Vol 21, No 2 (2022)

BACKGROUND: Non-exudative atrophic (geographic) macular degeneration of the retina is one of the causes of irreversible loss of central vision in the elderly. Its frequency of occurrence increases with age.

AIM: to evaluate the effectiveness of the extended complex of ophthalmoneurostimulation in patients with non-exudative atrophic (geographical) form of age-related macular degeneration.

MATERIAL AND METHODS: The study included 49 people (98 eyes) with geographic retinal atrophy, whose average age was 74±1.7 years, who were divided into 2 groups: group 1 ― 24 patients (48 eyes) aged 71.0±1.8 years, who underwent an extended complex of ophthalmoneurostimulation, including a course of endonasal electrophoresis of vitamin B₁₂ (for a course of 10 daily procedures), transocular infrared stimulation (for a course of 10 daily procedures), oxygen therapy with Heliox-21 breathing mixture (for a course of 10 daily procedures), and acupuncture (for a course of 10 daily procedures), and group 2 ― 25 patients (50 eyes) aged 75±1.1 years, who underwent a course of conservative treatment with vitamins according to existing ophthalmological standards, which served as a background in group 1. Visual acuity was assessed (visual acuity), indicators of optical coherence tomography and optical coherence tomography with angiography function of the retina, local photosensitivity, autofluorescence of the retina and bioelectric potential in pattern-electroretinography. Studies were performed before therapy, after 2 weeks, 3 months, 6 months, and 12 months, after a course of treatment.

RESULTS: Visual acuity and anatomical parameters of the retina in high resolution (thickness of the central zone and the thickness of the choroid) did not change during the entire observation period. Analysis of light sensitivity showed a significant normalization of the average threshold of retinal photosensitivity when prescribing an extended complex of ophthalmoneurostimulation.

CONCLUSION: Conducted extended course of physiotherapy significantly reduced the functional depression of the central visual field, coordinating with foci of retinal pigment epithelium atrophy. Most likely, this positive effect was achieved due to the activation of the level of the ganglionic and bipolar layers of the retina.

BACKGROUND: Combined treatment of cancer patients includes a large number of aggressive therapies that lead to a complex of functional disorders. There are no publications on the influence of physical factors on the electrical excitability of the muscles of the shoulder girdle and upper limb from the side of surgery in the early period after surgical treatment of breast cancer.

AIM: To determine the physical factor that will most significantly affect the electrical excitability of the muscles of the shoulder girdle and upper limb on the side of the operation after radical surgical treatment of breast cancer.

MATERIAL AND METODS: A randomized, placebo-controlled study was conducted in 100 patients in the early postoperative period (2–4 days after surgery) for breast cancer. All patients underwent medical rehabilitation: individual physiotherapy exercises, balance therapy, sessions with a medical psychologist, physiotherapy treatment with a monofactor. The main group included 34 patients who included an extended method of fluctuorization in the course of medical rehabilitation and additionally underwent fluctuorization of the muscles of the forearm, group 2 (comparisons, n=33) the extended method of local magnetotherapy was included in the rehabilitation program and group 3 (comparisons, n=33) in addition to rehabilitation, general magnetic therapy procedures were performed. Patients underwent a study of the excitability of the neuromuscular system on the apparatus of stimulation and electrotherapy ASEtM-01/6 "Elesculap Med TeKo".

RESULTS: It was found that fluctuating currents turned out to be more effective in the early stages, which pathogenetically contribute to the restoration of conduction along the peripheral nerves and the activation and contractility of the muscle fiber. A delayed effect of local and general magnetic therapy on improving the contractility of the muscles of the upper limb and the conductivity of the peripheral nerve fiber was noted.

CONCLUSION: The inclusion of monophysical factors in the course of standard medical treatment, a course of physical therapy, exercises on a stabiloplatform and individual psychotherapy in the early stages (on days 2–4) after surgery contributed to the improvement in the functioning of the upper limb and the restoration of the electrical excitability of the muscles and nerves of the operated limb.

BACKGROUND: The use of repetitive transcranial magnetic stimulation as a method of non-drug therapy of Parkinson's disease has been actively studied over the past decades. The prevailing number of repetitive transcranial magnetic stimulation protocols in Parkinson's disease use a high intensity of stimulation (80–120% of the value of the threshold of the evoked motor threshold from the muscles of the hand), while the choice of the stimulation intensity parameter was carried out empirically.

AIM: to study the effectiveness of low-intensity unilateral repetitive transcranial magnetic stimulation on motor and non-motor symptoms of Parkinson's disease.

