Method for diagnosing disseminated intravascular blood coagulation in the cases of burn disease
SUBSTANCE: method involves analyzing symptoms manifesting initial disseminated intravascular blood coagulation syndrome danger like burn area, availability of upper air passages burn, shock with its severity degree taken into consideration, sepsis development; clinical manifestations of disseminated intravascular blood coagulation syndrome like lung, kidney, liver function insufficiency, cerebral dysfunction, local and multiple hemorrhages, thrombosis, infarction; homeostasis system laboratory analysis data, hyper- and hypocoagulation based on chronometry test data, number of blood platelets, fibrin-monomer complexes, D-dimers, activity of antithrombin III, C and S proteins, XIIa-dependent fibrinolysis plasminogen content, availability of injured erythrocytes, combinations of laboratory tests for recognizing disseminated intravascular blood coagulation syndrome. Each sign under consideration receives a number of points corresponding to its diagnostic significance and integral value is calculated DIBCSIV=(X1+X2+…+Xn)/n, where n is the number of signs taken into consideration. DIBCSIV value equal to 1.0-1.5 units shows physiological norm. The value being between 1.6 and 2.5 units, light disseminated intravascular blood coagulation syndrome is diagnosed. The value being between 2.6 and 3.5 units, disseminated intravascular blood coagulation syndrome of medium severity is diagnosed; 3.6-4.5 points to one heavy severity degree; 4.6 and greater indicates highly severe case of disseminated intravascular blood coagulation syndrome.
EFFECT: high accuracy and objectiveness in differentiating syndrome severity degrees.
The invention relates to medicine, more specifically, to methods of diagnosis of the most life-threatening patient complications of burn disease - DIC (disseminated intravascular coagulation), and can be used by medical combustiologists, and medical technicians for timely detection of disorders of hemostasis in patients with thermal injury.
In practice, clinicians diagnosis of disseminated intravascular coagulation put on the analysis of clinical manifestations of this complication, as well as evaluating the overall results of laboratory tests of different parts of the system gemokoagulyatsii, endogenous anticoagulants and fibrinolysis. However, the conclusions of the medical clinicians on the results of considered characteristics largely subjective, depending on the level of professional knowledge and medical experience. As a result of the conclusion of the treating physicians combustiologists, consultants to the bedside, as well as specialists-clinical departments of the medical institution (medical technicians) are not standardized, and often diametrically opposed due to ambiguous understanding of the diagnostic value of certain characteristics of the syndrome of internal combustion engines, which are subjected to analysis. One of the main clause is icin this situation - no integral indicator, which allows you to combine all the analyzed characteristics and to Express the state of the system gemokoagulyatsii in the form of one single value.
Closest to the proposed technical solution is a method of diagnosis of DIC developed Weglikowy (Liceu VG Diagnosis and treatment of disseminated intravascular coagulation. - 2nd ed., Rev. - N.Novgorod, (in GMD, 1998. - 191 C.). According to the method prototype for assessing the status of the system gemokoagulyatsii take into account the signs (evidence) class a (initial clinical situation - starting factors for initiation and progression of the syndrome of internal combustion engines or so-called basic pathology), class b (clinical manifestations of DIC) and class C (data from laboratory tests of hemostasis). Each of the qualifying characteristics are assigned to "confidence", reflecting the degree of specificity of one or another symptom for the syndrome of ice. A set of confidence building measures (accounting certificates class a, b and C) are calculated according to equation Shortliffe. POI achieving aggregate measures of trust to 0.95 and more diagnosis of DIC. If a set of confidence building measures less than 0.95 diagnosis of DIC syndrome is rejected.
However, according to this method analyzes only the probability that the patient DIC. The more owls is the synergy of confidence building measures, the higher it is. The severity (form) DIC is not taken into account. Regardless of the value of aggregate measures of trust more than 0,95 Clinician using this method, this information is not received. It is not clear that the patient has latent, subacute or acute DIC, how the shape of the syndrome of ice time. It is impossible to determine when the latent DIC becomes subacute, and further in acute and Vice versa. It is not possible to quantify the dynamics of the pathological process (DIC) when the progression of burn disease or, on the contrary, when the recovery of the patient, and depending on the adequacy or inadequacy of medical treatment. In addition, the procedure of calculation of aggregate measures of trust various characteristics of class a, b and C using the equation of Shortliffe is rather time-consuming if it is not automated.
