Method for pre-operative detection of operation extent in patients with diffuse toxic goiter

FIELD: medicine.

SUBSTANCE: pre-operative fasting venous blood 1 ml is sampled at room temperature 20-24°C into an anticoagulant-free vacuum system (test tube). The test tubes are delivered in a sealed container at temperature 2-8°C for 2 hours to a laboratory for immunoenzyme assay and analysed to determine anti-thyroid stimulating hormone receptor antibodies. If the antibody level is 1.5 units/l or more, a thyroidectomy is performed, whereas the antibody level of less than 1.5 units/l requires performing a subtotal thyroid resection according to standard techniques.

EFFECT: invention enables reducing a probability of recurrent thyrotoxicosis in the patients after subtotal thyroid resection.

1 ex

 

The invention relates to medicine, namely to surgery and can be used to select the extent of surgery in patients with diffuse toxic goiter (DTG).

The problem of surgical treatment of patients with graves ' disease at the present stage is that the choice of optimal operation in a certain patient is not finally resolved.

Today there are 2 known approach to surgical treatment of patients with diffuse toxic goiter. The first approach is that patients DTZ performed Subtotal resection of the thyroid gland. Sick leave of thyroid tissue in the form of residue 2-6 G. the Problem with this approach is that 10-30% of patients have a relapse of the disease (Romanchishen A. F. surgery of the thyroid and parathyroid glands. - SPb.: PKI News, 2009. - 648 p.).

It should be noted that despite a high rate of disease recurrence after Subtotal resection of the thyroid gland, in many patients after surgery are able to achieve EU - and hypothyroid States. Therefore, we can conclude that in order to perform this operation requires strict patient selection.

The second approach is that patients DTZ remove the entire gland. This completely eliminates the possibility of disease recurrence. The problem with this approach is that in the postoperative period often develops paresis of the larynx (Il'ichev E. A. soavt. Clinical features of the larynx paresis after surgical treatment of diffuse toxic goiter. Journal of otolaryngology, 2011. - No. 3. - p. 51-54), hypoparathyroidism (Kuznetsov N. With.et al. Predictors of postoperative hypoparathyroidism after thyroidectomy and its treatment. - Clinical and experimental thyroidology, 2012. - V. 8. - No. 2. - S. 20-30).

The known method of determining the extent of surgery in patients with graves ' disease using invasive IR photosindiana thyroid tissue intraoperatively (Volodchenko V. P. Surgical treatment of diffuse toxic goiter, and methods of correction of postoperative functional disorders. Author. dis... doctor. honey. Sciences. - Khabarovsk, 2005. - p. 19-20). The inventive method is that during the surgery is photosindiana thyroid tissue and the analysis of the reflection coefficient. The detection of tumor formation on the background of diffuse toxic goiter patients are offered to perform thyroidectomy or epifascial Subtotal resection of the thyroid gland. In patients with diffuse changes in the thyroid tissue is performed Subtotal resection of the thyroid gland. Method of determining the extent of surgery in patients with graves ' disease using invasive IR photosindiana thyroid tissue intraoperatively taken by us as a prototype.

The disadvantages of this method from�esti, it may apply only during the operation and patient before surgery not reported how much the intervention will be performed. In addition, this method for determining the extent of surgery is based only on the morphological changes of the organ and does not take into account functional status (degree of autoimmune stimulation of the thyroid gland in patients with graves ' disease).

The object of the present invention is preoperative determination of the extent of surgery in patients with diffuse toxic goiter and reduced the number of postoperative complications.

This is achieved in that before the operation the patient DTZ determine the level of antibodies to the TSH receptor and on the basis of the results determine the amount of required operations.

