Method of non-invasive diagnostics of fibrosis in case of diffuse livere diseases

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely, to gastroenterology. For non-invasive diagnostics of fibrosis and cirrhosis in case of HBV and HCV infections complex ultrasonic examination of liver and spleen tissue is carried out. Additionally duplex scanning with colour Doppler mapping of porto-hepatic region vessels is performed and quantitative indices of hemodynamics of rate of blood flow in vessels, including splenic vein, are determined. Blood test is analysed and used to determine number of platelets, biochemical blood tests are performed, most significant for determination of disease degree indices of coagulogram are taken. After that, discriminant analysis of obtained characteristics and indices is carried out, and taking into account age and experimentally obtained coefficients, total value of two canonical discriminant functions F1 and F2 for HCV and HBV is calculated. Further, by obtained in empiric way territory map position of point for calculated by patient's concrete indices values F1 and F2 for cases of HCV-infection and HBV-infection is determined. Depending on point location on territory map case of mild fibrosis, severe fibrosis or liver cirrhosis is diagnosed.

EFFECT: method increases reliability of fibrosis and cirrhosis diagnostics in case of HBV and HCV infections.

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The invention relates to medicine, namely to a gastroenterologist, and can be used for determining the stage of fibrosis in diffuse liver disease.

There is a method of assessing the degree of fibrosis, as described in article Pavlov Charles steward and other "Modern elastometry, fibreboard and Akti-test in the diagnosis of liver fibrosis" in the Russian journal of gastroenterology, Hepatology, Coloproctology", 2008, volume XVIII, No. 4, p.43-52.

The known method includes ultrasound examination of the liver tissue (elastometry) to determine the density of the liver tissue and holding a fiber optic scope test and asset test respectively include getting 5 biochemical parameters (fibreboard test) and 5 of these indicators and additional alanine aminotransferase (Alat).

The disadvantage of this method is its poor reliability due to incomplete surveys. In addition, the known method is very expensive and not available everywhere due to the lack of in some hospitals the necessary reagents.

There is a method of assessing liver fibrosis, described in the article "Ultrasonic angiology research and elastometry - promising areas for non-invasive diagnosis of liver fibrosis" authors Casavola and others in the journal "Gastroenterology", 2008, №2.

In the known method of use who are ultrasound examination of the liver tissue to determine its elasticity using the apparatus of Fibroscan and studies of blood flow by ultrasound Doppler to determine diameters and speed indicators of the splenic and portal veins, the diameter of the common hepatic and splenic arteries in the region of the celiac trunk, and determination of the main quantitative parameters of arterial blood flow such as: the relative peak systolic velocity, maximum end-diastolic blood flow velocity for 2-3 cardiac cycle, time-averaged maximum diastolic velocity, peripheral resistance index, index, ripple, etc. were also Conducted histological examination of the liver by biopsy of the liver by the method of Mangini. The stage of liver fibrosis was assessed according to the METAVIR system. Comparison of patient groups on quantitative trait with different stages of fibrosis were conducted nonparametric method using a criterion of Mann-Whitney.

The disadvantage of this method is that not considered biochemical parameters.

The known method for non-invasive diagnosis of liver fibrosis, as described in the article the authors Takeway E.V. and other "Elastography liver in assessing the degree of fibrosis in chronic hepatitis C" in the journal "Hepatology forum" (Supplement to the journal "Clinical pharmacology and therapeutics") 2007, 2, 9, 10.

The known method is to estimate the values of biochemical samples ALT ACT and conduct of elastography defined for the I-density liver.

The disadvantage of this method is that it is not possible to determine the hemodynamics.

The known method for non-invasive diagnosis of liver fibrosis, as described in article Pisareva A.G. "Ultrasonic assessment of the degree of liver fibrosis in chronic viral hepatitis in children" in the journal "Medical imaging", 2001 spec. Edition, p.48-53.

The known method is that the conduct ultrasonic density estimation on a number of grounds: the size of the liver, the outer contour of the body, the homogeneity of the tissue, the degree of echogenicity and absorption of ultrasound, the size of the reflected signals, the state of the capsule, aperture and muzdalifah cept, the dimensions of the veins of the portal and splenic system.

The main disadvantage of this method is that it is indicative only and is an element of subjectivity in determining the criteria of liver fibrosis. In addition, this method does not allow to determine the hemodynamics.

A known method for the diagnosis of stages of chronic hepatitis, described in p. the Russian Federation No. 2314037 on CL No. A61B 8/00, Z. 18.04.06, op. 10.01.08.

A known method for the diagnosis of stages of chronic hepatitis includes a comprehensive ultrasound examination of the liver and spleen using the apparatus of Fibroscan additionally spend duplex scanning with color Doppler CT is the licensing of vessels Porto-hepatic region, and provide quantitative hemodynamics of blood flow velocity in the vessels and in the figures: in the portal vein (IV) maximum linear flow velocity (Vmin)=an 18.4 25.5 cm/s; the flow velocity averaged over time (TAMH)=26,65 of 34.8 cm/s; in the hepatic veins TAMH retrograde phase=16,5-24,3 cm/s; in the proper hepatic artery (SPA) Vmax=63,67-72, 5 cm/s, diagnosed with stage 1 chronic hepatitis; SPA Vmax=63,67-72,5 cm/s TMH=36,0-44,61 cm/s; in the splenic artery (SA) in the projection of the pancreas Vmax=MT 18 : 34-139,69 cm/s; in SA in the projection gate spleen Vmax=69,6-85,22 cm/s TMH=47,29-55,3 cm/s, resistant peripheral resistance index (RI)=0,58-0,70, pulsatory the peripheral resistance index (PI)=1,16-1,43, diagnosed with stage 3 chronic hepatitis; BB Vmax=34,66-41,6 cm/s, Vmin+20, 02-28,1 cm/s, TMH=26,8-33,24 cm/s; in splenic Vienna (SW) in the projection of the pancreas Vmax=27,236,23 cm/s, TMH=21,5-29,45 cm/s; RO TAMH retrograde phase=2,98 is 8.22 cm/s, TMH antegrade phase=17,0-26,78 cm/s; in SA in the projection of the pancreas Vmax=118,11-150,5 cm/s, TMH=52,98-79,9 cm/s, PI=1,7-2,24; in SA in the projection of the pancreas Vmax=118, 11-150,5 cm/s, TMH=46,45-61,2 cm/s, PI=1,16-1,687; ASO Vmin=26,0-40,45 cm/s; TAMH=63,65-74,58 cm/s, PI=1,41-1,77; SPA Vmax=62,16-74,63 cm/s; TMH=34,6-47,71 cm/s, PI=0,71 IS 0.86, PI=1.54-1,8 diagnosed with 4th stage of chronic hepatitis.

