Method for predicting prostatic tuberculosis

FIELD: medicine, urology.

SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.

EFFECT: more reliable and objective information.

1 ex, 1 tbl

 

The invention relates to medicine, namely to urology.

Diagnosis of extrapulmonary TB is a difficult task. Unlike tuberculosis, when the characteristic x-ray changes help to establish the diagnosis at the stage of minimal changes, specific process extrapulmonary localizations has no pathognomonic signs, with the exception of bacteria, which currently does not exceed 44%due to unreasonably widespread use of fluoroquinolones and other drugs, bakteriostaticheski affect Mycobacterium tuberculosis. Characteristic radiographic signs appear too late, at the stage of formation of cavities, when talking about the cure of the patient is not necessary.

For the timely diagnosis of extrapulmonary tuberculosis in 1921 in clinical practice are applied provocative TST [1].

The practical significance of the tuberculin tests for tuberculosis of the urogenital system is that they allow to judge the presence or absence of a specific active process long before the results of bacteriological examination of the urine of Mycobacterium tuberculosis (MBT).

Fundamentally provocative tuberculin skin test, based on a subcutaneous injection into the body t is bertolina and evaluation occur after the introduction of the reactions: reactions of the organism as a whole (overall reaction) the skin at the injection site (okolocha reaction and reactions affected by the specific process of the body (focal reaction).

The greatest practical value for tuberculostatic genitourinary tuberculosis is the assessment of the degree of focal reaction on the part of the affected organ. Originally proposed modification evaluation focal reactions related to the learning content in the urine of various markers of the inflammatory process, first of all cellular elements of the urine sediment[2, 3, 4, 5]. Factor limiting the application of the tuberculin test with a quantitative examination of urine sediment is pyuria. Also, a significant disadvantage is the lack of strict organ specificity and unreliability when limited by the volume of tuberculous lesions one kidney [6].

Methods based on the study of the dynamics of the content in the urine of non-cellular markers of the inflammatory process, fine, but setting them requires special reagents and equipment. Such methods are increasingly proteinuria, lysolaje after tuberculin injection [7, 8], tuberculina-radioisotope-venographically sample Budhraja (1973), modification of its Alabados and Avellini (1980) using segmental renogram and computer processing. In 1989 Laaper was developed by tuberculin-pharmaco-and digitalmania sample [9]. N.A. of Ginger in the same year suggested that tuberculina-transamidase sample [10].

Other specimens increase the efficiency of diagnosis is negligible, and therefore are used in phthisiatry not widely spread.

A known method for the diagnosis of active TB external Popov bodies change in conductivity of the skin of the scrotum (copyright certificate №1300688), but this method is not applicable for prostate cancer, deeply hidden in the small pelvis organs.

Thus, currently there is no effective and reliable method for the diagnosis of tuberculosis of the prostate; modern developments are related mainly tuberculosis of the kidneys or of the vulva, and the diagnosis of tuberculosis of the prostate is based on subjective symptoms and uninformative methods in routine laboratory diagnostics. The proposed method for the diagnosis of tuberculosis of the prostate by asking subcutaneous provocative TST, characterized in that it further before trial and after 48 hours spend the color mapping of the vessels of the prostate and reduce the hemodynamic diagnose tuberculosis, allows to obtain accurate and objective information, moreover to document it through the advantage which atki of dopplergram on the printer.

The method is as follows.

Within two days before trial and the three subsequent conduct thermometry every two hours. At baseline and after 24 and 48 hours after injection of 50 Tu of tuberculin under the skin shoulder carry out a General analysis of the blood sample Nechiporenko, urine cultures and prostate secretion in MW, fluorescent microscopy of urine; take into account General and colocou reaction. Additionally on the eve of the trial and after 48 hours performed color Doppler imaging of blood vessels of the prostate gland.

The study was conducted using ultrasonic scanner Hitachi - 515 (Japan) or similar. Pre-patient put a cleansing enema and appoint welcome to 1.0 fluid, the bladder was full.