The method is carried out as follows. In a patient with diffuse toxic goiter after determining the indications for surgery (recurrent, severe, intolerance of thyreostatics) and assess the degree of compensation of the disease (examine the level of free T4) take 1 ml of venous blood fasting during the room temperature of 20-24°C in vacuum system (tube) without anticoagulant and transported to the laboratory for enzyme-linked immunosorbent assay for 2 hours in an airtight container at 2-8°C and determine the level of antibodies to the TSH receptor in the patient's blood DTZ. Dimension p�otvoditsya in U/l (unit per liter). In the next phase, evaluate the obtained results. Values less than 1.5 IU/l is interpreted as negative, and greater than or equal to 1.5 IU/l is interpreted as positive.

When values of this index greater than or equal to 1.5 IU/l in patients predict a high risk of the recurrence of the disease while leaving the balance of any thyroid volume and such patients perform a complete removal of the thyroid gland (thyroidectomy).

When the level of antibodies to the TSH receptor is less than 1.5 IU/l predict a low risk of relapse of hyperthyroidism in the postoperative period. This group of patients is performed Subtotal resection of the thyroid gland with preservation of conventional amounts of thyroid remnant (2-6 ml).

Fundamentally in our proposed approach, before the operation it is necessary to investigate the immunological reactivity of the patient diffuse toxic goiter, namely, antibodies to the TSH receptor. This rate of each individual patient. And, hence the choice of the necessary volume of operation will be strictly individualized. Ultimately it will provide a stable remission, the absence of relapse of hyperthyroidism and minimization of specific postoperative complications.

The proposed method of determining the extent of surgery patients DTZ used in the clinic of faculty surgery Itself�MU since 2009 and has been used to determine the amount of surgery in 122 patients. 56 of them were performed Subtotal resection of the thyroid gland. All patients preoperative prediction coincided with postoperative results. The follow-up period ranged from 1 to 5 years. Recurrence of thyrotoxicosis in patients after Subtotal resection of the thyroid gland is not.

Clinical examples.

Patient Konnova L. 62 years admitted to the clinic of faculty surgery Samara state medical University 01.02.11. After the examination (ultrasound of the thyroid gland, a study of hormonal) diagnosed as diffuse toxic goiter of II degree. Thyrotoxicosis, severe, recurrent, drug subcompensated. As preoperative preparation the patient received tyrosol in the dosage of 10 mcg/day. The patient in another surgical hospital of the city was proposed to perform thyroidectomy, from which she abstained. When you receive investigated the level of antibodies to the TSH receptor, which was 0.3 U/l (less than 1.5), suggesting a low degree of autoimmune stimulation of the thyroid tissue. 10.02.2011 performed surgery - Subtotal resection of the thyroid gland according to Nikolaev, the amount of thyroid remnant was 1.8 ml (by intraoperative ultrasound). Postoperative paresis of the larynx has not developed, the level of calcium in the blood without lowering. Viewed through 3.5 years of relapse ti�of toxicosis after surgery no. Takes L-thyroxine 50 µg/day.

Thus, the method of preoperatively determining the extent of surgery in patients with diffuse toxic goiter can reduce the number of thyroidectomy and to minimize the likelihood of recurrence of thyrotoxicosis in patients after Subtotal resection of the thyroid gland due to the clear definition of the indications for this operation.

Method of preoperative determination of the extent of surgery in patients with diffuse toxic goiter, including definition of indications for surgery (recurrent, severe, intolerance of thyreostatics) and the assessment of the degree of compensation of the disease, characterized in that in patients before surgery taking 1 ml of venous blood fasting during the room temperature of 20-24°C in vacuum system (tube) without anticoagulant and transported to the laboratory for enzyme-linked immunosorbent assay for 2 hours in an airtight container with the temperature of 2-8°C and determine the level of antibodies to the TSH receptor, when antibody levels greater than or equal to 1.5 IU/l the patient perform thyroidectomy, when antibody levels less than 1.5 U/l the patient perform a Subtotal resection of the thyroid gland by standard methods.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to a method for the prediction of a risk of early microvascular complications in the children suffering from type 1 diabetes mellitus. The substance of the method consists in defining a duration of the diseases in years, the patient's age in years, a desquamated endothelial cell count, high-density lipoprotein cholesterol, total cholesterol, triglycerides, atherogenic index, glycohaemoglobin, average daily glycaemic level; making a linear regression analysis and calculating a risk ratio (R) of early microvascular complications in the children suffering from type 1 diabetes mellitus by formula. If the risk ratio is ≥1, the high risk of early microvascular complications during one year is predicted; the ratio < 1 shows the low risk of microvascular complications during one year.

