Method for the diagnosis of chronic vertebrobasilar insufficiency in adolescents undergoing natal injury of the cervical spine
The invention relates to medicine, namely to neurology. Conduct a comparative assessment of eographical index patients and healthy. Registration is carried out in occipito-mastoidal lead right and left hemispheres during the day. If no maximum value eographical index 11 and (or) 14 hours and right(or left hemisphere diagnose chronic vertebrobasilar insufficiency. The method reduces the time of the survey. 2 Il. The invention relates to medicine, specifically to the field of neurology, and relates to methods for diagnosing chronic vertebrobasilar insufficiency (chronic VBN), developed on the background of the transferred Natal injuries of the cervical spine (sh.about.p.).A known method for the diagnosis of various diseases by the method of rheoencephalography (REG). In particular, rheoencephalography studies were conducted in people with cerebral atherosclerosis [4, 2], hypertension  . Rheoencephalography studies are used to confirm the diagnosis of chronic vertebrobasilar insufficiency , however, the existing age limit indicator is on circulation during the day, adolescents, that is not possible in some cases to give a definite conclusion about the presence or absence of pathology vertebrobasilar basin brain. In the literature there are no data about the study of the information content of the daily changes of indices REG for the diagnosis of chronic VBN amid transferred Natal trauma sh.about.p.The authors studied the dynamics of pulse blood filling the vertebrobasilar basin brain with the help of recanalization "REAN-131" (, Taganrog) by the standard method . Investigated the performance of pulse blood supply to the brain: eographically index (RI) in occipito-mastodonia (Ω) lead, the most informative for this pathology , symmetrically in both hemispheres: in the course of the day every hour from 9 to 16 o'clockThe task of the invention is to provide a method of diagnosis, with simple, accessible, low cost.This object is achieved by comparative evaluation of RI in patients and healthy, and the specified evaluation is carried out on both hemispheres in occipito-mastoidal lead, and in the absence of the maximum value of RI at 11 and (or) 14 hours and right (or left hemisphere diagnose chronic vertebrobasilar values RI OM in healthy children as right, and on the left are 11 and 14 hours, min values for 12 and 15 hours (Fig.1).For clarity, the proposed diagnostic method we present specific examples of its implementation.Example 1. Patient P. , aged 13 turned in 13.11.001, complaining of headaches, pain in the cervical-thoracic spine, fatigue, memory loss. During the inspection upon receipt of notice a decrease in muscle tone with pererazgibanie elbows and knees with a click. Tendon reflexes live "S">"d" with hands and feet, Pussep "S" and "d" (+). FMN - without features. Sluggish posture, round back, Cleopatra chest, smoothed waist, wing-shaped blades. The dramatic tension of the neck muscles, their pain on palpation. Pain in the spinous processes of the cervical and thoracic spine. On the radiograph revealed the presence of additional vertebrae in the cervical spine. On a routine REG marked asymmetry of pulse blood on fronto-mastoidectomy, occipito-mastoidectomy leads to the left within the boundaries of normal values, form REG curve without features, signs of difficulty of venous outflow is not revealed. Samples with turning and bowing the head - negative.To assess the change of day from 9 to 16 hours every hour was measured indicators REG in occipito-mastoidal lead, which was used for the curves.Changes of indices REG day wore asynchronous hemispheric in nature. Max value of RI OM had left for 15 hours, the right for 13 hours, min - 12 hours left and at 11 o'clock on the right, none of the peaks do not coincide with those of the healthy (Fig. 2.1).Thus, the pathological form of the curves in figures RI Ω, reflecting the amplitude of the pulse of blood in vertebrobasilar basin, hidden confirmed the cerebral circulation with the appropriate clinical picture, i.e. the presence of chronic VBN amid transferred natality injury of the cervical spine.Example. 2. Patient C., 10 years have seen a neurologist about moved perinatal lesions of the Central nervous system. Upon receipt 17.02.2001, complained of recurrent pain in the neck, headaches, morning and evening, weakness in the limbs. Muscle tone is reduced to reservatio in the elbow joint into place. Tendon reflexes "d"="S". FMN: flattened "S" nasolabial fold, installation horizontal nystagmus more pronounced right. The left shoulder is bigger than the right. Curvature of the spine of the first degree, a moderate voltage SANY plitude RI within age norms; not detected asymmetry of the pulse of blood, and signs of difficulty of venous outflow. In TH abstraction slightly increased rate of peripheral vascular resistance, the sample with the tilt of the head - positive.To assess changes in pulse blood vertebrobasilar basin brain of the patient during the day from 9 to 16 hours every hour was measured indicators REG in occipito-mastoidal lead, which was used for the curves.The curves of diurnal fluctuations RI Ω mostly had no hemispheric asymmetry, but differed in shape from the curves of healthy adolescents. So, max values accounted for 13 hours both right and left, min values to the left by 10 and 15 min values