Method for prediction of thrombophilic complications accompanying hip replacement

FIELD: medicine.

SUBSTANCE: it involves general clinic blood analysis, venous blood sampling and blood serum sample preparation. Then prepared blood serum is analysed for the content of an intercellular adhesion molecule 1 - sICAM-1 and the neopterin level. If the sICAM-1 content varies within 247.7÷269.7 ng/ml and the neopterin level varies within 5.54÷6.66 nmol/l, a moderate risk of postoperative thrombophilic complications is predicted. If the sICAM-1 content varies within 335.4÷382.6 ng/ml and the neopterin level varies within 7.6÷9.4 nmol/l, a high risk of postoperative thrombophilic complications is predicted.

EFFECT: use of the given method allows providing objective prediction of a high risk of the onset and development of the thrombophilic complications in the patients after hip replacement with maintaining high accurate results.

1 ex

 

The invention relates to practical medicine, clinical and laboratory diagnostics and experimental medicine and can be used in traumatology and orthopedics in forecasting high risk of the emergence and development of thrombophilic complications of hip arthroplasty.

Deep vein thrombosis and pulmonary embolism are among the most frequent complications in orthopaedic practice. After hip replacement surgery deep vein thrombosis in the absence of specific prevention are identified in 45-70% of cases [evaluation of the efficacy and safety of prolonged use of Clexan after hip arthroplasty / Glavin [and other] // Thrombosis, hemostasis and rheology. 2003. №4(16), December. Pp.61-65]. Thrombosis after joint replacement due to the high invasiveness of the surgery. Massive damage to tissues, especially bone, leads to the release into the systemic circulation of a large number of thromboplastin and other activators, that causes the development of DIC, which is manifested in the initial phase of the hypercoagulation. Due to hypercoagulability is the formation of blood clots in the lumen and the vessel wall, which contributes to slowing of blood flow, often observed in patients with prolonged restriction ACC is gnosti, specific features of the operation, the possible compression of the venous trunks. Additional risk factors are large amounts of blood loss and hemotransfusion, and the use of bone cement in total arthroplasty of large joints of the lower extremities. According to contemporary literature data thrombosis of deep veins of lower extremities after surgery replacement of large joints occur with a frequency of 3.1 to 81%. Venous thrombosis is characterized by a latent period, the difficulty of diagnosis and the constant risk of thromboembolism, including life-threatening pulmonary embolism. Treatment of deep vein thrombosis and pulmonary embolism due to their frequent asymptomatic course is often delayed and inefficient [Pervukhin S.A., Curlew PV, Tereshenkov E.V. Hemocoagulation complications and their prevention in hip and knee joint // Bulletin of intensive therapy. 2007. No. 5. S].

A known method for predicting postoperative complications in patients with degenerative-dystrophic diseases of the hip joint at the hip [RU patent for the invention №2321865]. Explore the patient's peripheral blood prior to surgery. Cells peripheral blood and incubated in the received supernatant ODA is really the level of spontaneous interleukin-1 (IL-1) and stimulated with lipopolysaccharide (LPS) and interleukin-1 (IL-1). Then the ratio of the stimulated production of interleukin-1 (IL-1) to its spontaneous level is determined by the stimulation index. When the value of the stimulation index of less than 1, 2 predict complications during the postoperative period, in other cases, the prognosis is considered favorable.

However, the implementation of this method allows to predict postoperative complications in patients with degenerative-dystrophic diseases of the hip joint at the hip, not taking into account the risk of thrombophilic complications.

Also known is a method for predicting thrombotic and thromboembolic complications in patients with degenerative-dystrophic diseases of the hip joint after surgery arthroplasty [evaluation of the prevention of thrombotic complications of hip arthroplasty/ Yezhov YOU [and others]. URL: http://orthoexpo.ru/upload/Content/Tezisy_2008.pdf (accessed on 08.06.2010)]. 7 days after the operation performed bilateral phlebography of the lower extremities by the method Rabinov & Paulin drug "omnipak" with a concentration of 350 mg of iodine per 1 ml to 200 ml per limb. Complete filling of the venous bed, without depositing, filling defects and impaired patency regarded as the absence of blood clots. The filling defects venous channel - how the presence of thrombotic what bratvany varying degrees of limitation. No flotation defects as the absence of the threat of removal of a blood clot and subsequent embolism.