EFFECT: using the declared method enables increasing the prediction accuracy of microvascular complications in the children with type 1 diabetes mellitus.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: group of inventions refers to medicine and can be used for patient's status monitoring. A method for setting a time-varying physiological parameter warning signal involves patient's controlled parameter monitoring, comparing the controlled parameter to an initial cut-off criterion, varying the cut-off criterion temporarily by a cut-off criterion of deterioration after the therapy, and then after a certain period of time, by the cut-off criterion after the administration. The time allowed involves comparing the controlled parameter to the cut-off criterion of deterioration, and after the time allowed - to the cut-off criterion after the administration. The warning signal is initiated in response to the controlled parameter of one or more initial cut-off criteria, the cut-off criterion of deterioration and the cut-off criterion after the administration. The group of inventions also refers to a machine-readable carrier with software for implementing the method and to a system for user warning on the controlled parameter variation.

EFFECT: group of inventions provides higher accuracy and rate of assessing the patient's status according to the conducted therapy.

15 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: invention can be used for the purpose of the early prediction of cystic periventricular leukomalacia (PVL) in the newborns with very low (VLBW) or extremely low body weight (ELBW). Substance of the method: the newborns with VLBW and ELBW on the 3rd-7th day of life are examined to assess the perinatal medical history, namely the presence of chorioamnionitis and amniotic fluid nature, 5th minute Apgar score, the absence of prolonged artificial pulmonary ventilation, a severity of respiratory distress syndrome, the presence of pneumonia, sepsis, convulsive disorder, anaemia, laboratory signs of the systemic inflammatory reaction, average values of carbon dioxide, anionic bicarbonate and base deficiency in capillary blood, interleukine-6 and receptor interleukine-1 antagonist in venous blood serum. Each sign is assigned with a prognostic coefficient (PC). That is followed by determining total PC, and it is expected cystic PVL that is decided for if total PC is at least (+)9.5, whereas no cystic PVL is expected if total PC is (-)9.5 or less.

EFFECT: invention provides the early (for the first 7 days of life) prediction of cystic periventricular leukomalacia in the most susceptible category of patients that are children with very low and extremely low birth weight.

6 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: interferon is measured in plasmocytoid dendrite cells at week 12 of the treatment. Its gain in adults and children twenty times as much as compared to the pre-treatment initial level, or 2.6×102 times as much in adults, and 1.2×102 as much as compared to the normal values, the stable positive antiviral treatment response is predicted.

EFFECT: method enables providing the more accurate prediction for selecting the optimum therapeutic approach in each patient.

4 ex

FIELD: medicine.

SUBSTANCE: invention represents a method for assessing the mucosal immunity state of open cavities accompanying the prediction of the clinical course of infectious-inflammatory processes, characterised by the fact that having a pathogenetic factor established, degrees of microbiocoenosis disturbances of a specific biotope are recorded with the use of a complex of methods for estimating colonisation resistance factors, namely normal microflora, opportunistic microflora, immunoglobulins G, M, A, secretory immunoglobulin A and sc component; the mucosal immunity state is assessed according to the degree of microbiocoenosis disturbance, and the favourable outcome implying agent eradication or chronisation with agent persistence is predicted. The invention also refers to a method for correcting the infectious-inflammatory processes with the Kipferon® immunomodulator added.

EFFECT: increasing the prediction accuracy of the clinical course of the disease, extending the range of the method for correcting the infectious-inflammatory processes.

2 cl, 3 ex, 6 tbl, 1 dwg

FIELD: medicine.