were right at 10, 11 o'clock displaced with respect to the performance curve of healthy children 8 and 10 hours (Fig.2.2).Based on the results of studies in a patient found hidden vertebrobasilar failure, and analyzing the history and clinical picture, diagnosis: chronic vertebrobasilar insufficiency in the face forward Natal injuries of the cervical spine.Example 3. The patient Was 12 years. Upon receipt 23.01.2002, complained golovyashkina: gait - normal muscle tone is moderately reduced. Tendon reflexes live "d"="S", abdominal reduced, Pussep (+) "d" and "S". FMN: horizontal nystagmus, more to the left, weak convergence, easy, deviation of the tongue to the right. The detected tension of the neck muscles, their tenderness, left lower right shoulder, smoothed waist to the right, the curvature of the spine to the right in the thoracic Department of the I degree. On the radiograph sh.about.p.: cervical lordosis is straightened, but is restored when the extension. When max flexion - abnormal mobility With3-4. The height of the intervertebral disc is not reduced. On a routine REG: the shape of the curve without features, amplitude RI is reduced, without asymmetry, signs of difficulty of venous outflow is not revealed. Samples with turning and bowing the head - negative.For further diagnosis studied the changes of pulse blood filling the vertebrobasilar basin (RI Ω) during the day from 9 to 16 hours every hour.Curves built on the amplitudes RI Ω, had no hemispheric asymmetry, but differed in shape from the curves of healthy adolescents. The average value of RI per day was lower than that in healthy adolescents from both sides. The maximum and minimum values was not significantly different from the environments to the absence of extreme values. On the basis of the conducted studies and comparison with the clinical picture diagnosis: chronic vertebrobasilar insufficiency in the face forward Natal injuries of the cervical spine.Example 4. The patient Was 10 years. Upon receipt 24.12.2001, complained of pain and "crunch" in the neck when turning head, reduced vision, incontinence, weakness in the legs, instability of mood. Examination: normal gait, muscle tone is moderately reduced. Tendon reflexes live "d"="S". FMN: flattened "S" nasolabial fold, easy installation nystagmus in both directions. The head tends to the right. When turning the head, crunching into the sh.about.p., power in the hands reduced. The detected tension of the neck muscles more to the left, their tenderness to palpation. Curvature of the spine in the thoracic spine to the right of the I degree. On the radiograph: instability With3-4. On REG: the shape of the curve with signs of increased peripheral vascular resistance, the signal amplitude is within the age norm, minor hemispheric asymmetry. Samples with head turns positive.To assess changes in pulse blood vertebrobasilar basin brain patient is which was used for the curves (Fig.2.4).Revealed that the average value of RI for the day either on the right or on the left was higher than the value in healthy adolescents. Maximum values were left at 10 and 14 hours, the minimum value is 13 hours. To the right of the maximum value detected in 10 and 13 hours, and the minimum is 14 hours. Thus, the patient, at 10 o'clock occurred simultaneous increase in RI that does not coincide with the first maximum value in healthy adolescents. The second maximum peak on the left was 14 hours and coincided with those of the healthy, and the right one was out of phase with them.Clinical data, the results of radiographic studies and routine REG confirm that the identified differences in dynamics of RI during the day patients, and healthy children due to the presence of hidden vertebrobasilar insufficiency in the face forward Natal trauma sh.about.p.The proposed diagnostic method is applied at 23 and 35 healthy adolescent patients 10 to 15 years, of which 20 people were already confirmed diagnosis of chronic vertebrobasilar insufficiency in the face forward Natal injuries of the cervical spine, and 15 children, the diagnosis was detected for the first time.When examining the proposed method villablino a mismatch max and min values of RI in occipito-mastoidal lead on the right and (or) the left side with the same indicators in the group of healthy adolescents.Thus, the results obtained indicate the possibility of using the proposed method, namely about the study eographical index in occipito-mastoidal lead REG symmetrically in both hemispheres during the day every hour from 9 to 16 hours to diagnose in children hidden VBN amid transferred Natal injuries of the cervical spine references 1. L. D. Ugulava. Bioritmologicheskikh the formation of compensatory-adaptive reactions in the clinical model of stress. Abstract of thesis. Dr. Biol. of Sciences, Tomsk, TMI, 1999, 28 S.2. F. I. Komarov, Y. A. Romanov, N. And.The mosaic. The bases of bioenergetics - a new trend in biomedical science and practice. //Chronobiology and the bases of bioenergetics. /Ed. by F. I. Komarova. - M.: Medicine, 1989. - S. 5-17.3. L. P. Zenkov, M. A. Ronkin. Functional diagnosis of nervous diseases. - M.: Medicine, 1991. - 640 S.4. I. E. Orange. Natural curative factors and biological rhythms. Moscow: Medicine, 1988, 286 S.5. A. J. Ratner. Generic spinal cord injury in children. Ed. Kazan University, 1978, 216 S.6. A. J. Ratner. Violations of cerebral circulation in children. Ed. Kazan University, 1983, 144 S.
