The method of the diagnostic examination of patients with enuresis

 

(57) Abstract:

The invention relates to medicine, and neurology. In the complex examination of patients include cardiointervalography. ECG recorded three times at intervals of 5 minutes in 2-standard lead. Calculate the index of tension of regulatory systems (INS). Largest source IN less than 30 in.E. diagnosed with neurosis-like form of enuresis. Dynamics of changes IN at three times the measurement is judged on the severity and compansionate of enuresis. The method allows rapid diagnosis of neurosis-like forms of enuresis.

The present invention relates to medicine and can be used for diagnostic examination of patients with enuresis in order to identify and rapid diagnosis of neurosis-like forms of enuresis.

Development of new diagnostic methods of examination of patients with enuresis is an actual problem of modern medicine, because urination disorders are very common (about 10% of the world population), and current methods of examination do not always have the desired effectiveness. Causes of enuresis can be very different: the pathological processes in the urinary Postojna, genetic features, etc. In connection with this diagnostic examination of patients with enuresis is a comprehensive, aimed at the study of various organs and systems.

For the prototype of the invention is the classic, most common method of diagnostic testing of patients with enuresis, including a medical history, ultrasound of the kidneys and bladder, neurological examination (see, for example, N. Korovin.A., Gavryushin L. P., Zakharov, I. N. Enuresis in children. Moscow, 2000). Diagnostic testing in the method prototype is aimed at establishing the causes of enuresis and thus to establish forms of enuresis. The authors distinguish the following forms of enuresis: a neurotic, nervous, genetically caused, organic (CNS pathology and spinal cord), urological pathology. This classification mainly held by other authors. Sometimes as a separate form highlight psychopathic, epileptic, patoharakterologicheskie. Neurological examination in the complex General diagnostic examination of patients with enuresis is aimed at the identification and differentiation of neurotic and neurosis-like forms. Neurotic form of enuresis in the way-prototypically enuresis; restless, superficial, restless sleep with dreams; symptoms of neurosis; mild enuresis after the elimination of the causative factor.

Neurosis-like form of enuresis in the method prototype is diagnosed by the following criteria: absence of communication with stress (usually from birth); regular, frequent and persistent enuresis; deep sleep; no symptoms of neurosis; residual effects of CNS pathology; symptoms of Serebryaniy, hypertension-hydrocephalic syndrome and other syndromes.

However, as the authors of the prototype method, and many other authors have noted the great difficulty of extracting neurosis-like forms of enuresis. This is because often enuresis can occur from birth, but to be infrequent. However, after a stressful situation it can grow, become more intense, which may bring to mind another form of enuresis. Meanwhile, the separation of this form of enuresis during diagnostic examination is fundamentally important, because the treatment of these forms is different: in the neurotic form of treatment includes sedatives, neurosis-like - vegetososudistoy, nootropics, vascular equipment.

Often the diagnosis of neurosis-like forms of enuresis can be carried out only after the fact was not directed at the form of enuresis. For example, there were cases when the patient was exhibited neurotic form of enuresis, and assigned sedative therapy, which does not give the desired result (no marked decrease in the frequency of involuntary urination at night). In the future, if the purpose of the course of vegetarianfood, nootropic funds was obtained the desired effect in the form of ischemia in the frequency and intensity of enuresis.

The complexity of the rapid diagnosis of neurosis-like forms of enuresis stems largely from the lack of objective diagnostic criteria, because the diagnosis is mostly based on the data of the anamnesis and evaluation of neurological status. Also known diagnosis of neurosis-like forms of enuresis long enough, any rapid methods is not known.

The task of the invention is supposed to increase the accuracy of diagnosis of neurosis-like forms of enuresis, the objectification of this diagnosis, the possibility of rapid diagnosis.

The task in the way diagnostic examination of patients with enuresis, including a medical history, ultrasound of the kidneys and bladder, neurological examination, is achieved by the fact that the complex survey include cardioid who perform mathematical computer processing of the ECG to determine a value of the R-R interval and the subsequent calculation of the index of tension of regulatory systems (INS) by the formula

where IN the index of tension of regulatory systems;

The Ministry of defense (mod) is the most frequently occurring value of R-R interval;

AMO (amplitude mode) - the number of cardiac intervals in percent, corresponding to a range of fashion;

BP (variational scale) - the difference between the maximum and minimum value of R-R,

and if the original value IN less than 30 in.E. diagnosed with neurosis-like form of enuresis and the dynamics of change IN at three times the measurement is judged on the severity and compansionate enuresis, however, the greater the deviation from the original in the direction of decreasing IN, the greater the severity and less degree of compansionate enuresis.

