Method for predicting hepatic chronic diffuse diseases

FIELD: medicine, hepatology.

SUBSTANCE: one should detect splenic length in mm (X1) and circulation in portal vein, moreover, additionally, on should detect volumetric circulation in splenic vein in cu. cm/min. (X2), the index for the ratio of volumetric circulation in splenic vein to the area of longitudinal splenic section (X3), circulatory direction in left-hand gastric vein (X4) by establishing its direction towards the liver to be 1, from the liver to be 2, diameter of splenic artery in cm (X5) and transhepatic portal volumetric circulation in cu. cm/min. (X6), then one should calculate discriminant function Z = 15.9850 - 0.0187X1 + 0.2006X3 - 1.9025X4 - 19.0493X5 - 0.0025X6, where Z - the criterion for predicting "healthy-sick" state; then it is necessary to detect the group with hepatic diseases by the value of Z ≤ 1.621 to calculate for them discriminant function Y = 9.7396 - 0.0279X1 - 0.0018X2 + 0.1873X3 - 4.9174X4, where Y - the criterion to predict "patients with chronic hepatitis - patients with cirrhosis" state and at Y > 1.239 one should diagnose chronic hepatitis, at Y ≤ 1.239 - cirrhosis.

EFFECT: higher efficiency of diagnostics.

3 ex

 

The invention relates to medicine, more specifically to the diagnosis of chronic diffuse liver diseases, and may find application in the treatment of chronic hepatitis and cirrhosis of the liver.

Improving diagnosis of all forms of liver disease is an actual problem of modern medicine. This is largely due to the General increase in the number of viral hepatitis, and toxic liver damage different, first of all alcoholic etiology. Becoming increasingly common hepatitis C. In Russia today from 3 to 5 million people are carriers of viral hepatitis a, b and C, and the incidence has reached epidemic proportions. It is viral hepatitis mainly responsible for the development of chronic hepatitis and later cirrhosis. The second most important problem of modern Hepatology include alcoholic liver disease. 20-35% of people who regularly drink alcoholic beverages, alcohol hepatitis, 10-20% develop alcoholic cirrhosis of the liver.

In the U.S., the death rate from cirrhosis of the liver is 9.6 persons per 100,000 of the population, occupying seventh place in the structure of mortality. In Russia there was an increase in deaths from cirrhosis of the liver from 20.3 per 100,000 population in 1984 to 21.3 in 1998 among men and to a greater extent among women who - from 7.8 to 10.3, respectively.

At the present time to identify chronic diffuse liver diseases (HTTP) used laboratory methods, methods of radiation diagnosis, morphological examination of liver biopsy specimens.

Laboratory diagnostic methods include, first and foremost, biochemical blood tests, clinical analysis of blood, immunological tests. These studies are still the most simple, accessible method for diagnosing liver disease. However, often there is overdiagnosis, when the presence of antigen hepatitis or transient increase in the level of bilirubin is taken for liver disease, or under-reading in those cases, when patients are in remission, there is no increase in the level of enzymes and bilirubin.

Radiology HDSP focused primarily on the detection of portal hypertension associated with cirrhosis of liver and changes of the liver tissue, occurring in advanced stages of the disease. Often used for this x-ray of the esophagus and stomach or fibrogastroduodenoscopy to detect varicose veins of the esophagus and stomach. Often, however, when portal hypertension occurs the expansion of other collaterals that are not detected in these studies, which does not allow to put right on Agnes. The use of angiography is not very promising because of the high risk of complications in this study, invasiveness and a large number of patients. Changes of the liver tissue, which can be detected by ultrasound, computed or magnetic resonance tomography, as stated, evolve at later stages of the disease. Application of radioisotope techniques in the study of the liver is limited by the invasiveness of the procedure, the patient exposure, and low prevalence of scanners. In General, the detection of the disease using radiation techniques in the early stages or in the absence of obvious signs of portal hypertension is almost impossible.

Histological examination of biopsy specimens of the liver tissue is the most accurate method, however, due to the invasiveness may not be the screening method. Biopsy is used according to the indications in patients with already identified by other methods signs of liver disease with the purpose of clarification and confirmation of the diagnosis.

