Method for predicting unfavorable result of metastatic peritonitis

FIELD: medicine, anesthesiology, resuscitation.

SUBSTANCE: in patients one should study the content of lactoferrin in peritoneal exudates during the 1st d of postoperational period and at decreased value being below 3500 ng/ml on should predict unfavorable result. The suggested method provides correction of possible postoperational complications that deteriorate the flow of peritonitis and lead to lethal result.

EFFECT: higher accuracy of prediction.

3 ex

 

The invention relates to medicine, in particular to anesthesiology and critical care medicine.

The urgency of the problem of widespread peritonitis is no doubt, as this nosology remains among the leading causes of death in emergency surgery and medicine critical States. At the moment, therapy postoperative period when peritonitis does not have clear criteria that would characterize signs of adverse outcome of peritonitis at the stage before the appearance of clinical and laboratory explicit signs of deterioration. Thus, it remains highly relevant approach for adverse outcome of widespread peritonitis at the preclinical level.

A known method for predicting the outcome of acute period of burn disease. The method consists of drawing blood and added to a suspension of erythrocytes serotonin and the subsequent evaluation antiserotonin activity on the proposed formula. At lower antiserotonin activity less than 60% predicted an unfavorable course of burn disease [Bugrov, S.N., Vazina I.R., Levin GY a Method for predicting the outcome of acute period of burn disease. Patent No. 2152615. M CL 7 G 01 N 33/48. Bull. No. 19 dated 10.07.2000].

The disadvantage of this method is the complexity of the technical use of serotonin in the practice of laboratory SL is gby, the possibility of excess load receptors of erythrocytes other biologically active substances and false-positive results.

A known method for predicting mortality in patients with acute pancreatitis. The method consists in the evaluation of pH inside the mucous membrane of the stomach and tension of carbon dioxide in the patient's blood, when determining pH less 7,32 made a conclusion about NUTRISYSTEM acidosis and possible adverse acute pancreatitis [Con E.M., Cherkasov, VA, Samartsev, VA, Con VE a Method for predicting complications and fatal outcome in patients with acute pancreatitis. Patent # 216184. M CL 7 G 01 N 33/84. Bull. No. 1 from 10.01.2001].

The disadvantage of this method is the difficulty in carrying out the method (the need to place a separate probe into the stomach), the distortion results when using this method in terms of the syndrome of enteral insufficiency (long stagnation in the stomach), the difficulty in the interpretation of data on the pH inside of the gastric mucosa under conditions of endotoxic shock, which often complicates the course of acute abdominal diseases.

Closest to the claimed is a method for predicting postoperative acute peritonitis. The method consists in determining the initial level of glutathione in the blood of the patient p and a decrease of less than 0.32 mmol/l predict the development of septic complications [Flight B.A., Pusher A.B., Konvay EAST and other predictor of postoperative acute peritonitis. Patent No. 2164353. M CL 7 G 01 N 33/68. Bull. No. 8 for 20.03.2001].

The disadvantage of this method is the change in the concentration of glutathione in hepatic failure that accompanies a period of widespread peritonitis and can give false results, impaired secretion by the kidneys and the retention of substances with different degrees of severity of acute renal failure.

The objective of the present invention consists in the prediction of adverse outcome of widespread peritonitis by determining the content of lactoferrin (LF) in peritoneal exudate on the first day after surgery. On this basis, the optimum method of treatment aimed at correcting possible postoperative complications, worsening the course of peritonitis and the giver of death.

This object is achieved by the fact that patients with the widespread peritonitis examine the contents of lactoferrin in peritoneal exudate on the first day of the postoperative period and at lower rate of 3500 ng/ml predict adverse outcome.

The novelty of the method:

1. Control of LF content in peritoneal exudate is performed after surgical interventions for widespread peritonitis.

2. The LF of peritoneal exudate less than 3500 ng/ml indicates an unfavorable outcome of widespread peritonitis that requires additional therapy: strengthening antibacterial component and the joining of active methods of detoxification for additional protection against generalized microbial infection.

The method consists in the following: fence peritoneal exudate to study the LF content produced in the first day after surgery in patients with acute widespread peritonitis. For the determination of LF using peritoneal exudate, which immediately after removal from the abdominal cavity in a volume of 1 ml centrifuged. In the following were performed enzyme-linked immunosorbent assay exudate on the content of lactoferrin according to the method Nasariya, 1987.

