The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period
Acute cerebrovascular disease is an urgent and the most socially important problem in modern neurology, medical science and public health in Ukraine. Disturbed lipid metabolism plays a key role in development of cerebral atherosclerosis and eventually cerebrovascular incidents. New pathogenesis-asso...
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Фізико-хімічний інститут ім. О.В. Богатського НАН України
2011
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| Цитувати: | The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period / V.V. Teshchuk, V.I. Teshchuk, S.P. Skochko // Актуальні проблеми транспортної медицини. — 2011. — № 4 (26). — С. 84-88. — Бібліогр.: 4 назв. — англ. |
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nasplib_isofts_kiev_ua-123456789-1380902025-02-23T19:04:05Z The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period Вплив магнітолазеротерапії на ліпідний обмін при комплексному лікуванні хворих в гострому періоді ішемічного інсульту Влияние магнитолазеротерапии на липидный обмен при комплексном лечении больных в остром периоде ишемического инсульта Teshchuk, V.V. Teshchuk, V.I. Skochko, S.P. Клиническая медицина на транспорте Acute cerebrovascular disease is an urgent and the most socially important problem in modern neurology, medical science and public health in Ukraine. Disturbed lipid metabolism plays a key role in development of cerebral atherosclerosis and eventually cerebrovascular incidents. New pathogenesis-associated treatment approaches are being searched. This article summarizes the experience of magnetic and laser therapy of patients with ischemic stroke in acute periods, and the impact of treatment on host lipid metabolism parameters. Гострі порушення мозкового кровообігу представляють собою актуальну та найбільш соціально значиму проблему сучасної неврології, медичної науки та охорони здоров’я на Україні. Порушення ліпідного обміну відіграють основну роль в розвитку церебрального атеросклерозу, а в послідуючому інсультів. Проводиться пошук нових патогенетично обумовлених методів лікування. В статті представлений досвід застосування магнітолазеротерапії при лікуванні хворих в гострому періоді ішемічного інсульту, вплив лікування на показники ліпідного обміну в організмі пацієнтів. Острые нарушения мозгового кровообращения представляют собой актуальную и наиболее социально значимую проблему современной неврологии, медицинской науки и здравоохранения на Украине. Нарушения липидного обмена играют основную роль в развитии церебрального атеросклероза , а в последствии инсультов. Проводится изыскание новых патогенетически обусловленных методов лечения. В статье обобщен опыт использования магнитолазеротерапии при лечении больных в остром периоде ишемического инсульта, влияние лечения на показатели липидного обмена в организме пациентов. 2011 Article The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period / V.V. Teshchuk, V.I. Teshchuk, S.P. Skochko // Актуальні проблеми транспортної медицини. — 2011. — № 4 (26). — С. 84-88. — Бібліогр.: 4 назв. — англ. 1818-9385 https://nasplib.isofts.kiev.ua/handle/123456789/138090 616.36-002.2-085 en Актуальні проблеми транспортної медицини application/pdf Фізико-хімічний інститут ім. О.В. Богатського НАН України |
| institution |
Digital Library of Periodicals of National Academy of Sciences of Ukraine |
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DSpace DC |
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English |
| topic |
Клиническая медицина на транспорте Клиническая медицина на транспорте |
| spellingShingle |
Клиническая медицина на транспорте Клиническая медицина на транспорте Teshchuk, V.V. Teshchuk, V.I. Skochko, S.P. The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period Актуальні проблеми транспортної медицини |
| description |
Acute cerebrovascular disease is an urgent and the most socially important problem in modern neurology, medical science and public health in Ukraine. Disturbed lipid metabolism plays a key role in development of cerebral atherosclerosis and eventually cerebrovascular incidents. New pathogenesis-associated treatment approaches are being searched. This article summarizes the experience of magnetic and laser therapy of patients with ischemic stroke in acute periods, and the impact of treatment on host lipid metabolism parameters. |
| format |
Article |
| author |
Teshchuk, V.V. Teshchuk, V.I. Skochko, S.P. |
| author_facet |
Teshchuk, V.V. Teshchuk, V.I. Skochko, S.P. |
| author_sort |
Teshchuk, V.V. |
| title |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| title_short |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| title_full |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| title_fullStr |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| title_full_unstemmed |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| title_sort |
impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period |
| publisher |
Фізико-хімічний інститут ім. О.В. Богатського НАН України |
| publishDate |
2011 |
| topic_facet |
Клиническая медицина на транспорте |
| url |
https://nasplib.isofts.kiev.ua/handle/123456789/138090 |
| citation_txt |
The impact of magnetic and laser therapy on lipid metabolism in complex treatment of patients with ischemic stroke in acute period / V.V. Teshchuk, V.I. Teshchuk, S.P. Skochko // Актуальні проблеми транспортної медицини. — 2011. — № 4 (26). — С. 84-88. — Бібліогр.: 4 назв. — англ. |
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Актуальні проблеми транспортної медицини |
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АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТРАНСПОРТНОЙ МЕДИЦИНЫ № 4 (26), 2011 г.