However, the method is invasive, and requires additional tools.

There is also known a method of determining the risk of deep vein thrombosis of the lower extremities and pulmonary embolism in patients and orthopaedic profile [RU patent for the invention №2265853] by mathematical modeling using hemostasis. As hemostasis using tests of coagulation - T1and MA (ACT), f & TV. The value of these indicators using systematic multivariate analysis is performed using a mathematical model. Define the integral indicator of the hemostatic system during the study period after injury. The threshold values of the integral indicator is Xbi±Sbi=0,1243±0,01. The integral indicator value below these values determine how risk moderate dysfunction of hemostasis and above these values determine how high the risk of disorders of hemostasis, carries a high risk of hemorrhagic complications, thrombosis and embolism.

However, this method is used only koagulologicescoe indicators of hemostasis, which do not give information about the state of the vascular to mponent, that, in turn, reduces the accuracy of the research.

The closest analogue of the claimed invention is a method for predicting thrombophilic complications of hip arthroplasty [evaluation of the efficacy and safety of prolonged use of Clexan after hip arthroplasty / Glavin [and other] // Thrombosis, hemostasis and rheology. 2003. №4(16), December. Pp.61-65]. Preoperatively perform a complete blood count, determine prothrombin time, platelet count, concentration of D-dimers using a set of "Roche/Diagnostica Stago" method latex agglutination. After the operation is performed daily clinical monitoring to detect symptoms to suspect venous thromboembolism. The concentration of platelets determine two times a week for 3 months. Blood levels of D-dimers examined preoperatively and at 2, 10, 35, 90 day after it.

However, this method provides little information. The increase in D-dimers can occur not only when deep vein thrombosis, but also in many pathological conditions infection, inflammation, the presence in the blood of rheumatoid factor, cancer. In elderly patients, the specificity of the test for D-dimer is sharply reduced. A negative test for the presence of D-dimers is of diagnostic value is e only if you suspect a fairly extensive thrombosis.

The closest analogue, as above all the analogues, does not provide specific estimates of the forecast.

The task of the claimed invention is the provision of objective forecast of the high risk of the emergence and development of thrombophilic complications in patients after hip arthroplasty while maintaining the high accuracy of the result.

The essence of the invention is characterized by the fact that in the method for predicting thrombophilic complications of hip arthroplasty conduct a clinical study of blood, taking venous blood and prepare samples of blood serum samples, determined in the blood serum content of intercellular adhesion molecule 1 sICAM - 1 and the level of neopterin concentrations, when the values of the content of sICAM-1 in the limit 247,7÷269,7 ng/ml and the level of neopterin concentrations in the limit 5,54÷6,66 nmol/l predict a moderate risk thrombophilic complications in the postoperative period, when the values of the content of sICAM-1 in the limit 335,4÷382,6 ng/ml and the level of neopterin concentrations in the limit of 7.6÷9.4 nmol/l predict a high risk of thrombophilic complications in the postoperative period.

The technical result of the claimed inventions

The inventive method allows comparison with known technologies to improve objectives the ü forecast risk thrombophilic complications of hip arthroplasty and implement an earlier prediction, thus timely preoperative preparation of patients.

Developed by the present method technology expands the Arsenal of tools to objectively monitor the status of patients with hip arthroplasty.

The way technically and technologically with the first manipulation until almost the last operation - processing of the data, since all manipulations: blood sampling, selection and preparation of samples, the order of steps in the present method are the signs of technically actions.

The inventive method is as follows.

