Method for predicting costoclavicular syndrome
FIELD: medicine, vascular surgery.
SUBSTANCE: one should measure the width of costoclavicular space due to ultrasound scanning at simultaneous visualization of patient's clavicle and the first rib due to detecting maximal distance between them. At distance being under 5 mm one should diagnose costoclavicular syndrome. The innovation enables to detect costoclavicular space due to US scanning at calculating average value of costoclavicular space being at norm.
EFFECT: higher efficiency of diagnostics.
1 dwg, 1 ex
The invention relates to medicine, namely to vascular surgery.
Costoclavicular syndrome (Falconer-Weddel) - a pathological condition caused extravasal compression of the subclavian vessels and brachial plexus nerve between the clavicle and the first rib in the presence of a wide first edge, high standing, hypertrophic costoclavicular muscles. Some importance of physiological omission of the shoulder girdle, the curvature of the cervical-thoracic spine, the effects of fractures of the clavicle and the first rib with the formation of excessive bone spur and strain.
Diagnosis costoclavicular syndrome is primarily based on clinical symptoms, which are similar to symptoms of other syndromes of the upper thoracic aperture, data compression samples and the assessment of the degree of narrowing of the costoclavicular space (RCP) using x-ray examinations. X-ray analysis provides some assistance to determine the high standing of the first edge, the magnitude of the arc of the ribs in the lateral projection, the angle of the clavicle relative to the horizontal and frontal planes.
However, the methodology for determining the width of the RCP on radiographs quite subjective, are dependent on the method of installation, location of the patient to the device screen, geneticist is due to the width of the bone, require graphics computing the value of an angle and are therefore inconvenient in practice.
Closest to the claimed solution is the method of differential diagnosis of compression of the neurovascular bundle of the upper limb, the proposed Asspoint.com and co (certificate of priority No. 4677654 from 29.11.90).
This method is taken as a prototype. This method is based on measuring the width of the RCP on the radiographs from the upper edge of the front third of the first edge at its bend to the lower edge of the clavicle perpendicular to a determination of the degree of narrowing of the PKK (1 tbsp. - 4-8 mm, 2 tbsp. - 4-6 mm, 3 tbsp. - 0-3 mm) and calculate the angle formed by the axis of the middle part of the first edge and the axis of the inner half of the clavicle.
The disadvantage of the prototype method is the impossibility of precise calculation, as a clear visualization of the upper edge of the front third of the ribs is often difficult, in many cases, the shadow of the clavicle is partially overlapped with the shadow edges, which demonstrates the need for careful selection of the degree of lordosis of the patient for maximum visualization of the RCP under the control of fluoroscopy with increasing total dose of radiation.
The purpose of the invention is to develop a non-invasive method for determining the width of the RCP using ultrasound to calculate the average value of the costoclavicular interval normal.
The essential is to be inventions.
The method is illustrated in the drawing, where cl is the clavicle, cos - the first edge.
The proposed method consists in the following. Ultrasound examination of the RCP is patient is in sitting position with hands down in b-mode linear sensor with a radiation frequency of 7.5 MHz, which is located in the infraclavicular fossa. Changing the direction of the sensor at an acute angle (oblique cut), are displayed simultaneously, the clavicle and the first rib, is determined and recorded the maximum distance between these structures, which from the clavicle to the edge of the falls perpendicular.
The way to diagnose costoclavicular syndrome is to measure the width of the costoclavicular space. The measurement is performed with the help of ultrasound scanning with simultaneous visualization of the clavicle and the first rib by determining the maximum distance between them, and when the distance between them is less than 5 mm can be diagnosed costoclavicular syndrome.
This method examined 50 patients (18 males and 32 females) aged 18 to 52 years, with no signs of SUGA, and 5 patients with costoclavicular syndrome. The width of the RCP ranged from 5 to 9 mm and averaged a 7.2±0,9 mm In all patients with costoclavicular syndrome width of the RCP was less than 5 mm and was 3.6±0,4mm
On the basis of the received data is x, we can conclude, the average width of the RCP according to the U.S. less than that determined by x-ray and normal is 5 mm or more. If the width of the RCP is less than 5 mm in a patient can be diagnosed costoclavicular syndrome. The mapping of the data into the clinic and the results of Doppler ultrasound to confirm the diagnosis and determine further tactics of treatment.
