Method for predicting nontraumatic intracranial hemorrhage outcomes

FIELD: medicine.

SUBSTANCE: method involves evaluating prognostic signs and calculating their prognostic weight. Consciousness disorders and diagnosis set at prehospital stage are used as the prognostic signs. Calculations are carried out from formula: lethal outcome %= -15.99+19.1•C+14.7•DS-2.79•C•DS, where C is the ranged consciousness disorder degree, DS is the diagnosis set prehospital stage. The higher is the value, the higher is lethal outcome probability.

EFFECT: accelerated and simplified prognosis method.

 

The present invention relates to medicine, namely to neurosurgery, and can be used in forecasting outcomes nontraumatic intracranial hemorrhage.

Known way to predict the outcome of stroke (Misiuk NS, Mastikhin A.S., Grishkov Mrs x, fundamentals of mathematical prediction of human diseases. - Minsk. - 1972. - s-190). According to this method, the patient's condition is determined by the amount of characteristics: age, month of the disease, data history, General physical examination, neurological status, the results of instrumental methods of examination (ECG, blood pressure measurement). Just use about 32 symptoms. Weight symptom assessed on a five-point system. By exposing for each symptom inferred weights calculate the total amount of symptoms. The prognostic index is less than 95 characterize a favorable outcome, 95-110 dubious outcome, more than 110 unfavorable outcome.

The main disadvantages of this method are: the use of formulas for all types of stroke, which reduces its reliability and accuracy in the determination of outcomes in patients with nontraumatic intracranial hemorrhage; high complexity and processing time associated with a detailed examination of the patient, taking a history, conducting instrumental methods of IP is to study (ECG, measurement of blood pressure). In the result, this method cannot be used to establish the probability of the outcome in patients with intracranial hemorrhage at the time of delivery of pre-hospital medical care or in the first few minutes the patient has been admitted to the hospital for further treatment, namely solutions of the appropriateness of admission to a neurologic or neurosurgical Department and selection of the optimal type of treatment: conservative or surgical.

The prototype of the present invention is a method of prediction of treatment outcomes of patients with hemorrhagic stroke (Ponomarev V.A. Prognosis of surgical treatment of patients with hemorrhagic stroke. - Ed. Diss. Cand., - M - 1998, p.26-38). According to this method in patients with hemorrhagic stroke appreciate the following characteristics: the degree of disturbance of consciousness, severity of the middle cerebral dislocation syndrome, type of stroke, the ratio of the volume of the hematoma to the total volume of hematoma and perifocal zone changes (in CT), violations of EEG, different types of intraventricular hemorrhage and summation determine the probability of a lethal outcome in accordance with a pre-calculated predictive weights of attributes.

The main disadvantage of this method is high enough the Kai complexity of measuring these indicators, in the result, this method cannot be used immediately after the patient has been admitted to the hospital, when it is not carried out basic diagnostic tests (CT scan, EEG, etc. for rapid assessment of outcomes nontraumatic intracranial hemorrhage, select the profile of the Department (neurosurgical or neurological) and determine tactics of treatment.

The invention is directed to a method of predicting outcomes nontraumatic intracranial hemorrhage, allowing you to speed up and simplify the prior forecast outcomes nontraumatic intracranial hemorrhage that will contribute to the speed and adequacy of assistance provided by a large flow of patients. This is achieved in that in the method for predicting outcome of nontraumatic intracranial hemorrhage by evaluating a number of prognostic factors and the calculation of the overall predictive weight characteristics as prognostic signs use the degree of disturbance of consciousness and a diagnosis in the prehospital.

The inventive method differs from the prototype in that the calculation is done according to the formula:

% death = - 15,99+19,1•+14,7•DS-2,79••DS

where - ranked degree of disturbance of consciousness, DS - diagnosis in the prehospital.

P and predicting outcomes nontraumatic intracranial hemorrhage in order to accelerate the receipt of forecast use prognostic sign pre-hospital diagnosis, which is the expert evaluation of the patient with nontraumatic intracranial hemorrhage by a physician pre-hospital stage.

The method is as follows: in the initial examination of the patient in the emergency Department of the hospital determine the degree of impairment of consciousness and using pre-hospital diagnosis, which is the expert evaluation of the patient with nontraumatic intracranial hemorrhage, calculate the overall predictive weight signs and predict outcomes nontraumatic intracranial hemorrhage according to the formula obtained by regression analysis:

% death = - 15,99+19,1•+14,7•DS-2,79••DS

where 15,99; 19,1; 14,7; 2,79 - coefficients of the regression equations;

S - ranked the degree of disturbance of consciousness;

DS - diagnosis established at the prehospital stage.

The ranking of the indicators is as follows:

With the degree of impairment of consciousness:

1 - clear consciousness;

2 - moderate stun;

3 - deep stun;

4 - spoor;

5 coma I;

6 - coma II;

7 - coma III.