SUBSTANCE: method involves recording rheogram from feet and legs lifted and fixed at an angle of 45є. Then, rheogram is recorded on inhaling from legs directed vertically downward. Functional blood circulation reserve index is calculated as product of results of dividing and subtracting rheographic indices recorded under conditions of lifted and lowered extremities that means under conditions of functional venous system relief and venous hypertension, respectively.
EFFECT: enhanced effectiveness in recognizing patient group suffering from severe lower extremities ischemia.
FIELD: medicine; medical engineering.
SUBSTANCE: method involves doing multi-channel recording of electroencephalogram and carrying out functional tests. Recording and storing rheoencephalograms is carried out additionally with multi-channel recording of electroencephalogram synchronously and in real time mode in carotid and vertebral arteries. Electroencephalograms and rheoencephalograms are visualized in single window with single time axis. Functional brain state is evaluated from synchronous changes of electroencephalograms, rheoencephalograms and electrocardiograms in response to functional test. The device has electrode unit 1 for recording bioelectric brain activity signals, electrode unit 2 for recording electric cardiac activity signals, current and potential electrode unit 3 for recording rheosignals, leads commutator 4, current rheosignal oscillator 5, synchronous rheosignal detector 6, multi-channel bioelectric brain activity signals amplifier 7, electrophysiological signal amplifier 8, demultiplexer 9, multi-channel rheosignal amplifier 10, multi-channel analog-to-digital converter 11, micro-computer 12 having galvanically isolated input/output port and personal computer 13 of standard configuration.
EFFECT: enhanced effectiveness of differential diagnosis-making.
11 cl, 6 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves irradiating blood-carrying tissue area under control with luminous flow, receiving scattered luminous flow modulated with blood filling changes in blood vessels and capillaries of blood-carrying tissue and forming electric signal of pulse wave. Deviation signal of light-emitting and light-receiving transducers of optoelectronic converter relative to blood-carrying tissue area under control based on difference between the current and preceding values of impedance signal on the area under control. The signal being observed, prohibition signal is produced on pulse wave electric signal passage for excluding errors caused by motion artifacts from its following processing. The device has optoelectronic converter having light-emitting and light-receiving transducers and unit for producing pulse wave signal, which input is connected to light-receiving transducer output. Unit for forming deviation signal has two measuring electrodes connected to separate comparator inputs which output being deviation signal former output, is connected to control input of key. Information input of the key is connected to pulse wave signal former output.
EFFECT: improved noise immunity.
3 cl, 3 dwg
FIELD: medicine; medical engineering.
