Method of microsurgical treatment of varicocele
SUBSTANCE: discission of the skin and a subcutaneous fat of 2-3 cm in the projection of the external hole of the inguinal canal is performed. Spermatic cord is isolated and is taken on the holder. It is separated by a conventional longitudinal median line into the medial and lateral halves, followed by Doppler locating of each of them to reveal the testicular artery. Shells of the spermatic cord are dissected. A separate isolation and detailed Doppler exploration of each of the vessels of the half in which the artery was previously identified with the identification and preservation of all its branches are performed, as well as the ligation of all the remaining vessels of this and the opposite half of the spermatic cord.
EFFECT: method allows to reduce the frequency of the postoperative atrophy of the testicle and to reduce the likelihood of recurrences of varicocele.
2 cl, 1 ex, 4 dwg
SUBSTANCE: technique involves foetus's middle cerebral artery Doppler ultrasonography prior to and after a pregnant woman holds her breath as much as possible at a depth of inhale. Diagnostically significant indices of blood velocity curves resistance in the foetus's middle cerebral artery that are a systolic/diastolic ratio, a resistance, a pulsation index are measured with a breath-holding test conducted and taking into account foetus's daily rhythmostasis. If the Doppler ultrasound measures are: the systolic/diastolic ratio at 12.00 prior to breath-holding 3.71±0.05, after breath-holding 4.56±0.08 and at 20.00 prior to breath-holding 3.92±0.06, after breath-holding 4.74±0.09; the resistance at 12.00 prior to breath-holding 0.69±0.03, after breath-holding 0.87±0.04 and at 20.00 prior to breath-holding 0.80±0.03, after breath-holding 0.91±0.04; the pulsation index at 12.00 prior to breath-holding 1.78±0.04, after breath-holding 1.92±0.03 and at 20.00 prior to breath-holding 1.84±0.04, after breath-holding 1.97±0.04, changes in the foetus's functional status are detected and chronic foetal hypoxia is diagnosed.
EFFECT: technique enables increasing the diagnostic accuracy in chronic foetal hypoxia by measuring the functional parameters taking into account the time variations of daily rhythmostasis.
SUBSTANCE: common carotid artery (CCA) is scanned. A peak systolic blood flow velocity in the CCA and the beginning of the systolic peak to peak time, a final diastolic blood flow velocity in the CCA, systolic and diastolic CCA diameters are determined. The value K is determined by formula K=(Vs-Vd)·Dd2:[AT·(Dd2-Ds2)], wherein Vs, Vd is the peak systolic and final diastolic blood flow velocities in the CCA respectively, cm/s; Ds, Dd are systolic and diastolic CCA diameters, cm; AT is the time from the beginning of the systolic peak blood flow to its peak, s. If the value K is more than 8,500, the humoral transplanted heart rejection is diagnosed.
EFFECT: method enables increasing the early diagnostic accuracy of the humoral heart rejection by assessing the reliable diagnostic value that is a hardness of the vascular wall of the common carotid artery, and avoiding the invasive diagnostic intervention.
SUBSTANCE: technique involves transabdominal ultrasonography of jejumum and colon in longitudinal and transversal projections. The transabdominal ultrasonography is native with the patient positioned on his/her back. Visualising all the jejuneal segment involves taking intestinal loops without haustra as reference points. haustra are used as reference points for visualising the colon. pulsed Doppler velocimetry is conducted to determine a blood flow velocity in mesenterial arterial branches. A transperineal examination of the anorectal area is performed in the patient placed on his/her left side with bended knees. A sensor is placed into an anal pit directly and displaced from pubic to sacrum while scanning in two projections - longitudinal and longitudinal-oblique. The reference points are sacrum, symphysis, and anal canal. The state of a distal portion of rectal ampulla is assessed. The derived values are compared to the normal criteria. If observing any changes in the jejunum: wall thickening more than 2 mm, higher echogenicity, intestinal lumen narrowing; if observing any changes in the colon: haustra flatness, contour roughness, wall thickening more than 2.5 mm, mucosal thickness more than 1 mm, submucosal thickness more than 0.5 mm, the absence of clear layer differentiation, higher submucosal echogenicity, intestinal lumen narrowing, higher blood flow velocity in the mesenterial arterial branches more than 7.0 cm/sec; changes in adjoining organs: higher echogenicity of the greater omentum, envelopment of the jejuneal and colonic loops involved into the inflammatory process with the omentum, lengthening of the mesenterial, para-aortic lymph nodes more than 10 mm, free abdominal fluid, the changes in the anorectal area: rectal ampulla wall thickening more than 2.5 mm, higher echogenicity of perineal subcutaneous fat, anorectal fistulas and paraproctitis testify to the presence of colonic and jejuneal wall hyperplasia in the involved portions, mesenterial, para-aortic lymph node hyperplasia, reactive changes of the greater omentum, as well as the presence of a perineal inflammation, and Crohn's disease is diagnosed. The changes in the colon only: haustra flatness, smooth contours, wall thickening more than 2.5 mm, mucosal thickness more than 1 mm, submucosal thickness more than 0.5 mm, reduced clear differentiation, lower submucosal echogenicity, no intestinal lumen narrowing, higher blood flow velocity in the mesenterial arterial branches more than 7.0 cm/sec; changes in the adjoining organs: lengthened mesenterial and para-aortic lymph nodes more than 10 mm, no reactive changes of omentum, rectal ampulla wall thickening more than 2.5 mm without involving the perineal region testifies to colonic wall hyperplasia and mesenterial, para-aortic lymph nodes and enables diagnosing non-specific ulcerative colitis.
