Method for determination of threat of recurrence of gastroduodenal ulcer bleeding
The invention relates to the field of medicine. The detection method is characterized by the fact that the register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value of the redox potential of less than 70 mV assess the state of the tissue as ischemic damage and no threat of recurrent bleeding. The invention provides precision definition.
The invention relates to medicine, namely to methods for predicting recurrence of ulcer bleeding.
Known forecasting methods:
A) Statistical methods based on the selection in multivariate regression analysis, the most probable stigma threat of recurrent bleeding (G. P. Rustling and other “gastroduodenal Ulcer bleeding”. - Minsk, 1998).
The disadvantage of this method is that it does not take account ocalenie indicators of pathologic process and therefore in the method of statistical forecasting is already incorporated the probability of an incorrect prediction in 10-15% of cases.
B) endoscopic Ultrasound Doppler ulcers based on the study of blood flow velocity in the ulcer crater in the dynamics; increased speed of blood flow through relatively large arteries may indicate the risk of recurrent bleeding (Bernd Kohler, Maier Mattias "Acute ulcer bleeding (a prospective randomized trial to compare Doppler and Forrest classification in endoscopic diagnosis and therapy", Digestive Diseases and Sciences, 42(7) p.1370-74, July, 1997, D. Beckly, M. Casebow "Prediction of rebleeding from peptic ulcer experience with an endoscopic Doppler device", Gut, 1986, 27, p.96-99).
This method allows to determine the velocity of blood flow in large arteries, whereas the recurrence of bleeding may occur from smaller vessels; increased blood flow suggests the normalization of microcirculation after blood loss and not always indicative about the threat of recurrence of bleeding; this method is expensive, requires special equipment and skills of the personnel.
C) Sighting endoscopic thermometry ulcers based on the introduction through the biopsy channel of the fiberscope thermometer and measure the temperature of tissue in the ulcer crater. The increase of tissue temperature indicates an increase of blood flow in the plague and the threat of recurrence of bleeding (Lagoda, A. E. “the Justification of the principles of individualization of surgical treatment Bolin normalization of microcirculation after blood loss and not always indicative about the threat of recurrence of bleeding; temperature change is a very indirect measure of the intensity of local blood flow; local temperature indicator variable and may depend on a number of factors (e.g. temperature insufferable at endoscopy in the stomach of air).
The present invention is the elimination of the previously mentioned drawbacks.
This object is achieved in that a method for determining the threat of recurrence of gastroduodenal ulcer bleeding, namely, that register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value of the redox potential of less than 70 mV assess the state of the tissue as ischemic damage and no threat of recurrent bleeding.
The method is illustrated by the following example.
In the lumen of the stomach (duodenum) be fibrogastroduodenoscopy. Visually ilgausakas bleeding be performed endoscopic hemostasis one of the methods of engagements.
Next registration oxidation and restitution of action potential (redox potential, Eh) that occur between the measuring electrode implanted in Muco-submucosal layer of the wall of the stomach (duodenum), and the reference electrode.
The measuring electrode is a platinum electrode needle with a diameter of 0.6 mm and a length of 3 mm, the Measuring electrode is connected to a recording device through a conductor length of 2000 mm and a diameter of 1 mm. Conductor, the connection of the active electrode with the conductor and the nearest to the conductor 1 mm active electrode is covered with a layer of insulator (PVC skin). The total diameter of the conductor and insulator should not exceed 2 mm.
The reference electrode is silver chloride, standard, factory-made. The reference electrode is placed in the left axilla of the patient, the contact of the reference electrode and the skin through gauze napkins soaked with 0.9% sodium chloride solution.
The recording device is a voltmeter with a range of value not less than -300...+300 mV, resolution 1.
Validation of the potential of the measuring electrode Rel is ASS="ptx2">Fibrogastroduodenoscopy is introduced into the lumen of the stomach (the duodenum), the end face of fibrogastroduodenoscopy is placed in front of the investigated area of the wall of the body at a distance of 5 mm from the last.
Through the working channel of fibrogastroduodenoscopy in the lumen of the stomach (duodenum) is entered active electrode with the conductor.
The active electrode is implanted in the surveyed area of the wall of the stomach (duodenum) perpendicular to the plane of the mucosa to a depth of 2 mm to full contact insulator with a mucous membrane.
The recording device will be switched to the definition of potential. The true value of oxidation-healing capacity is the value to be registered not less than 1 min after the start of measurement.