Monitor the content of lactoferrin peritoneal exudate on the first day due to the fact that in the development of the syndrome of multiple organ failure as the cause of mortality in peritonitis pays great attention to the dysfunction of the nonspecific activity of neutrophils and the inability to adequately resist when creating restrictive protective barrier in the peritoneum. Timely early diagnosis of these disorders is very important to assign adequate correction of the normal functions of neutrophils, especially during the formation of this barrier that has the maximum on the first day. Our choice of the marker violations of nonspecific resistance - lactoferrin (LF) in peritoneal exudate reliably and early to diagnose the development of adverse outcome of peritonitis, promptly appoint a corrective treatment to avoid adverse disease outcome.

The LF of more than 3500 ng/ml indicates a favorable postoperative period that the correction does not require antibiotic therapy. The level of less than 3500 ng/ml in peritoneal exudate indicates a poor prognosis and requires strengthening antibacterial therapy.

Example 1

Patient C., no history 3456 hospitalized 13.04.2002 in the General surgery Department of the city clinical hospital №29 with a diagnosis of perforated duodenal ulcer, acute widespread peritonitis. In case of emergency surgery: laparotomy, closure of the perforated holes, sanation of abdominal cavity. The LF of the peritoneal exudate on the first day 3610 ng/ml. This situation is estimated by us as a favorable outcome of peritonitis. Assigned to standard antibiotics: Cefazolin 6.0 g/day and gentamicin 240 mg/day. The patient's condition has improved, which allowed the preponderance of the patient and with the improvement in the General surgery Department on the 4th day of the postoperative period.

Example 2

Patient K., no history 858 hospitalized 13.03.2002 in the General surgery Department of the city clinical hospital №29, diagnosed with destructive pancreatitis, enzymatic peritonitis. In case of emergency surgery: laparotomy, cholecystectomy, drainage stuffing bags and abdominal cavity. The LF of peritoneal exudate on the first day of the postoperative period (fence exudate drawn from the drainage tubes) was 2340 ng/ml Note that the indicators leukocyte index of intoxication were behind on their changes on the dynamics of LF in an average day. Prognosis of peritonitis assessed as unfavourable. In spite of intensive therapy (excluding content LF), the patient's condition progressively worsened, after 5 days of death during the progression of multiple organ failure.

Example 3

Patient L., no history 1215 hospitalized for emergency surgery city hospital №1 11.08.2002 with a diagnosis of postoperative peritonitis due to the inadequacy of the seams of the gastrojejunostomy (primary surgery: resection of the stomach). Operated emergency procedures: laparotomy, remezcla stomach, laparostomy. In the study of LF peritoneal exudate - 1200 ng/ml, which allowed us to detect adverse IP the od of peritonitis. In connection with the above possible adverse outcome from the first day to the patient in addition to traditional methods of therapy initiated intensive activities: enhanced antibacterial therapy by switching to Tienam 500 mg 3 times a day and conducted active methods of detoxification (sessions enterosorption). As a result of combined treatment the patient's condition has stabilized, we were able to transfer the patient to improve the Department's public profile.

Thus, patients with the widespread peritonitis determination LF peritoneal exudate on the first day allows us to predict adverse outcome in the postoperative period and in a timely manner to change tactics therapy.

A method for predicting adverse outcome of widespread peritonitis, characterized in that the patients investigated the content of lactoferrin in peritoneal exudate on the first day of the postoperative period and at lower rate of 3500 ng/ml predict adverse outcome.



 

Same patents:

FIELD: medicine, biochemistry.

SUBSTANCE: at testing one should precipitate high-molecular compounds with acetonitrile and register supernatant's spectral characteristics. Supernatant should be applied onto a paper filter, dried and put into solution containing aromatic aldehyde, acetone and concentrated hydrochloric acid taken at weight ratio of 70:5:1 to be kept for 2-3 min. Then it should be once again dried up to detect qualitative and semiquantitative content of oxidized tryptophan metabolites by intensity and chromatic shades. Moreover, by chromatic shades of yellow dyeing it is possible to detect the content of hydroxylated metabolites and by chromatic shades of violet dyeing - that of unhydroxylated ones.

EFFECT: higher significance of detection.

3 ex

FIELD: medicine.

SUBSTANCE: method involves determining plasminogen/plasmin, α2-macro-globulin, α1-antitripsin content at the first, third, fifth and tenth day. The plasminogen/plasmin level being equal to 66-74 mcmole/l or 100-120 mcmole/l, α2-macro-globulin level of 2.7-3.0 mcmole/l, α1-antitripsin content of 2.38-3.2 mcmole/l, systemic inflammatory response to purulent infection, light severity degree endotoxicosis is diagnosed and favorable disease outcome is predicted. The plasminogen/plasmin level being equal to 50-65 mcmole/l or 125-160 mcmole/l, α2-macro-globulin level of 2.3-2.6 mcmole/l, α1-antitripsin content of 3.3-4.0 mcmole/l, sepsis with organ and system dysfunction, moderate severity degree endotoxicosis is diagnosed and septic complication availability and lingering disease development course is predicted. The plasminogen/plasmin level being equal to 39-40 mcmole/l, α2-macro-globulin level of 1.58-2.08 mcmole/l, α1-antitripsin content of 5.0-6.2 mcmole/l, severe sepsis, septic shock, severe degree endotoxicosis is diagnosed and unfavorable disease outcome is predicted.

