Method for predicting the development of cerebral ischemic lesion in patients with aneurysmatic hemorrhages

FIELD: medicine, clinical neurology, neurosurgery.

SUBSTANCE: one should study both activation and aggregation of thrombocytes in blood of carotid artery, at the quantity of thrombocytic active forms being above 70% and the number of aggregated thrombocytes being above 9.0% one should predict the development of cerebral ischemic lesion along with stable focal neurological symptomatology, and at the quantity of thrombocytic active forms being below 30% and the number of aggregated thrombocytes being below 8.0% it is possible to predict positive dynamics in the course of the disease mentioned without developing cerebral ischemic lesion.

EFFECT: higher accuracy of prediction.

2 ex

 

The invention relates to medicine, namely clinical neurology, neurosurgery, and can be used to predict the development of ischemic brain vascular abnormalities in patients in the acute period of aneurysmal hemorrhage.

A known method for predicting the development of ischemic brain damage in patients with aneurysmal hemorrhage by defining radioimmune method in blood from a peripheral vein of thromboxane B2, which is the stable metabolite of thromboxane A2, released from platelets during aggregation (Iuvela S., Hilton M., Kaste M. Platelet thromboxane release and delayed cerebral ischemia in patients with subarachaoid hemorrhage / J. of Neurosurgery. - 1991. - Vol.74. - P.386-392). Patients with the contents of thromboxane B2 in the blood from a peripheral vein 48,8±and 7.3 nmol/l predict the development of ischemic brain injury with persistent focal neurological deficit in patients with the contents of thromboxane B2 27,5±3.2 nmol/l development of ischemic brain will not prognoziruyut.

However, the method is not sufficiently precise because:

- examine the blood from a peripheral vein, changes in the functional activity of platelets, which do not adequately reflect its status in the cerebral vessels;

- examine the contents of thromboxane B2, which characterizes the WTO the ranks of changes of platelets, related to their aggregation.

As a prototype the selected method for predicting the development of ischemic brain damage by determining the radioimmunoassay method of blood from the jugular vein β-thromboglobulin emitted from α-granules of platelets during aggregation (Ohkuma H., Suziiki S., Kimura M., Sobata E. Role of platelet functions for symptomatic cerebral vasospasm after subarachnoid hemorrhage of aneurysmal rupture / Stroke. - 1991. - Vol.22. - P.854-859). In patients with contents β-thromboglobulin blood from the jugular vein more than 80 mg/ml predict the development of ischemic brain injury with persistent focal neurological deficit.

The disadvantages of the prototype:

- high invasiveness: you must perform the puncture of the jugular vein, which is dangerous because of the possibility of the development of air embolism;

- lack of precision, because:

- investigate flowing from the brain venous blood, changes in platelet activity, which reflect the result of vascular lesions of the brain, not the cause, contributing to the development of ischemic brain damage;

- investigate the secretion β-thromboglobulin, which characterizes the secondary changes of platelets associated with their aggregation.

The invention is directed to a method of predicting the development of ischemic brain damage in patients with aneurysmal what krovoizliyaniya, ensure the reduction of invasiveness and improved accuracy.

This technical result in the implementation of the method is achieved in that in the known method for predicting the development of ischemic brain damage in patients with aneurysmal hemorrhage by determining the activity of blood platelets investigate the activation and aggregation of platelets in the blood from the carotid artery and the number of active forms of platelets more than 70% and the number egregiously platelets more 9,0% predict the development of ischemic brain injury with persistent focal neurological deficit, and when the number of active forms of platelets less than 30% and the number egregiously platelets less than 8,0% predict a positive trend in the course of the disease without the development of ischemic brain damage.

The method is as follows. The patient at the time performed in all patients with aneurysmal hemorrhage angiographic studies produce a single blood sample taken from the carotid artery. Morphological evaluation of platelet activation produced by modifying the method Shitikova A.S. (Shitikova A.S., Kargin E, Beleza PU, Tarkovsky LR, Saltykov NB, Pankratiev SE - Morphological assessment of increased intravascular platelet activation is in: Method recom. / Russian research Institute of Hematology and Transfusiology. - SPb., 1996. - 18 C.). The blood sample is carried out using plastic disposable syringes, minimally reducing the residence time of blood in them. So the way it reflects not only the intravascular activation of platelets, and the elements of their spontaneous activation related to the contact of blood with a syringe. Next, 0.5 ml of blood is fixed in 2 ml of glutaraldehyde, fixed blood is centrifuged, and the obtained supernatant at a dilution of 1:4 with glutaraldehyde fill the camera Goryaeva. Using fasovannogo microscope to determine the percentage distribution of forms platelet count of 200 cells counted the number of small and large units per 500 free cells, as well as assess the degree of aggregation on the relative number of platelets, which are involved in the aggregation reaction. When the number of active forms of platelets more than 70% and the number egregiously platelets more 9,0% predict the development of ischemic brain injury with persistent focal neurological deficit. When the number of active forms of platelets less than 30% and those involved in aggregates of cells is less than 8.0 per cent predict a positive trend in the course of the disease without the development of ischemic brain damage.