EFFECT: technique enables performing the early differential diagnosis of chronic inflammatory intestinal diseases by using the accurate qualitative and quantitative ultrasonic criteria.
SUBSTANCE: in case of unilateral cryptorchidism measured is a linear rate index of the blood flow in the medium segment of the recurrent artery of the healthy testicle Vmax1 and testicle in the cryptorchidism condition Vmax2. In case of bilateral cryptorchidism measured is the linear rate index of the blood flow in the medium segment of the recurrent artery of the right and left testicle. As Vmax2 taken is the lower index from the two measurements of the testicle blood flow. As the index of blood flow Vmax1 taken is the lower index of the age norm, constituting for children from 0 to 12 months - 1.2 cm/sec; from 1 to 3 years - 1.5 cm/sec; from 3 to 7 years - 1.8/sec, and for children above 7 years - 2.0 cm/sec. If the difference between Vmax1 and Vmax2 is larger than 25% of Vmax1 index, impairment of haemodynamics, requiring operative treatment, is diagnosed. If the difference is in the range from 15 to 25%, dynamic US-monitoring after 3, 6 and 9 months is required.
EFFECT: method makes it possible to objectify results of USE due to the clear determination of parameters of a threshold value of the blood flow index in the testicle arteries.
2 cl, 3 ex
SUBSTANCE: patient's epicardial fat thickness is measured by transthoracic echocardiography by means of a sector transducer at a frequency of 2,500 MHz on a free anterior wall of the right ventricle. Pulse Doppler imaging is performed to determine the diastolic function of the left ventricle - the E/A ratio measured as a transmitral blood flow velocity in the early diastolic filling of the left ventricle (E peak) to a transmitral blood flow velocity in a left auricular systole (A peak). If the epicardial fat thickness is from 2.7 to 4.5 mm, whereas the E/A diastolic function is less than 0.80, insulin resistance is diagnosed.
EFFECT: higher diagnostic accuracy, as well as wider number of individuals, who had the insulin resistance diagnosis.
1 tbl, 2 ex
SUBSTANCE: invention refers to medicine, namely to oncology and can be used for the prevention and early diagnosis of postmastectomy complications. The m. pectorales major et minor changes are ultrasonically assessed from the left and right in the 2-3 intercostal spaces along the midclavicular line. The muscle thickness and a degree of atrophy are determined. Phlebohaemodynamic disorders are detected by measuring a diameter and a blood flow rate with the use of thick gel pads; in v. subclavia dexter et sinister - along the clavicle between its middle and external one-thirds; in v. basilica dexter et sinister - at the border of the superior and middle one-thirds of the shoulder along the internal surface; in v. cephalica dexter et sinister - at the border of superior and middle one-thirds of the shoulder along the external surface; in v. radialis dexter et sinister - in the inferior one-third of the forearm 1.5-2 cm above the hand along the lateral surface; in v. ulnaris dexter et sinister - in the inferior one-third of the forearm 1.5-2 cm above the hand along the medial surface. An intensity of lymphostasis of the upper extremity is assessed by measuring the thickness of subcutaneous fat within the maximum intensity of oedema and phlebohaemodynamics in the vessels involved into the oedema, and of a symmetrical region of the counterlateral arm prior to and after treatment. The derived data are used to assess the functional disorders of the postmastectomy area.
