Method for determining adductor blood vessel in cerebral arteriovenous malformation
SUBSTANCE: method involves carrying out location measurements using transducer of 7.5 L in B mode, color dopplerometry mapping mode and in D mode. When obtaining an image characterized by anechogenic elongated formation having echogenic banding in B mode, high speed flow image with blood circulation directed towards the arteriovenous malformation in color dopplerometry mapping mode and bypass pattern image with high systolic and diastolic blood circulation speed and low pulsation index and resistance index values in D mode, adductor blood vessel in cerebral arteriovenous malformation is verified when having all the images located at the same place.
EFFECT: high reliability and accuracy of diagnosis.
The invention relates to medicine, namely surgery of cerebral vessels, and can be used when carrying out surgical procedures for the removal of arteriovenous malformations (AVM) of the brain.
There is a method of determining the leading vessel of the AVM by angiographic studies (Samotokin B.A., Khilko V.A. Aneurysm and arteriovenous fistula brain. HP: Medicine, 1973. - 288 S.). Make a puncture of an artery is injected contrast agent followed by a series of x-rays, which determine the position of the leading vessel of the AVM.
The disadvantages of the method include the inability to use it when conducting operations on an open brain as it requires special equipment for its implementation; the need for artery puncture with injection of a contrast agent, which has a negative effect on the entire body (allergic reactions) and directly on the vessel (angiospasm; radiation load on the patient.
There is a method of determining the leading vessel AVM of the brain by magnetic resonance imaging in combination with magnetic resonance angiography (Choline A. C. Magnetic resonance imaging in diseases of the Central nervous system. A guide for physicians, SPb.: Hippocrates, 1999. - 192 S.). Sposobov on obtaining a still image or moving units on the basis of the phenomenon of nuclear magnetic resonance. The method allows to identify the position of the leading vessel of the AVM in relation to the basic structures of the brain. The method is widely used in the preoperative diagnosis.
The disadvantages of this method are: it is challenging to use when conducting operations on an open brain as it requires special equipment for it; the resulting image reflects the position of the pathological education at the time of the study, and not at the time of surgery.
Closest to the claimed method is determining the leading vessel of the AVM by Doppler adopted for the prototype (Hassler W. Hemodynamic aspests of cerebral angiomas.//Acta Neurochir. 1986. - Vol.37, Suppl. - p.108-125). The method is based on the use of the Doppler effect in ultrasonic location of blood flow in the vessel microvascular sensor with a frequency of 16 or 20 MHz. Record the velocity of the blood flow with the already selected vessel after separation of education. Leading vessel is characterized by a pattern shunt with increased value and systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity.
The disadvantages of the prototype are: trauma, as it would require extensive osteoplastic craniotomy with a wide exposure of the brain to identify all the of Ferento and efferents, that is accompanied by bleeding from small arteries with dirty walls; the method can be applied only after the selection of the AVM from scarring and adhesions and allows you to get the resulting image of the vessel, and based only on the determination of the speed characteristics of the blood flow. In addition, microvascular sensor has low wear resistance and a high probability of failure during the operation.
The invention is directed to a method of determining the leading vessel of the AVM that reduce the trauma of the brain.
This technical result in the implementation of the invention is achieved in that in the known method of determining the leading vessel arteriovenous malformation of the brain by ultrasonic location in D mode, the peculiarity lies in the fact that additionally carry out location in the mode and color Doppler mapping (DDC), and all studies are carried out intraoperatively, and upon receipt of the image, characterized anechoic mass with the formation of oblong form with hyperechoic the striation in mode, high-speed flow with the direction of blood flow in the direction of arteriovenous malformations in DDC mode, pattern shunt with high systolic and diastolic velocity is of robotica with reduced values pulsating index and index resistivity in D mode in the same place, will verify leading vessel arteriovenous malformation of the brain.