A specific example of the method.
Patient lobster GT (history No. 12/0165) was admitted to the Department of vascular surgery RSC city with complaints of pain, swelling of the right hand, weakness in it, increased venous pattern. Patients consider themselves to be about 10 days, acutely ill, when after exercise pain appeared in his right hand, and by morning had severe swelling.
Objectively: General condition is satisfactory, the skin and visible mucous membranes pink, peripheral lymph nodes are not enlarged. Proper athletic. In the lungs vesicular breath, held all of the fields, the NPV - 19/min. Heart tones are clear, rhythmic, pulse rate is 72/min, BP 120/80 mm Hg Abdomen is soft, painless, peristalsis active, liver and spleen are not enlarged.
Local status: the right arm is swollen all over, the color with a bluish tinge, with comparative perimetric studies the difference in volume compared to the left 1.5-2.5 cm at different levels. There is argenna subcutaneous venous network on the right arm and right half of the thorax.
Pulsation of the radial artery at rest, distinct from both parties, when conducting samples abduction Lange weakened, but not eliminated, with the omission and lead hands ago not defined.
Laboratory values within normal limits.
On radiographs of the cervical-thoracic spine extension of the cervical ribs are not detected.
In ultrasonic dopplerography with duplex scanning and color mapping of blood flow revealed that the right subclavian vein is dilated, the blood flow in her low-amplitude, monophasic, in the lumen of the visualized thrombotic mass.
The linear velocity of blood flow in the subclavian artery alone, 38 cm/sec when moving the hands back down to 10 cm/sec.
The width of the costoclavicular interval was 3.7 mm
Diagnosis: costoclavicular syndrome, complicated by the syndrome Paget's disease of Strattera right.
Signs, distinctive features of the prototype:
1. To measure the width of the RCP used ultrasound unlike the prototype, where the evaluation is made by x-ray (no need for fluoroscopic control, and hence in the additional irradiation of the patient).
2. If the width of the RCP is less than 5 mm in a patient can be diagnosed costoclavicular syndrome. The mapping of the data into the clinic and the results of the ultrasound is howling dopplerography should confirm the diagnosis and determine further tactics and treatment of the patient. In the method prototype offers the following figures: 1 tbsp. narrowing of the RCP - 4-8 mm, 2 tbsp. - 4-6 mm, 3 tbsp. - 0-3 mm.
The positive effect from the use of the invention.
The proposed method is easy to use and does not require measuring instruments in contrast to the prototype. The way to diagnose costoclavicular syndrome allows adequate diagnosis of this pathology and to determine further tactics of conducting the patient.
The way to diagnose costoclavicular syndrome, which consists in measuring the width of the costoclavicular space, characterized in that the measurement is performed with the help of ultrasound scanning with simultaneous visualization of the clavicle and the first rib by determining the maximum distance between them and when the distance is less than 5 mm between the clavicle and the first rib can be diagnosed costoclavicular syndrome.
SUBSTANCE: method involves carrying out sonographic examination for detecting inclusions available in cystic bile, evaluating contractile gallbladder function; biochemical study for determining bile lithogenicity properties and blood lipid composition; morphological study for examining mucous and submucous layer cells. When detecting hyperechogenic particles suspension, bile inhomogeneity, ointment-like bile, availability of internal granulated mucous membrane lining in the gallbladder, high echogenicity and gallbladder wall thickening by 1-2 mm, availability of non-movable parietal neoplasms of high echogenicity having granulated outline and structure, gallbladder bile release fraction being equal to or less than 36.6% and bile saturation with cholesterol index being equal to or greater than 1.02 and general blood cholesterol level being equal to or greater than 5.8 mmole/l, high density lipoproteins cholesterol equal to or less than 1.1 mmole/l, low density lipoproteins cholesterol equal to or greater than 3.8 mmole/l, triglycerides equal to or greater than 1.4 mmole/l as well as foam cells being found in the mucous membrane and submucous layer of the gallbladder and epithelium dystrophy being available and de-epithelialization sites on separate fibers being found, gallbladder cholesterosis is to be diagnosed.