The present invention is to eliminate the existing shortcomings - the creation of an integrated indicator based on the information about the initial clinical situation (availability of factors of inductors initiation and progression of DIC), clinical manifestations of DIC syndrome and the results of laboratory tests of hemostasis system to evaluate and improve the accuracy of diagnosis of DIC based on gravity (form, and simplify this process.
The problem is solved due to the fact that in patients with burns analyze and take into account information about the original clinical DIC dangerous situation (the presence of the etiological factors in the initiation and progression of the syndrome DIC) - certificate class And clinical manifestations of disseminated intravascular coagulation (evidence grade b), and the results of laboratory tests of hemostasis (evidence grade C). Each indicator is assigned a score, the magnitude of which increases with increasing diagnostic significance (informative) one or another of the analyzed characteristic for the diagnosis of DIC (table). The integral indicator for the diagnosis of DIC syndrome (IPDS) calculated by the formula:
IPDS = (X1+X2+Xi)/n
where (X1+X2+Xi- the set of points of any number of attributes, n is the number of considered features, and when is IPDUS in the range of 1.0 to 1.5 units of the state system gemokoagulyatsii assessed as being within the physiological norm, in the range of 1.6 to 2.5% diagnose latent (light) DIC, 2,6-3,5% - subacute (moderate), 3,6-4,5%- acute (severe), and 4.6% and more acute (extremely heavy) syndrome disseminated is vertuani blood. IPDS expressed in conditional units.
The maximum number of considered features, especially when combined characteristics of all classes, will allow the most accurate and objective diagnosis of DIC, to define its shape (weight), or reject such, as some inaccuracies in the magnitude of the score of one or another of the analyzed characteristic offset by the aggregate of many other more accurate indication when calculating EPDS.
The method is as follows. The patient with thermal injuries analyze signs (evidence) class a, b and C, are presented in the table. Note the characteristics of the class: the burn area, the presence of burns of the upper respiratory tract, shock, given its severity, the development of the patient's severe complications of burn disease is sepsis. These symptoms reflect the degree of internal combustion engine-a dangerous situation. In the second phase, analyze the clinical manifestations of DIC syndrome (evidence grade C) - 14-24 (table). To detect signs of multiple organ failure (failure of function of lungs, kidneys, liver, brain dysfunction), local and multiple manifestations of disorders of blood clotting (bleeding, including gastrointestinal bleeding, thrombosis, heart attack). In the third step calculates the amount of points reflecting the measure of deviations (or lack thereof) in various parts of the system gemokoagulyatsii, endogenous anticoagulants and fibrinolysis - A.25-40 (table). Analyze the results of timing tests, counting the number of platelets, the study of structural indicators, activity of anti-thrombin III, etc. and also gives a measure of diagnostic value in points different variations of the results of laboratory tests for the detection of DIC (paragraph 41-50), which, as the data of literature and practice, have the greatest information with respect to the value for the diagnosis of disseminated intravascular coagulation. Summarize all the points, count the number of considered parameters (table) and calculate IPDS by the formula:
IPDS = (X1+X2+Xi)/n
where (X1+X2+Xi- the set of points of any number of attributes, n is the number of considered features, and when is IPDUS in the range of 1.0 to 1.5 units of the state system gemokoagulyatsii assessed as being within the physiological norm, in the range of 1.6 to 2.5% diagnose latent (light) DIC, 2,6-3,5% - subacute (moderate), 3,6-4,5% - acute (severe), and 4.6% and more acute (extremely heavy) syndrome disseminated intravascular swerty the project for blood.
Below are a few examples illustrating the application of the integral indicator for the diagnosis of DIC in burn disease (the results of the retrospective analysis of case histories of patients who were treated in the Russian burn center on the basis of the Nizhny Novgorod research Institute of traumatology and orthopedics).
Patient B-John S., 41 (East. b-nor No. 195571), entered the Russian burn center on the basis of the Nizhny Novgorod research Institute of traumatology and orthopedics about burn the flame of the head, trunk, upper and lower extremities AB-IV century in the area of 40% of the body surface. Burns of the upper respiratory tract. Index severity index (Frank) - 140 units report on the state of hemostasis on the totality of symptoms - acute DIC, (severe). Dynamics of IPDS: a day after thermal injury - 3,86% after 2 days - 4,22% after 5 days - 5,95% (acute DIC, extremely severe). On the 7th day the patient died.