The method is as follows. The study was conducted intraoperatively using ultrasonic device with sensor 7.5l, allowing you to get the image in mode, mode, color Doppler mapping (DDC) and D mode. Ultrasonic location is carried out after craniotomy through the Dura to her opening and before maningrida and encephalosis and highlight the leading vessel of the AVM from the rough adhesions in two mutually perpendicular planes from different points of view. Using and DRC modes define landmarks for navigation, which are the ventricles of the brain, the bones of the skull base and other clearly differentiable structure. For ease of interpretation of the image and the orientation of structures in the brain in the beginning it is advisable to use a plane close to the standard. Further, by changing the angle of the sensor itself is rendered pathological education. Mode DRC body AVM presents education with high-speed multi-directional flows.
If mode in the immediate vicinity of the body of the AVM renders a specific picture anechoic mass with education oblong form with hyperechoic the striation, the DRC that W is the place lazerette high speed flow with the direction of blood flow in the direction of the AVM. In D mode is determined by the pattern of the shunt, which is characterized by a high value and systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity, the combination of all three components allows to verify the leading vessel of the AVM. The location will determine the place of opening of the Dura and encephalocoele, floors leading vessel.
The method allows to determine the position of the leading vessel of the AVM in real time in relation to surrounding structures before opening of the Dura and its selection.
The inventive method developed in SE the Polenov research neurosurgical Institute them. Professor and Operated and clinically tested in the survey 3 patients.
Here is an example extract from the history.
Patient K., aged 23, IB 88-04, was treated In the Polenov research neurosurgical Institute with a diagnosis of AVM left parietal and temporal lobes.
Conducted angiographic examination. Identified the presence of AVM deep divisions left parietal and temporal lobes. Leading vessel branch of the left middle cerebral artery, which is indicated by the arrow (Figure 1).
Before the operation, 28.01.2004, patients received ultrasound through a bony defect in the skull. In mode is visualized specific picture anechoic mass with education predolgoj is the form with hyperechoic the striation, to set the pointer (Figure 2). Mode DRC on the place of education lazerette high speed flow with the direction of blood flow in the direction of arteriovenous malformations. Leading the vessel is indicated by a white arrow (Figure 3). In D mode Lazarova pattern shunt. PI=0,53, RI=0,43, Vsist=95 cm/s, Vdiast=54 cm/s (Fig 4).
29.01.2004 surgery: removal of the AVM left temporal lobe and parietal lobe.
During the operation, according to the present method, during the operation through a bony defect in the skull produced ultrasonic sonar sensors 5,0 P and 7.5 L in the mode of the DRC. Determined position of the body AVM, which is represented by the formation of a high-speed multi-directional flows (Figure 5). Lazarova leading vessel in the form of an anechoic mass with education oblong form with hyperechoic the striation in the mode that is indicated by the arrow (6). In DDC mode at the same location Lazarova high-speed stream directed to the body of the AVM. Leading the vessel is indicated by the arrow (7). In D mode, the flow in the formation is characterized by a pattern of shunt PI=0,38, RI=0,33, Vsist=91 cm/s, Vdiast=61 cm/s (Fig). On the basis of the obtained results verified the leading vessel AVM, its location in the substance of the brain. By ultrasound produced arcuate dissection of the Dura mater, below the projection AVM made available is to AVM. On the leading vessel imposed temporary clips. AVM was completely removed. The size and shape of the AVM coincided with the data of the ultrasound examination. Presents a photograph of the remote AVM (Fig.9).
The use of the claimed method allowed to detect the leading position of the vessel AVM, hold select and delete AVM with minimal trauma to brain tissue.
The method of determining the leading vessel arteriovenous malformation of the brain, including intraoperative ultrasound location in D mode, characterized in that the study was conducted with Dura additionally provide the location in the B-mode and color Doppler mapping (DDC) and upon receipt of the image, characterized anechoic mass with the formation of oblong form with hyperechoic the striation in b-mode, high-speed flow with the direction of blood flow in the direction of arteriovenous malformations in DDC mode, pattern shunt with high systolic and diastolic blood flow velocity with reduced values pulsating index and index resistivity in D-mode and the combination of all three images in the same place the vessel arteriovenous malformations and brain determine the cause.
FIELD: medicine, functional diagnostics, cardiology.