EFFECT: high accuracy of diagnosis.
SUBSTANCE: method involves applying ultrasonic Doppler flowmetry techniques for determining blood circulation characteristics in orbital artery, central retinal artery and posterior short ciliary arteries. Their changes are recorded once. Injured eye is compared to intact eye or both injured eyes are compared to control group eyes. Changes in maximum systolic blood circulation flow rate Vs, minimum diastolic blood circulation flow rate Vd and peripheral resistance index Ri values are recorded. Vs threshold value dropping by 11%, Vd threshold value by 34.6%, Ri value growing by 11.8% in central retinal artery on the injured eye or on both eyes and Vs value dropping b y 25.4%, Vd by 42% and Ri value growing by 11% in the posterior short ciliary arteries being observed, chronic uveitis clinical course is diagnosed to be the case. Vs threshold value growing up by 11%, Vd threshold value by 12%, Ri value dropping by 9% in central retinal artery and Vs value growing by 25%, Vd by 29% and Ri value dropping by 10% in the posterior short ciliary arteries being observed, acute uveitis clinical course is to be diagnosed.
EFFECT: high accuracy of early stage diagnosis; accelerated treatment course.
FIELD: medical engineering.
SUBSTANCE: device has tube and metal ball. The ball is connected to the tube by means of thread. The ball is 1.5 cm far from the tube. The tube is manufactured from polyvinyl chloride. Its wall is 1 mm thick and 1500-1600 mm long. Two marks are available on the probe one showing distance to antral stomach section and distance to greater duodenal papilla.
EFFECT: accelerated examination method; controlled probe working end.
2 cl, 1 dwg, 1 tbl
FIELD: medicine, oncological urology.
SUBSTANCE: in pre-operational period one should detect patient's age, the availability of severe concomitant pulmonary pathology, clinical stage of tumor, intergrowth of prostatic capsule in case of finger-type rectal investigation, tumor localization in prostatic central area at ultrasound testing, intergrowth of prostatic capsule at ultrasound investigation, if a patient has got the closest relatives suffering with prostatic cancer or if a patient has got the closest relatives suffering with the cancer of another localization. It is necessary to calculate the value for the risk of local relapse by the following formula: R=-(0.046xAGE)+(1.01xCONCOMIT)+0.45x(CLIN T)+(1.78xPERRECT)+(0.65xTRUSI 1)+(0.74xTRUSI 2)+(0.87xRELATIV 1)+(0.05xRELATIV 2), where AGE - patient's age (yr); CONCOMIT - the availability of severe concomitant pulmonary pathology: 0 -yes, 1 - no; CLIN T - clinical stage of tumor: 1 -T1, 2 -T2, 3 - T3; PERRECT - intergrowth of prostatic capsule in case of finger-type rectal investigation: 0 - no, 1 - yes; TRUSI 1 - localization of prostatic tumor in prostatic central area in case of trans-rectal ultrasound investigation: 0 - no, 1 - yes; TRUSI 2 - intergrowth of prostatic capsule in case of trans-rectal investigation : 0 - no, 1 - yes; RELATIV 1 - if a patient has got the closest relatives suffering with prostatic cancer: 0 - no, 1 -yes; RELATIV 2 - if a patient has got the closest relatives suffering with cancer of another localization: 0 - no, 1 - yes. At values being R>0 one should predict the risk of local; relapse during 5 years. The innovation enables to carry out complex evaluation of the most informative risk factors of local relapse of prostatic tumor at pre-operational stage after radical prostatectomy in digital equivalent by taking into account individual clinical value of each risk factor.
EFFECT: higher efficiency and accuracy of prediction.