Patient C-VA M.A., 45 East. b-nor N 191489), was admitted to the Department of thermal injury NIETO in connection with scald I-IIA tbsp. face, neck, trunk and upper extremities in the area of 40% of the body surface (an index of the severity of the defeat - 40%). In the interval from the first to 12th day after thermal injury, EPDS ranged from 2.0 to 2.33% Diagnosed latent DIC-si is drôme (mild), does not require special treatment for the correction of system gemokoagulyatsii. A day after thermal injury, IPDS - 2,1%, on the 6th day - 2,0%, on the 7th of 2.33%, 12th - 2,1% Starting from 14 days after burn (IPDS - 1,4 units) indicator not prevail of 1.5%, indicating full recovery of coagulation and anticoagulation systems of the body. The patient was discharged from hospital in satisfactory condition on the 19 th day from the date of the burn.
This example illustrates the wave-like change in the severity of the syndrome of the internal combustion engine when the latter moves from one form to another as the flow of burn disease.
The victim E-VA S.A., 67 (East. b-nor No. 194684), was admitted to the hospital burn Nizhny Novgorod research Institute of traumatology and orthopedics in connection with the flame burn of face, neck and both upper limbs, the back, the front surface of the chest on the area of 32% of the body surface (30% of severe burns IIIB-IV century). Burns of the upper respiratory tract. Index severity index (Frank) - 122 units a day after the burn, IPDS - 2,64% (subacute DIC or DIC moderate). After 2 days after injury recorded deepening of disturbances in the system gemokoagulyatsii: IPDS was 3,68% are Diagnosed with acute DIC (severe). On the 5th day the state of the system gemokoagulyatsii the creature is but has not improved (IPDS - 3,50% - subacute DIC). In subsequent periods of observation of the patient, the patient's condition continued to deteriorate, despite ongoing intensive treatment. On the 6th day after injury, IPDS was 4,60% (acute DIC, extremely severe), on the 7th day - 4,19 unit (acute DIC, severe), on the 8th day - 3,59 unit, on the 9th day condition continued to deteriorate (IPDS was 4.42%). The patient died on the 10th day after thermal injury.
The following example also demonstrates the wave for the severity of DIC syndrome in a patient who suffered from thermal injury, but with a favorable outcome of the pathological process.
Patient B s VA 41 years (East. b-nor No. 180123), was admitted to the hospital thermal lesions Russian burn center with burns the flame of the right shoulder, the back right side of the torso to the right on the square H. The degree of burn - II-IIIAB-IV. Index severity index (Frank) - 87% a day after the burn, IPDS - 2,43% (light DIC). On the 5th day from the date of injury of the analyzed indicator increased to 3.79% Diagnosed with latent transition in acute DIC (severe). A course of therapy for the correction of the hemostatic system. Starting from the 10th through the 17th day after injury, IPDS were in the range of 2.50% (latent DIC), then re-recorded arowana deterioration of hemostasis: on the 24th day after burn IRDS amounted to 2.64% (subacute DIC moderate). Treatment of disorder of the system gemokoagulyatsii again intensified. In subsequent follow-up period of IPDS declined after 32 days from the moment of thermal injury he amounted to 1.87% (latent DIC). The patient's condition continued to improve. 73-day system gemokoagulyatsii normalized (IPDS of 1.50%). 75 days the patient was discharged in good condition.
It is seen that the proposed method for the diagnosis of DIC in patients with thermal injury adequately reflects the state of the system gimotea, allows not only to diagnose the syndrome of DIC (or reject this diagnosis), but also to quantify the depth of disorders system gemokoagulyatsii to diagnose latent DIC (mild), subacute (moderate), acute (severe form) and acute (extremely severe) of DIC syndrome. This gives the opportunity to observe the development of the pathological process in the dynamics, to quickly identify the transition complications from less severe to more severe form, promptly appoint an adequate therapy, correcting the hemostatic system, to monitor the recovery and restoration of coagulation and anticoagulation mechanisms of blood. Use to calculate EPDS evidence of different classes is key to the most accurate is nd and correct assessment system gemokoagulyatsii, as this takes into account many factors associated with the development of disseminated intravascular coagulation. The ability to assess the state of the system gemokoagulyatsii with one integral quantities allows you to easily use the data not only in practical combustology, but in experimental medicine, in particular for statistical studies, especially in scientific work in assessing the effectiveness of new drugs and other therapeutic procedures that are developed and implemented in practice for the treatment of disseminated intravascular coagulation syndrome in burn disease.