If the value of the redox potential greater than or equal to 70 mm, the state of the tissue of the ulcer is regarded as progressive ischemic necrosis, indicating that the risk of recurrent bleeding and requires urgent surgical intervention.
If the value of the redox potential is less than 70 mV, the state of the tissue of the ulcer is regarded ka is of conservative treatment.
The method was tested on the basis of the Moscow hospitals.
The volunteers in the absence of pathology Eh stomach and duodenum was +15 mV.
In the measurement of Eh patients with an established bleeding from ulcers and subsequently not receiveremail Eh was +50-69 mV.
Patients subsequently developed recurrent bleeding (refused surgery) Eh before relapse was +70-mW.
This method for determining the yield statistically reliable results about the threat of recurrence of gastroduodenal ulcer bleeding on the value of the redox potential tissue ulcers. The method does not require expensive equipment.
Method for determination of threat of recurrence of gastroduodenal ulcer bleeding, characterized in that register redox potential tissue ulcers, through fibrogastroduodenoscopy into the lumen of the organ to be investigated is injected active platinum needle electrode perpendicular to the plane of the mucosa to a depth of 2 mm, and when the value of the redox potential equal to or greater than 70 mV, the state of the tissue ulcers appreciate how progressive ischemic necrosis and the risk of recurrent bleeding, and when the value reeva bleeding.
FIELD: medicine, hepatology.
SUBSTANCE: one should detect the level of hepato-specific enzymes (HSE) in blood plasma, such as: urokinase (UK), histidase (HIS), fructose-1-phosphataldolase (F-1-P), serine dehydratase (L-SD), threonine dehydratase (L-TD) and products of lipid peroxidation (LP), such as: dienic conjugates (DC), malonic dialdehyde (MDA). Moreover, one should detect the state of inspecific immunity parameters, such as: immunoregulatory index (IRI) as the ratio of T-helpers and T-suppressors, circulating immune complexes (CIC). Additionally, one should evaluate the state of regional circulation by applying rheohepatography (RHG), the system of microhemocirculation with the help of conjunctival biomicroscopy (CB) to detect intravascular index (II). In case of increased UK, HIS levels up to 0.5 mcM/ml/h, F-1-P, L-SD, L-Td, LP products, CIC by 1.5 times, higher IRI up to 2 at the norm being 1.0-1.5, altered values of regional circulation, increased II up to 2 points at the norm being 1 point, not more one should diagnose light degree of process flow. At increased level of UK, HIS up to 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 1.5-2 times, increased IRI up to 2.5, altered values of regional circulation, increased II up to 3-4 points one should diagnose average degree of process flow. At increased level of UK, HIS being above 0.75 mcM/ml/h, F-1-P, L-SD, L-TD, LP products, CIC by 2 and more times, increased IRI being above 2.5, altered values of regional circulation, increased II up to 5 points and more one should diagnose severe degree of process flow.
EFFECT: higher accuracy of diagnostics.
FIELD: medicine, infectology, hepatology.
SUBSTANCE: in hepatic bioptate one should detect products of lipid peroxidation (LP), such as: dienic conjugates (DC), activity of antioxidant enzymes, such as: catalase (CAT)and superoxide dismutase (SOD). One should calculate by the following formula: C = DC/(SOD x CAT)x100, where DC - the content of dienic conjugates, SOD - activity of superoxide dismutase, CAT - activity of catalase. At coefficient (C) values being above 65 one should predict high possibility for appearance of cirrhosis, at 46-645 - moderate possibility and at 14-45 -low possibility for appearance of cirrhosis.
EFFECT: higher accuracy of prediction.
FIELD: medicine, clinical toxicology.
SUBSTANCE: at patient's hospitalization one should gather the data of clinical and laboratory values: on the type of chemical substance, patient's age, data of clinical survey and laboratory values: body temperature, the presence or absence of dysphonia, oliguria being below 30 ml/h, hemoglobinuria, erythrocytic hemolysis, exotoxic shock, glucose level in blood, fibrinogen and creatinine concentration in blood serum, general bilirubin, prothrombin index (PTI), Ph-plasma, the state of blood clotting system. The state of every sign should be evaluated in points to be then summed up and at exceeding the sum of points being above "+20" one should predict unfavorable result. At the sum of "-13" prediction should be stated upon as favorable and at "-13" up to "+20" - prediction is considered to be doubtful.
EFFECT: higher accuracy of prediction.
