Method for differential diagnostics of infiltrative tuberculosis and inspecific pneumonia

FIELD: medicine, phthisiology.

SUBSTANCE: one should carry out test-therapy with antibiotics, moreover, preparation should be introduced into subcutaneous fiber of pre-tracheal area, subaxillary area at the side of lesion once daily at the dosage of 1/2 - 2/3 against the age daily dosage and 7-10 d later in case of roentgenologically proved healing of pulmonary inflammatory alterations one should state upon pneumonia, and in case of kept inflammatory alterations - tuberculosis. The present method enables to shorten the terms of diagnostics that, in its turn, enables to carry out corresponding therapy in due time and, thus, prophylaxis of possible jatrogenic complications.

EFFECT: higher efficiency of diagnostics.

2 ex

 

The invention relates to medicine, namely to Phthisiology.

The similarity of clinical and radiographic progression in infiltrative tuberculosis and nonspecific pneumonia complicates the diagnosis of tuberculosis.

However, the proposed methods for differential diagnosis of tuberculosis based on the comparison of the characteristic for tuberculosis and pneumonia clinical and radiographic signs have only indirect importance and need objective evidence [1, 2]. Trial therapy with broad-spectrum antibiotics when their traditional introduction (/m, per os), used as a differential diagnostic test between tuberculosis and pneumonia, in some cases even up to 4-6 weeks due to lack of clinical-radiological effect [3].

Our proposed method of differential diagnosis between infiltrative tuberculosis and nonspecific pneumonia is the change in the method of introduction of the antibiotic when conducting the test treatment (use of lymphotropic introduction)that allows you to make the correct diagnosis after 7-10 days. When nonspecific pneumonia, according to x-ray control, this term comes complete resorption of inflammatory changes in the lungs, tuberculosis positive radiological improvement is not observed.

We offer you the method the test treatment with broad-spectrum antibiotics is carried out by the method developed by us [4]. In the subcutaneous tissue pretracheal zone, subaxillary region on the affected side within 7-10 days once a day in a 0.25% solution of novocaine injected antibiotic dose 1/2-2/3 age daily dose. Before the introduction of antibiotic administered 1 ml (5 tised) heparin with 0.25% solution of novocaine (creation lymphotropic effect). Area drug alternate. The total volume of fluid 20 ml (two syringes 10 ml).

Example 1. Patient L., age 16, was on treatment in somatic hospital with a diagnosis of Acute right upper lobe pneumonia. Received antibiotics for 10 days. During this period, the change of the drugs was performed 5 times. When conducting x-ray control (on day 8 of treatment) showed a negative x-ray dynamics in the form of strengthening infiltrative changes in the upper lobe of the right lung and signs of hypoventilation. Suspected infiltrative tuberculosis of the lungs. Transferred to the research RAMS.

The purpose of diagnosis applied to the test-lymphotropic therapy the introduction of cefamezin. The drug was administered at a dose of 1.0 once a day for 7 days.

By the end of the course lymphotropic therapy showed complete resorption of infiltrative hypoventilation changes in the upper lobe of the right lung.

Test therapy using lymphotropic the introduction of the antibiotic on valila 7 days to diagnose pneumonia.

Example 2. The patient Was 17 years old, was treated in somatic hospital for acute, pravostoronnei proximal pneumonia. Within 3 weeks were treated with broad-spectrum antibiotics (ampioks, Cefazolin, ciprolet) with partial clinical and radiographic results. Was discharged for outpatient monitoring of TB diagnosed with Prostornaja proximal pneumonia, a protracted course.

In the PDD by place of residence continued treatment with antibiotics: Sumamed - 6 days ciprofloxacin - 8 days. The General course of antibiotic treatment was 34 days.

When conducting x-ray control a slight positive trend by reducing the intensity of inflammatory changes in the lung. A reliable comparative evaluation of the radiographs was difficult because of the varying quality of the compared images.

For the differential diagnosis between tuberculosis and protracted pneumonia is aimed at the research of the Russian Academy of medical Sciences.

Given the complexity of data interpretation of interarchive due to the low quality of the intermediate x-ray or absence in a patient with sputum smear carried out the test-treatment with gentamicin at a dose of 80 mg once a day, lymphotropic within 10 days.

By the end of the course lymphotropic therapy positive rent is ekologicheskogo effect is not obtained, that has allowed to exclude the nonspecific nature of inflammation and after 10 days the test treatment to the diagnosis of tuberculosis.

After 2 months of diagnosis of tuberculosis has been bacteriologically confirmed, sputum sowing method received abundant growth of the office.

Thus, lymphotropic of antibiotics in patients with nonspecific pneumonia, previously treated with antibiotics other methods (in/m, oral), helps to achieve a marked clinical and radiological improvement for a short period (7-10 days), which reduces the differential diagnosis between infiltrative tuberculosis and nonspecific pneumonia.

The proposed method can be recommended for widespread clinical use in the most difficult diagnostic cases.

Literature

1. The respiratory TB / edited Agiamento. - M., 1980. - P.236 - 237.

2. Katorgin N.A., S.M. Fedorov, Karpov I.V. Diagnosis of pulmonary tuberculosis in therapeutic hospital /national Congress on respiratory diseases, 12th: proc. Dokl. - M., 2002. - Page 287.

