ОПТИМИЗАЦИЯ МЕДИЦИНСКОЙ ПОМОЩИ В УСЛОВИЯХ МНОГОПРОФИЛЬНОЙ КЛИНИКИ ДЕТЯМ-ИНВАЛИДАМ С РАССТРОЙСТВАМИ ФУНКЦИИ ТАЗОВЫХ ОРГАНОВ

A program of complex examination and treatment of children with functional disorders of the pelvic organs of organic genesis was initiated on the basis of a multipurpose level III medical treatment facility of Moscow Heath Department in summer 2014. 30-bed assisted uronephrological health care facility for simultaneous hospitalization of a disabled child and his/her mother (or custodian) was located at the division of nephrology. In total 36 children (with parents) with a disturbed function of the pelvic organs such as disturbed spontaneous evacuation of the urinary bladder and bowel in 26 children and incomplete evacuation of the urinary bladder and bowel in 10 children were hospitalized. Vegetovascular dystonia with fixed bradycardia on ECG was found in 19 children (68%). Hydrocephalus was observed in 16 cases (57%). Primary shunting operation was performed at the age of 28-56 days. On the part of social adaptation, there was a lack of communication with peers in 7 children, disturbed relationships between parents and children due to the presence of disorder in 5 patients, acute concerns for the future in 6 children, depression in 8 children, and social ills in 10 patients. The conducted examination included consultations by a neurologist, urologist, nephrologist, orthopedist, neurosurgeon, physical therapist, physiotherapist, and doctor engaged in laboratory and instrumental diagnostics. 12 people had the syndrome of spinal cord fixation, disturbed support of the lower extremities, and disturbed independent evacuation and defecation (group 1). 10 other patients had no syndrome of spinal cord fixation in disturbed evacuation of the urinary bladder and intestine without preliminary attempts to restore urination and defecation acts (group 2). 14 people who had undergone orthopedic interventions had partially restored urination and defecations acts (group 3). The conducted course of diagnostics and treatment accounted for 12-16 bed days. It included 8-12 procedures of physiotherapy, massage and therapeutic exercise. Consultation of a child and his/her parent by a psychologist was conducted for at least 10 days. The most successful methods of mental therapy for adults and children were represented by Jungian art therapy and clinical conversation. Patient appointment scheduling was formed considering the results of diagnostics and treatment. Group (1) with the syndrome of spinal cord fixation was sent for planned surgical treatment to the department of neurosurgery. Children with disturbed support were shifted to the group of planned surgical treatment at the orthopedic department whereas the 3rd group of children with incontinence of urine and fecal incontinence was sent for planned treatment to the department of neurourology. From a multidisciplinary perspective, disabled children with myelodysplasia require a complex examination and treatment of organs and systems to optimize medical aid.На базе многопрофильного стационара III уровня медицинской помощи ДЗМ в летний период 2014 г. начата программа комплексного обследования и лечения детей с расстройствами функции тазовых органов органического генеза. В нефрологическом отделении был развернут уронефрологический стационар на 30 коек для совместной госпитализации ребенка-инвалида и матери (или опекуна). Всего были госпитализированы 36 детей (с родителями) с нарушением функции тазовых органов: нарушение самостоятельного опорожнения мочевого пузыря и кишки - 26 детей, неполное опорожнение мочевого пузыря и кишки - 10 детей. У 19 (68%) детей была выявлена вегетососудистая дистония с фиксацией брадикардии на ЭКГ. Гидроцефалия наблюдалась в 16 (57%) случаях. Первичное шунтирование было выполнено в возрасте 28-56 суток. Со стороны социальной адаптации имел место дефицит общения со сверстниками у 7 детей, нарушения взаимоотношений между родителями и ребенком из-за болезни - у 5 детей, острое переживание ребенком опасения по поводу будущего - 6 пациентов, депрессивные состояния - 8 детей, социальные трудности - 10 детей. Проведенное обследование включало консультации невролога, уролога, нефролога, ортопеда, нейрохирурга, врача ЛФК, врача ФТ, лабораторную и инструментальную диагностику. Были выявлены 12 человек с синдромом фиксации спинного мозга, нарушениями опоры нижних конечностей, самостоятельного опорожнения и дефекации (1-я группа). Еще 10 человек без фиксации спинного мозга, с нарушением опорожнения мочевого пузыря и кишечника, без предварительных попыток восстановления актов мочеиспускания и дефекации составили 2-ю группу. А 14 человек с частично восстановленным актом мочеиспускания и дефекации, перенесших ортопедические вмешательства, - 3-ю группу. Проведенный курс диагностики и лечения составлял 12-16 койко-дней. В него входили 8-12 процедур физиолечения, массажа, ЛФК. Занятия с психологом проводились в течение не менее 10 дней с ребенком и родителем совместно. Наиболее успешными методами психотерапии для взрослых и детей оказались юнгианская песочная терапия и клиническая беседа. По результатам диагностики и лечения была сформирована карта маршрутизации пациента. Пациенты 1-й группы были направлены на плановое оперативное лечение в отделение нейрохирургии, дети из 2-й группы переведены на плановое оперативное лечение в отделение ортопедии, а пациенты 3-й группы направлены на плановое лечение в отделение нейроурологии. Для оптимизации медицинской помощи детям-инвалидам с миелодисплазией требуется комплексное обследование и лечение органов и систем с мультидисциплинарных позиций

Physicochemical properties and biological activity of the water depleted of heavy isotopes

Data on physicochemical properties of the light water (deuterium concentration is reduced to the ratio D/H = 4 ppm and that of the isotope of oxygen 18-to the ratio 18O/16O = 750 ppm) have been obtained. They include the melting and boiling points, kinematic viscosity, density, the spin-spin proton relaxation time, self-diffusion coefficients, and the small-angle laser light scattering. It was found out that the biological activity of the light water was determined by the mechanisms different from the ligand-induced toxic effects. An explanation was proposed for the detected significant changes of the light water as compared with the high-resistivity water having geochemically ordinary isotope composition. This explanation was based on the mechanism of formation of supramolecular density inhomogeneities in water representing the deuterium-stabilized heterophase clusters. © 2011 Allerton Press, Inc

Physicochemical properties and biological activity of the water depleted of heavy isotopes

Data on physicochemical properties of the light water (deuterium concentration is reduced to the ratio D/H = 4 ppm and that of the isotope of oxygen 18-to the ratio 18O/16O = 750 ppm) have been obtained. They include the melting and boiling points, kinematic viscosity, density, the spin-spin proton relaxation time, self-diffusion coefficients, and the small-angle laser light scattering. It was found out that the biological activity of the light water was determined by the mechanisms different from the ligand-induced toxic effects. An explanation was proposed for the detected significant changes of the light water as compared with the high-resistivity water having geochemically ordinary isotope composition. This explanation was based on the mechanism of formation of supramolecular density inhomogeneities in water representing the deuterium-stabilized heterophase clusters. © 2011 Allerton Press, Inc