Method for the diagnosis of disseminated intravascular coagulation (DIC) with burn disease, which takes into account the information about the original clinical DIC dangerous situation, the clinical manifestations of DIC syndrome and the results of laboratory tests of hemostasis system, characterized in that analyze the following characteristics of the source engine is a dangerous situation - the burn area, the presence of burns of the upper respiratory tract, shock, given its severity, development of sepsis, the clinical manifestations of DIC-syndrome - failure of the lungs, kidney, liver, brain dysfunction, local and multiple bleeding, gastrointestinal bleeding, thrombosis, heart attack; result is you laboratory studies of homeostasis - Hyper - and hypocoagulation according to timing tests, the number of platelets, fibrin-monomer complexes, D-dimer, the activity of anti-thrombin III, protein C and S, XIIa - dependent fibrinolysis, the content of plasminogen, the presence of damaged red blood cells, the combination of the results of laboratory tests for the detection of DIC, each carried signs assigned a score corresponding to its diagnostic value, and calculate the integral indicator for the diagnosis of disseminated intravascular coagulation (IPDS) by the formula
IPDS = (X1+X2+...+Xn)/n
where (X1+X2+...+Xn- the set of points carried signs;
n is the number of considered features,
and when is IPDUS in the range of 1.0 to 1.5 units of the state system gemokoagulyatsii assessed as being within the physiological norm, in the range of 1.6 to 2.5% diagnose latent (light) DIC, 2,6-3,5% - subacute (moderate), 3,6-4,5% - acute (severe), 4,6 and more acute (extremely heavy) disseminated intravascular coagulation.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: one should evaluate the time for clotting of plasma under testing in phospholipid-dependent test, moreover, one should apply high- and low-sensitive thromboplastin reagents to lupus anticoagulant to calculate the ratio of indices of prothrombin time prolongation and at its value being either equal to or above 1.1 one should diagnose APS.
EFFECT: shortened terms of research.
1 ex, 4 tbl
SUBSTANCE: method involves checking consciousness, blood coagulation state, peripheral blood leukocytes number, K+ ions, bilirubin, fibrinogen, hemolysis and hemoglobinuria availability, prothrombin index and exotoxic shock development. Each value is calculated in points as follows. Lucidity is evaluated as -2 points; depression - +3 points; coma - +6 points; lack of changes in blood coagulation system - -2 points; coagulation availability without clinical injuries - +2 points; coagulopathy with clinical manifestation signs - +19 points; K+ ions concentration being less than 3.0 mmole/l - +3 points, from 3.1 to 3.5 mmole/l - -5 points, from 3.6 to 5.0 mmole/l - 0 points, greater than 5.0 points - +7 points, failure in determining K+ ions concentration - 0 points; hemolysis availability - +6 points, its lack - -3 points; hemoglobinuria availability - +8 points, its lack - -1 points; leukocytes number being less than 12.0x109/l - -2 points, from 12,1 to 18.0x109/l - 0 points, higher than 18.0x109/l - +8 points; hourly urine output being less than 30 ml/h - +6 points, greater than 30 ml/h - -2 points; bilirubin content being less than 31 mcmole/l - -2 points, from 30.1 to 50.0 mcmole/l - 0 points, greater than 50.0 mcmole/l - +2 points, failure in determining bilirubin content due to hemolysis being available -+6 points; prothrombin index being equal to or less than 60% - +3 points, greater than 60% - 0 points, failure in determining prothrombin index due to hemolysis being available - +12 points; fibrinogen concentration in blood plasma being less than 2.1 g/l - +4 points, from 2.1 to 4.0 g/l - -1 point, from 4.1 to 6.0 g/l - +1 point, failure in determining fibrinogen concentration due to erythrocyte hemolysis being available - +13 points; exotoxic shock development - +9 points, its lack - -1 point. The points are summed up. The value being greater than +13, admission for treatment in resuscitation department is indicated. The value being less than -13, admission for treatment in therapeutics department is indicated. The value being from -13 to +13, resuscitation expert consultation is advised.
EFFECT: high evaluation accuracy.
FIELD: medicine, laboratory diagnostics.