Closest to the present invention is a method of ultrasonic imaging of blood vessels of the liver, the proposed shipovym O.Y (Kida. Diss. “Diagnosis of portal hypertension ultrasound angiography of the liver”, Moscow, 2002).

In this work the study of the liver begins with mode gray scale. When identifying Malop tipichnyh diffuse changes of a parenchyma of the liver or signs of pathology of the veins of the liver is the mode of the color Doppler mapping, allow to assess the patency of the hepatic vessels, to determine the direction of blood flow in the branches of the portal vein, to reveal the functioning of portosystemic shunts. In the absence of such changes, the analysis of the basic indicators of liver hemodynamics using pulse dopplerography. The combination of reducing the linear velocity of blood flow in the portal vein with the increase of the resistance index in the hepatic artery and the monophasic flow in the hepatic veins is characteristic of established cirrhosis, functional class and on the classification of child-Pugh. In addition to the study of the liver and its vessels are measured by the size of the spleen. To the ultrasound signs of established cirrhosis of the liver, the authors attributed the splenomegaly (length spleen more than 120 mm) and expansion of the splenic vein (about 0.8 cm). Parallel progressive splenomegaly develops collateral channel, recanalization paraumbilical Vienna. Gradually increasing the restructuring of the parenchyma of the liver, manifested by the uneven contour, the heterogeneity of its structure and deformation stroke intrahepatic vessels. To late ultrasound signs of decompensated liver cirrhosis and severe portal hypertension, the authors include ascites, enlargement of the portal vein, the speed reduction of portal blood flow and mn of the large diameter recanalization paraumbilical Vienna, and in some cases the appearance of the reverse (hepatofugal) blood flow in the right branches of the portal vein due to a significant Porto cavalini bypass.

Thus, the prototype method allows to identify only patients with established cirrhosis, with functional class and on the classification of child-Pugh.

At the same time, patients with chronic hepatitis and cirrhotic patients with functional class according to the classification of child-Pugh, who have varicose veins of the esophagus, ultrasound criteria liver disease and portal hypertension are described method cannot detect. Differential ultrasound diagnosis of chronic hepatitis and "preclinical" stage of cirrhosis of the liver is not possible. The diagnosis can be put only on the basis of data from biopsy of the liver.

The technical problem of the present invention was to improve the accuracy of ultrasound diagnosis of liver disease due to the possibility of differential diagnosis of chronic hepatitis and cirrhosis of the liver.

This problem is solved by the fact that in the known method, including determining the length of the spleen, blood flow in the portal vein, according to the invention further define the area of the longitudinal section of the spleen, volumetric blood flow in the splenic ve is e, the direction of blood flow in the left gastric Vienna, the diameter of the splenic artery and transitory portal blood flow, calculate discriminant functions

Z=15.9850-H+H-H-H-H and

Y=9.7396-0.0279X1-H+H-H,

where Z is a diagnostic criterion States "healthy patients", Y - diagnostic criterion States "patients with chronic hepatitis patients with cirrhosis of the liver" of the previously set group of “patients” X1 is the length of the spleen in mm, x2 - volume blood flow in the splenic vein in cm/min, X3 - the index of the ratio of the volume of blood flow in the splenic vein to the square of the longitudinal section of the spleen, X4 - direction of blood flow in the left gastric Vienna, equal to 1, in the direction towards the liver and 2 in the direction from the liver, X5 is the diameter of the splenic artery in cm, X6 - transitory portal volumetric blood flow in cm3/min. In the presence of recanalization paraumbilical vein, it is defined as the difference between the minute volume of blood flow in the portal vein and paraumbilical Vienna. When Z>1,621 diagnose the absence of liver disease, when Z≤1,621 - the presence of liver disease. Patients in the group with liver disease are subjected to further study, further determining a value of Y. If Y>1,239 diagnose chronic hepatitis b in Y≤1,239 - cirrhosis of the liver.