SUBSTANCE: content of calcium and protein in oral liquid is determined before and after physical load, as well as a day after physical load. Recovery of content of calcium ions and protein in oral liquid after physical load to initial values is considered to be a criterion of total recovery of athlete's-volleyball player's organism, with evaluating time interval, required for said process.

EFFECT: invention makes it possible to determine reserve abilities of organism and its adaptability in athletes-volleyball players to physical load.

2 dwg, 4 tbl

FIELD: medicine.

SUBSTANCE: invention relates to the field of veterinary and can be used to diagnose the presence of a pathological effect of iron dextran on the piglets' liver. The essence of the method consists in carrying out the morphological systemic step-by-step analysis of histological liver cuts with the description of its histological structure, measurement of the average quantity of binucleate hepatocytes, apoptotic bodies and cells of the mononuclear-macrophage system. If the complex of pathognomonic morphological changes, including the presence of blood filling of sinus capillaries, oedema of the Disse's space; swelling of the vascular endothelium, granular dystrophy of hepatocytes, increase of the average quantity of cells of the mononuclear-macrophage system, including haemosiderophages by two times and more, as well as an increase of the quantity of binucleate hepatocytes and apoptotic bodies by 2 times and more, the effect of iron dextran on the piglets' liver condition is considered to be pathological.

EFFECT: invention provides an increased accuracy of the post-mortem diagnostics of the presence of a pathological effect of iron dextran on the piglets' liver.

1 tbl

FIELD: medicine.

SUBSTANCE: after thymomegalia has been excluded, tissue specimens of three-day-old mature newborns are studied to evaluate areas of inflammation changes in points in the placental umbilical cord (A), in the foetal placenta (B), in the maternal placenta (C), in extraplacental membranes (D); then thymomegalia is predicted by a discriminant equation: DE=-0.350×A-1.176×B-1.690×C-1.203×D, wherein DE is a discriminator function with a threshold equal to - 15.00. If DE is equal to or more than the threshold, the absence of thymomegalia is predicted; if D is less than the threshold, thymomegalia is predicted, whereas the score is taken at: (A) - 1 point - no inflammation, 2 points - amnionitis, 3 points - leukocytic infiltration in the Wharton's jelly, 4 points - phlebitis, 5 points - arteriitis, 6 points - a combination of two or more areas of inflammation: in blood vessels or in vessels and in the Wharton's jelly, (B) - 1 point - no inflammation, 2 points - chorioamnionitis, 3 points - villusitis, 4 points - vasculitis, 5 points - intervillesitis, 6 points - a combination of two or more areas of inflammation, (C) - 1 point - no inflammation, 2 points - villusitis, 3 points - vasculitis, 4 points - intervillesitis, 5 points - deciduitis, 6 points - a combination of two or more areas of inflammation, (D) - 1 point - no inflammation, 2 points - amnionitis, 3 points - chorioamnionitis, 4 points - deciduitis, 5 points - choriodeciduitis, 6 points - a combination of two or more areas of inflammation.

EFFECT: enabling the prediction of thymomegalia in the three-month-old mature newborns suffered prenatal influenza B complicated by placentitis.

2 ex

FIELD: veterinary medicine.

SUBSTANCE: method consists in determining in the scales of concentration of Mn and/or Cu by the method of atomic-emission spectrometry. The regression equation is calculated, and on the content of Mn and/or Cu in the scales a copper concentration is determined.

EFFECT: method is accurate, atraumatic and non-invasive, simple and easy to use.

3 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: after the ablation of the spleen, its weight is determined, the average area of a marginal zone of the spleen in histological cuts with coloration with hematoxylin and eosin is measured morphometrically. The obtained values are used to calculate the weight of the marginal zone and, if its values are ≤1.9 g, a favourable prognosis for the course of aplastic anaemia is made, if its value is >1.9 g, an unfavourable course of the disease is predicted.

