Method of treating hyperparathyreosis
SUBSTANCE: method of treating hyperparathyreosis involves patient's blood sampling prior to a surgery by excision of parathyroid adenoma vessels, removal of the adenoma, blood sampling in 5 and 10 minutes after excision of an adenoma vascular pedicle, parathyroid hormone ELISA test involving centrifugation of the samples, cultivation of the prepared centrate in plates containing ELISA reagents, ELISA interruption before a stabilisation phase by washing of the and adding chromogen then, evaluation of optical density of the solutions containing patient's blood serum, with considering a successful surgery and stating no need of bilateral neck cavity exploration required in observing the decrease of optical density of the solution sampled after adenoma resection in comparison with a pre-operative sample more than twice; the blood samples are centrifuged for 30-40 sec; the blood samples are divided into a number of portions and placed in different plate wells containing the ELISA reagents, incubation interruption and optical density analysis of the solution are performed simultaneously in three different samples making a series, and incubation time of the first series makes 5 minutes, and duration of incubation of the following series differs by 1 minute, and a success criterion is a relative decrease of optical density of the pre- and post-operative solutions. The analysis result is considered to be negative in the absence of the decrease of optical density of the pre- and post-operative solutions in the samples 10 minutes after of blood sample cultivation.
EFFECT: decreasing intraoperative injuries and improved cosmetic effect herewith maintaining a high level of operational efficiency and considerably reduced operation length.
2 cl, 1 ex
The invention relates to medicine, more specifically to methods of treatment of diseases of the parathyroid glands, namely hyperparathyroidism.
Currently, the most widespread method for the treatment of hyperparathyroidism associated with the formation of the patient adenomas of the parathyroid glands, is a bilateral surgical revision of the cavity of the neck with the visual determination of the state of the parathyroid glands, identifying adenomatosna modified parathyroid gland and removing it. This method is highly efficient and results in most (to 92.8%) cases to normalize the level of parathormone after the operation and restoration of normal parameters of calcium and phosphorus metabolism [Russel C.F., Edis A.J. Br. J. Surg., 1982. - V.69. - P.244-247].
However, bilateral revision of the cavity of the neck is quite traumatic intervention, carried out through the skin incision length of 7-8 cm, and is accompanied by tissue injury of the neck on both sides with subsequent scar formation process in the area of operation. In addition, when it is used, there is increased likelihood of postoperative hypoparathyroidism [Tibblin S., Bondeson A.G., Ljungberg O. Ann. Surg. 1982. - V.195. - P.245-252].
There is a method of treating hyperparathyroidism, which consists in conducting unilateral revision of the cavity of the neck with the visual determination of the state of colomitos is the breaking glands only on one side (right or left) of the [S.I. Roth, Wang C.A, J.T. Potts Hum. Pathol. 1975. - V.6. - P.645-648]. Definition of the side of the body which carried out audit of the parathyroid glands, is made on the basis of the preoperative examination, including ultrasound and subtraction scintigraphy with technetium. Such surgery can achieve cure of hyperparathyroidism in 88.8% of cases, while reducing trauma intervention compared with bilateral revision of the cavity of the neck [Bergenfelz A. et al. Ann. Surg. 2002. - V.236. - R-551].
However, the cosmetic effect of unilateral revision of the cavity of the neck is similar to the effect of bilateral revision. In addition, the probability of persistence of hyperparathyroidism after unilateral revision exceeds the risk after bilateral revision, because visually inspected not all of the parathyroid glands, resulting in a still presence in the body of the patient the second, not identified in the diagnostic phase, the adenoma. The frequency of occurrence of double adenomas of the parathyroid glands is up to 15%, i.e. is sufficiently high [Siperstein A. et al. Surgery. 2004. - V.136. - R-880].
There is a method of treating hyperparathyroidism, which consists in selective parathyroidectomy, i.e. the removal of adenoma of the parathyroid gland without revision of the remaining parathyroid glands [Udelsmn R. Ann. Surg. 2002. - V.235. - P.665-670]. Localization of the affected parathyroid gland is determined by the results of ultrasound and scintigraphy of the parathyroid glands, and removal of adenomas is performed through an incision of small size (2-5 cm), which improves the cosmetic result of the operation and reduces the severity of postoperative pain. However, there is a probability of persistence of hyperparathyroidism after surgery, associated with the possible presence in the body of the second adenoma of the parathyroid gland.
The closest to the technical nature of the claimed method is selective parathyroidectomy, in which the absence of the second adenoma is controlled by changing the level of parathormone serum after 5 or 10 minutes after removal of the adenoma [Bergson E.J. et al. Arch. Otolaryngol. Head Neck Surg. 2004. - V.130. - N.1. - P.87-91]. Measurement of hormone levels carry out enzyme-linked immunosorbent assay, which includes centrifugation of the blood sample within 5 minutes, the room received serum in wells containing fixed to the solid phase antibodies to parathyroid hormone, and conjugate the antibody-enzyme, incubating for 30 minutes. Then the wells are washed, removing the unbound portion of the conjugate, make a solution of substrate (Chromogen)to measure the optical density about the s and determine comparing with the calibration curve, the number of parathormone in the sample in PG/ml or pmol/L. the decline of the level of parathormone in the serum of more than 50% of the initial preoperative level is considered to be evidence of the lack of additional adenomas of the parathyroid glands in a patient, which allows the surgeon does not conduct bilateral revision of the cavity of the neck to determine the status of the remaining parathyroid glands.
