A method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis

 

(57) Abstract:

The invention relates to medicine, namely to surgery and endocrinology, and can be used for assessment of patients with thyrotoxicosis during preoperative preparation. Effect: increased accuracy in assessing the effectiveness of preoperative preparation. Before and after pre-determined quantitative and qualitative indicators of tissue geodynamics of the thyroid gland by ultrasound Doppler studies. Determine the concentration levels of immunoglobulin G and circulating immune complexes in serum. When the normalization is defined indicators consider preoperative preparation of effective and complete when the values above normal in 2-3 times is inefficient and incomplete. table 1.

The present invention relates to medicine, namely to surgery and endocrinology, and can be used for assessment of patients with thyrotoxicosis during preoperative preparation.

There is a method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis /1/ based on clinical indicators: the normalization of the ists: the normalization of the concentration of free hormone - thyroxine, triiodothyronine; indicators of iodine content associated with serum proteins and iodine extracted with butanol. Reduction of hormone levels and clinical signs are judged on the extent of drug compensation patient and readiness for surgery. However, this method is expensive, has no expressnet and often not possible to adequately judge the dynamics of the patient with thyrotoxicosis.

There is a method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis using polarographic to normalize the oxygen balance in the tissues and certain clinical manifestations of disease /2/. The disadvantage of this method is the lack of specificity level of the designated index to the thyroid gland, time-consuming laboratory testing. In addition, this method may not be an independent state assessment of thyroid status.

Closest to the proposed method is a method /3/ based on analysis of clinical data, the level of thyroid hormones - thyroxine and triiodothyronine, stroke volume of the heart method tetrapolar rheography, the pressure in the pulmonary artery and the right ventricle method Senderov ellenie vessels, specific pulmonary resistance, the maximum rate of ventricular pressure in phase izovolemicescuu voltage, index of contractility) and indices of cellular and humoral immunity, which gives the opportunity to obtain information on the functional state of various organs and systems in the process of stabilization of the patient with thyrotoxicosis during preoperative preparation.

The disadvantage of this method is the lack of data for assessment of thyroid hemodynamics. However, in patients with hyperthyroidism, there are significant changes in the circulation of the thyroid gland /4/, normalization which is an objective sign of euthyroid functional state of the thyroid gland /5/ and helps to prevent intra - and postoperative complications /6/.

In addition, this method is expensive, vysokointensivnymi, arduous, requires different inaccessible devices and test sets, the involvement of different specialists, as well as non-specific, which does not have a high accuracy of performance evaluation.

The technical result of the proposed method is to improve the accuracy in assessing the effectiveness of preoperative preparation is monogo status of the patient.

What's new is that before and after pre-determined quantitative and qualitative indicators of tissue hemodynamics of the thyroid gland by ultrasound Doppler studies and the levels of immunoglobulin G and circulating immune complexes in serum.

New is also that the normalization of the indicators considered for preoperative preparation of effective and complete, and when values of the identified parameters above normal in 2-3 times consider preoperative preparation inefficient and incomplete.

When assessing the effectiveness of preoperative preparation of patients with thyrotoxicosis using the proposed method, in contrast to known methods, to explore the complex tissue blood flow in the thyroid gland, the levels of immunoglobulin G and circulating immune complexes, which increases the accuracy of evaluating the effectiveness of preoperative preparation.

A comprehensive analysis of indicators of tissue blood flow in the thyroid gland, the levels of immunoglobulin G and circulating immune complexes in the dynamics contributes to the detection of latent immune changes with the spine of preoperative preparation.

The method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis is that in diseases of the thyroid gland, occurring with its increased functional status (thyrotoxicosis), linear increases the blood flow in the tissue of thyroid vessels with the quality of its change and the increased contents of immunoglobulin G and circulating immune complexes in the serum of the patient. When conducting preoperative preparation in patients with thyrotoxicosis normalized quantitative and qualitative indicators of tissue thyroid blood levels of immunoglobulin G and circulating immune complexes.

When carrying out the method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis, in contrast to known methods, assessment of tissue blood flow in the thyroid gland and immune status. A comprehensive analysis of indicators of tissue blood flow in the thyroid gland, the levels of immunoglobulin G and circulating immune complexes facilitates the identification of hidden changes in the immune system and thyroid blood flow in patients with thyrotoxicosis.