SUBSTANCE: on isolating the trunk of pulmonary artery one should measure circulation in its wall with the help of a laser-doppler flowmeter to detect average value of microcirculation, root-mean-square and interval of deviation against average value. Then one should detect average value of microcirculation and the value for circulation decrease after replacing the trunk of pulmonary artery into aortic position. If average value of microcirculation in the wall of pulmonary artery in position of aortic valve has been decreased by the value either equal or below 1.282xσ, one should predict favorable result of operation, if the decrease occurred by more than 1.282xσ, one should predict unfavorable result of operation. The method broadens the number of diagnostic means applied in the field of cardiosurgery.
EFFECT: higher efficiency and accuracy of prediction.
SUBSTANCE: method involves determining hemodynamic characteristics of blood circulation in vascular anastomosis area in standard zones distal and proximal with respect to the vascular anastomosis by means of ultrasonic dopplerography during the first 6 months, after vascular plastic operation being applied. Dynamic changes in the characteristics are interpreted in terms of full-valued vascular anastomosis condition.
EFFECT: high accuracy of diagnosis; high accuracy of ultrasonic blood circulation condition criteria.
11 dwg, 2 tbl
SUBSTANCE: method involves carrying out cardiotocographic examination taking into account day rhythmostasis and following data analysis. Diagnostically significant cardiotocographic characteristics like basal rhythm, accelerations, acceleration durations, motor fetus activity and integral fetus state characteristic are determined. Non-conjugated estriol/progesterone coefficient is calculated with day rhythmostasis taken into account. Maternal and fetal blood circulation hemodynamic values synchronization coefficient is determined. Diagnostically significant characteristics values typical for fetus hypoxia are determined. When carrying out cardiotocographic examination, basal rhythm (strokes/min) is equal to 156±2.9 at 12 o'clock and 159±3.7 at 20 o'clock; accelerations (strokes/min) 3.0±0.2 at 12 o'clock and 2.2±0.3 at 20 o'clock; acceleration durations (s) 14.2±0.7 at 12 o'clock and 13.6±1.2 at 20 o'clock; motor fetus activity (during 10 min) 2.0±0.4 at 12 o'clock and 1.7±0.3 at 20 o'clock; integral fetus state characteristic 1.25±0.15 at 12 o'clock and 1.37±0.22 at 20 o'clock. When determining noncojugated estriol/progesterone coefficient: 0.57±0.05 at 8 o'clock and 0.67±0.06 at 20 o'clock. When determining maternal and fetal blood circulation hemodynamic values synchronization coefficient: 2.35±0.19 before 37 pregnancy weeks date and 2.78±0.18 after 37 pregnancy weeks date. The values corresponding to the above referenced ones, functional fetus state change and chronic fetal hypoxia are to be diagnosed.
EFFECT: high accuracy of diagnosis.
FIELD: medicine, oncology.
SUBSTANCE: before the onset and 10-14 d after the end of chemotherapy course it is necessary to carry out chromatic Doppler mapping to evaluate maximal tumor rate of circulation, and at its decreased value being 25% lower against initial data one should establish process stabilization, and at its increase being 25% higher against the initial data - process progressing should be stated upon. The innovation enables to objectively evaluate efficiency of chemotherapy at applying safe, simple ultrasound trial for the purpose to specify subsequent therapeutic tactics.
EFFECT: higher efficiency and accuracy of detection.
8 dwg, 3 ex
SUBSTANCE: one performs ultrasonic echo-dopplerometric investigation of regional blood flow in prostate before and after treatment to determine quantitative parameters. When pulsation index is reduced from 1.39±0.12 before treatment to 1.10±0.09 after treatment and venous blood flow velocity increases, respectively, from 3,91±0.36 to 5,22±0.47, treatment is regarded effective and completed.
EFFECT: increased accuracy of estimation.
SUBSTANCE: method involves determining microcirculation indices in rest state by applying Doppler laser flowmetry method and capillary blood circulation reserve indices in occlusion sample under cuff pressure being 30 mm of mercury column as high as the systolic patient blood pressure during 3 min. Cardiorespiratory disorders development is predicted in postoperative period, The microcirculation indices being greater than 6.0 perfusion units in combination with capillary blood circulation reserve indices being greater than 300% or microcirculation indices being below than 4.5 perfusion units in combination with capillary blood circulation reserve indices being greater than 200%.
