Method of diagnostics and surgical approach to treatment of craniocerebral trauma in children
SUBSTANCE: invention relates to field of medicine, in particular, to neurosurgery. Minimal diametre of trepanation is calculated by formula: where: D1 is diametre in case if unilateral trepanation is performed; D2 is diametre in case of bilateral trepanation; W is mass-effect of trauma (%), which is calculated for patients with presence or absence of additional intracranial formation: hematoma, hydroma, hygroma, contusion focus, by given mathematical formulae. During calculation of mass-effect taken into account are: volume of additional formation, in cubic cm, and estimation of patient's state by GLASGO scale.
EFFECT: method makes it possible to determine optimal dimensions of trepanation hole for carrying out operations of decompression orientation in treatment of craniocerebral trauma in children.
The invention relates to medicine, in particular to neurosurgery, pediatric surgery, and can be applied in the choice of tactics of surgical intervention in children with traumatic brain injury.
Progressive persistent intracranial hypertension, characteristic of traumatic brain injury and do not respond to conservative therapy is an indication for surgery decompressive direction to create a backup space.
There are several ways to determine the size of trephination. In adult patients Bed, Too, Wmiprov [1, 2, 3, 6] suggested that bone-plastic trepanning with window size not less than 9×7×8 cm, URS  - not less than 12×15 cm In children A. Taylor  noted the positive effect from the trephination 4×4 see, However, the above methods are empirical and do not take into account the size of volumetric effects in trauma, as well as individual craniometric parameters, which is especially important in children.
According to A. M. Nikulin , a backup volume when conducting trephination with a diameter of 6 cm is 9 cm3; when the diameter of trephination 8 cm - 25 cm3; when the diameter trepanation window 10 cm - 55 cm3.
The objective of the invention is to improve the accuracy of calculation of the diameter trepanation holes when conducting operations at the children with craniocerebral trauma.
The invention consists in the method of calculation of the diameter trepanation holes (for unilateral or bilateral trephination), according to the invention, based on the estimated mass effect trauma, as well as the circumference of the patient's head.
The method is as follows.
The following data is collected: the results of clinical examination, measure the circumference of the head, in the presence of post-traumatic intracranial lesion is measured for its volume (CT studies). The obtained data are interpreted as follows:
1. Head circumference, cm (corresponds to the variable "L").
2. In the presence of post-traumatic lesion (hematoma, gidromy, hygroma) - the total volume, cm3(the variable "G").
3. Stem signs, in accordance with the methodology for the assessment of neurological symptoms (variable S): 4 - there are no violations, 3 - initial disturbance - reduced corneal reflexes, clonic spontaneous nystagmus, minor anisocoria, 2 - expressed human - expressed anisocoria, clinico-tonic nystagmus, reduced reaction of pupils to light, moderate paresis of upward gaze, bilateral pathological signs, 1 - gross violations - rough anisocoria, rough paresis of upward gaze, tonic multiple spontaneous NIST is GM or floating eyes, symptom of Hertwig-Morandi, roughly pronounced pathological signs, convulsions, 0 - critical violations bilateral mydriasis with no pupils to light, areflexia, muscular atony.
4. Hemispheric and craniobasal signs, in accordance with the methods of neurological assessment (variable "K"): 4 - there are no violations, 3 - initial violations reduced or absent abdominal reflexes, a unilateral increase in tendon reflexes, moderately expressed pathological signs on the one hand, soft mono - or hemiparesis, mild speech defects, 2 - expressed human pronounced mono - or hemiparesis expressed paresis of cranial nerves, expressed speech disturbances, seizures clonic or clinico-tonic convulsions in konechnostej, 1 - gross violations - roughly pronounced mono - or hemiparesis, or paralysis, rough speech disturbances, often repetitive clinico-tonic spasms in the extremities, 0 - critical violations - tripart, triplegia, tetraparesis, quadriplegia, bilateral facial paresis, aphasia, constant cramps in the extremities.