84
ACTUAL PROBLEMS OF TRANSPORT MEDICINE #4 (26), 2011
Disturbed lipid metabolism is a
pathogenic basis for the development of
cerebral atherosclerosis [1].
The current views of disturbed lipid
metabolism emphasize alterations in blood
lipoproteins where changes in apolipoprotein
composition, as well as excessive intake of
exogenous lipids, are considered to play the
key role [1]. Lipid ingestion by tissue begins
from activation of lipoprotein lipase which
cleaves major energy important lipids –
triglycerides : into fatty acids and glycerol
digested by tissues, the role of this lipid
metabolism stage is being quite significant,
if not fundamental [1].
The objective of our study was to
develop magnetic and laser therapy (MLT)
methods and to investigate its efficacy in
complex treatment of patients with acute
ischemic cerebrovascular stroke (AICVD), as
well as its impact on lipid metabolism in
general. 26 patients (19 males, 7 females)
aged 45:70 years with acute ischemic
cerebrovascular stroke hospitalized in
Angioneurology Department of Neurosurgery
and Neurology Clinic of Southern Regional
Army Health Clinical Centre (Odessa) and
General Intensive Care Unit of Kiev Regional
Clinical Hospital (Kiev) were examined. We
evaluated treatment of verified ischemic
stroke (n = 26) in the middle cerebral artery
(MCA) circulation using magnetic and laser
therapy (MLT) and traditional medications vs.
medication:only therapy (n = 30).
Our MLT methods involved transcranial
impact on ischemic focus, projection of
carotid arterial bifurcation on the side of the
focus, on eye bulb through closed eyelid on
the side of the focus and on collar zone (С
8
:
Th
3
segment projection), as well as
investigation of high density lipoproteins
(HDL), low density lipoproteins (LDL),
triglycerides, total cholesterol. Magnetic field
(MF) induction reaches up to 30 mT, laser
power (LP) : up to 50 mW, and frequency
modulation – up to 10 and 37.5 Hz.
Based on the direct results, the
treatment of 15 (57.69 %) patients in the
study group, and 33.3 % of patients in the
control group have finished treatement with
minimal and mild neurological deficiency. In
the follow:up the obtained results remained
the same for one year when continuing
rehabilitation activity.
We observed 26 patients with verified
ischemic stroke (IS) in the middle cerebral
artery (MCA) circulation (17 left, 9 right),
average age was 55.3 ± 4.7 years. The group
includued: 19 (73.1 %) males and 7 (26.9 %)
females. When hospitalized, patients, consid:
УДК 616.36&002.2&085
THE IMPACT OF MAGNETIC AND LASER THERAPY ON LIPID
METABOLISM IN COMPLEX TREATMENT OF PATIENTS WITH
ISCHEMIC STROKE IN ACUTE PERIOD
Teshchuk V.V., Teshchuk V.I., Skochko S.P.