Initially, patients with degenerative-dystrophic diseases of the large joints, such as spondylosis, before the surgery carried out physical examination using standard methods, i.e. conduct a complete blood count, coagulation tests - determine APTT, thrombin time, fibrinogen, prothrombin time Quick, XII dependent fibrillates,; fibrin monomer complex, the number of platelets and the concentration of D-dimers. The criterion of high risk thrombophilic disorders is increased levels of D-dimer in plasma >3.0 mg/ml based on the obtained results exclude from further study of patients with signs of thrombosis, remove them from the operation.

Then continue to study for those sick who, to whom it is suitable. Produce a sample of venous blood in a test tube 5 ml by centrifugation get the serum. Define obtained in the serum content of intercellular adhesion molecule 1 sICAM - 1 and the level of neopterin concentrations, the results of which are:

when the content of sICAM-1 in the limit 247,7÷269,7 ng/ml, and the level of neopterin concentrations in the limit 5,54-6,66 nmol/l predict a moderate risk thrombophilic complications in the postoperative period;

when the content of sICAM-1 in the limit 335,4÷382,6 ng/ml, and the level of neopterin concentrations in the limit of 7.6-9.4 nmol/l predict a high risk of thrombophilic complications in the postoperative period.

In the preoperative and early postoperative periods use individual tactics introduction patients depending on the prediction results.

Example.

Patient B., aged 45, was admitted to the hospital for surgery. Diagnosis: Bilateral dysplastic coxarthrosis III-IV severity. Shebalino-leading contractures of both hip joints. The asymmetry of the pelvis. Persistent pain syndrome".

Before the operation was conducted physical examination using standard methods, including defined the content of D-dimer in plasma <0.5 mg/ml According to the obtained results evidence of thrombosis was not found. Carried out the sampling of venous blood is blood and prepared samples of blood serum samples. Content in the sample serum intercellular adhesion molecule 1 sICAM - 1 was 248,2 ng/ml and the level of neopterin concentrations 5,56 nmol/l Predicted a high risk of thrombophilic complications in the postoperative period.

Spent surgery: total hip arthroplasty.

In the preoperative and early postoperative period used individual tactics introduction of the patient, including the appointment of medicines.

On the 5th day after surgery the patient has made the sampling of venous blood 5 ml Blood stabilized with sodium citrate in the standard ratio of 9:1, receiving the plasma, which determined the concentration of D-dimer, equal to 0.6 µg/ml, indicating a moderate risk of thrombophilic complications in the postoperative period.

The conclusion about the possibility of thrombophilic risk of complications in the postoperative period and the correct choice of doing preoperative preparation was confirmed.

A method for predicting thrombophilic complications of hip arthroplasty, characterized in that conduct clinical analysis of blood, taking venous blood and prepare samples of blood serum samples, determined in the serum with the holding of intercellular adhesion molecule 1 - sICAM-1 and the level of neopterin concentrations, when the values of the content of sICAM-1 in the limit 247,7÷269,7 ng/ml and the level of neopterin concentrations in the limit 5,54÷6,66 nmol/l predict a moderate risk thrombophilic complications in the postoperative period, when the values of the content of sICAM-1 in the limit 335,4÷382,6 ng/ml and the level of neopterin concentrations in the limit of 7.6÷9.4 nmol/l predict a high risk of thrombophilic complications in the postoperative period.



 

Same patents:

FIELD: medicine.

SUBSTANCE: surgery material is subject to immunohistochemical and pathomorphological analysis. A Ki-67 antigen expression level and a mutant p53 oncogene expression level are determined. An average diameter of malignant cell nuclei, or the presence or the absence of nucleoli in the malignant cell nuclei are evaluated with the presence or the absence of the nucleoli in the malignant cell nuclei are stated at various magnifications, while cariometry is enabled with a certain minimum count of renal cell carcinoma cell nuclei. The predicted oncological survival rate is calculated by formula: Ymbv=1.83X1+1.45X2+1.18X3, where Ymbv is a morphobiomolecular value; X1 is a histological malignancy degree in points; X2 is the Ki-67 expression level in points; X3 is the p53 expression level in points. The histological malignancy degree is shown by the average diameter of the malignant cell nuclei, or the presence or the absence of the nucleoli in the malignant cell nuclei. The Ymbv value ≤6.29 shows a favourable prognosis for the oncological survival rate in the patients; the Ymbv value 6.82-8.92 provides a relatively favourable prognosis, while the Ymbv value 9.19-11.55 enables to state a relatively unfavourable prognosis, and an unfavourable prognosis is given by the Ymbv value > 11.55.