SUBSTANCE: the suggested studying should be carried out on the glass simultaneously with several inductors by applying minimal inter-taking antilogarithms concentrations of aggregation inductors which correspond at double combination of inductors: ADP 5.0 x 10-8 M, adrenaline 3.0 x 10-9, collagen - dissolving the main suspension 1:8, thrombin 0.075 U/ml; at triple combination of inductors: ADP 10-9 M, adrenaline 10-9, collagen - dissolving the main suspension 1:9, thrombin 0.060 U/ml. The development of aggregation means thrombocytic activation in patients with arterial hypertension at metabolic syndrome. The method enables to evaluate the changes of thrombocytic functional state with combination of inductors more probably present in area of vascular lesion by applying minimal necessary concentrations that develops real conditions at hemostatic initiation in human vessels.
EFFECT: higher efficiency of studying.
3 dwg, 3 ex, 2 tbl
FIELD: medical engineering.
SUBSTANCE: device has non-absorbing substrate having hydrophilic target region, which is covered with reagent by applying non-impact micro-drop printing method to produce practically uniform reagent layer. The device is in particular usable for measuring blood coagulation time. Preferential invention embodiment involves determining blood coagulation time by carrying out monitoring of light transition through the target region as the blood sample cover interacts with the reagent.
EFFECT: high reliability of analysis results.
20 cl, 9 dwg
SUBSTANCE: method involves carrying out ultrasonic examination. Hepatic cholestasis being observed, morphologic examination of hepatic bioptate is carried out. Intralobular lymphoid cellular infiltrate on the hepatic cells necrosis place and nonuniform thickness of central vein wall, moderately marked pericentral and focal perihepatocellular fibrosis being available in combination with lipofuscin deposit and epitheliocyte desquamation in biliary ducts, TTV-caused chronic hepatitis is considered to be diagnosed.
EFFECT: high accuracy of diagnosis.
FIELD: animal science.
SUBSTANCE: one should detect haptoglobin types in cow's blood serum. Animals should be tested at the age of 8-10 mo either before or after the first calving. Animals of Hp 2-2 type should be referred to those with hereditary resistance for ovarian cysts development, and animals of Hp 1-1 type and Hp 2-1 type should be considered to be hereditarily predisposed to pathology under investigation. Application of the present method enables to detect animals with hereditary predisposition to the development of ovarian cysts in earlier period.
EFFECT: higher accuracy of prediction.
FIELD: medicine, obstetrics.
SUBSTANCE: one should detect ratio coefficients for the content of lactobacilli to conditionally pathogenic flora in scraped off samples obtained after mucus removal from the surface of posterior vaginal arch and cervical canal, and at their 2-fold decrease against the norm it is possible to conclude upon the risk of abortion. The method enables to perform efficient prediction before manifestation of clinical signs that makes it possible to carry out due therapy.
EFFECT: higher accuracy of prediction.
3 ex, 3 tbl
SUBSTANCE: one should prepare biological indicator beforehand consisting of 0.1% aqueous solution of amino acid mixture - aspartic acid, glycine, tryptophan, leucine, valine, serine, phenylalanine, threonine, 0.5% aqueous solution of dopamine neuromediator, 12% aqueous solution of magnesium sulfate at the ratio of 3:1:6 to be applied onto a glass plate and placed onto painful area in left costal-vertebral corner to be kept for 1-2 min, dried at 18 - 20 C and studied in polarized light with quartz compensator. In case of different degraded spherolytes of parti-colored coloring in a preparation one should diagnose chronic pancreatitis.
EFFECT: higher efficiency of quick test diagnostics.
12 dwg, 9 ex
FIELD: medicine, otorhinolaryngology.