Kiev Regional Clinical Hospital;
Southern Regional Army Health Clinical Centre (Odessa)
Acute cerebrovascular disease is an urgent and the most socially important problem
in modern neurology, medical science and public health in Ukraine. Disturbed lipid
metabolism plays a key role in development of cerebral atherosclerosis and eventually
cerebrovascular incidents. New pathogenesis:associated treatment approaches are being
searched. This article summarizes the experience of magnetic and laser therapy of patients
with ischemic stroke in acute periods, and the impact of treatment on host lipid metabolism
parameters.
Key words: Acute cerebrovascular disease, ischemic stroke, magnetic and laser
therapy, lipid metabolism.
ACTUAL PROBLEMS OF TRANSPORT MEDICINE #4 (26), 2011
АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТРАНСПОРТНОЙ МЕДИЦИНЫ № 4 (26), 2011 г.
85
ered to have moderate state by clinical
course using NIH SS Scale, Glasgow Coma
Scale, modified Barthel index adapted for
acute stroke trials, were selected for treat:
ment. All patients were examined using the
unified program of clinical, electrophysiolog:
ical, Doppler ultrasonographic, neurovisual
(brain computed tomography and brain mag:
netic resonance imaging) and laboratory bio:
chemical studies.
The main reasons of IS were:
atherosclerosis at 18 (69.23%) patients,
atherosclerosis with arterial hypertension at
22 (84.61 %) patients. For 12 (46.15 %)
patients the proximal cause of development
of hemodynamic brain disturbances was
extra:magistral cerebral stenosis and
occlusion (stenosis more than 50% or
significant deformation of vessels). Patients’
IS developed with blood pressure (BP)
changes, sudden rise or drop. For 6
(23.07 %) patients a stroke was preceded by
transient cerebrovascular events. Using brain
CT or MRI the focus of ischemic lesion has
been verified at 26 (100.0 %) patients: 7
(26.92 %) patients had cortical or subcortical
lesions; 5 (19.23 %) patients had
hemispheric deep lesions, 14 (53.85 %)
patients had cortical foci. We didn’t include
transient cerebrovascular events in our
investigation. The focus was large (more than
40 mm in diameter) in 4 (15.38 %) patients,
and medium (10–40 mm) in 12 (46.16 %)
patients, very small (less than 10 mm in
diameter) in 10 (38.46 %) patients. During
neurological examination of IS patients, we
have found the disordered motor function of
all patients monitored: hemiplegia in 6
(23.08 %), severe hemiparesis in 11
(42.31 %) (reduced muscular power to 1:2
points), moderate hemiparesis in 4 (15.38 %)
(reduced muscular power to 3 points), slight
and mild hemiparesis in 5 (19.23 %) (reduced
muscular power to 4 points). Disturbed or
changed sensitivity has been observed at 24
(92.31 %) patients, speech disturbances
(motor and/or sensory aphasia, disartria of
different intensity) were registered at 23
(88.46 %) patients.
3 (11.54%) patients demonstrated
extrapyramidal symptoms; 2 (7.69%)
patients demonstrated blurring. All IS
patients (n = 56) examined were randomized
into two groups: the first group (study group,
n = 26 pts.) received magnetic and laser
therapy (MLT) with basic medication
treatment; the second group (control group,
n = 30 pts.) underwent medication:only
treatment. Basic therapy included standard
dosages of current medications (ceraxon,
actovegin, aspirin, sulphated magnesia,
cerebrolysin, gliatilin; fraxiparin in individual
patients etc.). Moreover, moderate
hemodilution has been performed with blood
rheology and Ht monitoring, and when
intracranial hypertension symptoms
occurred, furosemide (lasix) was added.
Blood sugar level was also corrected. Our
method of MLT was used for the first group
patients. MLT was performed using serial unit
“MIT:1:MLT” of domestic production by
company “Medintech” SRI LLC. Patients
underwent treatement immediately after IS
verification (brain CT or MRI).
MLT procedures in the middle cerebral
artery circulation at ischemia were as follows:
: transcranially at the projection of
ischemic focus (MF up to 30 mT, LP up
to 50 mW, l = 0.78 јm, frequency
modulation 37.5 Hz). Exposure onto the
focal region supposed regulation of
physical and chemical processes
penumbra, decrease in local edema and
inflammatory events, stabilization of cell
membranes.