EFFECT: higher prediction accuracy.

5 dwg, 11 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to field of medicine, namely to hepathology and pediatrics. In order to predict exacerbations of chronic viral hepatitis B in teenagers, blood test is performed. By means of bioluminescent method determined is activity of lymphocyte enzymes in peripheral blood of patients: glucose-6-phosphate dehydrogenase (G6PDG) and lactate dehydrogenase (NADN-LDG), ratio of activities is calculated. If value of obtained index is equal or is higher than 1.15 exacerbations are predicted, if index value is lower than 1.15, absence of exacerbations is predicted.

EFFECT: method makes it possible to predict exacerbations of chronic viral hepatitis B in teenagers with clinical-biochemical remission with high accuracy.

4 ex, 2 tbl

FIELD: medicine.

SUBSTANCE: formation of a risk group of neoplastic disorders in a cervical epithelium is carried out by IF staining of a cervical epithelium smear with using a monoclonal antibody reacting with a sialylated conformational glycopeptide antigen determinant as a part of MUC1 followed by with cell finish staining with chromogenic nuclear stain. The sample is examined by alternated fluorescent light and transmission light. Each cell with a depolarised stained surface membrane detected by fluorescent light is examined in transmission light. If the cells with the depolarised stained surface membrane detected by fluorescent light show cytological symptoms of dyscariosis, and/or proliferative parabasal cell complexes with no symptoms of dyscariosis show depolarised stained surface membranes or granular stained cytoplasm, a patient is subsumed to the risk group of the presence of neoplastic disorders in the cervical epithelium.

EFFECT: higher analysis accuracy.

5 dwg

FIELD: medicine.

SUBSTANCE: whole blood is examined for a manganese level and two laboratory values, namely: a plasma antioxidant activity level and a plasma malonic dialdehyde content. Further, the correlation analysis of the specified laboratory values and the blood manganese level is performed, and if observing the authentic dependences simultaneously: the high blood manganese level - the low blood plasma antioxidant activity level, the high blood manganese level - the high blood plasma malonic dialdehyde level, the low blood plasma antioxidant activity level - the high blood plasma malonic dialdehyde level, manganese action is considered to be toxic.

EFFECT: higher accuracy and information value of the determination procedure.

2 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medicine and can be used for prediction of unfavourable yearly prognosis of ST-elevation myocardium infarction (STEMI). When patient is taken to hospital, class of cardiac failure and content of interleukin IL-12 in blood plasma are taken into account. Probability of myocardial infarction unfavourable yearly prognosis is estimated by mathematical formula applying independent variables and obtained in examination constants.

EFFECT: increase of accuracy of myocardial infarction unfavourable outcome prediction due to taking into account interleukin IL-12 content.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: LAKK-02 apparatus is used to evaluate a capillary blood flow reserve in two iontophoresis sampled taken from skin of a left forearm in a point along a median line 4 cm higher than styloid process of ulna and radius. An endothelial function coefficient EFC is calculated by formula: where AC BFR is the capillary blood flow reserve in response to acertylcholine; SN BFR is the capillary blood flow reserve in response to sodium nitroprusside. If the EFC value is lower than 1.0, a disturbed microvascular endothelium vasoregulation is stated.

EFFECT: use of the invention allows simplifying diagnostics of the microvascular endothelium status in patients with bronchial asthma.

3 ex

FIELD: medicine.