The inventive method of forecasting semices the th brain damage developed in SE the Polenov research neurosurgical Institute them. Operated and clinically tested in the survey in 17 patients. The resulting predictions were confirmed by clinical and neurological patterns of disease.

Examples of extracts from the histories.

Example 1. Patient B., 49, and/b No. 1975-2002 moved verified subarachnoid hemorrhage, manifested mild and moderate cerebral meningeal symptoms (headache, photophobia, actually meningeal signs). On the 12th day after the hemorrhage has been a considerable deterioration, depression of consciousness to moderate stun, the emergence of focal symptoms, indicating the defeat of the structures of the basin of the left MCA in the form of pronounced Senso-motor aphasia, failure VII and XII cranial nerves right, right hemiplegia, right-hand hemihypesthesia, and also structures the vertebro-basilar basin in the form of paresis of gaze to the side and up, bilateral Misa with a decrease in pupillary reactions, reduction of corneal reflexes. When performing computed tomography brain foci of pathological density in the brain substance is not detected, the detected blood clots in the projection of the fourth ventricle. When angiography is pronounced diffuse vasospasm A1 and M1 segments of the internal carotid arteries, more to the left, diffuse wetspa the m in the vertebro-basilar pool, data for the presence of vascular malformations is not revealed. Conducted in accordance with the present method the study of the activation and aggregation of platelets revealed an increase in the number of active forms of the platelet - 87% (over 70%), the numbers involved in aggregates of cells and 9.8% (more than 9.0 per cent). On the basis of the conducted research was the forecast of development of ischemic brain injury with persistent preservation of focal neurological symptoms. After treatment the patient was noted positive dynamics in cerebral symptoms, but remained focal symptoms in the form of speech disorders, right-sided hemiparesis.

Example 2. Patient X., 44 years old, and a/b No. 1346-01. Since hemorrhage verified when performing magnetic resonance imaging, up to the time of the study according to the claimed method had positive dynamics in the form of a significant reduction in cerebral and meningeal symptoms. At the time of taking blood from a patient had moderate meningeal, cerebral easy, easy, focal symptoms of lesions of the frontal lobes in the form of lower criticism to their condition, reduce memory for the next event, due to the presence revealed by magnetic resonance imaging hematoma interhemispheric fissure with breakthrough blood in Zheludok the new system. Angiography revealed an aneurysm A2 segment of the right anterior cerebral artery and middle cerebral artery. Spasm is not detected. In the study of the activation and aggregation of platelets revealed: the number of active forms of the platelet - 18% (less than 30%), the numbers involved in aggregates of cells to 7.7% (less than 8,0%). On the basis of the conducted research was given a favorable prognosis, which is confirmed by the positive dynamics of the disease without the development of ischemic brain damage.

Using the proposed method allows to reduce the invasiveness and improve the accuracy of forecasting of development of ischemic brain damage in patients with aneurysmal hemorrhage.

A method for predicting the development of ischemic brain damage in patients with aneurysmal hemorrhage by determining the activity of blood platelets, wherein investigate the activation and aggregation of platelets in the blood from the carotid artery, and the number of active forms of platelets more than 70% and the number egregiously platelets more 9,0% predict the development of ischemic brain injury with persistent focal neurological deficit, and when the number of active forms of platelets less than 30% and the number egregiously platelets less than 8,0% forecast put the nutrient dynamics in the course of the disease without the development of ischemic brain damage.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves determining coagulating blood viscosity values like reaction period r, thrombin constant K, maximum amplitude MA, time T for forming fibrin-thrombocytic blood clot, spontaneous blood platelets aggregation intensity Ar, retraction and spontaneous clot lysis total FA. The r being within 5-7 min, Ar from -2 to -6 relative units, K being within 4-6 min, MA within 500-700 relative units, T within 40-60 min and FA equal to 10-20%, low inflammatory process activity is considered to be the case. The r being less than 5 min, Ar equal to -8 to -12 relative units, T less than 40 min and FA less than 10% with no changes in K and MA being observed, inflammatory process activity in chronic glomerulonephritis case is considered to be of high severity degree.