EFFECT: prognosis of the aplastic anaemia course after splenectomy independent on the severity of the disease with the possibility to approach therapeutic treatment in a differential way.

2 ex

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. A laparoscopic surgical device contains a detachable instrument. The instrument contains an external rod and an internal drive plunger, which can be connected to each other in a detachable or a non-detachable way. The handle of the device contains a two-button mechanism for the engagement and release of a detachable, tool-containing rod. The two-button mechanism is made with a possibility of engagement with matching holes of the external rod and the internal plunger, which extends through the external rod.

EFFECT: handle contains a convenient in operation locking device, which provides the reliable fixation and convenient detachment of the tool end unit.

20 cl, 5 dwg

FIELD: medicine.

SUBSTANCE: left total nephrectomy is performed. A kidney is approached by forming an oval window into a mesocolon of a descending colon. The window area is limited by: v. mesenterica inf, arcus Riolani, a. colicae sin and a tail of pancreas. A ligament of Treitz, a peritoneum and mesocolon tissues are incised. A free oval area of the mesocolon and peritoneum are left on the kidney. The kidney is evacuated through the mesocolon window. The mesocolon is left open. A strand of a greater omentum is placed into a retroperitoneal cavity formed after the kidney has been removed. In specific case, the kidney is mobilised together with an adrenal gland.

EFFECT: method enables optimising the surgical procedure by eliminating the stage of intestinal mobilisation, leads to the fastest postoperative intestinal functional recovery.

3 cl, 2 ex

FIELD: medicine.

SUBSTANCE: peritoneum and mesocolon tissues of a descending colon are incised above an involved region and above a vascular renal pedicle to perform a left partial nephrectomy. Through the local mesocolon incision above the vessels, a renal artery is filopressed and compressed for thermal ischemia. A new growth is incised and evacuated through the mesocolon incision made above the involved region of the kidney.

EFFECT: method provides the ergonomic approach through a minimum thickness of the mesocolon tissues, minimises the risk of intestinal and splenic injuries and development of complications, ensures the fast postoperative intestinal functional recovery.

2 cl, 2 ex

FIELD: medicine.

SUBSTANCE: planned skin incision is first configured on an anteriolateral neck surface by projection zoning of a clavisternomastoid and a neck median line to be marked with colour graphic lines. A first line extends along a medial border of the clavisternomastoid. A second line extends from a suprasternal notch to the middle of a hyoid shaft. Both of the lines are then combined by drawing a perpendicular third line from a lower border of the middle of a hyoid shaft to the medial border of the clavisternomastoid, thereby forming a projection triangle. Cutaneofascial layers, platysma and subcutaneous fat are incised along the first and third lines to cut out a musculocutaneous flap, which is brought outwards. Underlying soft tissues are dissected to an anterior surface of cervical spinal bodies by splitting subcutaneous fat between a neurovascular bundle and a pharynx, detaching an intracervical fascia, splitting perioesophageal subcutaneous fat and displacing midline organs of the neck in the medial direction, and the neurovascular bundle - in the lateral direction.

EFFECT: method enables reducing a risk of treatment-induced traumatic injuries of the midline organs of the neck, an upper laryngeal nerve, upper and lower thyroid arteries, as well as a parenchyma and an excretory duct of a submandibular salivary gland with optimising topographo-anatomical relations of the incision wound structures, thus providing a surgical angle approaching 90 degrees.

1 ex

FIELD: medicine.

SUBSTANCE: muscle of the neophallus is mobilised. A corset is formed intra-operatively according to the diameter and length of a mobilised muscle from a mesh with non-absorbable polypropylene 0.5-0.6 mm thick monofilaments, with the porosity of 85-90%, with run-proof edges in case of resection. The muscle is circularly wrapped up with the formed corset.