The known method does not allow to determine the content of fibrous tissue in the liver, which reduces its validity, and are not always available in regular clinic where there is no machine Fibroscan". The disadvantage of this method is its complexity.

The task for the implemented technical solution is to increase the reliability and availability of diagnostic method while simplifying it.

The problem is solved in that in a non-invasive method for the diagnosis of fibrosis in diffuse liver disease, which consists in the fact that conduct a comprehensive ultrasound examination of the liver and spleen, in addition spend duplex scanning with color Doppler mapping of vessels Porto-hepatic region, and provide quantitative hemodynamics of blood flow velocity in the blood vessels, including splenic Vienna, and at certain values of these indicators make a conclusion about the presence and stage of fibrosis ACCORDING to the INVENTION, when conducting a comprehensive ultrasound examination of the liver and spleen additionally determine the density and dispersion of the liver tissue, spleen size, measure the diameters of portal and splenic veins as indicators of blood flow determine the linear and volumetric blood flow velocity in the portal vein, as well as splenomegaly index and additionally take a blood test, which determines the number of platelets, carried out the biochemical analysis of a blood with definition of such indicators as the sample ALT ACT with determination of their levels, GGT, cholesterol, alkaline phosphatase, take the most important to determine the stage of the disease indices of coagulation such as time rekaltsifikatsii plasma prodoljitel is of bleeding, fibrinogen, thrombin time, prothrombin index, then conduct a discriminant analysis of the characteristics and indicators and taking into account the age and experimentally obtained coefficients calculated the total value of the two canonical discriminant functions F1 and F2 for the case of HCV infection as:

K and K' empirical coefficients, a is the age, SD - dispersion liver, V-PV - linear blood flow velocity in the portal vein, OV-PV - volumetric rate of blood flow in the portal vein, OV-SV is the volumetric rate of blood flow in the splenic Vienna, SPI - splenomegaly index, Lien - size of the spleen, GGTP - gamma-glutamyltransferase, Chol - cholesterol, ALT - alanine aminotransferase, ACT - aspartate aminotransferase, alkaline phosphatase alkaline phosphatase, BP - time rekaltsifikatsii plasma, DK is the duration of bleeding, With - constant, and for the case of HBV infection as:

N and N' is the empirical coefficients, RS - duration of disease, BMI - body mass index, MD - density liver (OV-PV) is the volumetric rate of blood flow in the portal vein, the DSV is the diameter of the splenic vein (OV-SV) is the volumetric rate of blood flow in the splenic Vienna, KR - de Ritis coefficient, Chol. - cholesterol, alkaline phosphatase alkaline phosphatase, F - fibrinogen, PETIT prothrombin index, TV thrombin time - constant

next half is obtained empirically for a variety of discriminant values F1 and F2 territorial map built in the coordinate system X, Y, where X=F1, a Y=F2, determine the position of the point calculated for specific indicators of patient values F1 and F2 for cases of HCV infection and HBV infection, then the location of this point for HCV infection coordinate F1 in quadrant values(-12...+6...+2...-12) and coordinate F2 in the interval (-12...+4) and for HBV infection coordinate F1 in quadrant(-12...+4...-3...-12) and coordinate F2 in the interval (-12...+2) diagnose a case of lung fibrosis, HCV infection coordinate F1 in quadrant (-3...+6...+12) and the coordinate of F2 in quadrant (-12...+4...+6) and for the case of HBV infection coordinate F1 (+4...-2...+12) and the coordinate of the F2 values (-12...0...+12) diagnosed case of severe fibrosis, HCV infection coordinate F1 in the interval (-12...+12) and the coordinate of F2 in quadrant(+4...+5...+12) and for HBV infection coordinate F1 in quadrant(-12...-2...+12...-12) and coordinate F2 in the interval (+2...+12) diagnosed with cirrhosis of the liver.

Using blood tests to determine the number of platelets and holding thereon a series of biochemical samples, and the use of data of coagulation provides an opportunity to evaluate the content of fibrous tissue in the liver and its functional state, which in combination with ultrasonic determination of the density and dispersion of the liver, splenic size and diameters of portal and splenic veins, reflecting structurally the change of the liver, allows to determine the presence or absence of signs of portal hypertension and the determination of the linear and volumetric flow velocity, and splenorenal index, reflecting the structural change of the liver and indirectly confirming the data on the density of the liver, with subsequent construction of territorial maps according to the biochemical and Doppler studies and the determination of the location of the point, reflecting all the data for a specific patient, gives reliable information to determine the presence and stage of fibrosis in a more simple and available technology research.

The technical result is to increase the reliability of diagnosis by identifying biochemical studies of the functional state of the liver confirmed investigated using Doppler structural changes.

The inventive method has the novelty in comparison with the prototype, differing from it by the presence of such essential features as the definition of a comprehensive ultrasound examination of the liver and spleen additionally, the density of the liver tissue, spleen size, measuring diameters of portal and splenic veins, as the blood flow values of the linear and volumetric flow velocity in the portal vein, as well as spleen the renal index taking additional blood analysis, identifying him platelet count, conducting biochemical analyses of blood, determining their level, GGT, cholesterol, alkaline phosphatase, selection of the most significant for determining the stage of the disease indices of coagulation, such as time rekaltsifikatsii plasma, the duration of bleeding, fibrinogen, thrombin time, prothrombin index, the subsequent conduct of the discriminant analysis of the characteristics and indicators and taking into account the age and experimentally obtained coefficients, calculate a sum of values of the two canonical functions F1 and F2 for cases of HCV and HBV infections, the definition then obtained empirically for a variety of discriminant values F1 and F2 territorial map, built in the coordinate system X, Y, where X=F1, a Y=F2, the position of point for a particular calculated according to the testimony of the patient values F1 and F2, and the diagnosis in this situation the degree of fibrosis, which provides collectively achieve the specified result.

The applicant is not known technical solutions with the specified set of distinctive features that collectively achieve the specified result, he felt, therefore, that the claimed method meets the criterion of "inventive step".