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1 dwg

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EFFECT: high accuracy of diagnosis.

2 tbl

FIELD: medicine, obstetrics.

SUBSTANCE: the present innovation deals with predicting disadaptive processes in women in dynamics of menstrual cycle. During menstrual cycle beginning since the 1st d to the 21st d one should detect the dynamics for alteration in coefficient of activity of syntoxic adaptation programs (CASAP), calculated by the following formula:

where CST - concentration of blood serotonin, AAT-III - activity of antithrombin III, Aaoa - total antioxidizing activity of plasma, CCD8+ - concentration of T-suppressors, Cad - concentration of blood adrenalin, Cα2MG - concentration of α2-macroglobulin, CMDA - concentration of malonic dialdehyde, CCD4+ - concentration of T-helpers. Moreover, normally CASAP value alters two-fold against the first day of the cycle - since 0.70 up to 1.40 on the 21st d of the cycle, at no alterations in CASAP value one should diagnose female disadaptive alterations leading to failed pregnancy. The innovation enables to perform diagnostics of disadaptive processes in women in dynamics of menstrual cycle followed by prognostic conclusion upon future pregnancy.

EFFECT: higher accuracy of diagnostics.

2 ex

FIELD: medicine, diagnostics.

SUBSTANCE: one should study blood components to detect anticoagulant-fibrinolytic activity. Moreover, patient's blood should be sampled: in whole blood one should detect the presence of affected erythrocytes and evaluate the quantity of thrombocytes, in plasma it is necessary to study the activity of antithrombin III, XIIa-dependent fibrinolysis, the content of soluble fibrin-monomeric complexes, in blood serum of the sample taken one should detect the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, moreover, one should calculate integral value of renal-hepatic deficiency, to put corresponding point for the degree of parameters under testing, then one should calculate integral value of disseminated intravascular clotting (IVDIC) and at its value being 6.3 U and more DIC-syndrome should be diagnosed, moreover, at IVDIC value ranged 6.3-10.1 U it is possible to diagnose latent DIC-syndrome, at 10.2-14.6 - subacute DIC-syndrome and at 14.7 and higher - acute DIC-syndrome should be concluded.

EFFECT: higher accuracy and efficiency of diagnostics.

4 ex, 2 tbl

FIELD: medicine.

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EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.

1 tbl

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.

EFFECT: shortened terms of research.

1 ex, 4 tbl

FIELD: medicine.

SUBSTANCE: method involves checking consciousness, blood coagulation state, peripheral blood leukocytes number, K+ ions, bilirubin, fibrinogen, hemolysis and hemoglobinuria availability, prothrombin index and exotoxic shock development. Each value is calculated in points as follows. Lucidity is evaluated as -2 points; depression - +3 points; coma - +6 points; lack of changes in blood coagulation system - -2 points; coagulation availability without clinical injuries - +2 points; coagulopathy with clinical manifestation signs - +19 points; K+ ions concentration being less than 3.0 mmole/l - +3 points, from 3.1 to 3.5 mmole/l - -5 points, from 3.6 to 5.0 mmole/l - 0 points, greater than 5.0 points - +7 points, failure in determining K+ ions concentration - 0 points; hemolysis availability - +6 points, its lack - -3 points; hemoglobinuria availability - +8 points, its lack - -1 points; leukocytes number being less than 12.0x109/l - -2 points, from 12,1 to 18.0x109/l - 0 points, higher than 18.0x109/l - +8 points; hourly urine output being less than 30 ml/h - +6 points, greater than 30 ml/h - -2 points; bilirubin content being less than 31 mcmole/l - -2 points, from 30.1 to 50.0 mcmole/l - 0 points, greater than 50.0 mcmole/l - +2 points, failure in determining bilirubin content due to hemolysis being available -+6 points; prothrombin index being equal to or less than 60% - +3 points, greater than 60% - 0 points, failure in determining prothrombin index due to hemolysis being available - +12 points; fibrinogen concentration in blood plasma being less than 2.1 g/l - +4 points, from 2.1 to 4.0 g/l - -1 point, from 4.1 to 6.0 g/l - +1 point, failure in determining fibrinogen concentration due to erythrocyte hemolysis being available - +13 points; exotoxic shock development - +9 points, its lack - -1 point. The points are summed up. The value being greater than +13, admission for treatment in resuscitation department is indicated. The value being less than -13, admission for treatment in therapeutics department is indicated. The value being from -13 to +13, resuscitation expert consultation is advised.

