Method of differential diagnostics of necrotic pancreatitis

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgery. Blood is sampled from cubital vein in patients with acute pancreatitis on 1-3 and 7-10 day from disease beginning. Level of blood serum myoglobin is determined by method of performing reaction of passive hemagglutination. If level of blood serum myoglobin on 1-3 day increase from 95 to 128 ng/ml, acute fatty pancreatic necrosis is diagnosed, if myoglobin level in blood serum is higher than 128 ng/ml, hemorrhagic pancreatic necrosis is diagnosed, and if level of myoglobin in blood serum on 7-10 day increases higher than 256 ng/ml, hemorrhagic pancreatic necrosis in stage of infection of pancreatic necrosis nidus is diagnosed.

EFFECT: method allows to correct drug therapy and individually ground tactics of treating patients with acute pancreatitis depending on severity of disease form and presence of infection.

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The invention relates to medicine, namely to surgery, and will find wide application in the choice of tactics of treatment of patients with acute pancreatitis.

The incidence of acute pancreatitis in Russia and abroad is growing steadily. The proportion of patients with necrotic forms of pancreatitis is 15-20%. Lethality depending on the volume of necrosis remains at the level of 20% and above (Washatko W., Tolstoy ROAD, Corigin A.A. and others, 2000; Norton I.D., Clain J.., 2001).

With the development of pancreatic necrosis in 40-70% of patients infection occurs foci of necrotic destruction (Burnewicz SZ, Gelfand BYR, eagles, B.B., 2000). This category of patients is the most problematic group in the diagnostic, therapeutic, and economic aspects (Postyshev VK, Glushko, VA, 2003). Among the causes of high mortality one of the most important places is the late diagnosis of infectious complications of pancreatic necrosis.

Today, depending on etiology, phase and period of the development of the pathological process, the severity of the patient with acute pancreatitis produce well-defined concept in the future treatment of this disease. Noteworthy is also evidence of the development of pancreatitis endogenous intoxication (EI), which aggravates the disease and often leads to death.

In the early stage of disease is the leading cause of death of patients are complications of endotoxemia, such as pancreatic shock, toxic liver, kidneys, lungs, brain, heart, systems of macro - and microcirculation (Vasiliev, ETC, 1995; Kumar, S., N.L. Harvey, 1995; Kikuchi y, Shimosegawa T., Satoh, A., 1996). Mechanisms of development of a syndrome of EI based on numerous "vicious circles" and are autocatalytically, what makes for lightning-fast development of clinical signs of endotoxemia, often observed in patients.

World development experience pancreatology is characterized by two major trends. The first is the development and introduction into clinical practice of modern methods of research, such as ultrasound (us), computer tomography (CT), endoscopic retrograde retrograde cholangiopancreatography (ERCP), different ways angiography and endoscopic fibrogastroduodenoscopy (FGDS). The second trend involves becoming more common surgical treatments for OP using direct surgical interventions on mud and ductal system, and related agencies: biliary tract, gastrointestinal tract, vascular system. As a result, virtually all problems of diagnostics and treatment of mud have been rethinking and reassessment (Filimonov M.I. et al., 2000; Efimenko N.A., M.V. Lysenko, Urusov ST. et al., 2001; Bradley, E.L. III., 1999).

Known SPO is about differential diagnosis of acute pancreatitis (RF Patent No. 2277244, 27.05.2006). For this purpose, the blood serum sample of the patient examined by performing infrared spectrometry in the field of 1200-1000 cm-1with the determination of the height of the peaks of the absorption maxima at 1170, 1160, 1150, 1130, 1105, 1070, 1060, 1030, 1025 cm-1. By mathematical processing of the data received for a particular patient, get the coordinates of the points on the plane are compared with the corresponding standards of diagnostic "imaging", presented in the form of a flat polyhedra (diagnostic "images" norms and acute pancreatitis, swollen and destructive forms of acute pancreatitis, sterile and infected pancreatic necrosis). Depending on the facilities received point specific "way" make a diagnosis.

The disadvantage of this method is the complexity of the study and the lack of diagnostic accuracy.

A known method of differential diagnosis sterile and infected pancreatic necrosis, based on microscopic and microbiological examination of material taken during diagnostic puncture under the control of ultrasound sonography or computed tomography (Gelfand E.B., Gologorsky VA, Gelfand BYR // Anesthesiology and critical care medicine - 2003. No. 3. - P.29-33).