2 ex, 3 tbl
FIELD: medicine, juvenile clinical nephrology.
SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.
EFFECT: higher efficiency of detection.
7 dwg, 1 ex, 6 tbl
FIELD: clinical medicine, pulmonology.
SUBSTANCE: one should carry out complex estimation of interleukin-1β) concentration in blood, saliva, bronchoalveolar liquid. Moreover, one should detect distribution coefficient (DC) for IL-1β as the ratio of IL-1β blood content to IL-1β salivary content. At increased IL-1β blood content by 10 times and more, by 2 times in saliva, unchanged level of bronchoalveolar IL-1β, at DC for IL-1β being above 1.0 one should predict bronchial obstruction. The method enables to conduct diagnostics of the above-mentioned disease at its earlier stages.
EFFECT: higher efficiency of prediction.
FIELD: medicine, diagnostics.
SUBSTANCE: the present innovation deals with genetic trials, with diagnostic field of oncological diseases due to analyzing DNA by altered status of gene methylation that take part in intracellular regulation of division, differentiating, apoptosis and detoxication processes. One should measure the status of methylation in three genes: p16, E-cadherine and GSTP1 in any human biological samples taken out of blood plasma, urine, lymph nodes, tumor tissue, inter-tissue liquid, ascitic liquid, blood cells and buccal epithelium and other; one should analyze DNA in which modified genes of tumor origin or their components are present that contain defective genes, moreover, analysis should be performed due to extracting and purifying DNA out of biological samples followed by bisulfite treatment of this DNA for modifying unprotected cytosine foundations at keeping 5-methyl cytosine being a protected cytosine foundation followed by PCR assay of bisulfite-treated and bisulfite-untreated genes under investigation and at detecting alterations obtained according to electrophoretic result of PCR amplificates, due to detecting the difference in the number and electrophoretic mobility of corresponding fractions at comparing with control methylated and unmethylated samples containing normal and hypermethylated forms of genes one should diagnose oncological diseases. The method provides higher reliability in detecting tumors, detection of remained tumor cells after operation.
EFFECT: higher efficiency of therapy.
1 cl, 3 dwg, 4 ex
FIELD: medicine, gastroenterology.
SUBSTANCE: one should carry out diagnostic studying, moreover, on the 5th -6th d against the onset of exacerbation in case of gastric and duodenal ulcerous disease one should detect the content serotonin, histamine and acetylcholine in blood, then during 2-3 wk one should conduct medicinal therapy to detect serotonin, histamine and acetylcholine level in blood again and at serotonin content being by 2-3 times above the norm, histamine - by 1.15-1.4 times above the norm and acetylcholine - by 20-45% being below the norm one should predict the flow of gastric and duodenal ulcerous disease as a non-scarring ulcer.
EFFECT: higher accuracy of prediction.
SUBSTANCE: method involves taking blood from ulnar vein (systemic blood circulation) and from large vein of the injured extremity proximal with respect to lesion focus (regional blood circulation). Spontaneous NST-test value is determined and difference is calculated in systemic and regional blood circulation as regional-to-systemic difference. The difference value is used for predicting clinical course of pyo-inflammatory disease in extremities.
EFFECT: high accuracy of diagnosis.
4 cl, 2 tbl
FIELD: medicine, gastroenterology.
SUBSTANCE: one should introduce biologically active substance, moreover, in patient's blood serum one should detect the content of acetyl choline and choline esterase activity followed by 2-h-long intragastric pH-metry at loading with biologically active substance as warm 40-45%-honey water solution at 35-40 C, and at increased content of acetyl choline being above 1.0 mM/l, choline esterase being above 0.5 mM/l/30 min and pH level being 6.0-6.9 it is possible to consider apitherapy to be useful for treating ulcerous duodenal disease.
EFFECT: higher efficiency and accuracy of detection.
FIELD: medicine, gastroenterology.
SUBSTANCE: it has been suggested a new method to detect pharmacological sensitivity to preparations as acidosuppressors. After the intake of the preparation a patient should undergo fibrogastroduodenoscopy 3 h later, then, through endoscopic catheter one should introduce 0.3%-Congo red solution intragastrically and the test is considered to be positive at keeping red color that indicates good sensitivity to the given preparation, and in case of dark-blue or black color the test is considered to be negative that indicates resistance to this preparation. The suggested innovation widens the number of diagnostic techniques of mentioned indication.
EFFECT: higher efficiency of diagnostics.