EFFECT: high evaluation accuracy.

3 tbl

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.

EFFECT: higher efficiency of studying.

3 dwg, 3 ex, 2 tbl

The invention relates to medicine, namely to diagnostic methods
The invention relates to medicine, namely to methods assessment system gemokoagulyatsii, and can be used to determine changes in orientation of the coagulation potential of blood (Hyper - or hypocoagulation) in patients with DIC-syndrome

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.

EFFECT: higher efficiency of studying.

3 dwg, 3 ex, 2 tbl

FIELD: medicine.

SUBSTANCE: method involves checking consciousness, blood coagulation state, peripheral blood leukocytes number, K+ ions, bilirubin, fibrinogen, hemolysis and hemoglobinuria availability, prothrombin index and exotoxic shock development. Each value is calculated in points as follows. Lucidity is evaluated as -2 points; depression - +3 points; coma - +6 points; lack of changes in blood coagulation system - -2 points; coagulation availability without clinical injuries - +2 points; coagulopathy with clinical manifestation signs - +19 points; K+ ions concentration being less than 3.0 mmole/l - +3 points, from 3.1 to 3.5 mmole/l - -5 points, from 3.6 to 5.0 mmole/l - 0 points, greater than 5.0 points - +7 points, failure in determining K+ ions concentration - 0 points; hemolysis availability - +6 points, its lack - -3 points; hemoglobinuria availability - +8 points, its lack - -1 points; leukocytes number being less than 12.0x109/l - -2 points, from 12,1 to 18.0x109/l - 0 points, higher than 18.0x109/l - +8 points; hourly urine output being less than 30 ml/h - +6 points, greater than 30 ml/h - -2 points; bilirubin content being less than 31 mcmole/l - -2 points, from 30.1 to 50.0 mcmole/l - 0 points, greater than 50.0 mcmole/l - +2 points, failure in determining bilirubin content due to hemolysis being available -+6 points; prothrombin index being equal to or less than 60% - +3 points, greater than 60% - 0 points, failure in determining prothrombin index due to hemolysis being available - +12 points; fibrinogen concentration in blood plasma being less than 2.1 g/l - +4 points, from 2.1 to 4.0 g/l - -1 point, from 4.1 to 6.0 g/l - +1 point, failure in determining fibrinogen concentration due to erythrocyte hemolysis being available - +13 points; exotoxic shock development - +9 points, its lack - -1 point. The points are summed up. The value being greater than +13, admission for treatment in resuscitation department is indicated. The value being less than -13, admission for treatment in therapeutics department is indicated. The value being from -13 to +13, resuscitation expert consultation is advised.

EFFECT: high evaluation accuracy.

3 tbl

FIELD: medicine, laboratory diagnostics.

SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.

EFFECT: shortened terms of research.

1 ex, 4 tbl

FIELD: medicine.

SUBSTANCE: method involves analyzing symptoms manifesting initial disseminated intravascular blood coagulation syndrome danger like burn area, availability of upper air passages burn, shock with its severity degree taken into consideration, sepsis development; clinical manifestations of disseminated intravascular blood coagulation syndrome like lung, kidney, liver function insufficiency, cerebral dysfunction, local and multiple hemorrhages, thrombosis, infarction; homeostasis system laboratory analysis data, hyper- and hypocoagulation based on chronometry test data, number of blood platelets, fibrin-monomer complexes, D-dimers, activity of antithrombin III, C and S proteins, XIIa-dependent fibrinolysis plasminogen content, availability of injured erythrocytes, combinations of laboratory tests for recognizing disseminated intravascular blood coagulation syndrome. Each sign under consideration receives a number of points corresponding to its diagnostic significance and integral value is calculated DIBCSIV=(X1+X2+…+Xn)/n, where n is the number of signs taken into consideration. DIBCSIV value equal to 1.0-1.5 units shows physiological norm. The value being between 1.6 and 2.5 units, light disseminated intravascular blood coagulation syndrome is diagnosed. The value being between 2.6 and 3.5 units, disseminated intravascular blood coagulation syndrome of medium severity is diagnosed; 3.6-4.5 points to one heavy severity degree; 4.6 and greater indicates highly severe case of disseminated intravascular blood coagulation syndrome.

EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.

1 tbl

FIELD: medicine, diagnostics.

SUBSTANCE: one should study blood components to detect anticoagulant-fibrinolytic activity. Moreover, patient's blood should be sampled: in whole blood one should detect the presence of affected erythrocytes and evaluate the quantity of thrombocytes, in plasma it is necessary to study the activity of antithrombin III, XIIa-dependent fibrinolysis, the content of soluble fibrin-monomeric complexes, in blood serum of the sample taken one should detect the concentration of urea, creatinine, sodium, albumin, total cholesterol and the activity of aspartate aminotransferase, moreover, one should calculate integral value of renal-hepatic deficiency, to put corresponding point for the degree of parameters under testing, then one should calculate integral value of disseminated intravascular clotting (IVDIC) and at its value being 6.3 U and more DIC-syndrome should be diagnosed, moreover, at IVDIC value ranged 6.3-10.1 U it is possible to diagnose latent DIC-syndrome, at 10.2-14.6 - subacute DIC-syndrome and at 14.7 and higher - acute DIC-syndrome should be concluded.

EFFECT: higher accuracy and efficiency of diagnostics.

4 ex, 2 tbl

FIELD: medicine, obstetrics.

SUBSTANCE: the present innovation deals with predicting disadaptive processes in women in dynamics of menstrual cycle. During menstrual cycle beginning since the 1st d to the 21st d one should detect the dynamics for alteration in coefficient of activity of syntoxic adaptation programs (CASAP), calculated by the following formula:

where CST - concentration of blood serotonin, AAT-III - activity of antithrombin III, Aaoa - total antioxidizing activity of plasma, CCD8+ - concentration of T-suppressors, Cad - concentration of blood adrenalin, Cα2MG - concentration of α2-macroglobulin, CMDA - concentration of malonic dialdehyde, CCD4+ - concentration of T-helpers. Moreover, normally CASAP value alters two-fold against the first day of the cycle - since 0.70 up to 1.40 on the 21st d of the cycle, at no alterations in CASAP value one should diagnose female disadaptive alterations leading to failed pregnancy. The innovation enables to perform diagnostics of disadaptive processes in women in dynamics of menstrual cycle followed by prognostic conclusion upon future pregnancy.

EFFECT: higher accuracy of diagnostics.

2 ex

FIELD: medicine.

SUBSTANCE: method involves determining spontaneous blood platelets aggregation and one induced by adrenalin and collagen, thrombocytospecific peptides activity of β-thromboglobulin and thrombocytic factor 4 in blood plasma.

EFFECT: high accuracy of diagnosis.

2 tbl

FIELD: medicine.

SUBSTANCE: method involves determining coagulating blood viscosity values like reaction period r, thrombin constant K, maximum amplitude MA, time T for forming fibrin-thrombocytic blood clot, spontaneous blood platelets aggregation intensity Ar, retraction and spontaneous clot lysis total FA. The r being within 5-7 min, Ar from -2 to -6 relative units, K being within 4-6 min, MA within 500-700 relative units, T within 40-60 min and FA equal to 10-20%, low inflammatory process activity is considered to be the case. The r being less than 5 min, Ar equal to -8 to -12 relative units, T less than 40 min and FA less than 10% with no changes in K and MA being observed, inflammatory process activity in chronic glomerulonephritis case is considered to be of high severity degree.

EFFECT: high accuracy of diagnosis; enhanced effectiveness of treatment method selection.

1 dwg

FIELD: medicine, clinical neurology, neurosurgery.

SUBSTANCE: one should study both activation and aggregation of thrombocytes in blood of carotid artery, at the quantity of thrombocytic active forms being above 70% and the number of aggregated thrombocytes being above 9.0% one should predict the development of cerebral ischemic lesion along with stable focal neurological symptomatology, and at the quantity of thrombocytic active forms being below 30% and the number of aggregated thrombocytes being below 8.0% it is possible to predict positive dynamics in the course of the disease mentioned without developing cerebral ischemic lesion.

EFFECT: higher accuracy of prediction.

2 ex

FIELD: medicine, clinical neurology, neurosurgery.

SUBSTANCE: one should study the level of von Willebrand's factor in patient's carotid artery blood. At its content being below 105% one should predict the development of repeated AICH. The innovation improved information value of testing due to possibility to obtain reliable prediction in latent period, as well.

EFFECT: higher accuracy of prediction.

2 ex, 1 tbl

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