This method has the following disadvantages: the invasiveness and risk of secondary nosoco the territorial infection; as well as the need for special equipment, and personnel.

A known method of differential diagnosis sterile and infected pancreatic necrosis (RF patent No. 2319150, 10.03.2008), which boils down to the following: plasma determines the maximum intensity Lomonosovskiy gelatination chemiluminescence (Jmax) and sutasoma (S). When the value of Jmax in the period 1-7 days less than 30 mV, and the K-factor, calculated as the ratio Jmax/S, less than $ 0,056, diagnose infected pancreatic necrosis. This method requires specialized equipment, not very accessible due to pricing policy on chemicals.

The variety of used laboratory and instrumental methods suggests that none of them fully meets the needs of clinicians and is not an ideal marker for early diagnosis of pancreatic necrosis and prognosis of the disease (Halperin AI, Dokuchaev C.V., Pogosyan G.S., 2000; Balcony A.A., Kasumyan S.A., 2003).

Closest to the proposed invention is a method of diagnosis of infected pancreatic necrosis (Saveliev V., Filimonov M.I., Gelfand BYR, Bronevich SZ Tsydenzhapov C.P., eagles, B.B. Pancreonecrosis - topical issues of classification, diagnosis and treatment // Consilium medicum, 2000, vol. 2 - No. 7 - S.293-298), consisting in the determination of concentration is procalcitonin (PCT) plasma immunoluminometric and immunoassay methods. The basis of the method is the reaction of two monoclonal antibodies to the two positions of the molecules FCT (calcitonin and catagorization). The test is performed within two hours with the final invoice for semi-automatic analyzer, Ciba-Corning Magic Lite II, "Bayer". Immunoassay method allows testing for 30-45 minutes, showing the approximate levels of PCT (within <0.5 ng/ml from 0.5 to 2 ng/ml from 2 to 10 ng/ml >10 ng/ml). Increasing the concentration of PCT in the blood more than 1.8 ng/ml in two consecutive studies is a laboratory marker of bacterial infection foci of pancreatic necrosis with a sensitivity and specificity of this test 95 and 98%, respectively. The method avoids the drawbacks of the diagnostic puncture, however, requires expensive reagents, which severely limits its use in surgical departments public profile.

The disadvantages of the known methods are eliminated in the invention.

The objective of the invention is improving the accuracy and acceleration differential diagnosis of necrotizing pancreatitis.

The method is as follows: produce the blood from the cubital vein in patients with acute pancreatitis in 1-3 and 7-10 days from the onset of the disease. The level of myoglobin serum determined by the method of cultivation reactions Passy the Noah of haemagglutination (TPHA). When the level of myoglobin serum in 1-3 day from 95 to 128 ng/ml diagnose acute fatty pancreonecrosis, when the level of myoglobin in the serum of 128 ng/ml diagnose hemorrhagic pancreatic necrosis, while increased levels of myoglobin serum 7-10 days more than 256 ng/ml diagnose hemorrhagic pancreatic necrosis in the stage of infection of the lesion of pancreatic necrosis.

The technical result from the use of this method is that it allows high accuracy on the basis of quantitative criteria to diagnose a form of acute pancreatitis in the early stages, to predict the infection of lesion of pancreatic necrosis, thereby giving the surgeon the ability to adjust drug therapy and individually to justify the tactics of treatment of patients with acute pancreatitis, depending on the severity of the disease and the presence of infection.

Despite significant advances in the study of the pathophysiology OP, until recently, the problem remained the question of a unified treatment of the development stages of the disease. This fact is the cause of disagreements relating to the classification of clinical forms OP, which complicated the selection of optimal treatment plans and evaluate the effectiveness of different methods of complex treatment of patients with OP (Filimonov M.I., BORIS Gelfand, Burnewicz SZ, 2000; X. Molero, Guamer F., Salas, A., 1995).

Now for the OP allocate 4 phases: I - enzymatic phase; II - reactive phase; III - phase sequestration; IV - phase outcomes and consequences.