SUBSTANCE: the present innovation deals with treating diseases of the upper respiratory tract. One should detect disorders of mucociliary transport (MCT) due to measuring the motor parameters of ciliated epithelium cilia, at least, the rate of mucociliary transport that includes material sampling for further testing as ciliary epithelial cells and registration of cilia fluctuations in human respiratory tract due to TV microscopy performed in patient's lifetime. Material for testing should be sampled from mucosal surface of respiratory tract, and therapeutic tactics should be chosen depending upon motor velocity of cilium's tip obtained based upon mathematical modeling followed by calculations by the formula: , where Vc - velocity of cilium's tip [mcm*sec1]; C1, C2, α - calculated as average values being characteristic for every of human body states under investigation: healthy persons, patients with either acute or chronic forms of sinusitis by the developed model of cilia movement; C1 - curvature of cilium's working length, constant being equal to 1/38 mcm-1; C2 - cilium's curvature from its working length up to the tip [mcm-1]; α - cilium's inclination angle against vertical position [degrees]; π = 3.1417 - constant; L, Ts and Te - parameters measured individually in every patient; L - cilium's length [mcm]; Ts - time from the onset of movement till maximal straightening of cilium's tip [sec]; Te - time of efficient impact [sec]. Moreover, the value being Vc = 9.6 - 11.3 mm/min corresponds to normal MCT functioning. For patients with chronic purulent sinusitis beyond exacerbation accompanied with MCT disorder it is necessary to prescribe complex therapy: surgical or conservative therapy with preparations of secretolytic and secretomotory action. For patients with chronic purulent sinusitis beyond exacerbation without any MCT disorder one should prescribe surgical therapy. All patients with acute sinusitis with MCT disorder should be prescribed complex conservative therapy with preparations of secretolytic and secretomotory action. The method enables to specify optimal therapy based upon scientifically proved indications of investigations by taking into account individual peculiarities of every patient.
EFFECT: higher efficiency.
5 dwg, 3 ex, 2 tbl
FIELD: medicine, psychiatry, neurology.
SUBSTANCE: one should evaluate psychic state in patients and detect the quantity of eosinophils, basophils and rod neutrophils in peripheral blood. At eosinophils ranged 1.97-2.52%, basophils 0.12-0.14%, rod neutrophils 0.64-0.91% it is possible to diagnose depressive state. At eosinophils being below 1.32%, basophils from 0.03% and less, rod neutrophils from 1.27 and higher one should diagnose organic lesion of central nervous system.
EFFECT: higher accuracy of differential diagnostics.
10 dwg, 1 tbl
FIELD: medicine, hepatology.
SUBSTANCE: the present innovation deals with detecting bilirubin content both before and after curative starvation, moreover, curative starvation one should introduce antipyrine at the dosage of 1 mg/kg, in a day it is necessary to detect antipyrine content in saliva and urine and bilirubin content and at bilirubin content being 30-40 mM/l one should starve at daily intake of 400-450 kcal/d for 3 d, then one should again detect bilirubin level and at its increase by 50-100% one should again introduce antipyrine at the dosage of 1 mg/kg and according to its delayed half-life by 20-50% it is possible to diagnose Gilbert's disease.
EFFECT: higher accuracy of diagnostics.
FIELD: analytical methods in medicine.
SUBSTANCE: cells of tested organs are subjected to alternating cytological electrophoresis. When cell vibration amplitude rises by at least 20%, drug is regarded to be appropriate for treatment.
EFFECT: increased drug selection efficiency.
SUBSTANCE: method involves carrying out qulonometric sample titration with electrically produced oxidant like bromine. Bromine is electrically produced from 0.2 M potassium bromide solution in 0.1 M aqueous sulfuric acid solution on platinum electrode acting with constant current intensity of 5.0 mA. Antioxidant capacity is calculated from a formula.
EFFECT: simplified method of high effectiveness.
FIELD: disposable medicinal instruments, in particular, gynecological instruments, may be used for sampling of biological material for carrying-out researches in bacteriology and pathology, for example, from mucous membrane surface of vagina, cervical channel, or urethra.
SUBSTANCE: combined blood sampling instrument has elongated handle and two shanks with one blood sampling tool at distal end of each shank. Shanks are oriented with their distal ends along longitudinal axis of handle in opposite directions therefrom and have length not exceeding width of handle. One blood sampling tool is made in the form of spoon having width at least equal to width of shank end at shank and spoon junction site. Other blood sampling tool is made in the form of flat spatula having width exceeding that of handle. Other blood sampling tool is made heart-shaped in plan, said shape being formed by two petals with convex rounded ends. Petal ends protrude beyond shank and have longitudinal axes arranged at an angle with respect to one another. Length of handle is equal to or less than half the distance between distal ends of shanks and is equal to or less than length of shank, at end of which spoon is provided.
EFFECT: increased efficiency owing to multifunctional operation and employment of disposable gynecological tools for sampling of biological material from mucous membrane surfaces.
22 cl, 5 dwg