To resolve post the undertaken tasks we used the method of “Medical statusmenu”, the Central element of which is the development of a functional mathematical model linking the numerical values of indicators on integrated assessment of the state of the organism [Razorenov GI, Poddubsky GA Automated quantification and analysis of the status of the body (medical statusmenu). - L., Preprints LIIAN, part 1, 1985, 48 S.; Razorenov GI, Poddubsky GA Automated quantification and analysis of the status of the body (medical statusmenu). - L., Preprints LIIAN, h 2, 1986, 48 S.]. Previously this method was successfully used in immunology [Zaitseva G.A., Razorenov GI, Poddubsky GA to identify potential immunological reactivity of the individual in sepsis and tetanus toxoids for picking groups of immune donors. Method. REC., Kirov, 1990, p.1-10], cardiology [Balluseck F, Bondarenko B.B., Poddubsky GA, Razorenov GI Identifying individual susceptibility to myocardial infarction in immunogenetic status. Cardiology 1987, 2, p.60-63], transplant [Zaretsky, Y.M., Poddubsky GA, Razorenov GI, Durnev FORCE Optimization immunological matching between donor-recipient with a kidney transplant. Bulletin of the Academy of medical Sciences of the USSR, 1989, 3, p.56-61] and psychiatry [the Patents of the Russian Federation 2153290 and 2170056, MCI And 61 813].

The mathematical model is a quantitative regularities describing the organization of the breeding indices of body condition (body), which are the criteria intergroup differences Z1-2a criteria of differential diagnosis in the comparable groups of patients (in our case Z - healthy-sick or Z - hepatitis-cirrhosis).

One of the main stages of construction of diagnostic model was the selection procedure the minimum number of the most informative indicators. Minimization was carried out by the method of removal, i.e. by successive exclusion of the least informative indicator. The method was carried out in stages. At the first stage used the full set of k=49 indicators. It was an absolute vascular indices, which are characterized by the presence and diameter of the vessel: the portal vein, right and left branches of the portal vein, paraumbilical Vienna, retroperitoneal collaterals, splenic vein, superior mesenteric vein, the left gastric vein, splenic artery, hepatic artery. Also measured the length, width and size of the spleen was determined by the presence and degree of ascites. Absolute hemodynamic parameters included: the linear velocity of blood flow in the portal vein, right and left branches of the portal vein, paraumbilical Vienna, splenic Vienna, superior mesenteric Vienna, the left gastric Vienna, splenic and hepatic arteries, the presence and direction of blood flow in the left gastric Vienna, maximum si is Telichenko, end-diastolic velocity and resistance index in the splenic and hepatic arteries, segmental branches of the splenic artery. On the basis of the obtained absolute values were calculated estimated blood flow parameters and indexes. The estimated parameter was the minute blood flow velocity in the test vessel, which was calculated by the formula

M=L×D2/2×60,

where M is the minute blood flow (cm3/min),

L - linear blood flow velocity (cm/s)

D - diameter of the vessel (see).

This parameter was calculated for the portal vein, right and left branches of the portal vein, paraumbilical vein, splenic vein, superior mesenteric vein, the left gastric vein, splenic and hepatic arteries. Splenic index was calculated by the formula

SI=SVK/PI,

where SI is the splenic index,

CRS - minute blood flow in the splenic Vienna (cm3/min),

PS - the area of the spleen (cm2).

Transpency the portal blood flow was calculated by the formula

TCE=VK-PC

where TCE - transitory portal blood flow (cm3/min),

VK - minute blood flow in the portal vein (cm3/min),

PC - minute flow paraumbilical Vienna with her recanalization (cm3/min).

Then at each stage, the main task was to build a model of intergroup differences with calculation errors of the model to the I is determined by the number of erroneous classifications of the objects of the matched groups.

Transformed model acquires the property, it is very important to quantify the role of indicators, that is, the direction (positive or negative) and strength of their influence on the criterion of inter-group differences: a greater absolute value of the coefficient corresponds to a stronger influence of the corresponding index, regardless of its physical nature and units of measurement.

This property allows each stage to build the model, the calculation of the evaluation, a ranking of the coefficients in the model, then in the first place is the number of largest absolute value of the coefficient, the last place is the smallest. At the end of phase from consideration exclude the indicator with the lowest value of the absolute value of the coefficient and began the next step performed in the same sequence as the previous one. This procedure is executed k times.

After selecting the most significant (informative) parameters, with which the error model is minimal, built a mathematical model for the generalized parameter Z1-2- criterion intergroup differences of 1 patients (healthy) and 2 (patients) groups on the complex of informative parameters.