Declare the method can be widely used in gastroenterology, and therefore meets the criterion of "industrial applicability".

The invention is illustrated by drawings, where:

- figure 1 - values of empirical coefficients according to the results of discriminant analysis in HCV infection;

- 2 territorial map canonical discriminant functions 1 and 2 with HCV infection;

- figure 3 canonical discriminant functions 1 and 2 with HCV infection;

- figure 4 - predicted group membership fibrosis and cirrhosis in HCV infection;

- 5 - the values of the empirical coefficients according to the results of discriminant analysis with HBV infection;

- 6 - the territorial map of the canonical discriminant functions 1 and 2 with HBV infection;

- 7 - canonical discriminant functions 1 and 2 with HBV infection;

- Fig - predicted group membership fibrosis and cirrhosis in HBV infection;.

Fig.9 - territorial map canonical discriminant functions 1 and 2 for clinical example 1;

- figure 10 is a territorial map of the canonical discriminant functions 1 and 2 for clinical example 2.

The claimed non-invasive method for the diagnosis of fibrosis in diffuse liver disease is as follows.

Conduct a comprehensive ultrasound examination of the liver and spleen, while additionally determine the density of the liver tissue, once the EP spleen, measure the diameters of portal and splenic veins. Spend duplex scanning with color Doppler mapping of vessels Porto-hepatic region, and provide quantitative hemodynamics of blood flow velocity in the blood vessels, including splenic Vienna, as indicators of blood flow determine the linear and volumetric blood flow velocity in the portal vein, as well as splenomegaly index. Additionally take a blood test, which determines the number of platelets, carried out the biochemical analysis of a blood with definition of such indicators as the sample ALT ACT with determination of their levels, GGT, cholesterol, alkaline phosphatase. Take the most important to determine the stage of the disease indices of coagulation such as time rekaltsifikatsii plasma, the duration of bleeding, fibrinogen, thrombin time, prothrombin index. Next, perform a discriminant analysis of the characteristics and indicators and taking into account the age and experimentally obtained coefficients calculated the total value of the two canonical discriminant functions F1 and F2 for the case of HCV infection as:

K and K' empirical coefficients, a is the age, SD - dispersion liver, V-PV - linear blood flow velocity in the portal vein, OV-PV - volumetric rate of shelter is current in the portal vein, OV-SV is the volumetric rate of blood flow in the splenic Vienna, SPI - splenomegaly index, Lien - size of the spleen, GGTP - gamma-glutamyltransferase, Choi - cholesterol, ALT - alanine aminotransferase, ACT - aspartate aminotransferase, alkaline phosphatase - Alp, BP - time rekaltsifikatsii plasma, DK is the duration of bleeding, is constant.

Such as discriminant analysis and calculation of conduct and for the case of HBV infection as:

N and N' is the empirical coefficients, A3-duration of disease, BMI - body mass index, MD - density liver (OV-PV) is the volumetric rate of blood flow in the portal vein, the DSV is the diameter of the splenic vein (OV-SV) is the volumetric rate of blood flow in the splenic Vienna, KR - de Ritis coefficient, Choi. - cholesterol, alkaline phosphatase alkaline phosphatase, F - fibrinogen, PETIT prothrombin index, TV - thrombin time, is constant.

Then obtained empirically for a variety of discriminant values F1 and F2 territorial map, built in the coordinate system X, Y, where X=F1, a Y=F2, determine the position of the point calculated for specific indicators of patient values F1 and F2 for cases of HCV infection and HBV infection. When the location of this point for HCV infection coordinate F1 in quadrant values(-12...+6...+2...-12) and coordinate F2 in the interval (-12...+4) and for HBV infection coordinate F1 in quadrant(-12...+4��-3...-12) and coordinate F2 in the interval (-12...+2) diagnose a case of lung fibrosis, for HCV infection coordinate F1 in quadrant (-3...+6...+12) and the coordinate of F2 in quadrant (-12...+4...+6) and for the case of HBV infection coordinate F1 (+4...-2...+12) and the coordinate of the F2 values (-12...0...+12) diagnosed case of severe fibrosis, HCV infection coordinate F1 in the interval (-12...+12) and the coordinate of F2 in quadrant(+4...+5...+12) and for HBV infection coordinate F1 in quadrant(-12...-2...+12...-12) and coordinate F2 in the interval (+2...+12) diagnosed with cirrhosis of the liver.

Almost the inventive method was carried out as follows.

Only 450 cases were examined: 319 HCV RNA - positive and 131 patient HBV DNA - positive. Of them - 242 men and 208 women aged from 18 to 60 years. In the studied group consisted of 266 patients with CHC (by stage of fibrosis - F0-48, F1-132, F2-62, F3-24), 53 patients CPU in the outcome of CHC (31 - without esophageal varices, 22 - with esophageal varices). HBV DNA - positive patients were distributed as follows: 131 patients with CHB (by stage of fibrosis - F0-29, F1-24, F2-24, F3-26), 28 patients CPU in the outcome of HBV (14 - without the presence of esophageal varices, 14 - with esophageal varices). Were excluded patients with a body mass index over 30, alcoholic, drug liver disease, and patients with pulmonary, cardiac, renal failure more than 1 degree.

Patients were given a comprehensive clinical, biochemical examination (definition of de Ritis coefficient), triglycerides, virological examination (the methods of the om PCR). Was also conducted endoscopic examination (fibrogastroscopy=FGS) a determination of the degree of esophageal varices, ultrasonography (US) of the liver with Doppler venous portal system (USDG), amplitude discografia with calibration (ASC) using ULTRASONIC scannerHitachi. When USDG the presence of portal hypertension was estimated by the size of the portal and splenic vein (PV and SV), linear and volumetric blood flow velocity (BFV and USC) PV and SV splenorenal index (SPI). When AGK rated brightness (MD) and dispersion-% FASHION, characterizing the ratio of stromal and parenchymal cells. Elastometry with the definition of the indicator in kPa was conducted on the apparatus of Fibroscan" EchoSens, France). Statistical data processing was carried out using the software package Statistica-6, SPSS-10.

Was conducted discriminant analysis, which, given the small inter-group differences in terms of elastometry, and biochemical tests non-invasive assessment of fibrosis, it was decided to divide the patients into three groups: 1) mild fibrosis (F0-1), 2) severe fibrosis (F2-3), 3) cirrhosis (F4). The division into these groups determines further treatment tactics for patients.

