Method of assessment hearth acute odontogenic inflammation

 

(57) Abstract:

The method can be used in medicine, in particular in dentistry, and is used for assessment of acute odontogenic inflammatory diseases. By electron paramagnetic resonance researched oral fluid, it was evaluated the antioxidant activity of the organism - the ratio of the ratios of the intensities of the signals ceruloplasmin/transferrin (CPU/Tr) in oral fluid, consistent with its informative to reach the diagnostic threshold 17,25. When the value of the coefficient of ceruloplasmin/transferrin less 17,25 predict acute odontogenic periostitis, while values greater of 17.35 - acute odontogenic osteomyelitis and acute odontogenic osteomyelitis from cellulitis. The method provides increased sensitivity of the method, the acceleration of its execution and non-invasive. 3 Il., table 1.

The invention relates to medicine, namely to dental surgery.

The purpose of the invention is to develop a new method for assessment of inflammation in acute odontogenic inflammatory diseases (OOVS).

One of the significant manifestations OOVS are:

1) bre the body.

In the first case - it is dangerous from a proliferation of purulent process beyond the hearth OOVS.

In the second case, there is a depletion of the antioxidant defense system of the human body: increased lipid peroxidation (LPO) [3], reduces the content - tocopherol (vitamin E) [4].

Known laboratory test that was used to assess the condition of the hearth OOWS [4].

The prototype indicates that for the three forms OOVS maxillofacial region (CLO), namely: abscesses, phlegmon and chronic osteomyelitis, accompanied by the development of the syndrome lipid hyperoxidation, manifested in the increase in hydroperoxy lipids (CSR) in plasma and red blood cells on the background of low - tocopherol. Such high activity FLOOR, according to the authors, reflects significant structural and functional changes of cell membranes.

To assess the condition of the hearth OOVS us was elected to the method of electron paramagnetic resonance (EPR). The application of this method for analysis of saliva and blood can solve two problems at once:

1) to assess the degree of change in the barrier function of the tissues surrounding the hearth OOWS;

2) to evaluate the antioxidant dstanley non-enzymatic antioxidant system (AOS) of the body. The CPU performs diverse functions, in particular, it is the main serum antioxidant and circulating in the blood, intercepts excess free radicals (SRS), and inhibits the FLOOR. Tr - main component - globulin fraction, involved in the regulation of the content of free iron in the plasma, binding in the extracellular environment of Fe3+, Tr prevented the passage of free-radical reactions, which can lead to the formation of toxic products in the FLOOR.

The higher the ratio of the line CPU and Tr in the EPR spectrum, the higher the antioxidant activity of blood. The state of the antioxidant system CPU/Tr regarded as a valuable diagnostic criteria in various pathological conditions involving destruction of cells [1].

In the literature we have found the use of the definition of the ratio of CPU/Tr as a diagnostic test when OOVS, so we can say that our application has priority.

A detailed comparison of the proposed method and the method of the prototype allowed us to identify several advantages of our method, namely:

1. He reinvasion, since it requires drawing blood. This is important in terms of the danger of Contracting AIDS, Gaponov/cm3at that time, as the sensitivity of the method, the proposed prototype, 1 Ámol/l

3. Obtaining a biological sample of oral fluid for 5 minutes.

4. The start time of the measurement parameter CPU/Tr (saliva) to get the result - a few minutes.

5. Determination of the coefficient of CPU/Tr gives an objective view about the antioxidant capacity of the body with great accuracy. While the method proposed by the prototype, it is impossible to estimate the antioxidant capacity of the body, as it allows you to define only the degree of depletion of the antioxidant system of the organism.

6. The proposed method allows the differential to assess the condition of the body from the point of view of its antioxidant activity in General, and the state of the barrier tissues around the hearth OOVS.

7. Specific contribution to the antioxidant activity of the ions of Cu2+and Fe3+determined using the proposed method, significantly more:

1) concentration in oral fluid [2] Cu = 1168 ng/ml; Fe - 60737 ng/ml

2) concentration in blood plasma Cu - 0,0170,02 Ámol/l; Fe - 15,90,3 Ámol/L. At that time, as the concentration of vitamin E in plasma, determined way, pre is the odontogenic osteomyelitis and the abscess. Consequently, the possible differentiation of periostitis from osteomyelitis, odontogenic phlegmon.