In the result, we selected the following parameters: length of the spleen, volumetric blood flow in the splenic in the not, the index of the ratio of the volume of blood flow in the splenic vein to the square of the spleen, the direction of blood flow in the left gastric Vienna, the diameter of the splenic artery, transitory portal volumetric blood flow.

Then calculated discriminant functions for selected groups of patients. Used in statustitle four methods of constructing discriminant functions we have chosen the method of discriminant analysis, because it connects multidimensional analysis with traditional statistical methods underlying the evaluation apparatus of the quality of discrimination.

Using this technique were examined 309 persons, 62 of them was the control group without liver disease, 93 had chronic hepatitis and 154 - cirrhosis of the liver. The final diagnosis was verified in a laboratory study, histological liver biopsy and/or diagnostic angiography. The method consists in the following.

The study used ultrasound machine Aloka 650 (Tokio, Japan)equipped with a Doppler unit.

Ultrasonic examination is started according to the standard technique. Assess the homogeneity of the liver parenchyma to detect lesions. This is necessary, as is often the emergence of tumors in the background HTTP. The presence of the tumor leads to changes in the hemodynamics of the body, therefore, is in this method is not applicable. When detecting multiple small (2-8 mm in diameter) formations, which are located in both lobes of the liver, the picture is characteristic of cirrhosis of the liver with nodes regenerated. When identifying a larger single or multiple sites, more than 10 mm in diameter, patients require mandatory biopsy of the lesions.

Then examine the size of the spleen. In the left pojebani at the longitudinal location of the sensor on the medium or signedmessage lines visualize the spleen, trying to get the maximum cross-sectional area when passing through the plane of the slice through the gate body. Then conduct measurement - area of the longitudinal section and the length of the body.

After this study, the diameters of the vessels of the portal system. Visualize the portal, splenic, left gastric vein and re - paraumbilical vein.

The main trunk of the portal vein was measured in the region of the hilus of the liver, at a distance of 1-2 cm from the bifurcation. The study was conducted from intercostal access. The splenic vein visualize when the transverse location of the sensor in the epigastrium, for the pancreas. Its diameter is measured in the region of the tail of the pancreas. Then measure the diameter of the splenic artery. It runs parallel to the splenic Vienna, above it, with the tail of the pancreas. The measurement is carried out in optimally is to visualize the place, often at a distance of 1-2 cm from the bifurcation of the celiac trunk.

Coronary vein of the stomach (left gastric vein) visualize at the longitudinal location of the sensor under the xiphoid process of the sternum. It starts from the splenic vein near its junction with the portal vein passes behind the left lobes of the liver to the area of the esophago-gastric junction.

The umbilical vein visualize at the longitudinal location of the sensor as a tubular structure running from the designated division of left branch of the portal vein along the round ligament of the liver. Vienna comes from the liver, is under the anterior abdominal wall. Its diameter is measured over a space, passing in the liver tissue.

Doppler measurements were carried out in the same vessel, which was previously measured their diameter. The average blood flow velocity measured by the standard technique during one heartbeat. In coronary Vienna stomach the direction of blood flow is measured in any well-rendered part of the vessel, lying at an angle less than 60° to the Doppler beam.

Minute volume blood flow in the vessel are calculated according to the formula

M=L×D2/2×60,

where M is the minute blood flow (cm3/min),

L - linear blood flow velocity (cm/s)

D - diameter of the vessel (see).

In the left gastric Vienna determine only the presence and direction of blood flow. Measured the e conducted at a distance of 1-3 cm from the place where it flows into the splenic vein.

Transitory portal blood flow is calculated by the formula

TCE=VK-PC

where TCE - transitory portal blood flow (cm3/min),

VK - minute blood flow in the portal vein (cm3/min),

PC - minute flow paraumbilical Vienna with her recanalization (cm3/min).

Thus, determine the length and area of a longitudinal section of the spleen, the diameter and the average flow velocity in the portal vein, splenic and paraumbilical veins, the direction of blood flow in the left gastric Vienna, the diameter of the splenic artery. The diameter of the vessels and the value of the linear blood flow velocity calculated minute volume blood flow velocity. Then calculate discriminant functions

Z=15.9850-H+H-H-H-H and

Y=9.7396-H-H+H-H,

where Z is a diagnostic criterion States “healthy patients”,

Y is a diagnostic criterion States “patients with chronic hepatitis patients with cirrhosis of the liver”.