Phase I (first week of the disease). In this period, the formation of pancreatic necrosis and the development of endotoxemia (ET). The maximum period of formation of necrosis of the pancreas (mud) is 3 days, after that the process of formation of pancreatic necrosis stops by itself and does not progress further. But in severe cases, the formation of less necrosis (24-36 hours). The more powerful the process, the sooner it is implemented. The duration of endotoxemia does not exceed 5 days, so applying antifermentny drugs most effectively in these terms. Treatment programme in this period of the disease is reduced to the necessity of removing toxins from the abdominal cavity and retroperitoneal space. If necessary, surgical intervention is the subject of the operation is, as a rule, not the mud, and enzymatic exudate, i.e. pursue, first of all, one goal is detoxification, which is to remove enzymatic exudate and open retroperitoneal tissue (parapancreatic). Postoperative mortality is high (25-30%), patients die from bleeding and endotoxic shock, zakonomeren is worse after surgery. The second negative aspect early surgery is infection of the abdominal cavity and the development of purulent complications.

Phase II (2nd week of the disease) is characterized by the body's response to the clear foci of necrosis (as in mud and peripancreatic tissue), i.e. the reaction of rejection of necrosis with the formation of a sequestrum. The clinical form of this phase OP is peripancreatic infiltration, which, like other infiltrates, or further resolved, or suppurate. In this phase, the surgical intervention is highly undesirable and pointless.

III phase (3rd week of the disease can last for several months. Aseptic or septic sequestration begins with a 14-day. Small necrosis resolve and large listoobrabotka (Con E.M. et al., 2001; Watanabe, S., 1998). In the phase of purulent complications characterized by a new wave of STOR - but a septic origin.

IV phase (6 months or more) is formed Mature cysts, fistulas, chronic pancreatitis.

Thus, it is clear that the pathological OP program is implemented in the first 3 days of illness, and later have to deal with its consequences (Shalimov S. and et al., 1992; Thick A.D., 1997; Schulz N., Schulz E., 1990).

Considering the literature data and the results of their own observations, we can conclude about the involvement of muscle disorders in which the development of the syndrome of multiple organ failure (Cherkasov, VA, Sapelnikov V., Teplova N.N., Meshandin A.G., Balueva I.L., 1999).

Rhabdomyolysis is a clinical syndrome resulting from damage to skeletal muscle with the release of the cellular contents of the myocytes in the plasma (Farmer C, 1997).

When rhabdomyolysis in the blood system receives a large number of intracellular substances (lysosomal and mitochondrial enzymes, acidic products of anaerobic glycolysis, potassium, phosphorus, histamine, serotonin, bradykinin, oligo - and polypeptides and myoglobin) with the development of endotoxemia (Hue V, Martinot A., Fournier A., Cremer R., 1998). Admission to the General flow of products of destruction of the muscles leads to the development of multiple organ disorders.

Myoglobin is a specific marker of damage to muscle tissue, and the myoglobin released into the bloodstream at the initial stages of the destruction of muscle cells. Myoglobin performs the function of the respiratory pigment with enzyme activity, maintaining a constant level of oxygenation during muscle contraction. Normal blood has a very small amount of myoglobin from 7 to 85 ng/ml (Versalovic P.A., 1961; Chernyaev A.A., 1994).

Concentration of myoglobin in biological fluids is possible to monitor the effectiveness of treatment for rhabdomyolysis.

There is evidence that serum myoglobin can be considered as samostoiatelen the first token of endotoxemia and hypoxic-ischemic damage cells, tissues, accompanying any critical state (Cherkasov, VA, Sapelnikov V., Teplova NN. et al., 1999).

Therefore, it seems meaningful assessment mioglobinemii as an indicator of acute rhabdomyolysis diseases and critical conditions not directly related to the trauma. Least this phenomenon has been studied in the pathology of the organs of the abdomen.

In different phases and periods of development OP justified different surgical intervention, pursuing two main objectives: 1) to arrest the acute attack of the disease and prevent death; 2) to prevent a recurrence OP after the patient's discharge from hospital (Shalimov S.A., Nechitailo M.E. Ter-Minassian, punks A.I. and others, 1992; Yamomoto M, Takeyama Y., Veda I., 1997; D. Benchimol).

Thus, therapeutic management depends mainly on the form of the disease. If interstitial and necrotizing pancreatitis is crucial to the timely carrying out of conservative therapy and, to a lesser extent, operation, and during inflammatory-necrotic - only conservative treatment, purulent-necrotic form requires mandatory surgical intervention (Beger H.G., Uhl W., D. Beger, 1992; Banes P.A., 1994).