SUBSTANCE: one should evaluate morphological signs of blood serum: the area of peripheral region, the number of fissures and crystallization region, and ultrasound features, as well: the structure of cholecyst's wall, choledochus' diameter, availability of free liquid in abdominal cavity and hemodynamics in cholecyst's wall in points according to certain criteria. According to the sum of points a patient should be referred to the group of low risk for the development of complications to carry out repeated investigation in 6-8 h, or to the group of moderate risk for the development of complications to carry out repeated investigation in 3 h, or to the group of high risk for the development of complications being an indication for conducting urgent operation. The innovation provides earlier detection of complicated flow of chronic calculosis cholecystitis and helps to carry out correction of curative algorithm in due time. It, also, improves results of therapy and shortens the terms of rehabilitation.
EFFECT: higher accuracy of diagnostics.
SUBSTANCE: method involves carrying out ultrasonic examination of neck region. The ultrasonic examination is carried out by alternating scanning in frontal and frontolateral planes using superficial; transducers tuned at wavelengths of 5.0 MHz and 7.5 MHz in varying inclination angle from 45° to 135° from mental region downward along trachea to upper poles and thyroid gland isthmus level. Zones having echogenic parameters differing from those of normal tissues, tumor neoplasm availability is diagnosed.
EFFECT: high accuracy in visually determining laryngeal bulk neoplasms.
SUBSTANCE: method involves carrying out echocardiogram examination. Final diastolic size, posterior wall myocardium thickness of left ventricle and interventricular septum thickness are measured in diastole period. Forearm width between its lateral surfaces at the ulnar styloid process level, forearm circumference length at the ulnar styloid process level, forearm length from the styloid process to olecranon of the ulna is measured. Bone coefficient K is calculated. Left ventricle myocardium mass index Hi is calculated by applying original mathematical formula using k value. Left ventricle myocardium hypertrophy is diagnosed from Hi value.
EFFECT: high adequacy level in drawing left ventricle myocardium hypertrophy availability conclusions.
SUBSTANCE: method involves diagnosing blood circulation disorders. Mean blood circulation velocity and resistance index are studied by applying Doppler ultrasonography approach. Blood circulation parameters are estimated in the central retinal artery and normalized resistance-velocity index is calculated as RVI=|(RIn-RI')/Rin|/|(Vn-V')/Vn| under condition of V≠Vn, where RIn is the resistance index in the central retinal artery in normal state; Vn is the mean blood circulation velocity in the central retinal artery in normal state; RI' is the resistance index in the central retinal artery under study; V' is the mean blood circulation velocity in the central retinal artery under study. The normalized RVI value being greater than 0.35, proliferative diabetic retinopathy stage is diagnosed at 68% diagnostic accuracy. The value being less than 0.35, non-proliferative diabetic retinopathy stage is diagnosed.
EFFECT: high diagnosis accuracy.
SUBSTANCE: method involves measuring maximum urinary bladder volume, the number of urination movements during single urinary bladder evacuation cycle and residual urine volume after urination using ultrasonic method. Urination being accomplished in three or more movements and/or residual urine volume being equal to or greater than 20% of maximum urinary bladder volume, the newborn urinary bladder dysfunction is predicted to be available.
EFFECT: high accuracy in detecting urinary bladder dysfunction risk group in noninvasive way.
SUBSTANCE: method involves determining thyroid gland node diameter and thyrotropic hormone by applying ultrasonic examination approach. Histological examination is carried out with conclusion concerning morphologic nature being obtained like nodular colloid proliferating goiter or thyroid gland adenoma. Diagnostic index Σ is calculated from formula Σ=0.49*K1+0.07*K2-0.5*K3+1.76*K4-1.53, where K1 is the thyroid gland node diameter; K2 is the TTH concentration; K3 is the nodular colloid proliferating goiter index equal to 1 or 0; K4 is the thyroid gland adenoma index equal to 1 or 0. Diagnostic index Σ being less than zero, conclusions concerning powerless labor threat is to be drawn.
EFFECT: provided individual treatment approach; improved mother or fetus chances.
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.
SUBSTANCE: method involves carrying out skeletotopic conjunction and organ element localization description relative to vertebra body. Neck organ picture is described in skeletotopic manner using anterior contour of cervical vertebra body and transverse processes in upper, median and inferior portion of cervical vertebra with the exception of the first and the second one.
EFFECT: high accuracy in diagnosing pathological processes in neck organs and creating computer models.