Discriminant analysis is a two functions F1 and F2, of which Stroiservice with the x-axis (F1) and y (F2) and patient data appear in the field of mild or severe fibrosis, or cirrhosis of the liver (figure 2 and 6).

Conducting discriminant analysis allowed us to identify the most important constants (coefficients) for the distribution of patients in the above groups with HCV and HBV infection. When HCV infection (figure 1) they were USC-PV, RSC-SW, SLEEP. Using the coefficients of the canonical discriminant function allows you to divide patients into groups with a slight (1), heavy (2) fibrosis and cirrhosis of liver (group 3) when HCV infection by determining the centroids of groups in a graphical form (figure 3). When HCV infection is predicted as belonging to the 1st group for 93.4%, to 2-nd group of 67.4%, the 3rd group-100% (figure 4). When HBV infection is the most significant indicators for the group was the USC-RO, RSC-SW, De Ritis coefficient, the level of fibrinogen in the blood (figure 5). In the graphical version of the distribution of the patients in groups with light (4), heavy (5) fibrosis and cirrhosis of liver(6) with HBV infection with the determination of the centroids of the groups is presented in Fig.7. Predicted belonging to the 4, 5, 6 groups were 96.2%, 96%, 100%, respectively (Fig).

Below is a discriminant analysis, which was used for HCV and HBV infection patients are divided into the same 3 groups (HCV-1,2,3; HBV-infection-4,5,6)- with a slight, severe fibrosis and cirrhosis. Discriminant analysis as already mentioned the camping above, represents the 2 functions that build the graph with the abscissa and ordinate, and where the patient comes to light, severe fibrosis or cirrhosis of the liver.

Data for discriminant analysis with HCV infection are presented in table 1. The table below shows the main quality parameters and empirical coefficients, their significance for the functions F1 and F2. Below in the text are given they are given in the transcript, in parentheses brief notation and units, multiplied by the corresponding coefficients and a mathematical sign (plus or minus) for use in calculations.

Function F1: 1) Age (years))×0,021+; 2) the Dispersion of the liver tissue(SD %)×0,030+; 3) the Linear velocity of blood flow in the portal vein (V-PV cm/sec)×0,040+; 4) the Volumetric rate of blood flow in the portal vein(OV-PV, liters/min)×0,581-; 5) the Volumetric rate of blood flow in the splenic Vienna (OV-SV, liters/min)×4,962+; 6) splenomegaly index (SPI, %)×4,961+; 7) size of the spleen (Lien, s / C)×0,019+; 8) gamma-glutamyltransferase (GGT, u/l)×0,004-; 9) Cholesterol (Colest., mmol/l)×0,274+; 10) aspartate aminotransferase (ACT, u/l)×0.005 to; 11)alanine aminotransferase (ALT, u/l)×0,004+; 12) Alkaline phosphatase (alkaline phosphatase, u/l)×0,003+; 13) Time rekaltsifikatsii (BP, s)×0,166+; 14) Duration of bleeding (DK, min)×0,216-; 15) the Constant (C)=13,210. Then:

Function F2: 1)Age (years)×0,000+; 2) the Var is the risk of liver tissue (SD, %)×0,091+; 3) the Linear velocity of blood flow in the portal vein (v-PV, cm/sec)×0,090-; 4) the Volumetric rate of blood flow in the portal vein (OV-PV, liters/min)×2.101-; 5) the Volumetric rate of blood flow in the splenic Vienna (OV-SV, liters/min)×0,865+; 6) Splenomegaly index (SPI, %)×0.732-; 7) size of the spleen (Lien, s / C)×0,010+; 8) gamma-glutamyltransferase (GGT, u/l)×0,002+; 9) Cholesterol (Cholest, mmol/l)×0,94+; 10) aspartate aminotransferase (ACT, u/l)×0.005 to; 11) alanine aminotransferase (ALT, u/l)×0,000-; 12) Alkaline phosphatase(alkaline phosphatase, u/l)×0,001+; 13) Time rekaltsifikatsii (BP, s)×0,894-; Duration of bleeding(DK, min)×2.491+; Constant (C)=-13, 210. Then:

Results distribution of patients with mild (1), heavy (2) fibrosis and cirrhosis of liver (group 3) when HCV infection with the determination of the centroids of the groups according to the results of the discriminant analysis are shown in figure 3.

Predicted group membership with a slight(1), heavy (2) fibrosis and cirrhosis of liver (group 3) when HCV infection frequency(number of patients) and in percentage are shown in table 2 figure 4.

Data for discriminant analysis with HDV infection are presented in table 5. The table below shows the main quality parameters and empirical coefficients, their significance for the functions F1 and F2. Below in the text are given they are given in the transcript, SC is bkah brief notation and units multiplied by the corresponding coefficients and a mathematical sign (plus or minus) for use in calculations.

Function F1=1) disease Duration (RS, s)×0,367-; 2) Age (years)×0,30+; 3) body mass Index (BMI, kg/m)×0,177-; 4) the Density of the liver (MD, ed)×0,156-; 5) the Volumetric rate of blood flow in the portal vein (OV-PV, liter/min)×2,284-; 6) the diameter of the splenic vein (DSV, mm)×0,003+; 7) the Volumetric rate of blood flow in the splenic Vienna (OV-SV, liter/min)×3,030+; 8) size of the spleen (Liev, kV/cm)×of 0.066+; 9) De Ritis Coefficient (KR)×1,336-; 10) Cholesterol (Cholest, mmol/liter))×0,33+; 11) Alkaline phosphatase (alkaline phosphatase, IU/liter)×0,003+; 12) Fibrinogen (F g/l)×5,502-; 13) procurability index (PTI,%)×0,072+; 14) Thrombin time (TV, s)×0,131+; 15) the Constant (C)=6,298. Then:

Function F2=1) disease Duration (RS, s)×0,074+; 2) Age (years)×0,080+; 3) body mass Index (BMI, kg/m)×0,364-; 4)the Density of the liver(MD, ed)×0,072-; 5) the Volumetric rate of blood flow in the portal vein (OV-PV, l/min)×2,921-; 6) the diameter of the splenic vein (DSV, mm)×0,470-; 7) the Volumetric rate of blood flow in the splenic Vienna (OV-SV, l/min)×3,513-; 8) size of the spleen (Lien, s / C)×0,076+;9)De Ritis Coefficient (KR)×2,183-; 10) Cholesterol (Cholest., mmol/l)×0,664+; 11) Alkaline phosphatase (alkaline phosphatase, u/l)×0,011+; 12) Fibrinogen (F, g/n)×5,612-; 13) Prothrombin index (PTI, %)×0,029+; 14) Thrombin time (TV, s)×0,438+ 15) Constant (C)=1,178.