MATERIAL AND METHODS:An open prospective non-randomized clinical trial included 37 patients with stage I–III Parkinson's disease according to Hoehn–Yahr (1967), akinetic-rigid and mixed (akinetic-rigid-tremor) forms. All patients underwent repetitive transcranial magnetic stimulation according to the protocol: M1 stimulation zone, frequency 5 Hz, intensity 40% of the cortical motor threshold, on 6s, off 8s, total number of pulses per session 3000. The course of treatment is 10 procedures with 2 days (weekend) off.

RESULTS: All patients completed the study in accordance with the protocol. When analyzing the results of the UPDRS scale (Unified Parkinson's disease rating scale), positive dynamics was noted in all parts of the questionnaire: part I ― from 2 (0; 3) to 0 (0; 1) points, p <0.05; part II ― from 9 (5.5; 12.5) to 4 (2; 6.5) points, p <0.05; part III ― with 11 (7; 14.5) to 6 (2; 7.5) points, p <0.05; part IV (Schwab and England scale) ― from 80% (70; 95) to 90% (85; 100), p <0.05. There was also a selective effect on non-motor symptoms.

CONCLUSION: Low-intensity exposure (40% of the motor threshold) has a significant clinical effect on motor and non-motor symptoms of Parkinson's disease; stimulation of the primary motor cortex can have an antidepressant effect; repetitive transcranial magnetic stimulation has a selective effect on non-motor symptoms of Parkinson's disease: a predominant effect has been demonstrated with respect to olfactory, emotional, cognitive disorders, sleep disorders and hypersalivation; when assessing the dynamics of motor disorders, a more pronounced effect was noted with respect to rigidity, postural disorders, walking speed, and to a lesser extent, the effect on tremor was noted.

Supportive treatment plays an important role in oncology nowadays. The main aims of oncologic supportive treatment are management of cancer symptoms and adverse events of cancer treatment.

In terms of dermatologic adverse events the most important types of reaction are oral mucositis during radiation therapy, chemotherapy and during hematopoetic stem cell transplantation, palmoplantar syndrome during chemotherapy, palmoplantar skin reaction, acneiform paronychia and pyogenic granulomas during targeted therapy, immune-related dermatologic adverse events during immunotherapy.

During recent years, special attention has been paid to low level laser therapy for the prophylaxis and management of cancer therapy dermatologic adverse events. The effects of low level laser therapy may have a beneficial effect on many conditions that play important roles in the pathogenesis of radiation and chemotherapy-induced complications in oncologic patients. Therapeutic effects of low level laser therapy are attributed to the stimulation of adaptive processes and to the increase of nonspecific resistance. The latter develop due to the close interaction of the immune, humoral and nervous systems. When choosing a method for the supportive treatment of cancer therapy adverse events, it is extremely important to establish safety in terms of the tumor process and absence of negative effects on cancer treatment.

Effects of low level laser therapy on the proliferative and invasive activity of an existing malignancy remains a matter of debate due to conflicting results from in vitro studies.

At the same time, according to the results of numerous clinical studies, the use of this method is assumed to be safe for cancer patients.

This paper demonstrates a clinical case of the development of amyotrophic lateral sclerosis with lesions of the anterior horns of the spinal cord in the cervicothoracic region against the background of syringomyelia.

The main complaints of the patient at the initial request for medical care were associated with weakness and hypotrophy of the right hand. Electrokymography revealed signs of damage to the anterior horns of the spinal cord at the C5–Th1 level with a predominant lesion of the motor fibers of the right median and ulnar nerves. As a result, a diagnosis of amyotrophic lateral sclerosis was made. Magnetic resonance imaging revealed the presence of Chiari I malformation and severe syringomyelia of the cervical and thoracic calving of the spinal cord.

The patient underwent surgical posterior decompression of the foramen magnum. However, the treatment was not effective with the worsening of the neurological deficit in the right hand and the spread of motor deficit and hypotrophy to the left hand.

After the use of transcutaneous electrical neurostimulation of the median and ulnar nerves, there was a significant regression of motor deficit with a decrease in the severity of malnutrition without significant changes in the electromyography parameters of the median and ulnar nerves.

The absence of neurological deficit in the lower extremities, with the preservation of tendon reflexes in the norm, and the absence of pathological reflexes, indicates a high plasticity of the pyramidal tracts at the level of the spinal cord.

Regression of motor deficit after the use of transcutaneous electrical nerve stimulation is due to improvement in the state of altered motor units with hypertrophy of muscle fibers and acceleration of reinnervation processes.