Adequate therapeutic management is an important issue in the care of patients OP. None of the methods of conservative treatment OP cannot guarantee the termination of necrosis in the mud (Con E.M., Cherkasov A, Urman M.G., 2001).

Clinical and morphological Parallels with the OP in the early stages of the disease are often absent. It is not possible to make a correct idea of the scope and nature of the lesion mud and retroperitoneal tissue, as well as potential program of the development of the disease (Washatko P.W. et al., 2000; V.S. Zemskov, 2000; Banks R.A., 1993). Therefore, still remains debatable questions about the timing of the operation.

The choice of the optimal tactics, namely conservative or surgical treatment must be justified by a change of objective indicators scale integrated assessment of the patient (V.S. Zemskov, Kowalska I, Kruchina E.A., 1999; Lohmann, A., Kasperk R, 1998). Currently there are more than 20 prognostic systems, scales and ratios (Shugaev A.I., Hera, I.N., Andreev A.L., 1999; Cominotti, S., Di Summa P., Maraggia D. et al., 1999). He they all have the same value, but most of them were successfully tested in a large and respected scientific and practical institutions. First of all, they are the scale APACHE II, SAPS, SOFA, Glasgow, and Ranson criteria.

In the vast majority of hospitals Russia assessment of the severity of the patient carried out solely on the basis of routine clinical and laboratory data, the prognostic significance of which, as is known, does not exceed 50%. This situation reflected the fact that what too many (41%) surgical interventions in patients with OP perform 3-4 days from the onset of the disease, although, according to most researchers surgery at this stage is dangerous and hardly justified (Ivanov P.A., Grishin AV, Serbuk A.N., 1998).

Thus, today, the early diagnosis and prognosis of necrotic forms OP remain relevant and unsolved problem for emergency surgery (Zvyagin A.M., Slepnev HE, 2002; Balcony A.A., Kasumyan S.A., 2003; Norton I.D., Clain J.E., 2001).

During the development of the proposed method of differential diagnosis of necrotizing pancreatitis, we have examined patients of both sexes aged from 25 to 85 years with acute pancreatitis. Characteristics of the patients by age, gender, etiology and clinical form of pancreatic necrosis are presented in table 1. The main etiological factor in the development of acute pancreatitis was cholelithiasis (58,9%). Nutritional etiology of pancreatitis identified in 41,1%.

Table 1
Characteristics of the patients by age, gender, etiology and clinical form of pancreatic necrosis
The average age48,32+4,6 (25-85)
Gender (male/female)Mostly fat pancreonecrosis (JPN)24 (42,9%)
Mainly gemorragicaki pancreonecrosis (GTS)32 (57,1%)
Sterile pancreatic necrosis (SF)35 (62,5%)
Infected pancreatic necrosis (OR)21 (37,5%)
Biliary33 (58,9%)
Alimentary23 (41,1%)

All patients additionally, after obtaining informed consent, determined the level of myoglobin serum at admission and in the dynamics of the disease. All patients diagnosed with common forms of necrotizing pancreatitis (krupnooptovyj, Subtotal pancreatic necrosis with lesion of the retroperitoneal tissue. The diagnosis of necrotizing pancreatitis was based on the combination of clinical symptoms (severity of endogenous intoxication, paresis of the intestine, palpable infiltration, peritoneal symptoms and other) data and instrumental methods (blurred contours of the pancreas, hypoechoic foci, increase its size, exudate in the packing bag and the abdomen, infiltrate peripancreatic tissue with ultrasound; areas of destruction in the pancreas and peripancreatic tissue in CT), and set during the operation (foci steatocranus in the abdominal cavity, hemorrhagic exudate in the abdominal cavity, hemorrhagic saturation retroperitoneum and others). At the same time of 62.5% is a sterile pancreatic necrosis, in 37.5% infected. In 42.9% of patients diagnosed mainly fat pancreonecrosis, 57,1% - predominantly hemorrhagic.

In patients with hemorrhagic pancreatic necrosis (GPN) in the first 3 days from the moment of the disease the level of serum myoglobin statistically different from those in patients with fatty pancreatic necrosis (IPN), which is associated with the amount of tissue damage in the pancreas and retroperitoneal tissue. When the infection foci of pancreatic necrosis in 7-10 days from the time of the disease the level of serum myoglobin statistically different from those with sterile pancreatic necrosis.

