Method for diagnosing the cases of superior thorax aperture syndrome

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.

 

The invention relates to medicine, namely to vascular surgery. Until recently, that is, before the widespread introduction of ultrasonic duplex scanning, diagnosis of diseases included in the syndrome of the upper thoracic aperture (hereinafter referred to as SVGA), was based in most cases on the clinical application of compressive sampling (Rus, Lange, Togoville, Adana and others), which are quite subjective.

The most accurate and informative method of diagnostics of SUGA is angiography, but this method is invasive and cannot be used in all cases suspected of SVGA.

Doppler ultrasound is the best method of investigation of patients with SVGA, as it is a non-invasive, allows us to evaluate the results of compression tests, as well as to judge the degree of compression of the neurovascular bundle, which together with clinical manifestations allows you to select the severity of SUGA and differentiated approach to the choice of treatment method.

Prototype

Closest to the proposed method is described by A.V. Vardanyan (PhD thesis on the topic: “clinical picture, diagnosis and indications for surgical treatment of syndrome of compression of the neurovascular bundle at the exit of the chest”. Moscow, 1990, p.51-53). This JV the property taken as a prototype. It includes the study of linear blood flow velocity (hereafter - LSC) and blood pressure (hereafter BP) in the subclavian, axillary, brachial, ulnar and radial arteries at rest and BFV in the radial artery at 3 functional tests: abductee, hyperabduction and in the “military posture”. When the change of blood flow in collateral or its disappearance was confirmed by dynamic compression of the subclavian artery. The disadvantage of the method is confirmed only compression of the subclavian artery on the basis of changes in blood flow in the radial artery, without specific forms and degrees of severity of SVGA.

The purpose of the invention

The aim of the invention is to develop a method of ultrasound examination subclavian artery in patients with uncomplicated form of SUGA at rest and during exercise compressive sampling, which allows us to estimate the nature and extent of circulatory disorders in the upper limbs for accurate diagnosis.

The invention

The proposed method for the diagnosis of SUGA is as follows.

Ultrasonic duplex scanning with color Doppler mapping (DDC) is a linear transducer with a frequency of 7.5 MHz patient is in sitting position under normal physiological position of the hands. Investigated the blood flow throughout, i.e. on the beam, l is cheveu, brachial, and axillary arteries. Assesses the condition of the vessel in b-mode (lumen diameter, wall), in the color mapping mode and Doppler mode (the determination of the nature of blood flow and the characteristic speed parameters). Then purposefully explores the middle and distal segments of the subclavian artery with all the above characteristics and with simultaneous pressure measurement on the shoulder.

A method for the diagnosis of the syndrome of the upper thoracic aperture, consisting of ultrasound, characterized in that is carried ultrasound subclavian artery in its distal segment (lumen diameter, wall thickness, flow and BFV) with measurement of blood pressure in the middle third of the shoulder in the physiological position of the hand, and thus conduct compression tests which identify the specific nosological unit, which is included in SVGA, and the severity of the disease.

Next, the flow in the subclavian artery in the same localization of the sensor and on the same parameters evaluated when conducting compression samples:

1) test with abduction and hyperalgesia indicates syndrome pectoralis minor;

2) sample Lange - characteristic of scalenus syndrome;

3) test with ptosis and diverting hands ago, when the closing of the hands on the waist in a “lock” for tabernacling syndrome.

Ultrasound signs of compression of the subclavian artery can occur when the syndrome of the cervical ribs already with a slight lead hands (it all depends on the length of the ribs, the location of it in the tissues, place attachment), which in combination with the data of x-ray (the presence of additional edges) allows you to set the diagnosis.

On the basis of the received data USDG we can distinguish three degrees of severity of SUGA:

1. Easy - reduction lbfv up to 40% and the HELL up 20% from baseline while maintaining the main character of blood flow. In the absence of clinical manifestations and painful subjective sensations such indicators can be regarded as variants of normal.

2. The average reduction of lbfv up to 70% and the HELL up to 50% of the original values with the closure of the spectral window and the changing nature of blood flow on the backbone-modified.

3. Heavy decrease in BFV more than 70% and HELL more than 50% of the original down to the complete lack of blood flow in the subclavian artery (RCA).

A specific example of the method:

Patient Magomedov R. (history 12/0558), 26 years old, was admitted to the Department of vascular surgery of the RSC, Makhachkala with complaints of weakness, pain in his right hand, feeling cold, numbness in right hand, aggravated by the raised hand. The patient feels that he is about 2 years, previously treated at the neurologist diagnosed with steakholders cervical-thoracic spine. Objectively: General condition is satisfactory, the skin and visible mucous membranes pink, peripheral lymph nodes are not enlarged. Asthenic physique. In the lungs vesicular breath, held all of the fields, the NPV - 18 beats/min Heart tones are clear, rhythmic, heart rate of 74 beats/min HELL 110/70 mm Hg Abdomen is soft, painless, peristalsis active, liver and spleen are not enlarged.

Local status: both of the upper limb in length and in volume relatively the same, trophic disorders of the skin, no edema.

Pulsation of the radial artery at rest, distinct from both sides with lead and hyperabduction hand is determined. The test Lange left the ripple is determined, on the right disappears, the test Rus positive - fingers turn pale, feel cold, appear paresthesias.

In laboratory studies of pathological changes.