Research methods

1. EPR study of oral fluid.

The patient pre-rinse with water and boiled water in an amount of 200 ml within 5 minutes of the Oral fluid type in a dry test tube in the amount of 3.0 ml 1 ml oral fluid are thoroughly mixed with 0.1 ml of glycerol with a glass rod in a glass container with a volume of 1.0 ml, the mixture using a dry glass pipette is introduced into the quartz capillary, which is placed in liquid nitrogen. Register EPR spectrum. Apply low-temperature EPR technique (check 20-40oK) using a spectrometer ER-200 SPC "Bruker (Germany). Ceruloplasmin (Cu2+) and transferrin (Fe3+) are identified by the EPR signals with g 2.05 and 4,3 g, respectively. The antioxidant activity of the organism judged by the ratio of the intensities of the signals ceruloplasmin/transferrin in the oral fluid.

Were examined in 4 groups of patients:

1. With acute odontogenic the periostitis is 3 people.

2. With acute odontogenic osteomyelitis of 3 persons.

3. With odontogenic a phlegmon - 7 people.

of.

Let us look at examples from each group.

1. Patient Efimov, L. L., 57 years old, was hospitalized in the Department of maxillofacial surgery, emergency hospital 20.05.97, within 8 days from the onset of the disease with a diagnosis of acute purulent periostitis of the lower jaw to the left.

Medical history: 12.05.97, sick tooth, the next day there was swelling in the left lower jaw 18.05.97, the patient was referred to the dental clinic, where he was removed were peristome. Improvements followed. The patient was referred to the maxillofacial Department of the emergency hospital, where he was hospitalized.

The General condition for admission satisfactory, body temperature within normal limits. The patient underwent a course of antibacterial, anti-inflammatory therapy, physical therapy: UHF N 6.

The dynamics of changes in blood composition was as follows:

20.05.97, - erythrocytes - 4,2 1012, hemoglobin 140,6 g/l, leucocytes - 5,4 109, stab neutrophile leucocytes - 8%, segmented - 62%, monocytes - 5%, lymphocytes 25% ESR - 20 mm/hour.

27.05.97, - erythrocytes - 3,8 1012the hemoglobin is 125.8 g/l, colour index - 0.99, and the leukocyte - 3,5 109, stab neutrophil leukocyte is 27.05.97, pathological changes is not defined.

The ratio with the CPU/Tr was as follows: within 1 day upon receipt in the oral liquid CPU/Tr = 45,5/3,2 = 14,21 (Fig. 1).

The patient was discharged in good condition with recovery. Total hospital bed days - 10.

2. Patient Davletshin, A., 47, was hospitalized in the Department of maxillofacial surgery, emergency hospital 14.05.97, after 3 days from the onset of the disease, with a diagnosis of acute odontogenic osteomyelitis of the maxilla on the left.

The General condition for admission satisfactory, the body temperature of 37.5oC. prior To admission in the dental clinic 13.05.97, and 14.05.97, were removed teeth were peristome. 14.05.97 g in the case of hospitalization conditions potentiated infiltration anaesthesia with 1% solution of novocaine - 5,0 extend existing wounds, pus has been received, the wound drained. Had a course of antibiotic therapy (gentamicin 0,08 3 times a day for 7 days), desensitizing (diphenhydramine 1% - 2.0 and analgin 50% to 2.0 for 2 days at night), physical: UHF N-6. Temperature is normalized 16.05.97, the Dynamics of changes in blood composition was as follows:

14.05.97, - erythrocytes 4,5 1012, hemoglobine - 1%, monocytes - 1%, lymphocytes - 27%, ESR - 15 mm/hour.

27.05.97, - erythrocytes - 3,91 1012the hemoglobin - to 130.1 g/l, colour index - 0.99, and the leukocyte - 3,8 109, stab neutrophile leucocytes - 2%, segmented - 57%, eosinophil - 3%, monocytes 5%, lymphocytes 33-%, -ESR - 20 mm/hour.