Then:

Results distribution of patients with light (4), heavy (5), fibreboard is om and cirrhosis (6) with HBV infection with the determination of the centroids of the groups according to the results of the discriminant analysis are shown in Fig.7.

Predicted group membership with light (4), heavy (5) fibrosis and cirrhosis of liver (6) with HBV infection frequency (number of patients) and in the percentage shown in the table on Fig.

For confirmation of diagnosis for cases of HCV infection and HBV infection was performed liver biopsy with morphological verification of diagnosis and the determination of the YOKE (Knodell) and degree of fibrosis according to Metavir and Ishak (except for the group of patients with cirrhosis of the liver with the presence of esophageal varices (esophageal varices) and after bleeding from them), which confirmed the effectiveness of the proposed method for noninvasive diagnosis of fibrosis.

Clinical examples

Example 1. Patient R., 23 years, Clinical diagnosis: Chronic viral hepatitis C, 3A genotype, with minimal activity. For determining the stage of fibrosis carried out the biochemical analysis of blood (with determination of the level of gamma glutamyltranspeptidase - 12 u/l, cholesterol - 3.2 mmol/l, alanine amino-transferase 65 u/l, aspartic aminotransferase - 25 u/l, alkaline phosphatase - 48 u/l), triglycerides (definition of time rekaltsifikatsii - 30 seconds and duration of bleeding - 5 min), held ultrasonic duplex scanning(with the determination of the dispersion of the liver tissue is 10.2%, linear - 18,6 cm/sec and a flow rate of 1.1 l/min blood flow in the portal vein, volume rate of blood flow in the splenic Vienna - 0.3 l/min, the area of the spleen - 31 s / C). Calculated values of the function 1(f1=-2,303) and 2(f2=-1,273).

On the territorial map discriminant analysis (Fig.9) these values fall within the range of values of groups 1 lung brosis. A needle biopsy of the liver confirmed the predicted group.

Example 2. Patient, 60 years, Clinical diagnosis of liver Cirrhosis in the outcome of HCV infection, with minimal activity, genotype 1B, in the stage of compensation. Portal hypertension 0-1 degree (splenomegaly).

For determining the stage of fibrosis carried out the biochemical analysis of blood (with determination of the level of gamma glutamyltranspeptidase - 86,3 u/l, cholesterol - 3.2 mmol/l, alanine aminotransferase 99 u/l, aspartic aminotransferase-53 u/l, alkaline phosphatase - 96 u/l), triglycerides (definition of time rekaltsifikatsii - 30 seconds and duration of bleeding-7 min), held ultrasonic duplex scanning(with the determination of the dispersion of the liver tissue is 6.7%, linear-10.6 cm/sec and a flow rate - to 0.88 l/min blood flow in the portal Vienna, volumetric blood flow in the splenic Vienna-1,24 l/min, the area of the spleen - 86,3 cm). Calculated values of the function 1(f1=4,238)and 2(f2=-0,475).

On the territory of the school map discriminant analysis (figure 10) these values fall within the range of values group 3-cirrhosis of the liver. A needle biopsy of the liver confirmed the predicted group.

In comparison with the prototype of the proposed method is more reliable, affordable and simple.

Method for noninvasive diagnosis of fibrosis and cirrhosis in HBV - and HCV-infections, which consists in the fact that conduct a comprehensive ultrasound examination of the liver and spleen, in addition spend duplex scanning with color Doppler mapping of vessels Porto-hepatic region, and provide quantitative hemodynamics of blood flow velocity in the blood vessels, including splenic Vienna, and at certain values of these indicators make a conclusion about the presence and stage of fibrosis, characterized in that a comprehensive ultrasound examination of liver and spleen additionally determine the density and dispersion of the liver tissue, spleen size, measure the diameters of the portal and splenic veins as indicators of blood flow determine the linear and volumetric blood flow velocity in the portal and the volumetric rate in splenic veins, and splenomegaly index, additionally take a blood test, which determines the number of platelets, carried out the biochemical analysis of a blood with definition of such parameters as sample ALT ACT with determination of their levels, GGT, cholesterol is Rin, alkaline phosphatase, take the most important to determine the stage of the disease indices of coagulation, such as time rekaltsifikatsii plasma, the duration of bleeding, fibrinogen, thrombin time, prothrombin index, then conduct a discriminant analysis of the characteristics and indicators and taking into account the age and experimentally obtained coefficients calculated the total value of the two canonical discriminant functions F1 and F2 for the case of HCV infection:
F1=0,021×A+0,03×SD+0,04×(V-PV)+0,581×(OV-PV)-4,962×(OV-SV)+4,961×SPI+0,019×Lien+0,004×GGTP-0,274×Chol.+0,005×ACT-of 0.004×ALT+0,003×alkaline phosphatase+0,166×BP-0,216×DK-13,210;
F2=0,000×A+0,092×SD+0,09×(V-PV)-2,101×(OV-PV)-0,865×(OV-SV)+0,732×SPI-0,10×Lien+0,002×GGTP+0,094×Chol.+0,005×ACT-0,000×ALT is 0.001×alkaline phosphatase+0,120×BP-0,894×DK-2,491 where are empiricheskiie coefficients the following data: age, SD - dispersion liver, V-PV - linear blood flow velocity in the portal vein, OV-PV - volumetric rate of blood flow in the portal vein, OV-SV is the volumetric rate of blood flow in the splenic Vienna, SPI - splenomegaly index, Lien - size of the spleen, GGTP - gamma-glutamyltransferase, Chol - cholesterol, ALT - alanine aminotransferase, ACT - aspartate aminotransferase, alkaline phosphatase - Alp, VR - time rekaltsifikatsii plasma, DK is the duration of bleeding; and for the case of HBV infection as:
F1=0,367×DZ-0,030×A+0,177×BMI-0,156×D-2,284×(OV-PV)-0,003×DVS+3,030×(OV-SV)+of 0.066×Lien+1,336×R-of 0.333×Chol.+0,003×ALKALINE PHOSPHATASE OF+5.50×F-0,072×PTI+0,131×TV+6,298;
F2=0,074×DZ-0,080×A+0,364×BMI-0,172×MD-2,921×(OV-PV)-0,470×DSV+3,513×(OV-SV)+0,076×Lien+2,183×KR-0,664×Chol.+to 0.011×alkaline phosphatase+5,612×F-0,029×PTI+0,438×TV+1,178 where are empirical coefficients the following data: RS - duration of disease, BMI - body mass index, MD - density liver (OV-PV) is the volumetric rate of blood flow in the portal vein, the DSV is the diameter of the splenic vein (OV-SV) is the volumetric rate of blood flow in the splenic Vienna, Lien - size of the spleen, KR - de Ritis coefficient, Chol. - cholesterol, alkaline phosphatase - Alp, F - fibrinogen, PETIT prothrombin index, TV - thrombin time, then obtained empirically for a variety of discriminant values F1 and F2 territorial map, built in the coordinate system X, Y, where X=F1, a Y=F2, determine the position of the point calculated for specific indicators of patient values F1 and F2 for cases of HCV infection and HBV infection, then the location of this point for HCV infection coordinate F2 in the field values(-12...+6...+2...-12) and coordinate F1 in the interval (-12...+4) and for HBV infection coordinate F2 in the field(-12...+4...-3...-12) and coordinate F1 in the interval (-12...+2) diagnose a case of lung fibrosis, HCV infection, when values of the coordinate of the F2 region (-3...+6...+12) and the values on the coordinate of the F1 region (-12...+4...+6) and for the case of HBV infection when the values on the coordinate F2 (+4...-2...+12) and the coordinate values F1 (-12...0...+12) diagnostic who have a severe case of fibrosis, for HCV infection, when values of the coordinate F2 in the interval (-12...+12) and the values on the coordinate of the F1 field values(+4...+5...+12) and for HBV infection when the values on the coordinate in the field F2(-12...-2...+12...-12) and the values on the coordinate F1 in the interval (+2...+12) diagnosed with cirrhosis of the liver.