A new set of features to improve the accuracy of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis, reduces the time of the study, the proposed method is non-invasive, does not require expensive equipment that meets the criterion of "industrial applicability".

In the analysis of known methods revealed that they lack information about the impact of the distinctive features of the claimed method on the achievement of the technical result, therefore, the invention corresponds to the "inventive step".

The method is as follows. The study prostatamassage production with pulse sensor 5 MHz conduct the study of the linear velocity of blood flow through vessels in the parenchyma of the thyroid gland. Carry out the determination of the level of the linear flow velocity of the arterial and venous components that is quantitative indicators of tissue hemodynamics. Then calculate a quality parameter: arteriovenous ratio(a/b), which represents the ratio of the values of the linear velocity of blood flow in arterial and venous components. In the serum of the patient determine the levels of immunoglobulin G and circulating immune complexes by standard methods.

The concentration of serum immunoglobulin G class determined by radial immunodiffusion in gel. The level of circulating immune complexes was determined by precipitation of polyethylene glycol (mol. weight 6000).

Preoperative preparation in patients with thyrotoxicosis consider to be effective and completed with the normalization of quantitative and qualitative indicators of tissue hemodynamics of the thyroid gland by ultrasound dopplerography and concentration levels of immunoglobulin G and circulating immune complexes in serum and preoperative preparation of patients with thyrotoxicosis considered incomplete and ineffective in significantly (p<0,05) high pokazateli immune complexes in serum relative to norms in 2-3 times.

Normal levels of thyroid hemodynamics /7/ and normal levels of immunoglobulin G and circulating immune complexes /8/ received by the authors in the survey 18 healthy persons.

The proposed method examined 34 patients with thyrotoxicosis. All patients were examined modern generally accepted methods (clinical, laboratory, radiographic, ultrasonic examination, cytological and histological). All patients were operated and the diagnosis was verified by histological research of the operational material.

The results of statistical processing of the obtained data are presented in the table.

The method is illustrated by example confirming the possibility of implementation of technical solutions for obtaining a positive effect when using the whole set of features specified in the claim.

Patient U., 42, (history 2456) was admitted to the hospital 22.02.1999, complaining of tumor formation on the front surface of the neck, difficulty swallowing, decreased visual acuity, exophthalmia, palpitations, shortness of breath during physical activity, loss of hair, loss of weight. Increase sirsi-mercazole) with short remissions. 7 years of severe ophthalmopathy, which progresses (conducted treatment of retro-bulbar injection of dexamethasone, which gave a slight effect).

Over the past year notes increased and the seal of the thyroid gland and appeared in her tumorous formation. In the last 2 months has deteriorated General condition appeared difficulty swallowing, increased shortness of breath during physical activity. Over the past year lost weight 10 kg

When receiving a satisfactory condition. Pulse 80 beats per 1 min, BP 130/70 mm RT. Art. Marked exophthalmos, symptoms of Moebius and Graefe, lacrimation. Eye movements painful. Auscultation of the heart accent I tone at the top. ECG conclusion: sinus rhythm, heart rate 81 - 85 min, EOS rejected to the left. Ventricular trigeminy right. Systolic overload of the myocardium.

Laboratory data are normal.

Palpation of both lobes of the thyroid gland is increased up to the fourth degree, in the right lobe thick, lumpy mass education 2.0 x 3.0 cm, nesmeshaevo, painless, the skin over them is not changed. Regional lymph nodes are not enlarged. Ultrasonography: both lobes of the thyroid gland is increased; in C/C right lobe focal obrazovaniye seal thyroid parenchyma increased echogenicity with uneven edges and fuzzy boundaries; the isthmus is not expressed. In the study of fine-needle biopsy: thyroid cells of the epithelium with moderate proliferation.

To preoperative preparation, the following indicators dopplerography of the thyroid gland: the linear velocity of tissue blood flow (blood component) - 42 mm/s, the linear velocity of tissue blood flow (venous component) - 27 mm/s, the ratio(a/b) - 1.55V. The first immunological indexes: the levels of immunoglobulin G and 17.2 g/l, circulating immune complexes - 142 sm. unit

After preoperative preparation (drug, 2 sessions of intravascular laser irradiation of blood and 4 plasmapheresis) the health of the patient improved significantly. If you dopplerography obtained the following data: the linear velocity of tissue blood flow (blood component) - 10 mm/s, the linear velocity of tissue blood flow (venous component) - 5 mm/s, the ratio(a/b) is 2.0. Indicators of immunological indexes before surgery: the levels of immunoglobulin G - 11.3 g/l, circulating immune complexes - 36 srvc.ed.