Assigned the conduct of Doppler ultrasound with duplex scanning and color mapping of blood flow:

Right - 1) alone lbfv by PKA 48 cm/sec, the main flow; 2) when the lead hand lbfv 32 cm/sec, the flow of trunk; 3) when the sample Lange lbfv reduced to 11 cm/sec, the nature of the flow of backbone-modified; 4) when lowered and retracted his hand lbfv 43 cm/sec, the flow of the trunk.

To the left, respectively: 1) 53 cm/sec; 2) 43 cm/sec; 3) 52 cm/sec; 4) 48 cm/sec.

The pattern of blood flow remained trunk.

Systolic blood pressure to the right in the original position 110 mm Hg, when the sample Lange - 40 mm Hg

Diagnosis: SVGA, scalenus syndrome right, neurovascular form, uncomplicated option, severe.

9.10.01 routinely processed - scalenotomy right.

The postoperative course is smooth, marked regression of symptoms.

When the control USDG 10 day BFV right alone 42 cm/sec, the test Lange - 35 cm/sec while maintaining the main character of blood flow.

The histological conclusion: the final stage of chronic productive myositis.

The patient was discharged in satisfactory condition. When viewed through three months of data for no recurrence of the disease.

Signs, distinctive features of the prototype:

1. In the physiological position of the hand, the blood flow is investigated throughout (as in the prototype), but the compression of samples recorded changes of parameters of blood flow in the distal segment of the RCA (i.e. directly behind the site of compression), unlike the prototype, where the measured rate of flow in the radial artery.

2. In the method prototype is confirmed by the only fact of dynamic compression PKA no indication of the possible level of compression and, therefore, the specific not ogechukwu unit, included with SVGA. On offer as a method of the invention modify the characteristics of blood flow in certain compressive samples provide an opportunity to set a specific diagnosis and to differentiate between the choice of method of operation, namely:

a) the sample with the abduction and hyperalgesia - indicates syndrome pectoralis minor;

b) sample Lange - characteristic of scalenus syndrome;

C) the sample is omitted and diverting hands ago, when the closing of the hands on the waist in a “lock” for costoclavicular syndrome.

2) In the prototype does not provide guidance on determining the severity of SUGA on the basis of the data of the ultrasound examination. In the proposed method for the diagnosis of three degrees of severity of SUGA that helps in the choice of conservative or surgical treatment, namely: light while reducing lbfv up to 40% and the HELL up 20% from baseline, while maintaining the main character of the flow medium at lower lbfv up to 70% and the HELL up to 50% and change the nature of the blood flow on the backbone modified, heavy at lower lbfv more than 70% and HELL more than 50% of the original down to the complete lack of blood flow in the subclavian artery.

The usefulness of the proposal

In this way the diagnosis of SUGA examined 30 patients. Proposed as a method of the invention has allowed to improve the qualities of the diagnosis of this group of diseases, the method proved informative, gave the possibility to differentiate between the choice of treatment. As a result of treatment in all patients after compression, after the operation, the pulse at the radial artery did not disappear when performing compression of samples in the control USDG registered the increase in ISC when compressing two or more times in comparison with initial level.

The way to diagnose the severity of the syndrome of the upper thoracic aperture (SVGA), including ultrasound (US) subclavian artery (RCA), measurement of blood pressure (BP) and conducting compression tests, characterized in that the source ultrasound PKA conducted throughout under physiological position of the hand to measure blood pressure in the middle third of the shoulder, then, when performing compression tests, the change of blood flow parameters fixed in the distal segment of the RCA with simultaneous pressure measurement and depending on the degree of reduction of the linear blood flow velocity (BFV) and HELL compared to their baseline levels diagnosed three the degree of severity of SUGA: easy - while reducing lbfv up to 40% and the HELL up 20% from baseline, average - while reducing lbfv up to 70% and the HELL up to 50% and heavy at lower lbfv more than 70% and HELL more than 50% of the original down to the complete lack of blood flow in the RCA.



 

Same patents:
The invention relates to medicine, namely to ophthalmology, and can find application in the diagnosis of clinical variants of glaucoma that develops on the eyes with myopia
The invention relates to medicine, cardiology

The invention relates to medicine, in particular.

The invention relates to medicine and can be used to diagnose the degree of vibration disease

The invention relates to medicine and can be used for intraoperative diagnosis of patency mammarocoronary and coronary artery bypass grafts

The invention relates to medicine and can be used to determine blood flow in atlantooccipital venous sinus

The invention relates to medicine, namely, clinical physiology, and can be used in intracranial neurosurgical operations for monitoring cerebral blood flow

The invention relates to medicine and can be used to evaluate disorders of the arterial blood flow in the spinal cord

The invention relates to medicine, cardiology, cardiac surgery

The invention relates to medicine and can be used in physiological studies locking apparatus and rectal diseases

The invention relates to medicine, in particular to methods of Express-diagnostics of the human body under physiological parameters of biologically active points (BAP)

The invention relates to medicine, functional diagnostics and can be used to detect autonomic dysfunction and assessment of adaptive mechanisms of the autonomic nervous system (ANS)

The invention relates to medicine, in particular for veterinary

The invention relates to the field of medical equipment, namely to design devices for the transfer of electrocardiogram radio, and can be used in practical health care, including in the system of the ambulance, in the system of distance counselling centres

The invention relates to the field of medical equipment, namely to design devices for the transfer of electrocardiogram radio, and can be used in practical health care, including in the system of the ambulance, in the system of distance counselling centres

The invention relates to contactless investigation of the functional state of the cardiovascular system in the electromagnetic field, harmless to humans

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.

Up!