 

Same patents:

FIELD: medicine.

SUBSTANCE: peripheral blood thrombocytes of women suffering gestosis of various severity levels on their 32-38 weeks of pregnancy are analysed for the activity of glutathione reductase (GY), NADF-dependent glutamate dehydrogenase (NADFGDG) and NADF-dependent isocitrate dehydrogenase (NADFICDG). A nicotine amide adenine dinucleotide phosphate transfer coefficient (NTC) represented by the relation of the GY activity to a product of the NADFGDG and NADFICDG activities is calculated. At the NTC value is equal to 1.3 and lower, the newborn's Apgar score is predicted to be equal to 6 and less, and the NTC value exceeding 1.3 provides the Apgar score being 7-10 points.

EFFECT: more accurate prediction of the newborn's state.

2 tbl, 5 ex

FIELD: medicine.

SUBSTANCE: areas highly exposed to harmful chemical agents are chosen. A random group of children without clinical signs of living in this territory is tested using chemical laboratory tests of blood to identify the content of chemical compounds, which are priority chemical environmental factors on the selected area of residence and clinical and laboratory studies are conducted to determine a set of laboratory indicators of adaptation system. Then using the results of the study the average values of chemical compounds in the blood are fixed and then they are compared to the background and average values for each of the above laboratory parameters are fixed and compared to the physiological norm; deviation of this value from the normal rate reveals children bodies response to chemical exposure. Next, a causal relationship is established between the level of content of chemical compound in the blood and the response of the child body through deviation of laboratory parametres from the norm using a logistic regression model. Using method based on analysis of odds ratios the maximally inactive level of marker of exposure and corresponding response marker based on the conditions are determined under which the odds ratio that characterises the degree of the connection between exposure to a chemical compound and the body's response will be greater than or equal to one; for this a model of dependence between the level of a marker of exposure and the specified index odds ratio is designed, the parametres of the model are determined and they reflect the change in the probability using which the value of the maximally inactive level of marker of exposure is calculated, i.e. maximum ineffective concentrations of chemical compounds. From the entire spectrum of defined concentrations of certain chemical compounds for each laboratory parametre of adaptation systems choose the smallest value that is accepted as the maximally inactive concentrations on a child adaptation system for a given chemical compound i. In future diagnosis of violation of adaptation of children living in the selected area is performed by comparing the content Ci of certain chemicals in their blood with previously established value of inactive concentration for this chemical compound; and if a ratio is a violation of adaptation is diagnosed.

EFFECT: method allows diagnosing violation of children adaptation under chemical hazards of environmental factors with high precision at an early preclinical stage, with simultaneous simplicity and accessibility for a wide practical application.

5 tbl, 2 dwg

FIELD: medicine.

SUBSTANCE: zeolite antioxidant activity test is enabled by introducing a substance being tested into bodies of experimental animals. Biological products of tissues and organs of the experimental animals and control sets are prepared. Metabolic process indicator substances are evaluated. The pulmonary tissue, blood plasma, erythrocytes and thrombocytes are analysed for the content of lipid peroxidation products and natural antioxidants which are scored and summed up. The zeolite antioxidant activity is tested relatively to the normal values of the content of lipid peroxidation products and natural antioxidants which are defined as an arithmetical mean of the relevant values received in the animals of a control set.

EFFECT: enabled reliable zeolite antioxidant activity test at the enabled comparative evaluation of substances by this parametre.

2 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: vaginal fluid is analysed. The vaginal secretion is collected by means of a common tampon placed in a vagina for 8-9 hours, further weighted; microbial metabolites are extracted in equiponderate amount of distilled water, and the extract is analysed by gas-liquid chromatography. If the vaginal discharge contain acetic acid more than 0.315 mg/g and total propionic and butyric acids ≤0.200 mg/g in an age group of 17 to 34 years, and acetic acid more than 0.210 mg/g with total propionic and butyric acids ≤0.120 mg/g in an age group of 35 to 48 years, nonspecific aerobic vaginitis is diagnosed.

EFFECT: more accurate diagnosis of nonspecific aerobic vaginitis.

4 ex

FIELD: medicine.

SUBSTANCE: method of evaluating immunogenicity of brucella strains includes enzyme-linked analysis of culture supernatant of peripheral blood cells for content of cytokines - tumour necrosis factor (TNF-α), interleukin-1β (IL-1β) and colony-stimulating factor (CSF), synthesized by mononuclear cells of peripheral blood in vitro without impact (spontaneous production) and under the impact of antigens of evaluated brucella strains (induced production) and determination of their immunogenicity by ratio of spontaneous and induced production of said cytokines, brucella strains are considered immunogenic if their antigens cause enhancing of TNF-α by 1-1.25, IL-1β by 2-2.50 and CSF by 3-3.70.