5. Vital disorders, taking into account age-related norms, in accordance with the methodology for the assessment of neurological symptoms (variable "VIT"): 4 - there are no violations, 3 - initial disturbance - moderate bradycardia or moderate tachycardia, moderate tachypnea, reasonable arter the real Hyper - or hypotension, subfebrility, 2 - expressed human - sharp of the or bradypnoea, sudden tachycardia, sudden arterial Hyper - or hypotension, severe fever, 1 - gross violations - an extreme degree of the or bradypnoea, extreme Brady - or tachycardia, extreme arterial Hyper - or hypotonia, severe hyperthermia, 0 - critical violations - pathological types or stops breathing, the maximum reduction in blood pressure, nesochetaemyh heart rate, hyperthermia.
The diameter of trephination is calculated as follows
where D1 is the diameter when conducting unilateral trephination;
D2 is the diameter when conducting bilateral trephination;
W - mass-effect injury (in percentage units).
Conclusion about the magnitude of the mass effect of the injury is carried out according to the formulae given in tables 1,2.
Calculation of mass effect for patients with intracranial education (hematoma, hydroma, hygroma, a contusion focus):
|The estimated mass effect (W)||The formula for calculating the probability P(%)|
|from 5 to 12%||P2=100*(1/(1+e-(2,65-73.00*V+13.62*G)))*(1-(1/(1+e(20.64+6.88*S+6.88*K))))|
|from 12 to 20%||P3=100*(1-(1/(1+e-(2,65-73.00*V+13.62*G))))*(1/(1+e-(-9.89+8.79*VIT)))|
|V is the volume of the hematoma, CC, G - score scale GLASGO (if the score on the scale GLASLO>4, G=1, otherwise G=0); S - stem signs, K - hemispheric and craniobasal signs, VIT - vital violations.|
Calculation of mass effect for patients with no intracranial education (hematoma, hydroma, hygroma, a contusion focus):
|The estimated mass effect||The formula to calculate the probability (%)|
|from 5 to 12%||P2=100*(1/(1+e-(25,84+6.63*GLASGO)))*(1-(1/(1+e-(20.64+6.88*S+6.88*K))))|
|from 12 to 20%||P3=100*(1-(1/(1+e-(25,84+6.63*GLASGO))))*(1/(1+e-(-9.89+8.79*VIT)))|
|GLASGO - assessment on a scale GLASGO in points, S - stem signs, hemispheric and craniobasal signs, VIT - vital violations.|
The proposed method of calculating the diameter trepanation holes are easy to use and is possible even in the absence of high-tech imaging techniques.
The technical result of the application of the method is to achieve the maximum effect from operations decompressive direction in the surgical treatment of traumatic brain injury in children.
Sources of information
1. Zotov J.V., sedrenik CENTURIES Surgery traumatic intracranial haematomas and crush zone of the brain, str.
2. Lebedev V.V., Wenselowski Volume of surgical intervention in traumatic intracranial hematomas. Intracranial hemorrhage. Collection of scientific works of the Institute. Nevskogo. M., 1982. P. - 34-40.
3. Lebedev V.V. Zherikhin, V.V. Krylov Emergency surgery: a Guide for physicians. M, Medicine. 2000 - 568 S.
4. Pores J.V. selection Method craniotomy for traumatic subdural, intracerebral hematoma and traumatize the fir brain injury, dis.... Kida. the honey. Sciences / URS. - Moscow, 2007. - 45 S.
5. Nikulin A.M. Anatomical rationale for the size and localization trepanation holes in the surgical treatment of traumatic intracranial hematomas / Amerikuli // Matters. of neurosurgery. - 1988. No. 5. - P.6.
6. Ugryumov V.M. Severe closed traumatic brain injury. Publishing house "Medicine", 1974, 234 S.
7. Taylor, A., Warwick C., Rosenfeld, J., et al.: A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv. Syst. 2001; 17:154-162.