: projection of carotid arterial bifurcation
on the side of the focus (MF up to 30
mT, LP up to 40 mW, l = 0.67 јm,
frequency modulation 37.5 Hz).
Exposure to this zone provided magnetic
and laser irradiation of blood, glomus
caroticus and n. vagus. Stimulation of
this important structures resulted in
influencing blood rheology, BP and lipid
metabolism, vegetative functions etc.
Specified zones were stimulated
simultaneously for 10 : 15 min, which
corresponded to irradiation dose of 2–3
J/cm2 per zone [2,3].
Subsequently two more zones were
exposed:
АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТРАНСПОРТНОЙ МЕДИЦИНЫ № 4 (26), 2011 г.
86
ACTUAL PROBLEMS OF TRANSPORT MEDICINE #4 (26), 2011
: eye bulb through closed eyelid on the
side of the focus (MF up to 30 mT, LP up
to 40 mW, l = 0.67 јm, frequency
modulation 10 Hz). Magnetic and laser
stimulation of this zone influenced
vessels of the eye fundus (the middle
cerebral artery circulation) and optic
nerve leading to reduced angiospasm
and functional reorganization of optic
and epiphyseal system;
: projection on spinal cord at С
8
–Th
3
(MF
up to 30 mT, LP up to 50 mW, l = 0.78
јm, frequency modulation 10 Hz).
Exposure to this zone (segmental
vegetative centre promoting
maintenance of all sympathetic brain
structure) involved normalization of
energetic and metabolic processes in
the brain, vascular tone etc. [2, 3].
Stimulation of these zones was also
concurrent.
Thus, one session included exposure
to 4 zones using two frequency modulations
10 and 37.5 Hz, the total duration was up to
30 minutes. The treatment of 17 (65.39 %)
patients started within 24 hours, 4 (15.38 %)
patients : within 1:5 days, and 5 (19.23 %)
patients : within more than 5 days from
AICVD event.
The procedures were performed twice
24:hours on the first days. MLT procedures
were performed each 24 hours after 5:7 days
of stroke. The control group and the study
group were identical in timing of treatment,
clinical course and other symptoms (р >
0,05).
Therefore, inclusion of MLT into the
complex treatment of AICVD patients
improved the majority of hemodynamic
parameters. The other important data in
analysis of response to MLT included
observations (n = 5) when exactly on day 2–
3 a hypodense zone of medium (n = 4) or
big size (n = 1) was registered, the brain
matter density alterations not being detected
on 20–25 day. These observations were not
found in the control group.
Discussion of the results
Physical and chemical blood alterations
play a major role in mechanisms of vascular
pathology development, and when severe
disturbances, the vascular:thrombocytic
factor is added to atherosclerosis. In
vascular:thrombocytic mechanism
realization, two main processes are involved:
fibrinogenesis and fibrinolysis at the same
time. Normally they are mutually balanced,
the platelet adhesion increase in case of
pathology and the thrombocytic agents can
appear on the inner surface of cell wall,
especially in the sites of its lipid infiltration.
Further involvement of blood sedimentation
different factors results in fibrin thrombus
formation. As a result, the important objective
of the modern clinical medicine is to search
for medicinal products and methods which
would extensively influence intravascular
hemocirculation and would be safe for
patients. One of these methods is a magnetic
and laser therapy (MLT) which has favorable
impact on hemostasis according to
numerous studies issues: reduced
aggregation of red blood cell and platelet,
increased time of hemorrhage and
coagulation, decreased content in fibrinogen,
increase in fibrinolytic activity. MLT and
medication treatment had more favorable
impact on these parameters compared to
medication:only therapy. After ten sessions
of magnetic and laser therapy (MLT) we
observed reduced levels of triglycerides from
2.18 ± 0.054 mmol/L to 1.89 ± 0.129 mmol/
L and low density lipoproteins from 3.2 ±
0.451 mmol/L to 3.1 ± 0.342 mmol/L at our
patients. Evidently MLT has peculiar heparin:
like effect eventually due to the breach of
heparin:sulphate links resulting in lipoprotein
lipase (LPL) enzyme release into blood
circulation. This enzyme provides exogenous
fat intake by tissues [1]. LPL is localized onto
vascular endothelium, to which it is
“attached” with heparin:sulphate
proteoglycan chains [1], breaking off after
heparin administration. This enzyme can
cleave triglycerides [4]. At the same time an
increase in cholesterol level from 5.6 ± 0.654
mmol/L to 5.9 ± 0.263 mmol/L, В:
lipoproteins from 53 ± 3.67 U to 54 ± 2.375
U, and high density lipoproteins from 1.4 ±
0.153 mmol/L to 1.6 ± 0.146 mmol/L was
observed.