EFFECT: method improvement.

1 tbl

FIELD: medicine.

SUBSTANCE: sampling of patient's lacrimal fluid (LF) is performed, analysed reaction mixture (ARM), consisting of substrate and analysed lacrimal fluid (ALF) is prepared, where as substrate, collagen gel is used. In course of ARM preparation, ALF is mixed with collagen gel in ratio 1-1.5:1 and keep at room temperature until homogeneous mixture (said ARM) is obtained. After that said ARM is applied on a microscope slide, kept until complete drying up of the entire microscope slide surface, measuring the time of complete ARM drying up. Then, quantitative determination of ALF CA is carried out by means of preliminarily built calibration curve of dependence of time of complete drying up of standardised reaction mixture samples, each of which consists of substrate and collalisin solution with specified collagenolytic activity, on collagenolytic activity. Obtained earlier ALF CA value is compared with normal values and if value of collagenolytic activity is lower than 231.8 kU/ml, lower ALF CA is determined, if the value of said activity is 231.8-297.8 kU/ml, normal ALF CA is determined, and if the value of said activity is higher than 297.8 kU/ml, higher ALF CA is determined.

EFFECT: application of the method makes it possible to increase accuracy of LF CA determination, reduce duration of determination procedure, eliminate possibility of infecting people who are carrying out the analysis.

1 dwg, 3 tbl

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to oncology, and can be used for clinical effectiveness control in children with neuroblastomas. That is ensured by neo-adjuvant combination cytostatic therapy with peripheral vein blood sampling prior to and after each course of chemotherapy. Blood is examined for plasminogen and plasmin activity to calculate the relation of the first to the second. If the value increased after chemotherapy, a therapeutic clinical effect is predicted. If the value decreased or remained unchanged throughout two courses of chemotherapy, the absence of effect is predicted that is a basis for changing the cytostatics to provide an adequate treatment.

EFFECT: method provides assessing cancer invasiveness, its invasive and metastatic potential, detecting the patients with an expected therapeutic effect, good prognosis and the patients with no effect who require timely correction of anticancer therapy to provide prolonged and improved quality of life of the patients.

2 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: invention concerns a method for prediction of the efficacy of Infliximab inclusion in a conventional therapy of the patients with rheumatoid arthritis (RA). A patient's peripheral blood is examined for total lymphocyte content (TLC) expressing TNF-α-CD120a receptors, for levels of spontaneous and stimulated production of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). It is followed by calculating indexes of PHA action on PBMC (peripheral blood mononuclear cells) TNF-α and IL-6 production by formulae respectively: IA1=Ast/Asp, IA2=Bst/Bsp, where IA1 is an index of PHA action on PBMC TNF-α production; Ast is a level of stimulated TNF-α production, pg/ml; Asp is a level of spontaneous TNF-α production, pg/ml; IA2 is an index of PHA action on PBMC IL-6 production; Bst is a level of stimulated IL-6 production, pg/ml; Bsp is a level of spontaneous IL-6 production, pg/ml. Provided IA1≤2.4 and IA2≤1.6 and TLC≥6% simultaneously, the high efficacy of Infliximab inclusion in the therapy of the RA patients is predicted.

EFFECT: invention allows reliable prediction of the efficacy of Infliximab inclusion in the conventional therapy of the RA patients.

1 ex

FIELD: medicine.

SUBSTANCE: method starts with blood sample alkalisation with 10% sodium hydroxide to pH 8-10; dichlorobromomethane is recovered from the sample by hexane extraction; the extract is separated centrifugally at 7000-7500 rpm and analysed with gas chromatography in a partition gas chromatograph with an electron capture detector, while dichlorobromomethane is measured by a calibration diagram.

EFFECT: high sensitivity and accuracy of the method for blood dichlorobromomethane measurement.

1 ex, 5 tbl

FIELD: medicine.

SUBSTANCE: excitory cells of the immune system are recovered that is followed with primary incubation of the cells with an investigated substance to produce a primary-incubation supernatant or mixed cells and supernatant; secondary incubation of the target cells with the supernatant or mixed cells and supernatant wherein the secondary-incubation target cells are understood as human tumour cells or cell lines of an oncogenetic origins; the target cells are analysed where the analysis is specified in a group including an expression analysis of specific proteins and an apoptosis and/or necrosis analysis.

EFFECT: improvement of the method.

14 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, in particular, to ultrasonic diagnostics and neurology. Duplex ultrasonic scanning of extracranial segment of internal carotid artery is carried out, and if deformity of envelope of Doppler spectrum, reduction of spectrum window and increase of linear rate of blood flow in zone of tortuosity are detected, risk of medial carotid artery microembolisation is considered to be high.

EFFECT: method extends arsenal of means for determining risk of medial carotid artery microembolisation in children with pathologic tortuosity of internal carotid artery.

4 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to ultrasonic diagnostics in gastroenterology, and can be used for determining hemodynamic significance of blood flow disturbances in celiac trunk in children. For this purpose by method of Doppler ultrasonography indices of blood flow are estimated at inhale and exhale in celiac trunk and in splenic artery 30 minutes after food load. If peak systolic blood flow rate and index of peripheral resistance in splenic artery decrease, hemodynamic significance of celiac trunk stenosis in children is determined.

EFFECT: method increases accuracy of determining significance of celiac trunk stenosis independently on initial parameters of blood flow in abdominal aorta and celiac trunk due to selection of definite conditions of diagnostics in children, which also ensures detection of causes of pain abdominal syndrome, and therefore taking preventive or therapeutic measures, including surgical intervention in due time.

2 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to urology, and can be used for treating relative sterility in varicocele. That is ensured by preoperative testicle Doppler sonography (size and volume), evaluation of spermogram and hormonal status (blood plasma testosterone concentration). It is followed by calculation of a testicle atrophy index (TAI), and if the testicle atrophy index exceeds 22 % in normal testosteronemia, and if the testicle atrophy index exceeds 15% in hypertestosteronemia, the Mannar subinguinal microsurgical varicocelectomy is required. The patients not showing any improvements of the spermogram values within 12 months after varicocelectomy are additionally prescribed with a hormone-stimulating therapy by human chorionic gonadotropin preparations.