The method of calculation of the diameter trepanation holes when conducting unilateral or bilateral decompressive trephination in children with traumatic brain injury, characterized in that the minimum diameter of trephination is calculated by the formula:
where D1 is the diameter when conducting unilateral trephination;
D2 is the diameter when conducting bilateral trephination;
W - mass-effect injury (%), which is assumed to be 5%, if the probability of its occurrence, calculated by the formula
P1=100·(1/(1+e-(2,65-73,00·V+13,62·)))·(1/(1+e-(20,64+6,88·S+6,88·K))) in patients with the presence of intracranial hematoma and
P1=100·(1/(1+e-(25,84+6,63·GLASGO)))·(1/(1+e-(20,64+6,88·S+6,88·K))) in patients with no maximum;
or equal to 12%, if the probability of its occurrence, caters the Naya formula
P2=100·(1/(1+e-(2,65-73,00·V+13,62·G)))·(1-(1/(1+e(20,64+6,88·S+6,88·K)))) in patients with the presence of intracranial hematoma and
P2=100·(1/(1+e-(25,84+6,63·GLASGO)))·(1-(1/(1+e-(20,64+6,88·S+6,88·K)))) in patients with no maximum;
or equal to 20%, if the probability of its occurrence, calculated by the formula
P3=100·(1-(1/(1+e-(2,65-73,00·V+13,62·G))))·(1/(1+e-(-9,89+8,79·VIT))) in patients with the presence of intracranial hematoma and
P3=100·(1-(1/(1+e-(25,84+6,63·GLASGO))))·(1-(1/(1+e-(-9,89+8,79·VIT)))) in patients with no maximum;
where V is the volume of the hematoma, CC; G - score scale GLASGO (if the score on the scale GLASLO>4, G=1, otherwise G=0); GLASGO - assessment on a scale GLASGO in points; the S - stem signs; abstracting and craniobasal signs; VIT - vital violations.
SUBSTANCE: invention relates to medicine, namely to infectious disease, and can be used for prediction of antiretroviral therapy efficiency in case of HIV-infection. For this purpose by method of solid-phase immunoenzyme assay level of cytokines is determined. If indices of soluble tumour necrosis factor alpha receptor protein 75 are from 4335.48 to 6001.86 pg/ml, soluble tumour necrosis factor alpha receptor protein 55 - from 768.72 to 1323.87 pg/ml and soluble interleukin-6 receptor from 1770.77 to 3800.31 pg/ml, favourable clinic course of HIV-infection after 1-3 months since beginning of antiretroviral therapy is predicted.
EFFECT: method ensures increase of accuracy of antiretroviral therapy efficiency prediction due to selection of certain immunological criteria.
1 dwg, 7 tbl, 3 ex
SUBSTANCE: invention relates to field of medicine, in particular to nephrology. In order to predict progressing of steroid-resistant nephrotic syndrome in case of glomerulonephritis in children clinical-morphologic predictors of progressing and efficiency of the 1-st course of immunosuppressive therapy are estimated. As clinical-morphologic predictors of progressing determined are: "focal-segmental glomerulosclerosis, angiopathy of retinal vessels, increase of creatinine in blood in disease manifestation, stable increase of cholesterol level in blood >6.7 mmol/l, stable increase of fibrinogen in blood >4 g/l, disturbance of day rhythm of arterial pressure by "night-peackers" and "non-dippers" type, left ventricle hypertrophy in echocardiographic examination, increased size of kidneys in ultrasonic examination". If more than four clinical-morphologic predictors are detected and/or there is no effect from the 1-st course of immunosuppressive therapy, progressing of steroid-resistant nephrotic syndrome in case of glomerulonephritis in children is predicted.
EFFECT: method makes it possible to predict progressing course of steroid-resistant nephrotic syndrome in case of glomerulonephritis in children on the basis of early detection of clinical and morphologic predictors.