X1 is the length of the spleen in mm, x2 - volume blood flow in the splenic vein in cm3/min, X3 - the index of the ratio of the volume of blood flow in the splenic vein to the square of the spleen, X4 - direction of blood flow in the left gastric Vienna: 1 liver, 2 - from the liver, X5 is the diameter of the splenic artery in cm, X6 - transitory portal volumetric blood flow in cm3/min (at recanalization was paraumbilical the Noah Vienna this is the difference between minute volume of blood flow in the portal vein and paraumbilical Vienna).

When Z>1,621 diagnose the absence of liver disease, when Z≤1,621 - the presence of liver disease, with patients from the group with the presence of liver disease Y>1,239 diagnose chronic hepatitis b in Y≤1,239 - cirrhosis of the liver.

The essence of the method is illustrated by examples.

EXAMPLE 1. Patient G., born in 1985 Asked cnerry with suspected chronic hepatitis. The year before treatment screening was revealed elevation of liver enzymes. Blood tests for hepatitis negative. Was hospitalized in the clinic of the Institute with suspicion of chronic hepatitis of unknown etiology. Had no complaints. Marked by excessive development of the subcutaneous tissue, hair on the face and torso is not expressed. During the ultrasound the liver is increased, the echo is increased. The following parameters of blood flow: 72 mm - length spleen, 1036 cm3rpm - volume blood flow in the splenic Vienna, 22,05 - the index of the ratio of the volume of blood flow in the splenic vein to the square of the spleen, 1 - direction of blood flow in the left gastric Vienna, 0.5 cm - diameter of the splenic artery, 1040 cm3/min - transistory the portal bloodstream. When calculating the discriminant function is:

Z=15.9850-0.0187×72+0.2006×22,05-1.9025×1-19 .0493×0,5-0.0025×1040=5,035,

the patient belonged to the group of “healthy”. Laboratory values are not changed by histological liver biopsy - immunohistochemical study of liver tissue antigens of hepatitis b and C have been identified, the data for the presence of chronic hepatitis or cirrhosis of the liver is not received, a pronounced hepatic steatosis. The final diagnosis of hepatic steatosis, youth disparities, hypertensive angiopathy.

EXAMPLE 2. Patient I., born in 1983 Sent to cnerry the Ministry of health of the Saratov region with a diagnosis of cirrhosis, class, splenomegaly”. Diagnosed upon admission to the infectious diseases hospital about developed jaundice. Received symptomatic treatment. Then was referred to the gastroenterology Department of the regional hospital where he received treatment for cirrhosis of the class In child-Pugh - inderal, aldactone, asslover-Forte and salt-free diet. Complaints of malaise, swelling of legs, amenorrhea.

When entering cnerry was held ultrasound with Doppler examination, the following indicators: 77 mm - length spleen, 564 cm3rpm - volume blood flow in the splenic Vienna, 12,534 - the index of the ratio of the volume of blood flow in the splenic vein to the square of the spleen 1 - the direction of blood flow in the left gastric Vienna, 0.6 cm - diameter of the splenic artery, 2300 ml/min transpency the portal bloodstream. Subsequent calculation of the discriminant function produced the following indicators - Z=-1,844 that qualified us “sick”, and Y=4,0 that corresponded to the state of “chronic hepatitis”. The diagnosis was confirmed after laboratory tests and liver biopsy. Final diagnosis: chronic active viral hepatitis, splenomegaly, hypersplenism, amenorrhea secondary Genesis, jaundice mixed Genesis.

EXAMPLE 3. Patient S., born in 1955, was sent to cnerry with a diagnosis of chronic viral hepatitis”. Considered myself sick for 3 years, at the beginning of the disease in the blood was determined antigen of hepatitis C. For this reason, treated stationary at the Department of Hematology of the Alexander hospital. Received infusion therapy. At the time of treatment were complaints to moderate weakness. According to fibrogastroscopy, dilatation of the esophagus was not, and has not allowed to make a correct and timely diagnosis to treatment in the Institute. While laboratory tests at the time were almost within normal limits or were moderately elevated, alanineaminotransferase 33 U/1, aspartataminotransferaza 89 U/1 (N<50), alkaline phosphatase 351 U/1 (100-280), bilirubin 13.5 µmol/L.