Detailed description of the method and examples of its clinical application.

The diagnosis of acute necrotizing pancreatitis established on the basis of the anamnesis of patients with acute pancreatitis, the clinical picture of the disease, laboratory studies, including op is adelene activity of amylase in the blood, urine diastase, amylase peritoneal exudate, the dynamics of the homeostatic indicators (blood leukocytes, leukocyte index of intoxication, hematocrit, glucose, bilirubin, urea, creatinine, total protein, activity of alanine aminotransferase, aspartate aminotransferase, sodium, potassium, calcium, chlorine), instrumental studies, including ultrasonography of the abdominal cavity and retroperitoneal space, esophagogastroduodenoscopy, computed tomography of the abdominal cavity, according to testimony - emergency diagnostic laparoscopy.

All patients, after obtaining informed consent, further define the level of myoglobin serum at admission and in the dynamics of the disease: 1-3 and 7-10 days from the onset of the disease. Myoglobin in serum determined by the method of cultivation reaction passive haemagglutination (TPHA) microplating using sets "Diagnosticum erythrocyte for the detection of myoglobin, immunoglobulin dry" (research Institute of epidemiology and Microbiology, Nizhny Novgorod) on the Rott GI et al. (1989), Sloganator V.Y. et al. (1990). To improve the accuracy of the account of the reaction of the passive haemagglutination used developed in the clinic methodology examination of microplasmin coated with reagents in the scattered transmitted light (Babies V.F., Tarnowie, 1991). When the level of myoglobin serum in 1-3 day from 95 to 128 ng/ml diagnose acute JPN, when the level of myoglobin in the serum of 128 ng/ml diagnose GPN, and when the level of myoglobin serum 7-10 days more than 256 ng/ml diagnose hemorrhagic pancreatic necrosis in the stage of infection of the lesion of pancreatic necrosis.

Verification forms of pancreatic necrosis was based on visual inspection of the abdominal cavity during laparoscopy, histological examination of affected tissues. Verification of infection of pancreatic necrosis was based on bacteriological examination of peritoneal exudates and content stuffing bags obtained intraoperatively during laparoscopy or laparotomy.

Clinical example 1.

The patient is In s, 36 years old, medical history, No. 13, enrolled in the Department of surgery №2 MLUS GB No. 1 of Rostov-on-don 25.12.2005, through the day of the onset of epigastric pain, nausea and repeated vomiting. At survey: the state of moderate severity, pulse 86 beats/min, BP 130/80 mmHg, body temperature 36,9°C. the Language Shvat, white furred. Abdomen moderately swollen, palpation tense, painful in the epigastric region. Symptoms of peritoneal irritation negative. The leukocytes to 7.4×109/l, amylase blood - 38 g·h/is, blood sugar - 4.1 mmol/L. ultrasound Data: signs of acute pancreatitis. The level of myoglobin serum for 2 days from the onset of the disease amounted to 128 ng/ml, which corresponded to a fat pancreonecrosis. Through the day from the moment of receipt in connection with nerazreshimye the paresis of the intestine and to avoid acute surgical pathology (patient previously operated on) the patient underwent upper median laparotomy, drainage of stuffing bags retroperitoneal space, during surgery showed signs of fat pancreatic necrosis (plaques of stefanakos in the greater and lesser omentum, the tail and body of the pancreas). Bacteriological examination of the microflora is not detected. In the future, against the backdrop of ongoing and intensive antibiotic therapy has cured, the patient was discharged on the 11th day from the date of receipt.

Clinical example 2.