04.03.1999, operation. Both lobes of the thyroid gland is enlarged, in the middle third of the right lobe - tumor 2.2 cm in diameter with irregular edges. Regional lymph nodes definition postoperative study: undifferentiated carcinoma with invasion into their own fascia of the thyroid gland, C-cell adenoma in the "background" diffuse toxic goiter. The postoperative period was uneventful. Discharged on the 8th day under the supervision of an endocrinologist. Assigned to hormone therapy (L-thyroxine). 2 months after surgery, notes the improvement in General condition, gained weight 4 kg

Through the use of the proposed method of assessing the effectiveness of preoperative preparation time last reduced on average by 10 beds/day (221,0 beds/day when the method according to level of thyroid hormones and laboratory data, clinical symptoms, ECG data, spirography to UAH 121.1 bed/days with the proposed method), you can assess the condition of blood circulation of the thyroid gland and the immune status of a patient with thyrotoxicosis, which contributes to the prevention of intra - and postoperative complications.

List of used literature sources

1. Neimark, M. I., Kalinin A. P. Anaesthesia and intensive therapy in endocrine surgery. - Barnaul, 1995. - 174 C.

2. Sachkov P. M. Plasmapheresis - component pre-operative preparation of patients with thyrotoxicosis: author. dis....Kida. the honey. Sciences. - Saratov, 1989. - 12 S.

3. Merkulov, I. C. Selective software plasmaphereses. - Barnaul, 1991. - 22 S.

4. Schweiger U., Hosten N., Cordes, M. et al. Duplex ultrasound in thyroid function testing. // Fortschr. Rongetnstr. - 1996. - Vol. 164. - P. 114-118.

5. Becker D., Bair, H. J., W. Becker et al. Thyroid autonomy with color-coded image-directed Doppler sonography: internal hypervascularization for the recognition of autonomas adenomas. // J. Clin. Ultrasound. in 1997 - Vol. 25. - P. 63 - 69.

6. Neimark, M. I., Shmelev centuries, Raikin I. D. Prevention and treatment of early postoperative complications in surgical treatment of diseases of the thyroid gland. // Modern aspects of surgical endocrinology. - Saransk, 1997. - S. 192 -194.

7. Pinsky S. B., Beloborodov C. A., E. O. Chizhov, Fedorova O. A. monitoring in the evaluation of a comprehensive preoperative preparation of patients with thyrotoxicosis. // Actual problems of intensive therapy. - Irkutsk, 1997. - S. 19-22.

8. V. Beloborodov A., Rubashkina E. V., Zorig D., Lkhagvaswen Ts., Pinski, S. B., Kirdei E. G. Features of the immune status at the patients with various thyroid diseases. // The 1stMongolian-Russian International Medical Symposium. - Ulaanbaatar, Mongolia, 2000. - P. 51-52.

A method of evaluating the effectiveness of preoperative preparation of patients with thyrotoxicosis by analysis of the hemodynamic and immune status, characterized in that before and after pre-determined quantitative and qualitative indicators of tissue hemodynamics thyroid relatiouship immune complexes in serum and normalization consider preoperative preparation of effective and complete, and when values of the identified parameters above normal in 2-3 times consider preoperative preparation inefficient and incomplete.

 

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FIELD: medicine.

SUBSTANCE: method involves examining eyeball and retrobulbary space by means of ultrasonic scanner. Ultrasonic gray scale orbit scanning is applied in real-time mode to determine ultrasonic eye reposition. Positive ultrasonic eye reposition is determined and normal state is diagnosed when recording mobile unchanged shape and free oscillation orbit tissue movements. Changes in shape, contours and size of the eyeball and immobility of orbit tissues being recorded, negative ultrasonic reposition is determined and solid full-tissue neoplasms and structures are diagnosed to occur.

EFFECT: high objectivity of received data; accelerated examination; high accuracy of differential diagnosis.

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