EFFECT: high accuracy of prognosis.
SUBSTANCE: method involves carrying out visual and rectal examination. Peripheral blood circulation speed is measured in rectovaginal partition blood vessels. Rectovaginal partition folds are detected and increase in its thickness. Levators separation exceeding 20 mm is determined. Fibrous degeneration of rectovaginal partition is detected. Reduced blood circulation speed in levators is detected. Anterior rectocele is diagnosed. Values are measured by introducing ultrasonic transducer into the rectum. One of versions assumes introduction of hygienic intravaginal tampon into the vagina.
EFFECT: high reliability of diagnosis.
2 cl, 8 dwg
SUBSTANCE: method involves examining retina light sensitivity degree using computer-aided perimetry approach within 60° bandwidth from fixation point. Direct orbital muscle thickness and retrobulbar space volume is additionally determined by applying ultrasonic b-scanning method. Linear blood circulation speed and resistance index are also determined in the central retinal artery and posterior short ciliary arteries. Macular or general light sensitivity reduction 25% and more relative to age-specific norm being observed together with 50% growth and more in direct orbital muscle thickness, retrobulbar space volume growth by more than 35% in combination with linear blood circulation speed reduction in the central retinal artery and posterior short ciliary arteries by 40% and more and increasing resistance index by 20% and more relative to physiologic norm, optic nerve abnormality is diagnosed at early disease stages.
EFFECT: high reliability of diagnosis.
SUBSTANCE: method involves diagnosing gestosis severity degree with clinical signs and blood circulation being studied. Ultrasonic examination with Doppler color mapping is carried out in female patients manifesting fuzzy clinical symptoms. Intrarenal artery resistance index is determined. The value being within 0.62-0.65%, mild gestosis is to be diagnosed. The value being within 0.66-0.69%, moderate severity degree gestosis is to be diagnosed. The intrarenal artery resistance index being equal to or greater than 0.7%, severe gestosis cases are to be diagnosed.
EFFECT: high accuracy of diagnosis; noninvasive diagnosis method.
SUBSTANCE: method involves making lumbar puncture and measuring liquor pressure, taking pleocytosis into account, making ultrasonic transcranial Doppler flowmetric examination of brain, determining linear blood circulation speed on interior carotid artery and posterior cerebral artery, detecting intracranial venous discharge disorders through orbital and vertebral veins. Regression coefficient is calculated from a formula
where X1 is patient age (in years); X2 is the pleocytosis in the first lumbar sample (in cells number per 1 mcl of liquor); X3 is the meningitis symptoms duration (in days); X4 is the focal symptoms availability (1- yes, 0- no); X5 is the general cerebral symptoms duration (in days); X6 is the liquor pressure when taking the first lumbar puncture (in mm of mercury column); X7 is the linear blood circulation speed in interior carotid artery (in Hz/s); X8 is the linear blood circulation speed in posterior cerebral artery (in Hz/s); X9 is the intracranial venous discharge disorders based on ultrasonic transcranial Doppler flowmetric examination data; retrograde discharge through orbital veins, increased one through vertebral veins and others (1- yes, 0- no). Value of y≤0.5, unfavorable outcome is to be predicted with cerebroasthenic, asthenoneurotic and hypertension syndromes being formed. If y>0.5, favorable infectious process outcome is to be predicted.
EFFECT: high accuracy of diagnosis.
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.
FIELD: medicine, urology.
SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.
EFFECT: more reliable and objective information.
