads moistened with a solution of the medicinal substance are placed on the skin, or one of them is placed in the nasal cavity, ear, vagina, etc.; in some cases, instead of a gasket, a bath with a solution of a medicinal substance is used, into which a carbon electrode is lowered. E. l. used for diseases of the central and peripheral nervous system, musculoskeletal system, gynecological diseases, etc.

readings

Neurology: neuromyositis, radiculitis, neuritis, neuralgia, neurasthenia, migraine, neuroses, organic diseases of the central nervous system. Cardiology: heart disease (ischemic, chronic) without exacerbation, hypertension of both stages I and II. Therapy: chronic and acute bronchitis, bronchial asthma, pneumonia. ENT: tonsillitis, sinusitis, otitis media, pharyngitis. Gynecology: cervical erosion, endometriosis, colpitis, endometritis, cervicitis. Urology: prostatitis, cystitis, pyelonephritis. Gastroenterology: ulcers, colitis, gastritis with decreased and increased secretion, cholecystitis. Surgery: consequences of burns, postoperative wounds. Dermatology: acne scars, seborrhea

contraindications

Inflammatory processes; - Acute dermatitis; - Purulent processes; - Current intolerance; - Malignant tumors; - Fever; - Bronchial asthma(severe form).

Ultraphonophoresis is a medical procedure based on the introduction of anti-inflammatory drugs into a certain area of the patient’s body using ultrasound.

The use of ultraphonophoresis makes it possible to achieve an increase in the activity of cellular metabolic processes and improves blood and lymph circulation. With its help, stimulation of the cells of the deep layers of the skin is achieved, enriching them with oxygen, improving the structure of collagen. In addition, this method allows you to normalize the pH of the skin, stabilize metabolic processes and cell functioning mechanisms.

Thanks to ultrasonic influence, increased skin permeability to molecules is achieved medicines. During prolonged exposure, the required volume of the active substance penetrates the skin to a specified depth, where it accumulates. Thus, after the procedure is completed, the drug long time affects the problem area, providing a lasting therapeutic effect.

Advantages.

Ultraphonophoresis allows you to introduce vitamins (A, D, E, B), antibacterial agents, hormonal (hydrocortisone) and anti-inflammatory agents into the skin. The advantage of this procedure is the possibility of contactless transport of medicinal substances to the lesion, bypassing the bloodstream and ensuring a minimal likelihood of developing side effects.

Indications for use.

Inflammatory skin diseases;

Sprawl connective tissue in the area of scars after surgical interventions, cellulite, stretch marks on the skin;

Diseases of the muscular system;

Arthritis and other joint diseases;

Acne;

Contraindications.

In general, ultrasonic phonophoresis is a non-traumatic procedure and has almost no contraindications or side effects. However, patients should avoid this procedure if they have:

Eczema, herpes;

Facial nerve paralysis;

Infectious diseases in the acute stage (including viral);

Benign and cancerous skin diseases;

Neuralgia of the facial and trigeminal nerves, as well as other superficial nerves at the site of the proposed intervention;

Expansion of the saphenous veins in the area of influence;

Systemic and autoimmune skin lesions and connective tissue diseases.

Due to the lack of research, ultraphonophoresis is contraindicated in pregnant women and during breastfeeding.

This method should be used with caution in diseases of the cardiovascular system, as well as in the first three months of the rehabilitation period after major surgical interventions and after any maxillofacial operations.

A person who does not know and does not want to know the basic laws of science is potentially dangerous in our time, which we call the scientific and technological revolution.

A.B. Migdala

Physico-chemical processes

The action of direct current is based on the process electrolysis . Substances located near the electrodes disintegrate into ions. Ions move under the influence of current. Under the influence of an externally applied electric field, positively charged ions move towards the negative electrode, and negatively charged ones move towards the positive electrode.

Water molecules break down into H+ and OH- ions.

Near the electrodes, ions interact with water, forming electrolysis products - acid and alkali .

Electrolysis products can cause chemical burns at the site where the electrodes are applied - an alkaline burn under the cathode and an acid burn under the anode. This is especially true for stationary electrode placement. To avoid this, the electrode is separated from the skin with a hydrophilic pad. After the procedure, the gasket must be washed or replaced.

A change in ion concentration leads to irritation of skin receptors, resulting in a slight burning and tingling sensation.

The passage of current through tissue causes polarization - accumulation of oppositely charged ions on biological membranes.

Electrolysis and polarization have a profound effect on tissues and cells. At a certain concentration of ions, cells enter an excited (electrically active) state. This leads to a change in the permeability of cell membranes and, as a consequence, to a change in cellular and tissue metabolism and cell excitability.

At the same time, the passive transport of large protein molecules and other substances that do not carry a charge increases ( electrodiffusion ), and hydrated ions ( electroosmosis ).

Polarization gradually fades after the procedure over several hours - this determines the long aftereffect of the factor and the high efficiency of applying cosmetics after galvanization.

The physicochemical effects of galvanic current determine its physiological and therapeutic effect.

Physiological effects of galvanization

Calls a series physiological processes in those parts of the body through which it flows. Here are the most important ones.

Reflex action

When exposed to electric current on the skin, skin receptors are irritated. Reflex mechanisms are activated, and in response, the vessels of the internal organs dilate ( cutaneous-visceral reflex) and skin ( cutaneous-vascular reflex).

Hyperemic effect

Blood circulation in the area of galvanic current is significantly activated, and this effect continues for several hours after the session. Improved circulation, in turn, leads to increased oxygen and nutrients, entering the tissues, and accelerating the removal of waste products from cells, softening and resorption of scars, and accelerating regeneration.

The expansion of capillaries and an increase in the permeability of their walls occurs not only at the site of application of the electrodes, but also in deeply located tissues through which direct current passes.

Trophic effect

The trophic effect is due to the combined action of several factors - intensified blood circulation, increased permeability of cell membranes and increased regulatory function of the nervous system.

Regeneration is accelerated peripheral nerves, bone and connective tissue, epithelization of sluggishly healing wounds and trophic ulcers.

Thermal effect

This effect is not very large and is not used for heat treatment of fabrics as such. However, when galvanic current flows through the tissue, its temperature increases, and this enhances the effects described above.

Immunostimulating effect