Differential diagnosis method for detecting destructive changes in the cases of various forms of acute cholecystitis

FIELD: medicine.

SUBSTANCE: method involves determining infrared radiation absorption coefficient in blood plasma in bandwidth of 1543-1396 cm-1. The infrared radiation absorption coefficient is determined in %. The value being equal to 29.7±1.1%, catarrhal cholecystitis is diagnosed. The value being 26.4±1.4%, phlegmonous cholecystitis is diagnosed. The value being 21.2±1.8%, gangrenous cholecystitis is diagnosed. The value being equal to 18.6±0.5%, gangrenous perforated cholecystitis case is diagnosed. The value in norm is equal to 32.4±0.8%.

EFFECT: high accuracy and specificity of diagnosis.

 

The invention relates to medicine, namely to surgery. Acute cholecystitis is the most common emergency surgical pathology and currently holds second place after acute appendicitis.

Inflammation in the gallbladder wall often becomes destructive in nature, which in some cases leads to purulent-inflammatory complications in the postoperative period: the suppuration of postoperative wound, intra-abdominal abscesses and inflammatory infiltrates, which have their own peculiarities course, require additional therapy.

Particularly acute this problem becomes in the absence of a unified approach to the treatment of acute cholecystitis. This is largely hampered by the fact that until now have not yet developed reliable criteria for the preoperative evaluation of morphological changes of the gallbladder wall and the surrounding tissues of patients coming to the surgery hospital.

The analysis of literature showed that, to date, not found the best options research, which would not only be guaranteed a correct diagnosis of the underlying disease, but could predict the pathological process and the development of complications, and also contributed to a more active selection of patients to extra the data, immediate and delayed operations.

In emergency surgery, the diagnosis of acute cholecystitis is usually set on the basis of history and clinical data and laboratory findings. Of laboratory diagnostic methods used in clinical blood analysis, proposed by the authors as similar, where the rate of the disease is increasing leukocytes. In typical cases, the number of leukocytes is 10-15×109/l-shift formula of blood to the left (Acharei. Diagnosis of acute inflammatory diseases of the abdominal cavity. Chisinau. 1982. C. 76-79.)

However, this method has drawbacks, the number of cells varies under the influence of seasonal, climatic, physiological state of the organism, as well as in a variety of pathologies, which indicates a small informative this way and it is impossible to assess with it the degree of the inflammatory destruction of the gall bladder.

The authors suggest as a prototype method computer infrared spectrophotometry (spectroscopy) of blood plasma for the diagnosis of acute cholecystitis. (Avilabale, Emmahof, Vincible. About the possibilities and prospects for the use of infrared spectophotometry blood plasma for the diagnosis of acute cholecystitis. // theory and practice of regional medicine. -Tver, 2000. - C.250-251).

In the prototype apparatus was used which ethno-software system "Icarus" (patent No. 2137126 from 10.09.1999, "The way of the study of biological fluids and device for its implementation". Authors: Avilabale and others), allowing the study of blood and other biological liquids by their characteristic absorption spectra of infrared radiation to obtain new information about the characteristics of the functional state of an organism at different pathologies. The system includes a spectrophotometer operating in the wavelength range from 2 to 12 μm, and mated with him personal computer. The device has a high sensitivity, which is the original detector and the amplifier. Output information is the degree of radiation absorption (%) 9 optical channels.

The authors with the help of “Icarus” investigated the blood plasma of 31 people. In 21 of them (the main group) noted a clear picture of acute cholecystitis, and in some cases (patients who were operated) diagnosis found morphological evidence. 10 surveyed (control group) were healthy.

At admission the patient to the hospital made the blood (volume 2 cm3from the cubital vein and centrifuged. Microparti plasma (0.1 ml) were placed in a cuvette and subjected to spectrophotometrically 9 optical channels of the apparatus with selectable display the progress of the measurement results on the display. Based on the analysis of numerical and graphical indicators of the presence of a sufficiently clear and permanent differences in the absorption spectrum in the study of blood plasma of patients with acute cholecystitis and healthy individuals ranges 2120 1880...cm-1and 1831...1623 cm-1(the third and fourth optical channels). In these ranges, there was a decrease in the absorption coefficient of the infrared spectrum, which in the group of healthy patients was 64.3±0.6% in the third optical channel and 54.1±1.1% in the fourth optical channel; in patients with acute cholecystitis 57,4±1,9%, and 45.8±1.7% respectively.