The authors of this application for the first time shown that neurosis-like form of enuresis can be very quickly and effectively differentiated, if the complex diagnostic examination of patients to enable neurocardiovascular. Studies have shown that the group of patients with neurosis-like form of enuresis clearly differs largest such index, as the index of tension of regulatory systems (INS). It is established that with neurosis-like form of enuresis value in most cases less than 30 in.ETBE Express method because the survey takes about 15 minutes. At the same time, the accuracy of the method is high, and the availability of quantitative criteria allows you to objectify conclusions about the degree of pathological changes and more adequately to choose the course of treatment.

The proposed method is as follows.

Diagnostic examination of patients is complex and aimed at the examination of various organs and includes the history, ultrasound of the kidneys and bladder, neurological examination.

With the exception of urological pathology on ultrasound of the kidneys and bladder carefully conduct a neurological examination to identify neurosis-like forms of enuresis. In addition to studies of obstetric history, nature, sleep, urination disorders, state of the Central nervous system in complex surveys include the assessment of kardiointervalografii on the proposed method, which is as follows.

The patient three times at intervals of 5 minutes record the ECG in 2-standard lead. Then spend mathematical computer processing of the ECG to determine a value of the R-R interval followed by counting in a conditional edible common value of R-R interval;

AMO (amplitude mode) - the number of cardiac intervals in percent, corresponding to a range of fashion;

BP (variational scale) - the difference between the maximum and minimum value of R-R.

Neurosis-like form of enuresis is diagnosed, if IN less than 30 in.E., the difference in the measurement will correspond to the degree of decompensation.

Examples of specific performance of the method is given in the form of extracts from the history of the disease.

Patient B., 12 years old, was admitted with complaints about bedwetting. The patient is a minor 2-3 times per month, while the patient is sleeping deeply, not wakes up after involuntary urination. In the neurological status of the observed increase in tendon reflexes on both sides, the presence of reflex Jacobson-Affection on both sides.

When NCIG revealed the following changes: IN - 17.7; IN - 11.1; EN - 8.1., ie is vagotonic increasing as the measure that indicates the state of decompensation of the autonomic nervous system, which allowed the diagnosis of neurosis-like variant of enuresis. Neurosis-like variant pathology was confirmed revealed changes in the EEG in moderate changes of bioelectric activity of the Ministry of health is hypotension without difficulties outflow. Also noted a positive effect on the background of neuroprotective therapy.

The proposed method examined 15 patients. The results showed high accuracy of the proposed method: all patients with neurosis-like form of enuresis indicators IN were less than 30.

The method of the diagnostic examination of patients with enuresis, including a medical history, ultrasound of the kidneys and bladder, neurological examination, characterized in that the complex survey include cardiointervalography and the patient three times at intervals of 5 min record the ECG in 2 standard lead and carry out mathematical computer processing of the ECG to determine a value of the R-R interval and the subsequent calculation of the index of tension of regulatory systems (INS) by the formula

JN=AMO/2VR Mo,

where IN the index of tension of regulatory systems;

The Ministry of defense (mod) is the most frequently occurring value of R-R intervals;

AMO (amplitude mode) - the number of cardiac intervals in percent, corresponding to a range of fashion;

BP (variational scale) - the difference between the maximum and minimum value of R-R,

and if the original value IN less than 30 in.E. diagnosed with neurosis-like form of enuresis, and Dean is and the greater the deviation from the initial decrease IN the greater the severity and less degree of compansionate of enuresis.

 

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Electrode device // 2234851
The invention relates to medical equipment, namely, devices for measuring bioelectric potentials, mainly used in medical diagnostics devices for both multiple and single use

Electrode device // 2234851
The invention relates to medical equipment, namely, devices for measuring bioelectric potentials, mainly used in medical diagnostics devices for both multiple and single use

FIELD: medicine.

SUBSTANCE: method involves carrying out ultrasonic scanning examination of subclavian artery over its whole extent in physiological arm position with arterial blood pressure being measured in the middle one third of the arm. Next, when applying compression tests, blood circulation parameters variations are recorded in distal segment of the subclavian artery with arterial blood pressure being concurrently measured. Three degrees of superior thorax aperture syndrome severity are diagnosed depending on reduction of linear blood circulation velocity and arterial blood pressure compared to their initial values. Mild one takes place when linear blood circulation velocity reduction reaches 40% and arterial blood pressure 20% of initial level, moderate one when linear blood circulation velocity reduction reaches 70% and arterial blood pressure 50% and heavy one when linear blood circulation velocity reduction is greater than 70% of initial level and arterial blood pressure is greater than 50% to the extent of no blood circulation manifestation being observed in the subclavian artery.

EFFECT: high accuracy of diagnosis.

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