DS - diagnosis established at the prehospital stage.

1 - "Nontraumatic intracranial hemorrhage" (the presence of intracranial hemorrhage).

2 - Acute violation of cerebral kavooras the con" (without setting type vascular accident).

3 - "Ischemic stroke" (wrong type is set to vascular accident).

4 - have a different vascular pathology (such as "hypertensive crisis", "encephalopathy" and so on).

5 - Installed disease of other origin ("acute myocardial infarction", gastrointestinal bleeding, and so on).

The more the indicator, the higher the probability of death.

The inventive method of predicting outcomes nontraumatic intracranial hemorrhage developed in the Polenov research neurosurgical Institute them. Operated and underwent clinical trials in 682 patients with nontraumatic intracranial hemorrhage admitted to the hospital. The reliability of the method - p<0,001 (over 99.9%). The accuracy of the model (prediction accuracy) RI=75%.

Examples of extracts from the histories.

Example 1.

Patient L-(IB. N 8714) was admitted to the hospital with dignosis coronary heart disease. When viewed in the waiting room, the patient recorded impairment of consciousness, coma II and suspected nontraumatic intracranial hemorrhage.

According to the claimed method using the formula was predicted outcome:

- 15,99+19,1•+14,7•DS-2,79••DS=-15,99+19,1•6+14,7•5-2,79•6•5=88,41%

The probability of a fatal outcome was 88,41%, in this regard, given the high probability of a fatal outcome, the patient is to continue the examination and treatment admitted to the neurology ward, where the diagnosis of intracranial hemorrhage was confirmed. After 16 days of inpatient treatment, the patient has come to be lethal.

Example 2.

Patient L (IB. N 1915) was admitted to the hospital with a diagnosis of acute ischemic stroke. When viewed in the waiting room it is established that the patient is in moderate stun. Suspected nontraumatic intracranial hemorrhage. Using the formula was predicted outcome:

-15,99+19,1•+14,7•DS-2,79•-DS=-15,99+19,1•2+14,7•2-2,79•2•2=40,45%

The probability of a fatal outcome was 40,45%, in this regard, the patient was hospitalized in the neurosurgery Department, where the examination was confirmed intracranial hemorrhage and underwent an operation for the removal of the hematoma. After 4 weeks the patient is in satisfactory condition discharged from the hospital.

A method for predicting outcome of nontraumatic intracranial hemorrhage, including the assessment of prognostic signs and the computation of their cumulative prognostic weight, characterized in that the calculation is done according to the formula

% deaths =-15,99+19,1•+14,7• DS-2,79 • • DS

where 15,99; 19,1; 14,7; 2,79 - coefficients of regression equations;

S - ranked the degree of disturbance of consciousness;

1 - clear sosn the tion;

2 - moderate stun;

3 - flexible stun;

4 - spoor;

5 coma I;

6 - coma II;

7 - coma III;

DS - diagnosed prehospital:

1 - nontraumatic intracranial hemorrhage,

2 - acute violation of cerebral circulation,

3 is an ischemic stroke,

4 - hypertensive crisis, encephalopathy,

5 is a disease of other origins

and the more the indicator, the higher the probability of death.



 

Same patents:

FIELD: medicine.

SUBSTANCE: method involves studying blood samples with venous blood mixed with vital stain like methylene blue. Degree of vital stain absorption by erythrocytes is determined by applying photocolorimetry. The value drop being more than 25%, extracorporal detoxication is to be predicted as ineffective.

EFFECT: simplified method.

6 tbl

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

The invention relates to medicine, namely to Perinatology, and can be used to determine the status of the fetus of female health workers

The invention relates to medicine, namely to Oncology

The invention relates to medicine, reflexogenic

The invention relates to medicine, namely to Oncology, and can be used in neurology, traumatology, surgery, forensic medical examination to determine pain syndrome

The invention relates to the field of medicine and veterinary medicine, and specifically to obstetrics and gynecology, and can be used in the diagnostic process of the physiological state of the female reproductive system, pregnancy planning or adopting measures for protection from unwanted pregnancy, and can also be used in animal husbandry when determining the period of ovulation in animals

The invention relates to medicine, in particular to the treatment and intraoperative diagnosis of diseases of the hepatobiliary zone

The invention relates to medicine, namely, neurology, and can be used in patients with tick-borne encephalitis to predict the possible development of focal forms in the early stages of the disease

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.

SUBSTANCE: method involves studying blood samples with venous blood mixed with vital stain like methylene blue. Degree of vital stain absorption by erythrocytes is determined by applying photocolorimetry. The value drop being more than 25%, extracorporal detoxication is to be predicted as ineffective.

EFFECT: simplified method.

6 tbl

FIELD: medicine.