SUBSTANCE: method involves carrying out ultrasonic examination of aorta coarctation stenosis nature. Apex direction of angle formed with longitudinal axes of ascending and prestenotic aorta area is determined. Four aorta coarctation patterns are selected on measured values combination.
EFFECT: high objectiveness degree in determining aorta coarctation nature and selecting treatment mode.
4 dwg, 1 tbl
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
SUBSTANCE: method involves applying primary and repeated ultrasonic examination of abdominal cavity and evaluating symptoms. Patient drinks or receives as infusion more than 1 l of water or physiological salt solution cooled to 4-5° C in portions with 15 min long pauses during 30-60 min before carrying out repeated ultrasonic examination.
EFFECT: high reliability of early stage diagnosis.
SUBSTANCE: method involves introducing auto leucocytes marked with 99mTc-hexamethylenepropyleneaminooxime in intravenous bolus dose. Heart contour images are recorded first when the bolus passes through heart cavities, pulmonary artery and ascendant aorta arc. Single-photon emission computer tomography of chest is carried out 3.5±0.5 h for discovering inflammation foci with exact correspondence of patient body to initial one. Tomographic slices are superimposed over heart contours to localize the inflammation foci.
EFFECT: high accuracy of measurements; reduced radiation loading; accelerated examination process.
SUBSTANCE: method involves recording choledochus diameter changes in carrying out Oddi sphincter relaxation with isosorbide dinitrate in combination with nutrient loading by means of ultrasonography. Diagnosis is carried out in two stages. Maximum choledochus diameter is determined in the morning with empty stomach at the first day at the beginning of the study. The value is taken as the initial value (Din). Then, standard breakfast is given to the patient like 200 ml creamy yogurt containing 10% fat and choledochus diameter (dxi,j) is measured twice with 40 min long pause. Diameter variation (δDij) is measured at 40 and 80 min relative to initial value using formula δDij = (Din - dxi,j)/Din*100%, where i is the parameter values at 40 min of study; j the parameter values at 80 min of the study. At least one δDij value becoming greater than 25%, the second study stage is carried out the next day. 10 mg of isosorbide dinitrate is given to the patient with empty stomach in the morning. 40 min later, the first choledochus diameter D1 value is measured and standard breakfast is given to the patient like at the first day study. Maximum choledochus diameter (dxi,j) is once more measured twice with 40 min long pause at 40 and 80 min, respectively. Diameter variation (δDij) is measured relative to the first measurement using formula δDij = (D1 - dxi,j)/D1*100%, where i is the parameter values at 40 min of study; j the parameter values at 80 min of the study. At least one δDij value becoming greater than 25%, organic change of Oddi sphincter is to be diagnosed. At least one δDij value becoming equal to or less than 25%, functional disorder is diagnosed.
EFFECT: high reliability of diagnosis.
SUBSTANCE: method involves carrying out multi-positional ultrasonic scanning in real-time mode applied to anterior tibia tuberosity surface. 2 mm to 2 cm large hyperechogenic fragment(s) with acoustic shadow remaining at the same place when bending knee joint is/are found.
EFFECT: high accuracy of diagnosis.
SUBSTANCE: method involves determining liquid content volume in stomach cavity in 60 min after taking 150 ml of boiled water in performing ultrasonic examination through frontal abdominal cavity wall. Repeated examinations are done every 5 min later on. Liquid being observed in the stomach for the second time or many times in the amount of 10% of total volume or more, duodenogastric reflux is considered to be the case.
EFFECT: high objectivity of diagnosis; reduced risk of traumatic complications; low costs.
SUBSTANCE: method involves carrying out Doppler tissular echocardiography examination. Left ventricle myocardium segments movement characteristics are measured in time in each j-th segment. Regional myocardium productivity index Ij of the left ventricle is measured with formula containing isovolumic contraction time, isovolumic relaxation time and withdraw period duration being used. Ij values estimation is carried out in segments fed by single coronary artery branch with blood. Left ventricle regional myocardium productivity index value being not less than in two segments fed by single coronary artery branch with blood and equal to or greater than 0.8, cardiac ischemia disease is to be diagnosed.
EFFECT: simplified diagnosis method.