SUBSTANCE: method involves recording multichannel electroencephalogram, electrocardiogram record and carrying out functional test and computer analysis of electrophysiological signals synchronously with multichannel record of electroencephalogram and electrocardiogram in real time mode. Superslow brain activity is recorded, carotid and spinal artery pools rheoelectroencephalogram is recorded and photopletysmogram of fingers and/or toes is built and subelectrode resistance of electrodes for recording bioelectrical cerebral activity is measured. Physiological values of bioelectrical cerebral activity are calculated and visualized in integrated cardiac cycle time scale as absolute and relative values of alpha-activity, pathological slow wave activity in delta and theta wave bandwidth. Cerebral metabolism activity dynamics level values are calculated and visualized at constant potential level. Heart beat rate is determined from electrocardiogram, pulsating blood-filling of cerebral blood vessels are determined from rheological indices data. Peripheral blood vessel resistance level, peripheral blood vessel tonus are determined as peripheral photoplethysmogram pulsation amplitude, large blood vessel tonus is determined from pulse wave propagation time data beginning from Q-tooth signal of electrocardiogram to the beginning of systolic wave of peripheral photoplethysmogram. Postcapillary venular blood vessels tonus is determined from constant photoplethysmogram component. Functional brain state is determined from dynamic changes of physiological values before during and after the functional test. Device for evaluating functional brain state has in series connected multichannel analog-to-digital converter, microcomputer having galvanically isolated input/output ports and PC of standard configuration and electrode unit for reading bioelectric cerebral activity signals connected to multichannel bioelectric cerebral activity signals amplifier. Current and potential electrode unit for recording rheosignals, multichannel rheosignals amplifier, current rheosignals generator and synchronous rheosignals detector are available. The device additionally has two-frequency high precision current generator, master input of which is connected to microcomputer. The first output group is connected to working electrodes and the second one is connected to reference electrodes of electrode unit for reading bioelectrical cerebral activity signals. Lead switch is available with its first input group being connected to potential electrodes of current and potential electrodes unit for recording rheosignals. The second group of inputs is connected to outputs of current rheosignals oscillator. The first group of outputs is connected to current electrodes of current and potential electrodes unit for recording rheosignals. The second group of outputs is connected to inputs of synchronous detector of rheosignals. Demultiplexer input is connected to output of synchronous detector of rheosignals and its outputs are connected to multichannel rheosignals amplifier inputs. Outputs of multichannel bioelectrical cerebral activity signals amplifier, multichannel rheosignals amplifier and electrophysiological signal amplifier are connected to corresponding inputs of multichannel analog-to-digital converter. Microcomputer outputs are connected to control input of lead switch, control input of multichannel demultiplexer, control input of multichannel analog-to-digital converter and synchronization inputs of current rheosignals oscillator and synchronous detector of rheosignals. To measure subelectrode resistance, a signal from narrow bandwidth current generator of frequency f1 exceeding the upper frequency fup of signals under recording is supplied. A signal from narrow bandwidth current generator of frequency f2≠ f1>fup is supplied to reference electrode. Voltages are selected and measured at output of each amplifier with frequencies of f1, f2 - Uf1 and Uf2 using narrow bandwidth filtering. Subelectrode resistance of each working electrode is determined from formula Zj=Ujf1 :(Jf1xKj), where Zj is the subelectrode resistance of j-th electrode, Ujf1 is the voltage at output from j-th amplifier with frequency of f1, Kj is the amplification coefficient of the j-th amplifier. Subelectrode resistance of reference electrode is determined from formula ZA=Ujf2 :(Jf2xKj), where ZA is the subelectrode resistance of reference electrode, Ujf2 is the voltage at output from j-th amplifier with frequency of f2, Jf2 is the voltage of narrow bandwidth current oscillator with frequency of f2.
EFFECT: wide range of functional applications.
15 cl, 10 dwg
FIELD: medicine, surgery.
SUBSTANCE: one should evaluate clinical state of a patient and as objective parameters one should calculate rheological and brachio-malleolar indices, detect fractional tension of oxygen in capillary blood. At observing clinical improvement accompanied by increased rheological and brachio-malleolar indices by more than 0.1, increased blood saturation with oxygen by more than 10 mm mercury column one should state upon a "good" therapeutic effect. At detecting clinical improvement accompanied by the increase of either one or several objective parameters, or if dynamics of these values is not available - effect should be considered as a "satisfactory" one. At kept ischemic pain at rest without decrease of its intensity, impossibility to keep a limb in horizontal position for a long period of time, the absence of positive dynamics of trophic disorders, at kept ischemic edema and at no alterations in objective parameters - should be determined as "no dynamics". In case of enhanced ischemic pain and edema of foot, at progressing necrotic alterations in foot - one should detect "deterioration" of patient's state. The method increases the number of diagnostic means.
EFFECT: higher accuracy of evaluation.
1 ex, 1 tbl
SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.
EFFECT: high reliability of the results.
18 dwg, 3 tbl
FIELD: medicine, neurology.
SUBSTANCE: a patient should be in initial position when his/her sight is directed towards the ceiling and in 3-5 min it is necessary to register a background rheoencephalogram, then a patient should fix the sight at a pointer's tip being at the distance of about 30 cm against the bridge of nose along the middle line, then the sight should be directed into marginal position due to shifting pointer to the left. Then the sight should be returned into initial position and 3 min later it is necessary to register rheoencephalogram of vertebro-basilar circulation, calculate rheographic index (RI), coefficient for RI ratio on returning the sight from left-hand marginal position into initial one (k2) and at k2>1.098 from the left and (or) k2>1.085 from the right one should detect alteration in vertebro-basilar circulation by reflector mechanism. The method excludes biomechanical impact in stimulating proprioceptive receptors of muscular-ligamentous system under stretching.