SUBSTANCE: biopsy materials of a mucous membrane of a gastric corpus and a duodenum are analysed for mast cell count per 100 cells of infiltrate. At detecting more than 3.5 mast cells per 100 infiltrate cells in the biopsy materials of the mucous membrane of the gastric corpus and more than 4.75 cells per 100 infiltrate cells in the biopsy materials of the mucous membrane of the descending duodenum, immunohistochemistry or PCR diagnostics are required. If detecting Epstein-Barr virus antigens or DNA in the biopsy materials of the gastric and duodenal mucosa, EBV associated gastroduodenitis is diagnosed.

EFFECT: use of the technique allows diagnosing EBV associated gastroduodenitis in children.

2 ex

FIELD: medicine.

SUBSTANCE: biological material sampled from a patient's tympanic cavity is analysed for the presence of any extracellular agents of CO by a microbiological method. The PCR-EF method is used to analyse the smears of the middle ear mucosa for the presence of DNA of any endocellular agents of CO. The combined detection of the presence of any extracellular agents in purulent discharge of the middle ear, and the presence of DNA of any extracellular agents in the smears of the middle ear mucosa enables diagnosing chronic purulent othelcosis.

EFFECT: use of the declared method allows providing higher diagnostic reliability of chronic othelcosis.

2 ex

FIELD: medicine.

SUBSTANCE: invention describes a method of determination of ethanol and other metabolites content in human blood by liquid phase chromatography, including preparation of blood distillates by vapour straight distillation and blood component analyis, characterised by the fact that it is combined with one-stage quantitative determination of ethanol, diethyl ester, acetaldehyde, acetone, methylacetate, ethylacetate, propyl alcohol, isobutyl alcohol, butyl alcohol, isoamyl alcohol with the use of capillary chromatographic columns; the concentration of the determined blood components is calculated by formula: where a is chromatographic study results, mg/dm3; V is a distillate volume, cm3; m is a whole blood weight, g.

EFFECT: method can be used in clinical laboratory diagnostics in studies of metabolic disorders caused by alcohol poisoning, and in judicial medical activity for diagnosing of a degree of intoxication of live persons.

1 ex, 1 tbl, 2 dwg

FIELD: medicine.

SUBSTANCE: patients in their 16 weeks of pregnancy initiated by ART methods are examined for fibrinogen levels, and chorion volume is calculated by formula: V =π/6∙ABC (cm3), where A is a maximum length, B is a maximum width, and C is a maximum thickness of the chorion measured by ultrasonic examination. Further, a prognostic index is calculated: F=1.35*FG-0.02*V-5.75, where FG is fibrinogen levels (g/l), V is chorion volume (cm3), const - 5.75. If the F value is less than 0, favorable prognosis for a foetus is considered, while F more than 0 shows a high probability of intrauterine growth retardation.

EFFECT: use of a method allows higher prediction accuracy of intrauterine growth retardation in the second trimester of pregnancy after auxiliary reproductive technologies.

2 ex

FIELD: medicine, psychiatry.

SUBSTANCE: one should isolate DNA out of lymphocytes of peripheral venous blood, then due to the method of polymerase chain reaction of DNA synthesis one should amplify the fragments of hSERT locus of serotonin carrier gene and at detecting genotype 12/10 one should predict the risk for the development of hallucino-delirious forms of psychoses of cerebro-atherosclerotic genesis.

EFFECT: more objective prediction of disease development.

3 ex

FIELD: medicine, urology.

SUBSTANCE: one should conduct subcutaneous prevocational tuberculin test and, additionally, both before the test and 48 h later it is necessary to perform the mapping of prostatic vessels and at decreased values of hemodynamics one should diagnose tuberculosis. The information obtained should be documented due to printing dopplerograms.

EFFECT: more reliable and objective information.

1 ex, 1 tbl

FIELD: molecular biology.

SUBSTANCE: the suggested innovation deals with the fact that nucleic acids should be isolated directly out of the sample without pipetting stage but with the help of interconnected reservoirs being prepared beforehand. The above-mentioned vessels should be applied either separately or being interconnected according to standard microtitrating format. The sample should be mixed with a lyzing buffer and nucleic acids are bound with matrix in closed system including, at least, two interconnected reservoirs. Forced movement of sample's mixture and buffer back and forth from one reservoir into another one for several times through narrow passage provides their thorough intermixing. The method provides quick and safe isolation of nucleic acids.

