APPLICATION
OF HBO FOR TREATING OF ULCER OF STOMACH AND
DUODENUM
Recommendations
The two principle problems of
gastroenterology are: the ulcer of stomach and of duodenum. The studying of the
dependence of the pathology on the age, amount of the focus, period of anamnesis,
disease complications and the accompanying diseases. The ulcer is generally the
decease of not old people; thus the problem of its treating
as more sooner becomes very important. There are dangerous complications
of the disease, such as perforation and ulcer bleedings. The complications can
result in ulcer deformations and stenosis. They often have to be operated as the
result. Vast schedule of complications requires the lessening of the probability
of their emergency. New methods of conservative treating are: local endoscopic
influence (thermal, injectional and mechanical) and various groups of medicines:
a) lessening the acidity of
stomach - they suppress H2-receptors, tricyclic compounds, benzimidazols,
corticohypathalames, new antiholynergists, antacids;
b) protectors of mucosal,
compounds, containing the colloidal bismuth, extraction of solodka, sulphatized
disaccharides;
c) antisecretal protectors -
prostaglandites, their way of influence is in study yet;
d) catalysts of reparation - HBO
in particular.
This method can be called a
pathogenic one as one of the iterations of the ulcer is local ishemia of stomach
and intestine. The
prolonged stress can result in
generalized ishemia of the stomach's film with necroses of flesh and peripheral
vascularity, diapedesis of erythrocytes and foundation of ulcer. The damaged
zone has vasaless fundus flesh and blood circulation; capillary stasis, vast
vascular anastromosis. Treating of ulcer by means of oxygental invasion in
stomach and intestine isn't a novation, but HBO saturates the flesh more
efficiently. Besides it improves the flesh metabolism; that results in the
acceleration of regeneration o mucosal.
Characterization of the method.
HBO is efficient in treating of
hypoxia of flesh. It improves the partial tension of oxygen in tissue after the
respiration of the aerial mix at the improved tension. The application of method
is based on physical laws of dissolvability of gases in liquids (Bowl Mariott,
1662; Pascal, 1663; Henry, 1803; Dalton, 1803; Pauzeyl, 1840-1841; Pheek, 1855),
which declare, that the amount of gas (oxygen in particular), dissolved in blood
is proportional to the tension and temperature. Partial pressure or tension of
gas is proportional to concentration and the pressure of mix. Treating therapy
can be held in common barochambers with the volume of above than 3000 l.; with
the saturation of 10AT, fooled with pressed aerial mix. That chamber can contain
the stuff simultaneously with sick person. Single place chambers (OLB) with the
volume less than 2500 liters, can gain the internal pressure of no more than
3AT. These chambers are fooled only with oxygen. The working pressure - is the
saturation, required in the process of the HBO. For the treating of ulcer the
working pressure usually equals 1AT of oxygen. The extra pressure - is the
pressure additional to the one in normal atmosphere. Addition of extra pressure
and of atmosphere's one gives an absolute pressure. Extra
and absolute pressure is measured in technical atmospheres and marked as
ATI and ATA, correspondingly. Technical atmosphere, AT - that is 1 kilogram per
square santimeter equals the pressure of mercury cord of 735,6 sm. height.
Physical atmosphere equals 1,033 kg/(sm.*sm.), or 10,33 meters water cord or 760
mm high mercury cord.
The one extra AT of oxygen
improves its concentration in blood by 3,5-4 times; carbon dioxide lessens at
2-3 mm of mercury cord (if the value of pH of blood is about 7,40-7,43).
The oxygental therapy under
improved pressure reduces any form of oxygen harvest; the blood is fooled
completely with oxygen. The main part of the oxygen is dissolved in plasma of
blood.
Indications and contraindications
of HBO.
Indications of HBO in treatment
of ulcer of stomach and intestine are:
1. Acute form of disease,
accompanied with the results of the investigation (independent on any reaction
of the patient).
2. Absence of treating effect
after prolonged medicinal therapy.
3. Accompanying of the acute
ulcer with diabetes, chronic hepatitis, cirrhosis of liver, obliterate
endarteritis.
There are absolute and
conditional contraindications for the application of HBO in treating of ulcer.
Absolute contraindications:
1. Epilepsy and similar diseases.
2. Diseasive holes in lung.
3. Hard hypertension.
4. Otorhinolaryngologic diseases .
5. Claustrophobia.
6. Acute sensitivity to oxygen.
7. Cellar peculiarities in
biopsy.
8. Ulcer bleedings.
Conditional contraindications:
1. Seam deformation with the
development to the stenosis;
2. Penetration of ulcer into
neighboring organs;
3. Individual contraindication to
the aerial pressure shifts.
The HBO should be temporary
contraindicated if the head-cold is on.
Probable complications and how to
avoid them.
The HBO can cause:
1. Pain in head, nose, ears. The
continuation of HBO-course can be permitted by otorhinolaryngologist.
2. Damages of lung; barodamages -
the continuation of course would be done in a specialized division.
3. Barootitis, barosinusites.
Treating should be as usual.