When transabdominal studies use standard ultrasonic electronic convex probe with a frequency of 3.5 MHz. The study was conducted through the anterior abdominal wall. For transrectal ultrasound-covered condom sensor (frequency 6.5 MHz) injected into the rectum to a depth of 5-6 see

Assess the shape, size, echo and echo-structure of the prostate gland in mode. This is followed by color Doppler imaging to assess blood flow in the prostate gland.

Color scanning is ultrasonic technology visualise the tion of blood flow, based on the registration of the velocity of blood flow, coding these speeds in different colors and overlay the received picture on a two-dimensional black and white image of the examined body. Evaluate the vascularization of the tissue of the prostate and hemodynamics in its vessels. Quantitative characteristics of vascularization of the prostate gland are the density of the choroid plexus and the average diameter of blood vessels [11].

The study of the hemodynamics of the prostate was carried out using ultrasonic Doppler pulsed-wave mode.

In the study of dynamic in the color scan mode was chosen vessel with the best visual settings, which allowed to identify the vessel as one of the main and was allowed to record the Doppler spectrum as suitable for analysis. These parameters served as the major diameter of the vessel, the proximal division of the smaller branches, no tortuosity of the vessel and its location at an acute angle (less than 70°) to the scanning axis.

Using ultrasonic Doppler pulsed-wave mode, a graphical image of the spectrum of Doppler frequency shift in the selected vessel.

Assessment of qualitative characteristics of the spectrum of the Doppler frequency shift was carried out according to the conventional technique. In addition, it was carried out determination of the quantitative characteristics of Doppler spectrum: peak linear velocity of blood flow, diastolic, average speed of flow, volume rate of flow, pulsatile index and resistance index.

Peak linear blood flow velocity (Vp) is the largest linear velocity of blood flow in the vessel at the time of systole, measured in cm/S.

Diastolic linear blood flow velocity (Vα) is the minimum speed of blood flow in the vessel at the time of diastole.

The average blood flow velocity (Vm) is the average linear velocity of blood flow over time and is determined automatically, measured in cm/s Volumetric blood flow velocity (FV) is the amount of blood passing through the cross section of the vessel for 1 minute, measured in liters/min Pulsatile index (PI) is the ratio of the difference between the maximum linearity and diastolic velocity to the average linear velocity, measured in arbitrary units, USD and is described by the formula:

where Vp is the peak linear velocity of blood flow; Vd - diastolic blood flow velocity; Vm is the average velocity of the blood flow.

The resistance index (RI) is the ratio of the difference between the maximum linear and diastolic velocity to peak linear velocity of blood flow; measuring is carried out in conventional units, c.u. described by the formula:

where Vp is the peak linear velocity of blood flow; Vd - diastolic blood flow velocity.

The importance of these parameters served as a quantitative characteristic of the hemodynamics of the blood vessels of the prostate gland.

Example 1.

Patient N., 17 years were admitted to our Department with complaints of persistent pain in the lumbar region, frequent painful urination. Onset connects with hypothermia 3 months ago. A resident of the district. Student of the school. Brother and sister healthy. Parents are healthy. Contact with TB patients and animals were not. Bad habits not. During examination: the patient's condition is satisfactory, the normal shape. An objective examination of the pathology of organs and systems no. When inspecting local status genitals formed on the male type: testicles in the scrotum are not changed. Upon examination of the prostate size 2,0×3.0 cm, smooth, painful, Magdalena groove is defined. The laboratory examination of blood: hemoglobin 123 g/l, leukocytes 9*109g/l, erythrocyte sedimentation rate 22 ml/hour, neutrophils 52, lymphocytes 40. Urine analysis: leukocyte 3-4 in eyeshot, red blood cells 10 in the field of view, urine in BC triple negative. Analysis of the urine on Nisurance of 1000 leukocytes, erythrocytes 1000. The secret to depict athelney cancer: a large number of leukocytes, erythrocytes 10-15, lecithin grains are not a large number, Bq is not detected. Sperm count: sperm count in 1 ml of 67 million active mobile 45%, sedentary 17%, still 48%, the amount of fructose 5.5 mmol/l, the percentage of pathological forms 2. Bacteriological examination of the growth of microorganisms not. Ultrasound of the prostate: the size 2,0×3,1×2,8 see Volume 18 cm3contours gland clear, the structure is non-uniform in the Central areas of both lobes lazerous hypoechoic areas without clear contours, the blood flow is reduced, the testes and epididymis without changes.