EFFECT: method allows higher clinical effectiveness and lower drug-induced body burden due to an adequate choice of a therapeutic approach consisting in proved prescription of the hormone-stimulating therapy.

5 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to neurology and functional diagnostics, and aims at diagnosing early forms of cerebrovascular insufficiency. It involves transcranial Doppler sonography to evaluate the blood circulation values, a resistance index, with performing a counterlateral head rotation test. It is added with echocardiography to type central hemodynamics. Also, computed electroencephalography is performed. A heart rhythm variability is examined that involves orthostatic and antiorthostatic tests. Also, immune homeostasis is analysed. If observing an eukinetic type of central haemodynamics, hypersynchronous EEG-patterns; impaired adaptation-compensation potential with no load test decrease as shown by heart rhythm variability examination, lymphopenia, total metabolite growth, humoral link activation, hypoperfusion in one of a cerebral vascular circulation, initial manifestations of cerebrovascular insufficiency is diagnosed. A hypokinetic type of central haemodynamics, desynchronous EEG-patterns, considerable load test decrease of adaptation-compensation potential, lymphocytosis, hypoperfusion in two cerebral vascular circulations enable to diagnose stage 1 dyscirculatory encephalopathy.

EFFECT: technique provides differential diagnostics of the initial manifestations of cerebrovascular insufficiency and stage 1 dyscirculatory encephalopathy in mature-aged patients at the stage of observing no anatomical changes of vascular patency.

2 ex, 6 dwg

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely, to ultrasonic diagnostics, and is intended to predict development of liver impairment in patients after hemihepatectomy. Ultrasonic Doppler sonography of portal system vessels is carried out. Time of acceleration is identified in splenic artery before operation and 2 days after, and if time of acceleration increases 1.5-2.1 times, development of liver impairment is forecasted in post-operational period.

EFFECT: method is noninvasive, makes it possible to forecast development of liver impairment in patients after hemihepatectomy.

2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to surgery and functional diagnostics. Hemodynamic parametres Vmax, RI, PI are measured in point, corresponding to anatomical localisation of main stem of presenting interest artery of anterior abdominal wall. If Vmax is larger or equals 8.00, PI is larger or equals 1.50, RI is larger or equals 0.80, type of blood flow is estimated as compensated; if Vmax is 6.00-7.99, PI is 1.3-1.49, RI is 0.60-0.79 - as subcompensated; if Vmax is less than 6.00, PI is less than 1.3, RI is less than 0.60 - as decompensated. If one of hemodynamic parametres goes out of the limits of specified intervals towards increase or decrease, interpretation is performed by the smallest value towards the worsening of blood flow characteristic.

EFFECT: claimed is new method of estimation of blood flow in arteries of anterior abdominal wall.

5 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and X-ray diagnostics and is intended for selection of method of plasty of post-operational and recurrent ventral hernias. In pre-operational period ultrasonic tomography of tissues and bloodstream of anterior abdominal wall is carried out with estimation of width of hernial orifice and parameters of blood flow Vmax, RI, PI in 6 points with further interpretation in points and selection of hernioplasty method. If sum is less than 12 points, sub-lay hernioplasty is performed. If sum is from 12 to 17 points, combined hernioplasty sub-, in-lay is performed. If sum of points is larger or equals 18, hernioplasty sub-lay is performed.

EFFECT: method allows to optimise selection of tactics of surgical treatment of post-operational and recurrent hernias.

3 ex, 3 dwg, 3 tbl

FIELD: medicine.

SUBSTANCE: device for determination of injection point in area of vessel, through which performed is injection of medication in target region of patient's organism, contains: identification means for identification of topology of vascular tree vessels, feeding target region; means for flow determination for determination of percent content of medication delivered to target after injection in different potential injection points in vascular tree; means of sorting for selection as optimal injection point, of potential injection point, which leads to higher percent content of medication delivered to target. Other version of device additionally suggests presence of display means for displaying vascular tree and presenting optimal injection point. Method includes: preliminary identification of topology of vascular tree vessels, feeding target region; determination of percent content of medication delivered to target region after injection in various potential injection points of vascular tree; selection as optimal injection point, of potential injection point, which leads to higher percent content of medication delivered to target.

EFFECT: invention allows to determine quantitatively and visualise both tumour treatment efficiency and negative impact on adjacent healthy tissues.

13 cl, 6 dwg

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to ultrasonic diagnostics, and aims at the descended intestine blood supply assessment in the patients with colorectal cancer (CRC) by the intraoperative triplex scanning. It involves an intraoperative Doppler ultrasound of the inferior mesenteric artery (IMA). For this purpose, a sterile sensor is placed in an operative wound on the abdominal aorta in a projection of the IMA outlet 2-3 cm above bifurcation of the aorta in the mesenteric width, and an aorta cross-section is displayed. A duplex IMA scanning follows with the use of colour Doppler imaging and pulsed wave Doppler, the qualitative indices are measured: Doppler curve shape, Doppler spectrum type, as well as blood flow values determined in health in definite ranges wherein the IMA is described as an artery of high peripheric resistance, while blood supply of the descended transplant is considered as good; when observing quantitative discrepancies, the absence of the IMA trunk is stated, while blood supply of the descended transplant is considered as poor.

EFFECT: method allows determining intraoperative qualitative and quantitative values of the IMA blood flow in the CRC patients for operative aid planning.

1 dwg, 1 dwg, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to surgery and X-ray diagnostics, and is intended for selecting tactics of post-operational treatment of patients with ventral hernias after hernioplasty with mesh transplant. On the 5 day of post-operational period carried out is ultrasonic tomography of tissues and bloodstream of anterior abdominal wall with estimation of width of infiltration zone and blood flow indices Vmax, RI, PI in 6 points with further interpretation into points and selection of further treatment tactics. If sum is less than 14 points, no additional therapeutic measures are taken, if sum is from 15 to 18 points, conservative measures of local character are taken, physiotherapeutic impact is performed; if sum of points is higher or equals 19, puncture aspiration of liquid component under ultrasonic control and antibacterial therapy are carried out.

EFFECT: method allows to optimise selection of tactics of post-operational treatment after hernioplasty with mesh transplant, prevent, detect in due time and carry out treatment of possible complications of post-operational wound, improve treatment results.

3 ex, 3 tbl, 3 dwg

FIELD: medicine.

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.

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