EFFECT: high accuracy of diagnosis.

5 tbl

FIELD: medicine.

SUBSTANCE: method involves studying lactoferrin content in blood serum and peritoneal exudates in postoperative period every day during the first three days. Lactoferrin concentration in blood serum being concurrently reduced by 0.02 mcmole/l or less and increasing lactoferrin concentration in peritoneal exudates by 0.04 mcmole/l or more, enteric detoxication is considered to be effective.

EFFECT: high quality of estimation.

2 tbl

FIELD: medicine.

SUBSTANCE: method involves determining cathepsin D activity in endometrium bioptate. The value being equal to or less than 0.1 units of enzymatic activity per hour, external genital endometriosis is diagnosed.

EFFECT: high accuracy of diagnosis.

1 tbl

FIELD: medicine, biochemistry.

SUBSTANCE: in blood serum one should detect the level of lactoferrin and biliary acids. At their ratio being equal to 5-17 it is necessary to detect chronic hepatitis of high activity.

EFFECT: higher accuracy of detection.

3 ex

FIELD: forensic medicine.

SUBSTANCE: for the purpose to detect the sequence of applied lesions at availability of several wounds, scratches and ecchymoses on a cadaver one should study the activity of alkaline peptides isolated out of affected tissue by the impact of blood neutrophils of healthy donors upon phagocytosis. Moreover, the highest stimulating effect belongs to the peptides isolated out of the lesion applied earlier. The method enables to detect the sequence of applied lesions more accurately and differentiate the repeated lesion applied 5 min later, or more.

EFFECT: higher efficiency and accuracy of detection.

2 ex, 2 tbl

FIELD: medicine, ophthalmology.

SUBSTANCE: in lacrimal liquid one should detect the content of interleukin 8 (IL-8) and that of interleukin 1 beta (IL-1β) to calculate prognostic coefficient (PC) due to dividing the first value by the second one by the following formula: At PC value being below 10.0 one should predict favorable disease flow, and at PC value being above 10.0 - unfavorable flow.

EFFECT: higher accuracy of prediction.

2 ex

The invention relates to medicine, in particular to obstetrics

The invention relates to ophthalmology, namely oftalmologii, and is intended to improve the accuracy of predicting the metastasis of uveal melanoma

The invention relates to medicine, in particular for the diagnosis of infectious diseases

FIELD: medicinal immunology.

SUBSTANCE: one should sorb inspecific immunoglobulin G in microplot's holes, then one should successively supplement these holes with solution containing guinea-pig's serum and sodium ethylenediaminotetraacetate and after incubation - an analyzed sample containing Clr2s2 complex of human component at unknown activity and pseudoglobulin fraction of human blood serum obtained due to dialysis against distilled water, and, also, a buffer solution that contains calcium and magnesium ions and after incubation it is necessary to wash and dry the plot, holes should be supplemented with enzymatic conjugate with antibodies against human C3 component and substrate of this enzyme, according to the quantity of formed product of enzymatic reaction one should calculate the activity of Clr2s2 complex.

EFFECT: higher efficiency of detection.

1 ex, 1 tbl

FIELD: medicinal immunology.

SUBSTANCE: the present innovation deals with detecting functional activity of complement components in human blood serum while predicting the row of diseases and in biological preparations, as well. One should sorb immunochemically pure immunoglobulin G in microplot's holes, then it is necessary to supplement the holes with an analyzed sample that contains human complement C3 component at unknown activity, and solution that contains guinea-pig's serum to carry out incubation. Then the content of holes should be poured out to introduce enzymatic conjugate with antibodies against human C3 component and substrate of this enzyme into the holes. C3 activity should be calculated according to the quantity of developed product of enzymatic reaction.

EFFECT: higher sensitivity and shortened terms of detection.

2 dwg, 2 ex

FIELD: clinical biochemistry.

SUBSTANCE: one should detect the concentration of extracellular nucleic acids connected with cell surface of formula blood elements in total fraction obtained due to a two-staged elution of blood cells fraction, and at zero value of this value one should diagnose cancer.

EFFECT: higher significance of diagnostics at early stages.

2 cl, 4 ex, 3 tbl

FIELD: medicine, immunological diagnostics.