Patient P s, 56 years old, medical history, No. 711, enrolled in the Department of surgery №2 MLUS GB No. 1 of Rostov-on-don 11.03.2008, after 9 h of the onset of epigastric pain, nausea and vomiting. At survey: the state of moderate severity, pulse 84 beats/min, BP 110/80 mmHg, body temperature 36,8°C. the Tongue dry, white furred. Abdomen moderately swollen, palpation tense, painful in the epigastric region. Symptoms of peritoneal irritation are poorly is good. Leukocytes of 8.2×109/l, amylase blood - 110 g·h/l, blood sugar and 5.6 mmol/L. ultrasound Data: without obvious pathological formations. The level of myoglobin serum in 1 day from the onset of the disease amounted to 129 ng/ml, which corresponded to hemorrhagic pancreatic necrosis. After 8 hours from the time of receipt (11.03.2008,) when symptoms of peritonitis and to exclude other acute surgical pathology patient comorbidities - schizophrenia) produced diagnostic laparoscopy, in which signs of hemorrhagic pancreatic necrosis: up to a liter of dark hemorrhagic exudate, edema and hyperemia of the round ligament of the liver, severe vascular injection parietal peritoneum, sluggish bowel movements. Produced laproscopically sanitation and drainage of the peritoneal cavity. Bacteriological examination of the microflora in the exudate was not found. In the future, against the backdrop of ongoing and intensive antibiotic therapy has cured, the patient was discharged on the 9th day of receipt.

Clinical example 3.

Patient D-ova, 36 years old, medical history, No. 318 enrolled in the Department of surgery №2 MLUS GB No. 1, Rostov-on-don 07.02.2007, through the day of the onset of epigastric pain, nausea and repeated vomiting. At survey: the state of the medium of the cords is STI, pulse 80 beats/min, BP 110/80 mmHg, body temperature of 36.7°C. the Tongue dry, white furred. Abdomen moderately swollen, palpation tense, painful in the epigastric region. Symptoms of peritoneal irritation are weakly positive. Leukocytes and 11.6×109/l, amylase blood 120 g·h/l, blood sugar - 8.2 mmol/L. ultrasound Data: signs of acute pancreatitis. The level of myoglobin serum for 2 days from the onset of the disease was 256 ng/ml, which corresponded to hemorrhagic pancreatic necrosis. After 8 hours from the time of receipt when symptoms of pancreatic peritonitis (07.02.2007,) made an open diagnostic laparoscopy (patient previously operated on), which detected the signs of total hemorrhagic pancreatic necrosis: up to a liter of dark hemorrhagic exudate, edema and hyperemia of the round ligament of the liver, severe vascular injection parietal peritoneum, swelling anterior wall of the stomach, swelling of the greater omentum, sluggish bowel movements. Produced upper median laparotomy, lavage and drainage of the peritoneal cavity and stuffing bags. Bacteriological examination of the microflora in the exudate was not found. In the future, against the backdrop of ongoing and intensive antibiotic therapy for 7 days from the onset of the disease revealed an increase in serum myoglobin to 262 ng/ml, was clopidrogel infection lesion of pancreatic necrosis, and hyperleukocytosis to 12,h9/l and hyperthermia to 38°C. ultrasonography and computed tomography signs of lesions in the pancreatic head. 14.02.2007, the patient underwent an operation of the relaparotomy, drainage of abscess of the pancreas head. Bacteriological examination detachable - Kl.pneumoniae, St.faecium. In the future, on a background of treatment has cured, the patient was discharged on the 55th day of receipt.

Thus, the study of the level of serum myoglobin in patients with destructive pancreatitis allows to determine the form of pancreatic necrosis (fat or hemorrhagic), to improve treatment outcomes of patients with acute pancreatitis and to develop an algorithm for a differentiated approach to treatment depending on the severity of endotoxemia, etiology of pancreatitis and timing of the disease.

The inventive method has been tested successfully in clinical practice and can be recommended for wide use in surgical hospitals.

The method of differential diagnosis of necrotizing pancreatitis, including the exploration of the patient's blood, wherein in the serum of venous blood of the patient with acute pancreatitis method of cultivation reaction passive haemagglutination determine the level of myoglobin is 1-3 and days and 7-10 days from the onset of the disease and with increasing levels of myoglobin in the 1st-3rd day from 95 to 128 ng/ml diagnose acute fatty pancreonecrosis, when the level of myoglobin in the 1st-3rd day of 128 ng/ml diagnose hemorrhagic pancreatic necrosis, while increased levels of myoglobin in 7-10 days more than 256 ng/ml diagnose hemorrhagic pancreatic necrosis in the stage of infection of the lesion of pancreatic necrosis.



 

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EFFECT: technique is characterised by high sensitivity and allows predicting the development of impaired respiratory activity of erythrocytes in the pregnant women with the herpes virus infection episode.

