A method for predicting extraperitoneal complications of widespread peritonitis
The invention relates to medicine, in particular to anesthesiology and critical care medicine. Patients examine the contents of lactoferrin in the serum and peritoneal exudate on the first day of the postoperative period. While declines in serum levels of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications. The method is simple and easy to perform and allows early to predict the development extraperitoneal complications.
The invention relates to medicine, in particular to anesthesiology and critical care medicine.
Peritonitis and its common form is the most serious option surgical infection, which can worsen symptoms of sepsis and multiple organ failure. First of all organ complications that accompany a period of widespread peritonitis are complications of the lungs, in particular infectious-inflammatory diseases (acute pneumonia, endobronchitis). The second place is occupied extraperitoneal complications of the kidneys. At this point the t of clear criteria which would characterize the signs of the disease at early stages (before clinical manifestations). Thus, it remains highly relevant approach to identify complications at the preclinical level prior to the onset of clinical signs of pneumonia and endobronchitis.
A known method for predicting the development of extracranial infectious complications and outcome of acute period of traumatic disease of the brain by hematological tests: leukocyte index of intoxication, neutrophile-leukocyte index Krebs, counting the absolute number of lymphocytes, which were analyzed in comparison with the patient assessment of level of consciousness (BOS). During the analysis, in addition to the graphic pattern and the magnitude relation of R2was calculated by the formula this regard, expressed in charts (Okulov C. M. “Clinical and diagnostic value of changes in indicators in the acute period in isolated brain damage”. The dissertation on competition of a scientific degree of the candidate of med. of Sciences, St. Petersburg, 1997).
The disadvantage of this method are lability leukocyte index of intoxication, the possibility of developing infectious complications in normal and reduced share is.
A known method for predicting complications in patients with acute pancreatitis. The method consists in the evaluation of pH inside the mucous membrane of the stomach and tension of carbon dioxide in the patient's blood, when determining pH less 7,32 made a conclusion about NUTRISYSTEM acidosis and possible adverse acute pancreatitis [Kon E. M., Cherkasov C. A., Samartsev C. A., Cohn C. E. a Method for predicting complications and fatal outcome in patients with acute pancreatitis. Patent # 216184, M CL 7 G 01 N 33/84, bull. No. 1 from 10.01.2001].
The disadvantage of this method is the difficulty in carrying out the method (the need to place a separate probe into the stomach), the distortion results when using this method in terms of the syndrome of enteral insufficiency (long stagnation in the stomach), the difficulty in the interpretation of data on the pH inside of the gastric mucosa under conditions of endotoxic shock and reduced blood flow in the mucosa, which often complicates the course of acute abdominal diseases.
Closest to the claimed is a method for predicting extracranial infectious complications, and assess the adequacy of treatment in post-traumatic period, for calsim blood test is proposed to investigate the phagocytic activity, Nst-test, the peroxidase activity of monocytes and neutrophils. Sign threats of infectious complications is the functional activation of monocytes with simultaneous inhibition of absorption and digestive ability of macrophages. (Gizatulin M. I. “Features reactivity phagocytic system in the acute period of isolated brain damage”. The dissertation on competition of a scientific degree of the candidate of med. Sciences. Leningrad, 1990).
The disadvantage of this method is the complexity of the analysis techniques activity of monocytes, the possible effects of medical procedures on the effectiveness of the test (load antibiotic endogenous toxicosis), and the absence of data on the impact of resorption of the peritoneum components of endogenous intoxication as one of the main factors in the development extraperitoneal complications.
The objective of the present invention consists in predicting extraperitoneal complications of widespread peritonitis by determining the content of lactoferrin (LF) in the serum and peritoneal exudate on the first day of the postoperative period. On this basis, the optimum method of treatment aimed at possible prophylaxis extraperitoneal investigate the serum and peritoneal exudate on the LF content in the first day after surgery and simultaneous decline in the serum of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications that requires additional therapy: strengthening antibacterial component therapy, joining active methods of detoxification for extra protection from systemic infection, the remedial fibrobronchoscopy.
The novelty of the method:
1. The control content of the LF during the first days after surgery.
2. The LF in the serum of less than 1000 ng/ml indicates inadequate nonspecific resistance of macrophages blood and possible generalization of the microflora causing peritonitis, abdominal cavity when it is released into the systemic circulation.
3. The LF of the exudate is less than 3500 ng/ml predicts the ineffectiveness of the protective barrier of the peritoneum as a factor counteracting the generalization of microorganisms.
Control of the concentration of lactoferrin is due to the fact that in the development extraperitoneal complications of peritonitis pays great attention to the dysfunction of the nonspecific activity of neutrophils in the blood, and on the border between the peritoneum and blood. Timely early diagnosis of these disorders is very important to assign adequate correction and restoration of normal function, n is the RNO and early to diagnose the development extraperitoneal complications depending on the status of peritoneal macrophages and neutrophils blood in the postoperative period and promptly appoint a corrective treatment to avoid adverse disease outcome.