SUBSTANCE: in patients' coprofiltrates simultaneously in one diagnostic kit on should detect the presence of erysipelas viral antigen and erysipelas viral antibodies and at antigen content being above 1.3 relative units and antibodies being below 0.30 relative units it is possible to predict the flow of infection during 6-8 d, and at antigen content being above 1.3 relative units and antibodies being above 0.60-0.80 relative units one should predict the flow of infection during 2-3 d. The method enables to predict the development of complications.

EFFECT: higher accuracy of prediction.

2 ex, 1 tbl

FIELD: chemical industry; biological industry.

SUBSTANCE: method and device can be used for testing biological, chemical and biochemical surface sensors which operation is based upon excitation of surface electromagnetic waves on surface of solid body. Change in phase of surface (or waveguide) wave is measured by means of interference between signal wave (waveguide or plasma) propagating along tested surface and volumetric reference wave propagating inside liquid directly above the surface at a small angle to the surface. Both interfering waves pass through liquid cell. One wave has shape of surface (plasma or waveguide) wave, the other one has shape of volumetric wave propagating directly above the surface. Change in volumetric parameters of liquid, for example, refractivity, influences both waves - signal surface and reference volumetric. The influence is mutually compensated in registered interference signal. Sensitivity to volumetric parameters of liquid is reduced while high sensitivity to properties of surface layer is kept.

EFFECT: improved precision.

7 cl, 10 dwg

FIELD: medicine, ophthalmology.

SUBSTANCE: the present innovation deals with detecting clinico-functional parameters by studying patient's lacrima due to crystallographic technique. For this purpose one should measure relative width of peripheral zone of crystallization and detect the availability of transitional area between crystallization zones; and if relative width of peripheral crystallization zone is above one seventh of crystallogram's radius and it is possible to observe transitional area between peripheral and central crystallization zones one should diagnose keratoconus at its early stage.

EFFECT: higher accuracy of diagnostics.

2 dwg, 2 ex

FIELD: biochemical engineering.

SUBSTANCE: set is usable for testing antibodies in tumors, like radioactively labeled anti-CD20-conjugates. The conjugates are used for treating and diagnosing B-cell lymphoma tumors. All reagents are sterile.

EFFECT: wide range of functional applications.

103 cl, 38 dwg, 46 tbl

FIELD: medicine, immunology.

SUBSTANCE: in blood serum of pregnant women one should detect the content of circulating immune complex of myelin as the main protein with immunoglobulin G at pregnancy terms after 20 wk and its values being below 0.1 mcg/ml illustrate uncomplicated pregnancy, the level ranged 0.1 - 0.2 mcg/ml points to preeclampsia of light degree, the level of 0.2-0.5 mcg/ml points to preeclampsia of severe degree. The present innovation provides earlier diagnostics before manifestation of traditional clinico-laboratory data.

EFFECT: higher efficiency of evaluation.

3 ex, 1 tbl

FIELD: medicine, surgery.

SUBSTANCE: one should carry out virological testing patient's blood serum and hepatic bioptates. At detecting TTVDNA and HGVRNA it is necessary to perform ultrasound survey, and at availability of biliary sludge one should conclude upon early stage of cholelithiasis.

EFFECT: higher accuracy of diagnostics.

3 ex

FIELD: microbiology and immunology, in particular immunodiagnosis.

SUBSTANCE: atypical strain of melioidose Burkholderia pseudomallei-111-6-1 with altered phenotype defected with respect to synthesis of 8 antigen and acting as immunosuppressor is used as antigen for animal immunization. Immune serum is obtained after 2 immunization cycles of animal-producer with titer in gel immunodiffusion reaction not less than 1:128.

EFFECT: immune serum with increased specific activity.

2 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: the present innovation deals with comparing the amplitudes of test curves of pH measurement in mouth cavitary media both before and after application of suggested preparations. Test curves of pH measurement towards acidic side are being obtained after activating acid-forming oral microflora with 15 ml 50%-saccharose solution as oral rinsing for 30 sec, and test curves of pH measurement towards alkaline side are being obtained after activating ammonia-forming microflora with 15 ml 8%-carbamide solution (oral rinsing for 30 sec). One should evaluate the efficiency of such preparations according to the difference of amplitudes for test saccharose and carbamide pH curves (ΔAs and ΔAc) obtained both before and after application of the preparations suggested, total evaluation of preparation impact upon oral microflora should be performed due to comparing the values of ΔAs and ΔAc. The method provides evaluation of preparation impact not only upon acid-producing oral microflora but ammonia-producing one, as well.

EFFECT: higher efficiency and accuracy of evaluation.

1 dwg, 1 ex

Up!