On ambulat the Pnom stage, at the time of treatment, the patient was performed ultrasound with Doppler. The parameters obtained in the study: 112 mm - length spleen, 1220 cm2rpm - volume blood flow in the splenic Vienna, 16,27 - the index of the ratio of the volume of blood flow in the splenic vein to the square of the spleen, 2 - direction of blood flow in the left gastric Vienna, 0.8 cm - diameter of the splenic artery, 122 cm3/min - transitory portal volumetric blood flow. When calculating discriminant functions were obtained following indicators - Z=-2,196 that qualified as “sick”, and Y=-2,363, testified to the presence of cirrhosis. In addition, the patient had such signs of portal hypertension, as ascites and recanalization paraumbilical Vienna. The surface of the liver was finely tuberous that talked about the formation of nodes regenerates. The size of the liver were reduced. The gall bladder was determined several concretions. On the basis of ultrasound examination, the conclusion is made about the patient developed cirrhosis of the liver with symptoms of atrophy and severe portal hypertension.

A survey of computed tomography laboratory tests, liver biopsy, confirmed the accuracy of diagnosis. The final diagnosis of cirrhosis (viral in the stage of atrophy), the port is supplemented flax hypertension, ascites, cholelithiasis, chronic atrophic antral gastritis. Previously we conducted a screening ultrasound allowed to make a correct diagnosis.

Held at hospitalization conservative therapy helped to eliminate ascites, normalize liver enzymes, significantly improve the health of the patient.

To date, the proposed method is examined 87 patients with suspected chronic diffuse liver disease, all of them was set to the exact nature of the disease, as well as a differential diagnosis: chronic hepatitis or cirrhosis.

Using the proposed method allows for rapid screening of patients at risk for development of chronic diffuse liver diseases, while significantly reducing the time of examination of the patients, to reduce the cost of diagnostic procedures that significantly reduce the time of hospitalization of patients.

The method developed in the Department of radiodiagnostics, cnrri and was clinically tested in 87 patients with a positive result.

Method for the diagnosis of chronic diffuse liver diseases, including determination of splenic length mm (X1) and blood flow in the portal vein, characterized in that it further definition is given in volumetric blood flow in the splenic vein in cm 3/min (x2), the index of the ratio of the volume of blood flow in the splenic vein to the square of the longitudinal section of the spleen (X3), the direction of blood flow in the left gastric Vienna (X4), taking it to the liver for 1, liver 2, the diameter of the splenic artery in cm (X5) and transicional portal volumetric blood flow in cm3/min (X6), calculate the discriminant function Z=15,9850-0,H+0,H-1,H-19,H-0,H where Z is the diagnostic criterion States “healthy patients”, highlight the group with liver diseases by value Z≤1,621 and expect for them discriminant function Y=9,7396-0,H-0,H+0,H-4,H, where Y is the diagnostic criterion States “patients with chronic hepatitis patients with cirrhosis of the liver” and when Y>1,239 diagnose chronic hepatitis b in Y≤1,239 - cirrhosis of the liver.



 

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54 cl, 7 dwg

FIELD: medicine.

SUBSTANCE: method involves examining eyeball and retrobulbary space by means of ultrasonic scanner. Ultrasonic gray scale orbit scanning is applied in real-time mode to determine ultrasonic eye reposition. Positive ultrasonic eye reposition is determined and normal state is diagnosed when recording mobile unchanged shape and free oscillation orbit tissue movements. Changes in shape, contours and size of the eyeball and immobility of orbit tissues being recorded, negative ultrasonic reposition is determined and solid full-tissue neoplasms and structures are diagnosed to occur.

EFFECT: high objectivity of received data; accelerated examination; high accuracy of differential diagnosis.

1 tbl

FIELD: medicine.

SUBSTANCE: method involves measuring forced exhalation volume per 1 s. Systolic pressure in pulmonary artery and ratio of maximum blood circulation speeds through tricuspid valve into diastole. Prediction is carried out on basis of value calculated from mathematical formula including measured and calculated parameters.

EFFECT: enhanced effectiveness of prediction.

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.

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