EFFECT: provision of the sufficient rigidity of the neophallus and elimination of its deformation due to the application of the corset, formed from the mesh with non-absorbable polypropylene monofilaments.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to sealing device for reparation of heart defect and vessel diseases in the process of performing surgical operations for treating such diseases as patent foramen ovale (PFO) or heart stunt, vascular system diseases, etc. Sealing device contain stretchable frame ad sealing element. Frame contains multitude of wires, each of which passes from proximal end to distal end of frame. First and second segments from multitude of wires form wound proximal loop and distal loop respectively. Multitude of wires form proximal disc and distal disc when sealing devise is extended. Proximal disc and distal disc are located between proximal and distal loops. Each wire from multitude of wires forms respective petal of proximal disc and respective petal of distal disc. Respective petals form zones of overlapping and unsupported sections. Sealing element, at least, partially encapsulates extending wire frame.

EFFECT: invention has improved compatibility with heart anatomy, it is easier to extend, reposition and return into initial condition in the place of opening.

25 cl, 16 dwg

FIELD: chemistry.

SUBSTANCE: invention refers to medicine, namely surgery, and can be used for treating aseptic pancreonecrosis. Intra-organic pulseless pancreatic segments are localised and removed. To cover the pancreas, a greater omentum is incised into two portions - 1/3 from the left and 2/3 from the right up to a base of the greater omentum. Segments with pulse oscillation amplitude not less than 3.0 mm in the left 1/3 of the greater omentum and not less than 2.0 mm in the right 2/3 of the greater omentum are localised. The left portion in the distal segment is anchored with U-sutures to peripancreatic subcutaneous fat, whereas the right portion in the distal segment is anchored to a right hepatic lobe.

EFFECT: method enables arresting the disease progression and preventing infected pancreatic necrosis, improving pancreatic tissue blood supply by detecting the intra-organic pulse, removing all necrotic portions of the pancreas and using the greater omentum to cover the pancreas.

3 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: distal pancreas resection is performed. That involves transecting a parenchyma to the right from a superior mesenteric vein. That is followed by a resection of an anterior surface of the pseudocysts of the head of pancreas. A Roux pancreatocystojejunoanastomosis with isolated enteric loop is created.

EFFECT: reduced intraoperative injuries and risk of postoperative complications, lower extent of the operation, preserved portion of the pancreatic parenchyma and physiological passage of food and bile in the gastrointestinal tract by the distal pancreas resection and created pancreatocystojejunoanastomosis with the cyst walls and the anterior surface of the head of pancreas.

1 ex

FIELD: medicine.

SUBSTANCE: invention refers to systems for applying a filling material onto a working surface and can be used for applying a multicomponent compound, such as a surgical filling material for a tissue mass. A mixture feed device comprises a Luer mandrel sub-assembly, a cannula and a nozzle atomiser sub-assembly. The Luer mandrel sub-assembly is formed to contact at least two containers and forms the first and second fluid pipes of the mandrel for facilitating the flow of the first and second components. The cannula comprises the first and second cavities carrying the fluid. Each cavity is fluid connected to one of the first or second fluid pipes of the mandrel. The nozzle atomiser sub-assembly is arranged at the end of the cannula and involves at least a part of a nozzle insert placed into a nozzle cap. The nozzle cap has an end wall with an outlet therein. The nozzle insert and nozzle cap form at least three feed channels and are configured to limit at least three fluid passages in three respective feed channels. Each of the three feed channels is fluid connected to the fluid passage.

EFFECT: more effective mixing of the components, prevented cross-contamination of the components and facilitated fluid feed.

12 cl, 25 dwg

FIELD: medicine.

SUBSTANCE: invention refers to traumatology and orthopaedics and is applicable for joint drainage in revision endoprosthesis replacement. A drain tube is inserted into a wound with implanting a bone cement spacer containing an antibiotic. Within the first 24-48 postoperative hours, the fluid content is actively gradually evacuated from the postoperative wound every hour for 10-15 minutes.

EFFECT: method enables increasing the antibacterial effect.

FIELD: medicine.

SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.

EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.

5 cl, 1 dwg

Up!