2 ex, 4 tbl
SUBSTANCE: invention relates to medicine, namely to neurology, and can be used for prediction of complications, associated with endured first acute cerebral circulation disorder. At 3-4 week of acute cerebral circulation disorder state of cognitive status in patient is determined by means of MMSE test, degree of neurologic deficiency is determined using Scandinavian stroke scale NIHSS, education level is determined. Degree of cognitive disorder in early rehabilitation period of stroke (K) is calculated by formula: K=18.83+0.71·X+0.33·Y-0.27·Z; where X is patient's education level, where 1 point is incomplete high education, 2 points - high education, 3 points - specialised high education, 4 points - higher education, Y is result of MMSE test in acute period - in points, Z is value of NIHSS stroke scale at the end of acute period - in points. If K value is 28-30 points - no disorders of cognitive function will take place, 24-27 points - pre-dement cognitive disorders will take place - 1 degree, 20-23 points - dementia of light expression degree - 2 degree, 11-19 points - dementia of moderate expression degree - 3 degree will take place.
EFFECT: providing early prediction of cognitive deficiency formation in patients, who endured acute cerebral circulation disorder for the first time, namely ischemic stroke of hemispheric localisation, aimed at administration of preventive treatment in due time.
SUBSTANCE: invention relates to medicine, in particular to ophthalmology. Acute blood serum and lachrymal fluid of a patient with uveitis are analysed for prostaglandin E2 concentration with calculating a ratio of blood serum prostaglandin E2 concentration to lachrymal fluid E2 prostaglandin E2 concentration. The value within 0.54-2.93 makes to diagnose rheumatoid arthritis, while the value 8.3-26.0 shows Marie-Strumpell disease.
EFFECT: method provides more frequent diagnosis of rheumatic uveites.
SUBSTANCE: invention refers to medicine, and can be used for determining a severity level of acute pancreatitis. That is ensured by patient's lymphocyte chemoluminescence and measuring a production level of active forms of oxygen. Spontaneous chemoluminescence Imax within 46.12 to 266.12, Squar within 2.5E+05 to 7.8E+04, Tmax within 3.2 to 4.5, Tcent within 9.2 to 17.4, Simtr within 2.6E-01 to 5. OE-01 and activated chemoluminescence Imax within 48.0 to 151.0, Squar within 1.2E+05 to 3.9E+05, Tmax within 4.3 to 8.4, Tcent within 27.7 to 30.3, Simtr within 1.7E-01 to 2.8E-01 show a mild severity of acute pancreatitis. Herein, Imax is chemoluminescence intensity, Squar is a curve area, Tmax is peaking time, Tcent is percent peaking time, Simtr is curve symmetry, E is estimated chemoluminescence activity described by kinetic parametres of the chemoluminescence reaction curves. In case of Imax> 266.2, Squar≤2.4E+05, Tmax> 4.6, Tcent≤9.1, Simtr> 5.1E-01 and activated Imax> 151.1, Squar> 4.0E+05, Tmax> 8.5, Tcent> 30.4, Simtr> 2.9E-01, the severity level is considered to be moderate. Spontaneous Imax≤46.0, Squar> 7.9E+04, Tmax≤3.1, Tcent> 17.5, Simtr≤2.5E-01 and activated Imax≤47.9, Squar≤1.1E+05, Tmax≤4.2, Tcent≤27.6, Simtr≤1.6E-01 indicate the severe disease.
EFFECT: method allows higher objectivity and fast determination of the severity of a pathological process and prescription of enhanced antibacterial and detoxification therapy in cases of the severe disease.
2 tbl, 4 ex
SUBSTANCE: invention refers to medicine, particularly to therapy, pediatrics, threpsology. It involves clinical and laboratory examination, a subject is finger skin. Nail bones of three fingers are coated simultaneously with 7.5 % aqueous hydrogen peroxide on a palmar surface. A physiologically optimum availability is indicated by no skin albication; lower normal level decrease of availability presents single albication points; selenium deficiency is shown by merged albication regions taking a greater portion of the coated surface.
EFFECT: method allows screening examination of population.