Some drawbacks of this method are the lack of specificity to assess the severity of the inflammatory and destructive changes in the various forms of acute cholecystitis, time consuming due to the need to complement studies of routine diagnostic methods.

The authors propose a method of differential diagnosis of destructive changes in the various forms of acute cholecystitis using infrared spectrophotometry blood plasma.

In studies performed with the hardware-software system "Icarus". When the admission of patients to hospital made the blood (volume 2 cm3from the cubital vein. Micropore plasma (0.1 ml) were placed in kyotei been spectrophotometrically 9 optical channels of the apparatus with selectable display the progress of the measurement results on the display. One of the features of the hardware part of the system is that the entire flow of infrared radiation directed to the sample cell with the investigated liquid (blood plasma), using a special interference filters repeatedly logged in nine ranges (channels) infrared spectrum of electromagnetic radiation: 1-(3500...3100 cm-1), 2-(3085...2732 cm-1), 3-(2120 1880...cm-1), 4-(1831...1623 cm-1), 5-(1729...1533 cm-1), 6-(1543...1396 cm-1), 7-(1470...1330 cm-1), 8-(1170...1057 cm-1), 9-(1067...cm-1).

Surveyed 167 patients admitted to hospital with clinic of acute cholecystitis. All performed cholecystectomy in different terms from the time of receipt. About the form of cholecystitis judged by histological examination of the preparation of the gallbladder. Catarrhal cholecystitis was diagnosed in 48 patients, flegmonoznih - 81, gangrenous 32, gangrenous-perforating - 6. As the object for the spectrophotometric study was performed with the blood plasma of patients. The study was conducted using a hardware-software system “Icarus”, which allows to obtain an indication of the absorption of infrared radiation (in percent) in 9 zones range from 3500 and up to 963 cm-1. The most informative according to the study is the sixth channel (range -1543...1396 cm-1). When analyzing the results of ispolzovalis indicators of radiation absorption obtained in the study using the same hardware and software system of blood plasma in 30 healthy individuals.

Statistically significant decrease in the degree of radiation absorption of the investigated material (compared to control) in the range 1543-1396 cm-1in all forms of acute cholecystitis. There was also a clear dependence of the absorption of radiation in this range from the nature of the morphological changes of the gallbladder wall (the decrease in the emergence and progression of destructive process). This was determined indicators absorption of infrared radiation, considered the coefficient of absorption in %. The most characteristic absorption rate of radiation for the differential diagnosis of acute cholecystitis is revealed in the sixth (1543-1396 cm-1the range of the infrared spectrum, which amounted to: in catarrhal cholecystitis 29,7±1.1%under flegmonozna - 26,4±1,6%, with gangrenous - 21,2±1,8%, with gangrenous-perforating to 18.6±0.5%, at the normal value of the absorption coefficient 32,4±0,8%.

This regularity is very important as a practical matter, as a result, there is a possibility the data obtained by infrared spectophotometry blood plasma, not only to confirm the diagnosis of acute cholecystitis, n and to judge the severity of the inflammatory process in the gall bladder, what is crucial when deciding on the indications for surgical treatment. It should be noted that the proposed method of infrared spectrophotometry extremely simple to execute, and the duration of the study is only about 5 minutes.

The method of differential diagnosis of destructive changes in the various forms of acute cholecystitis, including determination of the coefficient of absorption of infrared radiation of the plasma, characterized in that determine the performance of the absorption of infrared radiation in the range 1543÷1396 cm-1calculate the coefficient of absorption of infrared radiation (in %) and the value of the absorption coefficient and 29.7±1.1% of diagnosed catarrhal cholecystitis, when the value of the absorption coefficient of 26.4±1,6% - flegmonoznih, 21,2±1.8% by gangrenous, and when the value of the absorption coefficient of 18.6±0,5% - gangrenous-perforating, when the normal value of the absorption coefficient 32,4±0,8%.



 

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