EFFECT: higher accuracy and reliability of detection.
2 ex, 2 tbl
FIELD: medicine, resuscitation.
SUBSTANCE: one should detect cerebral perfusion pressure (CPP), intracranial pressure (ICP), values for blood saturation with oxygen in radial artery and jugular vein bulb (SaO2, SjO2), additionally one should study lactate level in jugular vein bulb and radial artery, calculate venous-arterial difference according to lactate (▵lactate), cardiac ejection (CE) due to thermodilution and hemoglobin level. Values for cerebral oxygen transport function should be calculated by the following formulas: mĎO2 = 0.15 x CE x CaO2 x 10; mVO2 = 015 x CE x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SaO2; CjO2 = 1.3 x Hb x SjO2. In case of noninvasive detection - due to pulsoxymetry one should measure peripheral saturation (SpO2), due to parainfrared spectroscopy - cerebral oxygenation (rSO2) and cardiac ejection due to tetrapolar rheovasography (CEr), detect and calculate the values of cerebral oxygen transport system according to the following formulas: mĎO2 = 0.15 x CEr x CaO2 x 10; mVO2 = 0.15 x CEr x (CaO2 - CjO2) x 10; CaO2 = 1.3 x Hb x SpO2; CjO2 = 1.3 x Hb x rSO2. At the value of mĎO2 86-186 ml/min and more, MVO2 33 - 73 ml/min, ▵lactate below 0.4 mM/l one should evaluate cerebral oxygen transport system to be normal and the absence of cerebral metabolic disorders. At mĎO2 values below 86 ml/min, mVO2 being 33-73 ml/minO2, ▵lactate below 0.4 mM/l one should state upon compensated cerebral oxygen transport system and the absence of metabolic disorders. At mĎO2 being below 86 ml/min, mVO2 below 33 mM/l, ▵lactate below 0.4 mM/l one should conclude upon cerebral oxygen transport system to be subcompensated at decreased metabolism. At the values of mĎO2 being 86-186 ml/min and more, MVO2 below 33 ml/min, ▵lactate below 0.4 mM/l one should establish subcompensated cerebral oxygen transport system at decreased metabolism. At values of lactate being above 0.4 mM/l and any values of mĎO2 and mVO2 one should point out the state of decompensation in cerebral oxygen transport system and its metabolism. The innovation enables to diagnose disorders and decrease the risk for the development of secondary complications.
EFFECT: higher efficiency and accuracy of evaluation.
1 cl, 3 ex, 1 tbl
SUBSTANCE: method involves setting a patient in vertical posture with stabilogram and rheoencephalogram being concurrently recorded with frontomastoid and accipitomastoid leads being used retaining head position with stressed neck extensor muscles state and head position with relaxed neck extensor muscles state. Stabilogram parameters characterizing vertical posture stability and rheographic index of each of four brain basins. When combining better filling of cerebral basins with blood and higher standing stability, training is carried out in keeping head positions allowing better filling of cerebral basins. If better filling of cerebral basins with blood follows with no increased standing stability, the trainings are carried out in keeping head position with stressed neck extensor muscles state. The training sessions are given twice a day for 15 min during two weeks.
EFFECT: enhanced effectiveness of treatment.
2 cl, 3 tbl
SUBSTANCE: method involves determining pulsating arterial blood flow parameters. To do it, measuring electrodes are applied in main liver body mass location zone. Electrode-to-electrode distance is additionally measured and hepatic index is calculated from formula HI=ρ*L2*Ad*ET*HBR/Z2*1000*S, where HI is the hepatic index (l/min/m2), ρ is the constant reflecting volume blood resistance (150 Ohm cm), L is electrode-to-electrode distance (cm), Z is the base impedance (Ohm), Ad is the differential rheogram amplitude (Ohm/s), ET is blood expulsion time (s), HBR is heart beat rate per 1 min, S is the body surface (m2), 1000 is the coefficient for converting to liters. HI value being greater than 0.225 l/min/m2, porto-portal and/or porto-central hepatic fibrosis is diagnosed.
EFFECT: wide range of functional applications.