EFFECT: method enables assessing the degree of structural changes of the postmastectomy area in relation to the healthy side, which makes it possible to predict technical difficulties in surgical repairs, to determine the presence of subclinical phlebohaemodynamic disorders, specifying the level of the maximum blood flow block, and evaluating the effectiveness of corrective actions at lymphostasis.
9 dwg, 2 ex
SUBSTANCE: invention relates to medical equipment, namely to means for performing cardio-pulmonary resuscitation of people. Device for control of cardio-pulmonary resuscitation contains ultrasound converter, unit of electrodes, connected via interface to processor, connected with display, memory unit, sound signaller, unit of light-diode signallers, unit of connection with central control panel unit of operation mode selection, unit of connection with the internet and, via USB interface, with unit of top level software. Device also contains colour television microcamera, connected via successively installed block of signal amplification and filtration and unit of processing and imposing alignment of images to additional processor input/output, illumination unit, pulse measurement unit, gas analyser, unit of microphones with matching unit, connected with processor and power supply unit. Pulse measurement unit and unit of electrodes are made with possibility of fixation on patient by means of fixation unit, with unit of microphones, controlled illumination unit and gas analyser being fixed on patient by means of additional fixation unit. Method of control contains stages of obtaining ultrasound echo signals and electrosignals, characterising blood flow in blood vessel, determination of blood flow characteristic by impedance of neck tissues in the process of performing cardio-pulmonary resuscitation, presentation of sound and visual information about patient/s condition. After that, current information about patient's condition is formed by television images and geometrical and colour characteristics of eye pupil and eye iris are determined, with estimation of colour and geometrical characteristics of blood vessels. Sound laryngeal signals, exhaled gas and patient's pulse are also read and analysed, light signals are used to signal about patient/s condition and patients condition is estimated basing on data of comparison of standard and current information.
EFFECT: application of invention makes it possible to extend functional possibilities, increase operation speed, immediacy and accuracy in performing cardiopulmonary resuscitation.
16 cl, 10 dwg
SUBSTANCE: method for detecting the burn wound granulation readiness for autografting involves the granulation microcirculation by laser Doppler flowmetry to calculate an average microcirculation (M, p.u.). That is combined with combining a granulation microcirculation effectiveness index (MEI). If the MEI is more than 1.6, and M is more than 3 p.u. the reparative ability of the burn wound granulation is considered to be preserved, and the granulation appears to be ready for autodermoplasty. If MEI is less than 1.6 regardless of the value M, the reparative ability of the burn wound granulation is considered to be diminished, the wound requires additional wound cleansing and granulation incision.
EFFECT: method enables providing the higher diagnostic effectiveness of the reparative ability of the tissues, selecting the autodermoplasty time, reducing the rate of transplant rejections and cutting the treatment costs and reducing the length of staying in hospital.
SUBSTANCE: microcirculation is assessed by laser Doppler flowmetry using combined functional tests - thermal postural leg test and thermal postural arm test. Both tests involve recording a microcirculation index. The derived data are saved. An average basic microcirculation from the 10th to 110th seconds is evaluated for the leg and arm tests according to the provided formulas. That is followed by calculating an average relative microcirculation Irel1 and Irel2 during the functional leg exposure according to the presented formulas. If any of the two values Irel1, Irel2 is below standard - Irel1<3.7; Irel2<3.5, the presence of microcirculatory disorders is stated in the person being tested.
EFFECT: method is accurate, simple, enables immediately detecting systemic microcirculatory disorders in the patients suffering carbohydrate metabolism disorders on the basis of available diagnostic tests and measured microcirculation parameters; using the combined functional tests involves most regulatory mechanisms that provides obtaining the reliable microcirculation information from the patients of this category.
2 cl, 2 dwg, 2 ex
SUBSTANCE: triplex scanning of the interlobular artery of the upper kidney pole is performed in clinostasis, and then within the first minute in orthostasis. The acceleration time (Ta), the total time of the blood flow during one cardiac cycle (Tt) are measured, their ratio Ta/Tt in clinostasis and orthostasis is calculated. After that the acceleration time index (ATI) is calculated by the mathematical formula. If Ta/Tt is less than 0.09 and ATI is less than 0, early affection of the kidneys, accompanied by arteriovenous shunting, is diagnosed.
EFFECT: method makes it possible to identify the group of patients requiring prophylaxis or treatment and in this way prevent the development of complications, disability retirement and mortality.
1 dwg, 3 tbl, 4 ex
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.
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
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
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
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.
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.
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
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
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.
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
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