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to diagnostic methods. Homogenate of placenta of pregnant woman who had herpes-virus infection is analysed by ELISA method for activity of granzyme B, titre of antibodies in pregnant woman's peripheral blood, and simultaneously number of syncyotrophoblast nuclei in apoptosis is calculated. If antibody titre is 1:3200 and granzyme B content is 283.14±18.00 pg/ml, percentage of nuclei in apoptosis state is 1.5±0.09%; if antibody titre is 1:6400 and granzyme B content in placenta homogenate is 712.84±23.00 pg/ml content of nuclei in apoptosis state is 2.0±0.12%; if titre of antibodies to herpes virus is 12800 and content of granzyme B in placenta homogenate is 1007.53±31.50 pg/ml (control - 251.10±31,00 pg/ml) percentage of nuclei in state of apoptosis increases to 3.5±0.08% (control - 1.0±0.009%).

EFFECT: method ensures high sensitivity of detecting nuclei in state of apoptosis in syncyotrophoblast at the background of increased content of granzyme B in placenta homogenate.

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to laboratory analysis and can be used for prediction of course of wound process in case of purulent-inflammatory diseases if maxillofacial region of microbial etiology. In carrying out microbiological analysis of wound discharge, presence or absence of microorganisms and their concentration are determined, in case of immunologic analysis registered are total number of leukocytes, ESR, levels of medium circulating immune complexes (CIC), antibodies to streptococcus (ASL-O), immunoglobulin A (IgA). Analysis is carried out befire and on 5-7 day after operation, and in case of complete elimination of microorganisms in wound or reduction of their concentration to <103 CFU/tamp., as well as reduction in blood serum for not less than 30% of total number of leukocytes, antibodies to streptococcus, and reduction for not less than 25% of value of ESR, CIC, IgA, favourable course of wound process is predicted, in case if indices are different - prediction is unfavourable.

EFFECT: method allows to reduce time of patient's hospitalisation, carry out adequate therapy in post-operational period in due time, does not require additional equipment for carrying out microbiological and immunological analysis.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, in particular to cardiology, neurology, ophthalmology, is used to carry out diagnostics of predisposition to ischemic neuroopticopathy in elderly people with ischemic heart disease (IHD), arterial hypertension (AH) and dyscirculatory encephalopathy (DEP). Blood is sampled from ulnar vein, blood samples are forms, from which DNS is separated, amplification of DNA fragments is pertformed, after that genotyping on polymorphisms del-425 and 3'-UTR of c-fms geneand polymorphism 64V of CCR2 gene is carried out, if in elderly women heterozygous genotype 64V/641 of polymorphism 64V of CCR2 gene, and heterozygous genotype 12 of polymorphism 3'-UTR of c-fms gene are detected, predisposition to ischemic neuroopticopathy is diagnosed.

EFFECT: detection of predisposition to ischemic neuroopticopathy in elderly people for administration of adequate preventive treatment.

7 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to biochemical investigations in oncology, and can be used in determination of activation or stabilisation of pathologic process in patients with primary-resistant Hodgkin's lymphoma. In patients with primary-resistant Hodgkin's lymphoma at stages of treatment, by radioimmune method determined is content in blood of thyroid gland hormones - triiodothyronine and thyroxine, and adrenocortical hormone - cortisol, their concentration is summed up and in case of total level of hormones is within 278.2 nmole/l - 0 333.0 nmole/l conclusion about activation of malignant process is made, if total level of said hormones is 432.4 nmole/l - 833.2 nmole/l conclusion about absence of process activation is made.

EFFECT: prediction of process activation or stabilisation in patients with primary-resistant Hodgkin's lymphoma is an informative test for evaluation of pathologic process state and can be recommended for monitoring of patients at treatment stages.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to obstetrics, and can be used for prediction of preterm effusion of amniotic fluid in pregnant women with gestation term 32-36 weeks. Essence of invention lies in the following: in blood serum of pregnant women with gestation term 32-36 weeks IL-8 level is determined, and if its value equals or is lower than 15.4 ng/ml, preterm effusion of amniotic fluid is predicted.

EFFECT: method is simple in implementation and allows to predict development of preterm effusion of amniotic fluid with high accuracy, sensitivity and specificity, which makes it possible to select correct tactics of monitoring women with risk of said obstetrics pathology development, to avoid complications of labour activity and perinatal pathology.