Data abnormal Doppler waveforms are presented in table 1.

Table 1

Changes LDF patient N. on the background of subcutaneous provocative tuberculin skin test
OptionsThe Central areaThe peripheral zone
 Before sampleAfter 24 hours.Before sampleAfter 24 hours.
Linear peak velocity, cm/sfor 6.815,326,415,13
Linear diastolic velocity,

cm/s
3,21of 2.512,892,32
Linear average velocity, cm/s5,02a 3.94,253,4

Conducted provocative tuberculin skin test. After 48 hours in blood hemoglobin - 123 g/l, leukocytes - 10*109g/l, ESR - 23 ml/h, neutrophils 52, lymphocytes 37. The secret of the prostate gland: leukocyte 8-10, red blood cells do not. Urine tests: a large number of leukocytes, erythrocytes 10-15.

When re-color mapping of vessels within 48 hours found a linear decrease of peak diastolic velocity at 20-22%, which allowed the diagnosis of tuberculosis of the prostate gland and start TB treatment. After 3 weeks received the growth of M. tuberculosis in the prostate secretion, taken against the background of subcutaneous provocative tuberculin tests. Thus, routine laboratory data were not informative and bacteriological verification had to wait a long time. The application of the proposed method led to 3 weeks earlier to establish the correct diagnosis and start appropriate treatment.

The proposed method was tested in 17 patients: 9 patients with tuberculosis of the prostate, 8 - chronic nonspecific prostatitis. All patients with tuberculosis of the prostate gland dopplergrams was a marked decrease in kavoor is placed on the 20-22%. At the same time, none of the patients with chronic nonspecific prostatitis no marked changes LDF 48 hours after subcutaneous provocative tuberculin skin test that shows high efficiency and specificity of the proposed method.

LITERATURE

1. Karo W. Der diagnostische Wert des Tuberculins bei den Erkrankungen der Harnwege//z Urol. - 1922. - Bd. 16-S. 316.

2. Aidarov A. A., Makarova GD// Kazan, honey. Journe. cash. - 1972. No. 2. - Ñ.38-40.

3. Grund E, Shapiro A.L.//lab. case. - 1972. No. 3. - S-179.

4. Puzanova V.A. et al.//Probl. TB. - 1995. No. 2. - P.58.

5. La portee du test ela tuberculine dens le depistage de la tuberculose du rein//Urol. Internat. - 1975. - Vol. 30, No. 5. - P.321-325.

6. Belenky, MS Clinical tuberculin diagnostics. Kiev, “Health”. - 1984. - P.88.

7. Pytel Y.A., A.L. Shapiro, S.B.//Sov. the honey. - 1975. No. 7. - Pp.96-100.

8. A method for the diagnosis of tuberculosis of the urinary system/Mochalova ETC. - Application for invention No. 1208616 with a positive decision from 19.01.86.

9. Chabad A.L., Amelin AV, Makhlin NV//Sov. the honey. - 1983. No. 12. - S-106.

10. Ginger N.A.// Sat. scient. Tr. young scientists. - M., 1989. - P.12-13.

11. Ignashin NS, Goryunov VG, Vinogradov V.R. Transrectal ultrasound scanning in the diagnosis of chronic inflammatory diseases of the prostate. //Urol. and nefrol., 1987. No. 5. P.54-56.

A method for the diagnosis of tuberculosis of the prostate by asking under what you provocative TST, characterized in that it further before trial and after 48 h hold color mapping of the vessels of the prostate and reduce the hemodynamic diagnose tuberculosis.



 

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