ACTUAL PROBLEMS OF TRANSPORT MEDICINE #4 (26), 2011
АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТРАНСПОРТНОЙ МЕДИЦИНЫ № 4 (26), 2011 г.
87
Thus, MLT inclusion into the complex
treatment had a favorable impact on all key
values of blood rheology and coagulation;
essential is that those changes were reported
relatively early on 7:10 day after IS.
Subsequently, changes rate was not so fast
but de facto continued for the whole acute
period. Significant changes (p < 0,05) of
several hemorheological values in the control
group were recorded on 12–14 day only.
Specifically, changes in hemorheology and
coagulation blood parameters correlated with
improved clinical manifestations. According
to immediate results, 15 (57.69 %) patients
in the study group, and 33.3 % of patients in
control group underwent treatment with
minimal and mild neurological deficiency.
While analyzing the treatment outcomes in
the study group in 6 months, the following
data was obtained. The recovery processes
continued within the whole group, and
rehabilitation level of the patients increased
significantly (p < 0,05) (the number of
patients with severe and partial dependence
reduced and the number of patients
“completely independent” increased by
10 %). In the control group (n = 30): 1 patient
had suffered the internal carotid artery
operation and 1 patient died due to repeated
AICVD, other patients kept de facto the same
rehabilitation capacity with slight increase in
positive gradation. In one year we could
obtain data concerning health condition of 23
(88.46 %) study patients and 28 (93.33 %)
control patients. It should be noted that the
number of patients “completely
independent” and “independent in everyday
life” remained almost unchanged, and the
number of patients with more severe
condition decreased by 7.69 %. Patients’
social activity level in the control group did
not significantly change compared to 6
months period, but it remained lower that in
the study group. Therefore, our investigations
show that the most significant recovery time
for loss functions at patients with moderate
AICVD was acute period of IS when patients
reached by 21 day a certain social activity
level. No wonder that the tendency for early
rehabilitation at cerebrovascular accident
patients is evidently observed in modern
angioneurology. These effects are observed
when patients are transferred from intensive
care unit to early rehabilitation unit under
condition of the stable hemodynamics on 5:
7 day of disease. Therefore, our clinical
studies show that complex treatment of acute
IS (optimal treatment beginning in the
“therapeutic window” period) using
conventional medication therapy, and MLT
represents an effective method significantly
better than medication:only therapy.
However, medication therapy with MLT of
approximately 30% patients in the very early
period allows preventing development of
ischemic focus and restricts its development
(hypodense zone registration). Moreover, the
early rehabilitation of AICVD patients is a
necessary instrument to prevent
development of muscular contractures,
dystrophic changes in joints etc., eventually
determining patient’s ability to work, self:
maintenance, namely to social
independence.
Thus, magnetic and laser therapy of
patients with acute ischemic cerebrovascular
stroke has a significant neuroprotective
effect manifesting in positive dynamics of
cognitive functions and whole brain
symptoms. And the focal symptoms
decreased faster with essential function
recovery speed compared to the group of
patients received medication:only therapy.
Magnetic and laser therapy positively
influenced the vegetative nervous system,
enabled improvement in blood rheology,
elimination of vasospasm, reduced cerebral
edema (if present) and decreased the period
of its existence evidently influencing the rate
of thrombosed vessel recanalisation. Actually,
the developed method of magnetic and laser
therapy has no contraindications, however it
is advisable to use it during acute period,
optimally during “therapeutic window”
period, namely, on the first 24 hours of a
cerebrovascular accident. At the same time,
the MLT method is still advisable in later
periods (up to 12:15 days after stroke).