1 tbl, 4 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to diagnostic methods and deals with method of diagnosing entry of nuclei of placenta pili syncyotrophoblast into apoptosis by determining in placenta homogenate content of IgG and IgM antibodies to phosphatidylserine in pregnant women, who had herpes-virus infection in the third trimester of pregnancy. Method lies in determination of IgG and IgM antibodies to phosphatidylserine in placenta homogenate by ELISA method. If titre of antibodies to HSV-1 equalled 1:6400, 4.70±0.08 U/ml of IgG and IgM antibodies to phosphatidylserine were detected; if titre was 1:12800, content of IgG and IgM antibodies to phosphatidylserine increased to 5.60±0.06 U/ml (control - 2.50±0.07 U/ml), number of syncyotrophoblast nuclei in state of apoptosis constituted 4.50±0.20% (control - 1.5±0.20%).

EFFECT: method possesses high sensitivity and allows to predict development of apoptosis in nuclei of placenta pili syncyotrophoblast in case if number of IgG and IgM antibodies to phosphatidylserine in placenta grows.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to biochemical investigations in oncology, and can be used in treatment of Hodgkin's lymphomas with primary drug resistance of tumour to standard schemes of drug intervention. Novelty and essence of investigation lies in the following: in patients with Hodgkin/s lymphoma at treatment stages by radioimmune method determined is content in blood of total and free thyroxine, coefficient of ratio of concentrations total thyroxine/free thyroxine is determined and if its values are within 8.4-11.2 conclusion about absence of clinical effect of anti-tumour therapy is made, if coefficient values are within 14.2-22.8, conclusion about presence of clinical effect of treatment is made.

EFFECT: laboratory biochemical analysis determines clinical efficiency of the method or its absence during treatment procedures in patients with application of standard chemichal therapy, autolymphochemical therapy and is valuable laboratory test for determination of treatment efficiency and further tactics of patients monitoring.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to neurology. Risk factors are determined from history of life: family history of cardio-vascular disease, hypertension disease and in case of its presence regularity of anti-hypertensive therapy intake, marital status, age, education, psychoemotional stress, sex, also taken into account is expression of detected during first examination cognitive impairment and results of its treatment. Their gradations and numerical values are determined, prognostic coefficients F1, F2 are calculated by mathematical formulas with further comparison of their values. If F1 is higher than F2 favourable type of cognitive impairment course in patients with ischemic stroke is predicted, and if F2 is higher than F1 - unfavourable type of cognitive impairment course.

EFFECT: method ensures possibility of estimation of clinical course of cognitive impairment, thus allowing to increase efficiency and purposefulness of preventive and medicinal measures in groups of patients with risk of developing unfavourable course of cognitive impairment.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of pedagogics, and can be used in activities of medical, health and sport institutions, method of estimating efficiency of sport and recreation activities at secondary educational institution. Physical fitness is determined by indices of hemodynamic components of cardio-vascular system and index of physical development. Diagnostics of conditions, process and result of institution activity is performed by criteria: value, aim, organisation-activity, health-preservation. On the basis of calculated criteria determined is integral coefficient of sport and recreation activities, which indicates of efficiency of sport and recreation activities at secondary educational institution.

EFFECT: method allows to carry out comprehensive analysis of institution activities by directions, evaluate efficiency of sport and recreation activities in structure of health-preserving activity of secondary educational institution, detect shortcomings and perform targeted correction of detected violations by realisation of elaborated measures.

13 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to traumatology, orthopedics and immunology. In order to predict prosthesis instability in endoprosthetics of large joints, analysis of immunologic parametres in patient's peripheral bloodbefore operation is carried out. Cells of peripheral blood are incubated without stimulation with mitogen and with stimulation with bacterial lipopolysaccharide. In obtained supernatants concentration of TNF-a (Tumor Necrosis Factor-α) is determined. Stimulation index is determined by ratio of stimulated TNF-α product to its spontaneous level. If determined index value is higher than 2.5 high risk of development of instability of endoprosthesis components is predicted.

EFFECT: method allows to increase objectivity of prediction of development of prosthesis instability due to earlier determination of individual immunologic reactivity of organism to damaging factors of various types and to perform immunologic rehabilitation of patients in due time, as well as to simplify technology of prediction and reduce multiplicity of laboratory reaseach.

3 ex, 2 tbl

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

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