3. Korovkin B.C. On timeliness of diagnosis of infiltrative pulmonary tuberculosis // national Congress on respiratory diseases, 12: abstracts of the reports. - M., 2002. - S.

4. Firsova, VA, by Ovsyankin Y.S., Gubkin F Patent No. 2104046 February 10, 1998 - “a Method for the treatment of TB is ESA light”.

The method of differential diagnosticity infiltrative tuberculosis and nonspecific pneumonia with the test treatment with antibiotics, characterized in that the drug is injected in the subcutaneous tissue pretracheal zone, subaxillary region on the affected side 1 time a day at a dose of 1/2-2/3 of age daily dose and after 7-10 days when the resorption of inflammatory changes in the lungs, established radiographically, diagnosed with pneumonia, while maintaining the inflammatory changes - TB.



 

Same patents:

FIELD: hepatology.

SUBSTANCE: invention is destined for use in hospitals, addiction dispensers, and Department of forensic medical examination when determining narcotic intoxication. For that aim, morphologic examination of hepatic tissue (obtained through biopsy or autopsy) is performed and condition of cells of monocytic-macrophage system of liver is estimated. When increased level of endoteliocytes in sinusoids in periportal region relative to remaining part of parenchyma is observed, acute narcotic intoxication is determined and, when these changes are observed across all surface of hepatic segment, chronic intoxication of human organism is stated.

EFFECT: enabled distinguishing acute and chronic forms of narcotic intoxication.

5 ex

FIELD: medicine.

SUBSTANCE: method involves applying flexible dental cappa plates having built-in radiopaque net set congruently to gingiva contour when being manufactured, and radiopaque thread placed on dental pocket bottom around teeth under study. Mesh diameter is equal to 1 mm. Several dental pocket depth values are measured. Total failure scale in periodontium is determined from formula CP=(D1+D2+…+Dn)/(L1+L2+…+Ln)*100%, where CP is the periodontium destruction degree, D1,D2,…Dn mean depth of each bone pocket in mm, L1,L2,…Ln is the total length of tooth root in mm. CP value being below 20%, I degree periodontium failure is diagnosed. The value being from 20 to 50%, II degree periodontium failure is diagnosed. The value being higher than 50%, III degree periodontium failure is diagnosed.

EFFECT: high quality of diagnosis.

FIELD: medicine.

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.

1 tbl

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

FIELD: medicine.

SUBSTANCE: method involves determining proportion of cyclic adenosine monophosphate to cyclic guanosine monophosphate, serotonin and histamine level and serotonin/histamine ratio coefficient, content of prostaglandin E2 and prostaglandin F2α and adenylatecyclase index. Cyclic adenosine monophosphate to cyclic guanosine monophosphate ratio being equal to 2.7-3.3, serotonin level of 4.5-6.6, content of prostaglandin E2 being equal to 670-1340 mg/g of protein and prostaglandin F2α to 320-960 mg/g of protein, label index being equal to 10.1-35,0% and adenylatecyclase index being equal to 19.2-30.0 rmole/g of protein/min, stomach and duodenal ulcer healing is predicted.

EFFECT: high accuracy of prognosis.

FIELD: medicine, urology.

SUBSTANCE: one should detect the level of prostatic specific antigen (PSA) concentration in patients' blood serum after prostatectomy, moreover, blood PSA values should be determined both before and after massage of prostatic channel, moreover, in cases when PSA blood values are within the norm one should detect PSA in urine both before and after massage of prostatic channel and at availability of growth dynamics of its values one should detect PSA concentration in blood serum both before and after massage of prostatic channel and, moreover, if PSA values in blood serum after massage of prostatic channel are above its initial values it is possible to predict the development of local relapse of prostatic cancer.

EFFECT: higher efficiency and accuracy of prediction.

3 ex, 1 tbl

FIELD: medicine; medical engineering.

SUBSTANCE: method involves puncturing articulation, discharging liquid and setting a device in canal under puncture and in articulation cavity. The device is stretched in the articulation cavity. The device opening is positioned under skin allows closing it. Device has tubular member having one end manufactured as a sack with capillary holes. Cork is mounted in tubular member inlet. Substance for manufacturing tubular members absorbs liquid and is not liquid-proof.

EFFECT: reduced risk of traumatic complications when repeatedly introducing drugs and discharging liquid into the same cavity; simplified design; slow drug infusion within long time; low cost draining process.

4 cl, 1 dwg

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, obstetrics.

SUBSTANCE: the innovation deals with detecting human sex both before and after conception in women with 28-d-long menstrual cycle. According to the Table described in this innovation one should detect what month by parity a mother was born in. It is considered that in all months that correspond by parity with the month of mother's birth the conception of girls should happen and in months that don't correspond by parity with the month of mother's birth - the conception of boys should happen.

EFFECT: higher accuracy of detection.

9 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: method involves carrying out blood serum examination. Infrared blood serum spectroscopy, infrared radiation transmission index and mean transmission coefficient value are calculated at the second day after surgical intervention. The mean transmission coefficient value being found less than 64.4 in 2120-1880 in 2120-1880 cm-1 bandwidth, peritoneal commissure disease is predicted to be the cases.

EFFECT: high prognosis accuracy.

2 ex

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!