Magnetic and laser therapy is convenient to
apply for each patient without complications
and it can be carried out at the specialized
angioneurology units in combination with
АКТУАЛЬНЫЕ ПРОБЛЕМЫ ТРАНСПОРТНОЙ МЕДИЦИНЫ № 4 (26), 2011 г.
88
ACTUAL PROBLEMS OF TRANSPORT MEDICINE #4 (26), 2011
standard medication therapy with
significantly reduced pharmacological load.
The mechanisms of lipid metabolism
regulation in vascular cerebral accidents are
still not completely studied. Verification of our
hypothesis of MLT impact on lipid
metabolism will enlarge our knowledge of
cerebral atherosclerosis pathogenesis and
consequently of acute ischemic
cerebrovascular disease thus giving
opportunity to prevent the vascular cerebral
accident, and when incurred, to include MLT
into pathogenetic therapy of acute ischemic
cerebrovascular disease.
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му лікуванні ішемічного інсульту в го:
строму періоді (методичні рекомен:
дації) / Самосюк І. З. ,Головченко Ю.І,
Поліщук М.Є., Зозуля І.С., Самосюк
Н.І. — К., 2002. — 21 с.
4. Гонський Я.І., Максимчук Т.П., Ка:
линський Н.І. Біохімія людини. – Тер:
нопіль: Укрмедкнига, : 2002.:726 с.
Резюме
ВПЛИВ МАГНІТОЛАЗЕРОТЕРАПІЇ НА
ЛІПІДНИЙ ОБМІН ПРИ КОМПЛЕКСНОМУ
ЛІКУВАННІ ХВОРИХ В ГОСТРОМУ
ПЕРІОДІ ІШЕМІЧНОГО ІНСУЛЬТУ
Тещук В.В., Тещук В.Й.,
Скочко С.П.
Гострі порушення мозкового крово:
обігу представляють собою актуальну та
найбільш соціально значиму проблему су:
часної неврології, медичної науки та охо:
рони здоров’я на Україні. Порушення
ліпідного обміну відіграють основну роль
в розвитку церебрального атеросклерозу
, а в послідуючому інсультів. Проводиться
пошук нових патогенетично обумовлених
методів лікування. В статті представлений
досвід застосування магнітолазеротерапії
при лікуванні хворих в гострому періоді
ішемічного інсульту , вплив лікування на
показники ліпідного обміну в організмі
пацієнтів.
Ключові слова : гостре порушення
мозкового кровообігу, ішемічний інсульт,
магнітолазерна терапія , ліпідний обмін.
Резюме
ВЛИЯНИЕ МАГНИТОЛАЗЕРОТЕРАПИИ
НА ЛИПИДНЫЙ ОБМЕН ПРИ
КОМПЛЕКСНОМ ЛЕЧЕНИИ БОЛЬНЫХ В
ОСТРОМ ПЕРИОДЕ ИШЕМИЧЕСКОГО
ИНСУЛЬТА
Тещук В.В., Тещук В.И., Скочко С.П.
Острые нарушения мозгового крово:
обращения представляют собой актуаль:
ную и наиболее социально значимую про:
блему современной неврологии, меди:
цинской науки и здравоохранения на Ук:
раине. Нарушения липидного обмена иг:
рают основную роль в развитии цереб:
рального атеросклероза , а в последствии
инсультов. Проводится изыскание новых
патогенетически обусловленных методов
лечения. В статье обобщен опыт исполь:
зования магнитолазеротерапии при лече:
нии больных в остром периоде ишемичес:
кого инсульта, влияние лечения на пока:
затели липидного обмена в организме па:
циентов.
Ключевые слова: острое нарушение
мозгового кровообращения,
ишемический инсульт, магнитолазер&
ная терапия, липидный обмен.
Впервые поступила в редакцию 01.12.2011 г.
Рекомендована к печати на заседании
редакционной коллегии после рецензирования
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