4. Intoxication with oxygen
together with slight sensitivity to oxygen. The paleness, high value of pulse,
trembling of mouth, sweatiness, respiratory violations - these phenomena display
the intoxication. Further phenomena are the convulsions and unconsciousness. In
general the hyperoxia should steadily reduce the pulse; if it is improving, the
course should be immediately interrupted.
Investigation of ulcers preceding
the HBO therapy.
A number of investigations before
the HBO can assess the efficiency of course and avoid the complications. These
are:
1. Roentgenoscopy of stomach can
determine the ulcer of stomach or intestine (predictions for application) or
tumor or ulcer with stenosis (predictions for the contraindications);
2. Esofagogastroduodenoscopy that
can determine the ulcer properties (deepness, shape, existence of
gastroduodenitis, erosion of phlegm; the biopsy, if needed.
3. Roentgenoscopy of breast.
4. Otorhinolaryngologic
consultancy. 5. Electrocardiogram.
6. Urine's analysis.
7. Biochemical blood
investigation. 8. Investigation of stomach secret. 9. Stool investigation.
10. Amylase urine investigation.
11. Liver's blood investigation.
12. Gastrin of blood.
13. Catecholamines of urine.
14. Cholycystographia to avoid
the concrements and investigate the bile.
15. Investigation of psychics of
sicks and application of sedatives or antidepressants, if required.
Recommendations and the method of
HBO therapy.
HBO division stuff together with
curing doctor should appoint the scheme of course: number of procedures,
exposition, accompanying medicinal therapy. The dress shouldn't contain
synthetics, wool or silk; the cremes and oil on skin are also forbidden. Head
should be covered with a special cap. The procedure should take place forty
minutes after food reception. The nose should be cleaned (with probable
application of ephedrine or adrenaline). Curing doctor should take part in the
first procedure to determine the individual response to the oxygen invasion. The
pulse should be controlled. Smoking is forbidden three hours after the
procedure.
The HBO in First Moscow Medical
Institute is concentrated in a special division (Tel. No.2481439, 2481507) with
OLB "Oka". The system includes conditioner with pressure terms from
0,1 up to 10AT and a special closed bed. The air stream is released in
conditioner from the carbon dioxide and vapor. The temperature can also be
regulated. The sick can be placed, lying or sitting, in the bed. The probe
procedure lasts for 20-30 minutes with 1,5-1,7AT saturation; later the oxygental
pressure improves to 1AT. The compression and decompression would be done with
the speed of value less than 0,1AT per min. The procedures should take place
every day (12-17 procedures per course with oxygental pressure of 2AT and 10
minutes for compression and decompression periods).
The favorable therapy.
1. Food - diet No. 1 (Pevzner).
2. Cholinoticks and antacids are
desirable.
3. Nicodin or levomicetin for
sanation of bile tubes.
4. Metoclopramid (cerucal,
reglan) if diskinetical phenomena are present.
5. Sedatives and antidepressants
(on recommendation).
6. The medical supporters of
seaming.
Medical control of the treating.
Endoscopic control is desirable
for the controlling of the efficiency of HBO - therapy. The roentgen obtains
information on seam deformations and stenosis (being the rejections); but
surface ulcers are hardly to be investigated as well as the status of ulcer and
status of phlegm. After endoscopic analysis the scheme of seance can be
determined: if ulcer is shallow, the number of procedures is 12; otherwise - 15
-17. If no seaming is observed the scheme should be changed; in particular the
colloidal bismuth or vinilin can be
used. The pain lessens already in the beginning of course of HBO; the feelings
are bettering; but these changes cannot represent the reality; thus the
endoscopy is vitally required for controlling of healing of ulcer of stomach or
intestine.
Clinic recommendations.
1. If ulcer wounds are less than
5 sm. width, 12 procedures of HBO would be enough for the treating.
2. If the ulcer is larger than 5
sm., an additional course of 5-6 procedures is required (or additional course of
medicines for the acceleration of reparation: aloe, solcoseril, metronisadol,
etc.). 3. The feelings of a sick never would be a display of the success of
curing process. The endoscopy is compulsory. It helps in advance to
handle the course; after the
course is over, it helps to work out the further curing activity.
4. The supporting discinetics,
amount of ulcer wounds, existence of duodenogastral reflex do not correlate with
the speed of seaming.
5. If prolonging cholecystitis
accompanies the ulcer disease, an additional sanation of bile tubes is
desirable.
6. The HBO isn't recommended for
already operated on perforation of ulcer patients.
7. The cholinoreducing medicines
can be applied for the reason of influence of HBO on the acidity of stomach
enzymes.
8. HBO is of advantageous
application for the prolongly unseamed ulcer.
9. Partial destruction of the
Gis'es branches, represented at electrocardiogram, can't be the contraindication
for the course of HBO.
10. If the ulcer is swallow, the
application of HBO permits to avoid the deformation of the duodenum. That fact
is very important: the operation on stenosis is prevented.
11. After HBO the remission of
ulcer can be prolonged to 1,5-2 years.
In addition
we wish to stress that the HBO therapy is an advantageous method of
treating the prolongly unsealed and regularly acuting ulcer of stomach and
duodenum. We believe these recommendations to be useful in treating of ulcer by
means of HBO.