The method consists in the following: blood and peritoneal to study the LF content produced in the first day after surgery in patients with acute widespread peritonitis.
For the determination of lactoferrin using venous blood and peritoneal exudate. Immediately after exposee biological fluid volume of 1 ml centrifugeuse. In the following were performed enzyme-linked immunosorbent assay of serum content of lactoferrin and solid-phase immunoelectrophoresis for the determination of LF in peritoneal exudates.
The control content of the LF during the first days after surgery due to the fact that, due to increased permeability of the peritoneum for microbial toxins and inefficient secretion by macrophages possible generalization of microbial toxins and their systemic effect - development extraperitoneal complications (pneumonia, traheobronhity, toxic encephalopathy, renal failure).
The LF in the serum of less than 1000 ng/ml indicates inadequate nonspecific resistance of macrophages blood and possible generalization of the microflora, the date of 3500 ng/ml predicts the ineffectiveness of the protective barrier of the peritoneum as a factor opposing generalization of microorganisms. Reduced rate LF does not allow neutrophils to ensure adequate antimicrobial response.
Patient C., no history 47, was hospitalized in the Department of emergency surgery of the city clinical hospital №1 06.06.2002 g with a diagnosis of penetrating wound of the abdomen with damage to the colon, widespread purulent peritonitis. In case of emergency surgery, surgery: laparotomy and closure of the damage to the intestine, laparostomy. When repeated readjustment of laparostomy the LF of (blood taken from a vein on the first day of the postoperative period, the exudate obtained during surgery) on the first day in the serum was 805 ng/ml in peritoneal exudate 2110 ng/ml Interpreted this condition as inefficient system of polymorphonuclear leukocytes on combating generalization of flora from the abdominal cavity. On the third day was fixed acute right-sided pneumonia as extra-peritoneal complication of peritonitis
Patient K., no history 388 hospitalized 03.03.2002 in the Department of emergency surgery of the city clinical hospital №1 with a diagnosis of gyrovague, drainage stuffing bags and abdominal cavity. The LF of the blood serum (the fence in the postoperative period) amounted to 790 ng/ml, the LF of peritoneal exudate (analysis taken into surgery to wash the abdominal cavity) 803 ng/ml On the second day the patient experiencing the effects of acute pneumonia, tracheobronchitis. The diagnosis is confirmed by x-ray picture of the chest (infiltration of the right lung), band shift of neutrophils, obtaining purulent sputum when the bailouts of the tracheobronchial tree). The patient in addition to traditional methods of therapy initiated intensive activities: conducted sessions fibrobronchoscopy, enhanced antibacterial therapy - Tienam 500 mg/3 times a day and conducted active methods of detoxification. As a result of combined treatment the patient's condition has stabilized, complications cropped, which allowed us to conduct a series of sanitation operations for optimal performance.
Thus, patients with the widespread peritonitis definition of LF content in the blood and peritoneal exudate allows to predict the development extraperitoneal complications common periodinane extraperitoneal complications of widespread peritonitis by studies of biological fluids, characterized in that the patients investigated the content of lactoferrin in the serum and peritoneal exudate on the first day of the postoperative period and during the simultaneous decline in the serum of less than 1000 ng/ml and less exudate 3500 ng/ml predict the likelihood of extraperitoneal complications.
FIELD: medicine, ophthalmology.
SUBSTANCE: in lacrimal liquid one should detect the content of interleukin 8 (IL-8) and that of interleukin 1 beta (IL-1β) to calculate prognostic coefficient (PC) due to dividing the first value by the second one by the following formula: At PC value being below 10.0 one should predict favorable disease flow, and at PC value being above 10.0 - unfavorable flow.
EFFECT: higher accuracy of prediction.
FIELD: forensic medicine.
SUBSTANCE: for the purpose to detect the sequence of applied lesions at availability of several wounds, scratches and ecchymoses on a cadaver one should study the activity of alkaline peptides isolated out of affected tissue by the impact of blood neutrophils of healthy donors upon phagocytosis. Moreover, the highest stimulating effect belongs to the peptides isolated out of the lesion applied earlier. The method enables to detect the sequence of applied lesions more accurately and differentiate the repeated lesion applied 5 min later, or more.
EFFECT: higher efficiency and accuracy of detection.
2 ex, 2 tbl
FIELD: medicine, biochemistry.
SUBSTANCE: in blood serum one should detect the level of lactoferrin and biliary acids. At their ratio being equal to 5-17 it is necessary to detect chronic hepatitis of high activity.
EFFECT: higher accuracy of detection.