1 tbl, 3 ex
SUBSTANCE: invention refers to medicine, namely to cardiology and therapy, and can find application in clinical practice for treating primary hypertension complicated by a crisis course. Red blood cells are analysed for 2,3-DPG and lactate and pyruvate concentrations to calculate a lactate/pyruvate ratio. If the calculated ratio reaches a physiological value not exceeding 17.455±0.355, an adequate prescription of a therapeutic preparation is concluded, while prescription of the preparation is considered to be effective in additional decrease of 2,3-DPG level to 15.00 mcmol/ml and lower.
EFFECT: laboratory-biochemical findings promote higher clinical effectiveness in patients with hypertension complicated by the crisis course.
SUBSTANCE: invention relates to field of medicine, namely to neurooncological surgery. In order to diagnose patients affected by brain tumours, histological analysis of tumour sample with determination of its type is carried out. Hystological sample of tumour is grinded in medium of liquids DMEM/F12, 10% fetal bull serum, 5% of L-glutalin and 5% of gentamycin, filtered and centrifuged. After that, phosphate-salt buffer is added to mixture, cell suspension is separated. Into board holes cell suspension and medium without cells are introduced. Content of board is incubated in thermostat at temperature 37°C in presence of 5% CO2. After incubation, different cytostatics are introduced into holes with cell suspension and medium with their different concentration, after following incubation into each board hollow MTT solution in phosphate-salt buffer is added. Board content is incubated in thermostat and 100 mcM of isopropanol with 0.04 M HC 1 are added into each hole. Optic density in board holes at wave length 570 nm is measured. Results are evaluated comparing parametres of measured optic densities of medium and cell suspension with cytistatics and estimating % of cell death in tumour samples with different concentration of cytostastics.
EFFECT: method makes it possible to increase accuracy and efficiency of diagnostics by individual selection of cytostatics with determination of their concentration and with evaluation of sensitivity of cytostatic corticosteroid function.
2 ex, 2 tbl
SUBSTANCE: invention relates to medicine of disasters, and can be used in emergency cases in case of serious isolated traumas, multiple injuries and combined trauma. For this purpose seriousness of trauma is estimated in accordance with injury severity scale by table No 9, represented in invention description. If in case of isolated trauma, combined trauma or multiple injuries the most severe injury is evaluated in 3 points, diagnostic measures are taken in full volume in order to detect possible hidden injuries, and specification of character of obvious injuries of anatomical areas. Also carried out is supporting infusion therapy and surgery is performed in case of emergency indications. If the most severe injury is evaluated in 4 or 5 points, intensive therapy is carried out, diagnostic measures are taken in minimal volume with further carrying out of surgery by vital indications. After surgery and relative state stabilisation diagnostic procedures are performed in full volume, and in case, if hidden injuries, requiring surgical correction by emergency indications, are detected, surgery is carried out.
EFFECT: method allows to ensure the most accurate estimation of injuries and in accordance with it to determine optimal tactics of patient's treatment in the first hours after trauma.
9 tbl, 2 ex
SUBSTANCE: invention relates to field of medicine, namely to oncology. In order to predict efficiency of anti-tumour treatment exudate from abdominal cavity is analysed. By method of filtration detoxication obtained is protein concentrate of ascitic fluid, used for extracorporal incubation with cytostatics and carrying out intraperitoneal chemotherapy. Preliminarily determined are type of structure building of solid concentrate phase and stability of systemic and subsystemic signs. Preservation of physiologically stable radial or partly radial type of phase of ascitic fluid concentrate with formation of monomorphic singularities and concretions is prognostic sign of maximal autoascitochemotherapy efficiency - complete tumour regression. Pathologically unstable irradial and circular type of protein concentrate phase with polymorphic structures of singularities and concretions determine prognosis of treatment efficiency in form of partial tumour regression. Pathologically stable structure with irradial, circulatory type and type of "double phase" without preservation of systemic signs of concretions and singularities points to correspondence to effect of tumour growth stabilisation.
EFFECT: method allows to determine prognostic criteria of anti-tumour treatment efficiency, which will allow to correct treatment in due time.
6 dwg, 6 ex, 4 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
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.
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.
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.
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.
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.
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
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.