1 ex, 1 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves applying ultrasonic Doppler echolocation techniques for scanning blood circulation at selected area of cardiovascular system, determining blood circulation velocity vector projections and calculating blood circulation speed. Echolocation is carried out by using at least three non-complanar probing ultrasonic rays set at angles relative to selected area of cardiovascular system in the range of 0-±80°. Selected blood circulation area orientation angles are measured relative to scanning ultrasonic rays and Doppler frequency shifts in each measuring channel are determined. Blood circulation speed is calculated as where ω0i is the radiation frequency of ultrasonic oscillation in ray I, Δωi is the Doppler frequency shifts in measuring channel i, V is the ultrasonic wave propagation speed in the medium, ϑk is the blood circulation speed in selected area, ϑki is the blood circulation velocity projection to scanning ray i, a,b,c,h,k,n11,n12,n13 are the coefficients depending on ultrasonic rays orientation. The device has measuring unit having ultrasonic transducers and electronic unit having switch, high frequency oscillator, calculating unit, indication and control unit. The measuring unit is manufactured as bracelet which segments are connected to each other by means of adjustable hinges and has gages for measuring lateral segment orientation angles relative to the central segment and gages for measuring ultrasonic transducer orientation angles relative to the i-th segment where i = 1,2,3, connected to calculating unit, switch, indication and control unit connected to high frequency oscillator, ultrasonic transducers of the measuring unit are connected via the switch to the high frequency oscillator.
EFFECT: high accuracy of measurements; wide range of functional applications.
2 cl, 2 dwg
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.
SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.
EFFECT: enhanced accuracy of prediction.
FIELD: medicine, nephrology.
SUBSTANCE: one should detect circulation rate characteristics and vessel's diameter due to dopplerography, moreover, on should measure vessel's diameter directly in area of anastomosis, as for circulation rate characteristics they should be determined in constant-wave Doppler mode in area of circulation's maximal rate. Moreover, one should measure anastomosis' cross-sectional area and heart rate, moreover, one should calculate circulatory volume through anastomosis by the following formula: V(ml/min) = A VTI HR, where A - anastomosis' cross-sectional area (sq. cm), VTI - integral of circulatory linear rate through anastomosis (cm), HR - heart rate.
EFFECT: higher accuracy of detection.
4 ex, 1 tbl
SUBSTANCE: method involves determining linear blood circulation speed above and below diaphragm using dopplerography approach. State severity class is determined as healthy, recovering and heavy from measured linear velocities ratio. Applied therapy effectiveness is determined on the measured linear velocities ratio exiting beyond the scope of severity class range, when analyzing patient state dynamics.
EFFECT: high accuracy in estimating patient health state.
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.
FIELD: medicine, cardiology, endocrinology, gynecology.
SUBSTANCE: one should detect informational-valuable signs of patient's state, such as either the presence or absence of hypertonic disease and uterine extirpation together with adnexa, the value of body weight index, predominance of disorders according to modified menopausal index (MMI)such as autonomic, metabolic-endocrine or psycho-emotional ones, the type of metabolic structures of blood serum, moreover, it is necessary to echocardiographically detect stroke volume, cardiac index and systemic vascular resistance (SVR), at ultrasound testing one should detect maximal linear rate of circulation (LRC max) by medial cerebral artery and thyroid alterations, rheovasographically one should detect specific circulation (SC) of shins, at testing laser doppler flowmetry one should detect microcirculation index, biochemically it is necessary to detect the value of beta-adrenoreactivity, cholesterol level and that of B-lipoproteides, crystallographically - the presence of serotonin and dopamine crystals, due to immunoenzymatic assay on should detect the values by Table 1 and then after obtaining the values of diagnostic coefficients of every parameter it is necessary to summarize them and obtain diagnostic index (DI), at its value being below 10 one should state no alteration, at its value 10-10 - undetermined state, at its value being 21-30 - the 2nd severity degree of disorders, and at DI value being above 31 one should state the 3d severity degree of disorders available.
EFFECT: higher accuracy of evaluation.
5 ex, 2 tbl
FIELD: medicine, obstetrics, gynecology.
SUBSTANCE: one should study circulation in one of fetal renal arteries during the second half of third trimester of pregnancy. At increased resistance index from 0.81 and higher and, correspondingly, systolodiastolic ratio - from 5.1 and higher - one should fix the presence of fetal hypoxia and the necessity for urgent correction of this state. The suggested method increases the number diagnostic preparations and enables to increase the significance of predicting the state of neonatals.
EFFECT: higher accuracy of evaluation and prediction.
5 dwg, 5 ex, 1 tbl