SUBSTANCE: method involves determining cathepsin D activity in endometrium bioptate. The value being equal to or less than 0.1 units of enzymatic activity per hour, external genital endometriosis is diagnosed.
EFFECT: high accuracy of diagnosis.
SUBSTANCE: method involves studying lactoferrin content in blood serum and peritoneal exudates in postoperative period every day during the first three days. Lactoferrin concentration in blood serum being concurrently reduced by 0.02 mcmole/l or less and increasing lactoferrin concentration in peritoneal exudates by 0.04 mcmole/l or more, enteric detoxication is considered to be effective.
EFFECT: high quality of estimation.
SUBSTANCE: method involves determining plasminogen/plasmin, α2-macro-globulin, α1-antitripsin content at the first, third, fifth and tenth day. The plasminogen/plasmin level being equal to 66-74 mcmole/l or 100-120 mcmole/l, α2-macro-globulin level of 2.7-3.0 mcmole/l, α1-antitripsin content of 2.38-3.2 mcmole/l, systemic inflammatory response to purulent infection, light severity degree endotoxicosis is diagnosed and favorable disease outcome is predicted. The plasminogen/plasmin level being equal to 50-65 mcmole/l or 125-160 mcmole/l, α2-macro-globulin level of 2.3-2.6 mcmole/l, α1-antitripsin content of 3.3-4.0 mcmole/l, sepsis with organ and system dysfunction, moderate severity degree endotoxicosis is diagnosed and septic complication availability and lingering disease development course is predicted. The plasminogen/plasmin level being equal to 39-40 mcmole/l, α2-macro-globulin level of 1.58-2.08 mcmole/l, α1-antitripsin content of 5.0-6.2 mcmole/l, severe sepsis, septic shock, severe degree endotoxicosis is diagnosed and unfavorable disease outcome is predicted.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, biochemistry.
SUBSTANCE: at testing one should precipitate high-molecular compounds with acetonitrile and register supernatant's spectral characteristics. Supernatant should be applied onto a paper filter, dried and put into solution containing aromatic aldehyde, acetone and concentrated hydrochloric acid taken at weight ratio of 70:5:1 to be kept for 2-3 min. Then it should be once again dried up to detect qualitative and semiquantitative content of oxidized tryptophan metabolites by intensity and chromatic shades. Moreover, by chromatic shades of yellow dyeing it is possible to detect the content of hydroxylated metabolites and by chromatic shades of violet dyeing - that of unhydroxylated ones.
EFFECT: higher significance of detection.
FIELD: medicine, anesthesiology, resuscitation.
SUBSTANCE: in patients one should study the content of lactoferrin in peritoneal exudates during the 1st d of postoperational period and at decreased value being below 3500 ng/ml on should predict unfavorable result. The suggested method provides correction of possible postoperational complications that deteriorate the flow of peritonitis and lead to lethal result.
EFFECT: higher accuracy of prediction.
FIELD: veterinary medicine.
SUBSTANCE: method involves determining low and middle molecular mass substances content in blood plasma and erythrocytes and general blood plasma albumin concentration. Integral index is calculated on basis of obtained values using formula II=100*S238-298(plasma)/S238-298(erythrocytes)*GAC, where S238-298(plasma) and S238-298(erythrocytes) are the low and middle molecular mass substances content in blood plasma and erythrocytes, respectively, determined from area of figures restricted by spectral curves in wavelength range of 238-298 nm and abscissa axis (conditional units2); GAC is the general blood plasma albumin concentration (g/l). The value being from 2.1 to 3.0, the first endotoxicosis degree is diagnosed. The value being from 3.1 to 4.5, the second endotoxicosis degree is diagnosed. The value being from 4.5 to 6.0, the third endotoxicosis degree is diagnosed. The value being greater than 6.0, the fourth endotoxicosis degree is diagnosed. The normal value is equal to 0.5-2.0.
EFFECT: high accuracy of diagnosis.
1 dwg, 1 tbl
SUBSTANCE: method involves separating blood serum proteins into fractions, determining albumins and alpha-2-globulins content and controlling their content changes during the disease development process. Gamma-globulin content is determined in per cent ratio with respect to total protein quantity. Then, changes in the fractions content are controlled from the first to the third week. Albumin content being in norm and alpha-2-globulins content becoming greater to the end of the first week by 30-50% when compared to normal value and dropping to norm at the second week end and gamma-globulin content increasing from norm by 10-30% to the second or the third week, high inflammatory process activity is to be diagnosed. Albumin content dropping by 10-30% from normal value at the second week, alpha-2-globulins content growing by 10-20% of norm and gamma-globulin content dropping by 30-50% at the second or the third week when compared to norm, low inflammatory process activity is to be diagnosed.
EFFECT: high accuracy and reliability of diagnosis.