EFFECT: higher efficiency.

44 cl, 4 dwg, 1 ex

FIELD: medicine, phthisiology, microbiology.

SUBSTANCE: diagnostic material is poured preliminary with chlorohexidine bigluconium solution, homogenized, kept at room temperature for 10-12 h and centrifuged. Precipitate is poured with Shkolnikova's liquid medium, incubated at 37oC for 3 days, supernatant part of Shkolnokova's medium is removed, fresh Shkolnikova's medium is added, and precipitate is stirred and inoculated on the dense cellular egg media. Sensitivity of the strain is determined in 3 weeks by the presence of growth in the control tube only. Invention provides enhancing precision and reducing time for assay. Invention can be used in assay for medicinal sensitivity of tuberculosis mycobacterium.

EFFECT: improved assay method.

3 ex

FIELD: medicine, biotechnology, pharmacy.

SUBSTANCE: invention relates to agents used for treatment of pathological states associated with disorder of synthesis of neuromediating substances. Method involves the development of pharmaceutical composition and a method for it preparing. Pharmaceutical composition represents subcellular synaptosomal fractions: synaptic membranes, "light" synaptosomes and "heavy" synaptosomes prepared from gray matter of cerebral hemispheres from experimental animals based on the goal-seeking modification of humoral mediators of nerve endings transformed to synaptosomes in development and regression of malignant processes. The composition provides inhibiting the growth of tumor cells, to elevate span-life of patients with ascite Ehrlich's sarcoma, breast adenocarcinoma Ca-755, Wolker's carcinosarcoma-256.

EFFECT: valuable medicinal and anti-tumor properties of composition.

12 cl, 3 tbl, 3 ex

FIELD: medicine.

SUBSTANCE: method involves carrying out microscopic examination of blood serum samples taken from femoral vein and cubital vein. Femoral vein sample is taken on injured side. The examination is carried out before and after treatment. The blood serum samples are placed on fat-free glass slide in the amount of 0.01-0.02 ml as drops, dried at 18-30°C for 18-24 h. The set of pathological symptoms becoming larger or not changed after the treatment in comparison to sample taken before treatment, and morphological picture of samples under comparison taken from the cubital vein showing no changes or being changed to worse, the treatment is considered to be effective.

EFFECT: enabled medicamentous treatment evaluation in course of treatment to allow the treatment mode to be changed in due time; avoided surgical intervention (amputation); retained active life-style of aged patients.

4 dwg

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

FIELD: medicine, juvenile clinical nephrology.

SUBSTANCE: disease duration in case of obstructive pyelonephritis should be detected by two ways: either by detecting the value of NADPH-diaphorase activity, as the marker of nitroxide synthase activity in different renal department and comparing it to established norm, or by detecting clinico-laboratory values, such as: hemoglobin, leukocytes, eosinophils, urea, beta-lipoproteides, lymphocytes, neutrophils, the level of glomerular filtration, that of canalicular reabsorption, urinary specific weight, daily excretion of oxalates, arterial pressure, and estimating their deviation against average statistical values by taking into account a child's age.

EFFECT: higher efficiency of detection.

7 dwg, 1 ex, 6 tbl

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.

2 ex

FIELD: medicine, biology.

SUBSTANCE: invention relates to nutrient medium used for accumulation of cells for the following cytological and/or immunocytochemical analysis carrying out. Invention relates to medium containing salts NaCl, KCl, anhydrous CaCl2, MgSO4 x 6 H2O, MgCl2 x 6 H2O, Na2HPO4 x 2 H2O, KHPO4, NaHCO3, and also glucose and Henx's solution, 10% albumin solution and polyglucin taken in the ratio 1:1:1. Invention provides enhancing the preservation of cells.

EFFECT: improved an valuable properties of nutrient medium.

3 ex

Up!