SUBSTANCE: method involves evaluating prognostic signs and calculating their prognostic weight. Consciousness disorders and diagnosis set at prehospital stage are used as the prognostic signs. Calculations are carried out from formula: lethal outcome %= -15.99+19.1•C+14.7•DS-2.79•C•DS, where C is the ranged consciousness disorder degree, DS is the diagnosis set prehospital stage. The higher is the value, the higher is lethal outcome probability.

EFFECT: accelerated and simplified prognosis method.

FIELD: medicine.

SUBSTANCE: method involves evaluating proliferating processes by calculating index of positive cell nuclei (Ki-67). The Ki-67 value being from 6 to 16%, erosive ulcerating stomach lesions accompanied by stomach hemorrhage and hemorrhagic shock is to be predicted. The value being from 17 to 30%, erosive ulcerating stomach lesions without hemorrhage is to be predicted.

EFFECT: high accuracy of prognosis.

1 tbl

FIELD: medicine, urology.

SUBSTANCE: the present innovation deals with differential diagnostics of prostatic cancer and other prostatic diseases at the stage of primary inspection. The method includes the detection of PCA and calculation of probability coefficient for prostatic cancer (PCC) by the following formula: where e - the foundation of natural logarithm (e=2.718…), PCA - the level of total blood PCA in ng/ml, V - patient's age in years. At PCC value being above 0.2 one should diagnose prostatic cancer and to establish final diagnosis one should perform polyfocal prostatic biopsy. The method enables to increase accuracy of diagnostics at decreased number of unjustified prostatic biopsies.

EFFECT: higher efficiency of diagnostics.

2 ex

FIELD: medicine.

SUBSTANCE: method involves determining homeostasis values and absolute number of neutrophils and lymphocytes in particular. Low neutrophil number being determined in a child during a number of years and low number of lymphocytes in the persons from the nearest child surrounding, the persons are to be examined for given psychosomatic pathology availability with following medical treatment to be applied to eliminate the detected pathology and to normalize homeostasis values and lymphocyte number among others.

EFFECT: enhanced effectiveness of prophylaxis.

FIELD: medicine.

SUBSTANCE: method involves measuring radio signals and low frequency spectra of signals emitted by oral cavity organs and tissues in maxillofacial area. Decoding and comparison of the spectra to healthy organs and tissues spectra is carried out. Then, modulated information signals in infra-low frequency bandwidth corresponding to healthy organs and tissues signals are applied. Low frequency radio signals and spectra are measured. Treatment with modulated signals in infra-low frequency bandwidth is applied directly to organ or its location zone via skin.

EFFECT: enhanced effectiveness in diagnosing and treating oral cavity organs and tissues in maxillofacial area.

5 cl, 3 tbl

FIELD: medical engineering.

SUBSTANCE: device has bottom and cover joined in inseparable way so that no chance is available to mismatch covers belonging to different containers. The bottom and internal part of cover are lined with sponge so that the allergenic disks are kept in uniformly wetted state. Grate with holes is attached to lower sponge, the holes narrowing downward as cones so that the allergenic disks are kept in stable vertical position.

EFFECT: simplified access to disks using forceps; excluded misidentification risk.

5 cl, 6 dwg

FIELD: medicine, operative gynecology.

SUBSTANCE: at final stage of laparoscopic operation for 5-7 min one should introduce 16 U lidase in 1 ml 2%-lidocaine solution into uterine mesentery from both sides, and then, by not removing a needle - a half of single dose of antimicrobial preparation in 1 ml 2%-lidocaine solution, then in postoperational period - an antimicrobial preparation applied during laparoscopy lymphotropically under mucosa of lateral vaginal arch from both sides for 5-7 d once daily and one antimicrobial preparation - intravenously for 5-7 d, moreover, as antimicrobial preparations one should apply gentamicin, metrogyl and other preparations permitted for intravenous application. The present innovation stimulates lymphatic drainage in area of inflammation and activates interstitial humoral transport of antimicrobial preparations that, in its turn, favors complete sanitation of inflammation foci and prophylaxis of disease relapses.

EFFECT: higher efficiency of therapy.

1 cl, 1 ex

FIELD: medicine.

SUBSTANCE: method involves applying biological indicator as mixture composed of 0.1% aqueous solution of amino acids: leucine, glycine, proline, serine, phenylalanine, histidine, oxyproline, arginine, glutamic amino acid and aspartic amino acid, 0.5% aqueous solution of neuromediators like dopamine and histamine, 12% aqueous solution of magnesium sulfate in proportion of amino acids : neuromediators : magnesium sulfate = 4:1:5. Indicator kept on neck surface in thyroid gland projection during 3-5min. It is dried at T=+35-40°C, studied in polarized light with quartz compensator. Columnar, columnar-and-striated, sheaf-like crystals and discharged polygonal variegated chambers being observed, thyroid gland hyperfunction is to be diagnosed.

EFFECT: high accuracy of diagnosis.

13 dwg

Up!