In the General analysis of urine from 21.05.97, pathological changes, in addition to reducing the specific weight up to 1005, was not found.

The ratio of CPU/Tr was as follows: within 1 day upon receipt in the oral liquid CPU/Tr = 47,1/2,3 = 20,478 (Fig. 2).

The patient was discharged in satisfactory condition with recovery. Total hospital bed days - 13.

3. Patient Tsarev O. B., 34 years old, was hospitalized in the Department of maxillofacial surgery, emergency hospital 05.03.97, after 7 days from onset of illness with a diagnosis of acute odontogenic osteomyelitis of the mandible to the left of odontogenic phlegmon kralovice-jaw space.

Total status at entry was satisfactory, the body temperature of 37.5oC. 05.03.97, under General anesthesia was performed the autopsy phlegmon from the skin, resulting pus, the wound drained; deleted 06.03.97, the patient's condition deteriorated, appeared soreness n is L to 4 times a day), then 07.03.97, the condition had improved, the temperature normalized - 10.03.97, underwent a course of antibiotic therapy (gentamicin - 0,098 3 times a day for 14 days), desensitizing (diphenhydramine 1% - 2,0 2 times a day for 2 days), physical: UHF N 6.

The dynamics of changes in blood composition was as follows:

05.03.97, - erythrocytes - 5,0 1012the hemoglobin - 161,3 g/l, leucocytes - 9,2 109, stab neutrophile leucocytes - 3%, segmented - 72%, monocytes - 2%, lymphocytes - 23%, ESR - 29 mm/h.

12.03.97, - erythrocytes - 5,47 1012the hemoglobin - 166,8 g/l, colour index - of 0.91, leukocytes - 5,2 109, stab neutrophile leucocytes - 8%, segmented - 52%, eosinophil - 3%, monocytes - 1%, lymphocytes - 36%, erythrocyte sedimentation rate of 14 mm/hour.

In the biochemical analysis of blood from 07.03.97, and 12.03.97, and in the General analysis of urine from 06.03.97, abnormalities were not found.

Triglycerides from 07.03.97,: prothrombin index - 100%, ABP 242, ethanol test +, fibrinogen - 5,0, TT - VI, fibrinolytic activity is 4.5. 12.03.97, - prothrombin index - 13%, ABP - 46, ethanol test is negative, TT - VI, fibrinogen - 4,5, fibrinolytic activity to 5.0.

The ratio of CPU/Tr was as follows: 1 the flax able to improve outpatient aftercare. Recommended mechanotherapy.

As seen from the above examples, the value of the coefficient of CPU/Tr increases in the number of nosological forms: periostitis - osteomyelitis - osteomyelitis from cellulitis.

Therefore, using the ESR method in the analysis of oral fluid for assessment of the hearth OOVS and condition of the AOC of the human body is more suitable that allows you to recommend its use as a diagnostic test when OOVS maxillo-facial area.

The sources of information.

1. Bakeev R. F. Destruction of tissues and blood clotting. Kazan, 1994, S. 217.

2. Bunny C. E., Bakirov, W. T. the Content of chemical elements in a mixed restimulating the saliva of a healthy person. Dentistry, 1991, 70, N 1, p. 14 - 17.

3. Rahimov H. R., Zakharov Centuries, Sergeev Y. N. Assessment of current early process field of surgical interventions on the soft tissues of the face and neck on indicators of free radical oxidation in peripheral blood. Dentistry, 1990, No. 4, S. 40 - 42.

4. Suleymanova, S. , Saidbekov O. S., Alekperov N. In. Status of lipid peroxidation with purulent-inflammatory diseases of maxillofacial area. Dentistry, 1992, No. 1, S. 36 - 37 the bone of the patient by the method of electron paramagnetic resonance (EPR), characterized in that evaluate the antioxidant activity of the organism on the ratio of the ratios of signal intensity of ceruloplasmin (CP) / transferrin (Tr) in oral fluid, consistent with its informative to reach the diagnostic threshold 17,25, namely: if the value is less 17,25, predict acute odontogenic periostitis, and a value greater than 17,25, predict acute odontogenic osteomyelitis and acute odontogenic osteomyelitis from cellulitis.

 

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