The disadvantage of this method is the length of the laboratory analysis is not less than 40 minutes, including 5 minutes spent on centrifugation of the blood sample, 30 minute - incubation (30 minutes is the stabilization of the formed complexes of the antibody-antigen-antibody-enzyme), 5 minutes by washing the sample, adding Chromogen solution, reading the results of a study comparing the result with the calibration curve and the results in the selected measurement units. In the result, there is a need for long waiting for the results of laboratory studies during the operation, which greatly extends its length.
Technical problem on which this invention is directed, is the reduction of the operation time of patients with primary hyperparathyroidism by conducting selective parathyroidectomy with intraoperative determine the population dynamics of changes in the level of parathormone blood.
The basis of the decision task was based on the problem of finding such a mode of processing blood, which would allow to obtain data about the absence of additional adenomas of the parathyroid glands in a shorter time. During the experiments it was found that technical result can be achieved by carrying out centrifugation for 30-40 with blood samples taken 1 minute before the cut-off vessels adenoma of the parathyroid gland, and after 5 and 10 minutes after the cut-off vessels adenoma with subsequent simultaneous cultivation of each of the samples on multiple wells and simultaneous interruption of the immune response after every 1 minute of starting with 5 minutes in three different samples, forming a series, at different periods of incubation by washing the wells followed by the addition of the Chromogen and the measurement of the optical density of the obtained solutions with the registration of the reduction optical the density of the solution obtained by the processing of blood samples taken after the cut-off vessels adenomas, more than 2 times compared with the solution obtained by processing samples immediately before the cut-off vessels adenomas, the test is considered positive, and bilateral revision of the cavity of the neck is not performed. As a rule, the examination is carried out up to 10 minutes cultivation inclusive. No set is on result within 10 minutes of cultivation is considered as indicating the presence of the second adenomas.
Laboratory investigation of all three blood samples are produced simultaneously, which enables the analysis of the results of a typical calibration curve of the analyzer as the analyzer calibration in the study of all three blood samples is the same, and additionally to reduce the time of getting results, and enable automated analysis of samples.
The proposed method allows to replace the calculation of the level of parathormone in the blood in absolute values for the comparison between the optical density of the corresponding solutions. As from the start of incubation curves of the binding of immune components (antibodies, hormone molecules, complexes of antibody-enzyme") in solutions containing the blood plasma of the patient before the cut-off vessels adenomas and after 5 and 10 minutes after the cut-off vessels, are expressed offset from each other, the difference in optical density after the addition of the Chromogen is fixed reliably at an early period of incubation. In most cases, the drop in optical density 2 times detected already after 4-5 minutes of incubation, and therefore the test result can be obtained much earlier than would be achieved by a stabilization phase (30 minutes).
The drawing shows the differences in the curves of variation of the optical p is h solutions obtained by treatment of the blood plasma of the patient taken before removal of the adenoma (upper curve) and after 5 minutes after its removal (lower curve). As an example, the selected measurement results of the relative density of the solution, expressed in relative light units (RLU), between the test samples on the incubation period of 4 minutes.
The nature and advantages of the proposed method, and industrial applicability of the invention are illustrated by the following examples.
Example 1. In the clinic UHF STMTS University in the period from September 2010 to February 2010 were in the treatment of 35 patients with a diagnosis of Primary hyperparathyroidism". In all patients the localization of adenomas of the parathyroid gland was determined before surgery by using ultrasound and subtraction scintigraphy with technetium.
Patients was carried out surgery in volume selective parathyroidectomy (in 20 cases in the traditional way, in 15 cases by using videoassistance methods of removal of adenomas). The size of the skin incision ranged from 1.5-2 cm in videoaccelerator.com method of operating up to 3-3,5 cm in the traditional intervention.
In 33 cases, the use of preoperative data of the survey allowed us to localize the adenoma of the parathyroid gland in perational wound. After mobilization adenomas, 1 minute before crossing vessels adenomas, conducted the sampling of venous blood of the patient, after which the leg of adenoma was kopirovali and crossed. After 5 and 10 minutes after clipping and crossing vascular pedicles adenomas conducted sampling of venous blood, after which all three samples were simultaneously placed in a centrifuge and centrifuged for 30 seconds at a speed of 3000 rpm.
After 30 seconds of each tube were selected part of the blood serum, which was transferred into wells for enzyme immunoassay and placed in immunoassay analyzer. Incubation of blood samples with standard reagents for immunoassay (time to reach the phase stabilization of the enzyme reaction for a used set of reagents for 30 minutes) was carried out at room temperature in several wells. The immune reaction was interrupted in three samples simultaneously through 2, 3, 4, 5, 7, 8, 9, 10 minutes by rinsing the appropriate wells followed by the addition of the Chromogen solution. Conducted analysis of the optical density of the obtained solutions, expressed in relative light units (RLU, Relative Light Unit). Based on the results of this analysis were decided on the need for bilateral revision cavity neck is whether the termination of the operation. In the fall of optical density more than 2 times in samples obtained after 5 or 10 minutes after removal of adenomas, compared with the sample obtained prior to removal of the adenoma, the test result is considered positive, in connection with which the operation was stopped and had stitches on the wound. In the absence of the dynamics of the decline in optical density or by increasing its held bilateral revision of the cavity of the neck.
The tube with the rest of the blood and deposited on the bottom of the shaped elements continued centrifuged for 4.5 minutes, then was removed from the tubes serum. This part of the serum was placed in immunoassay analyzer, and incubated according to the standard scheme (incubation 30 minutes, rinse, adding Chromogen, reading results, the calculation of the absolute level of parathormone in pmol/l by comparison with a standard calibration curve).
In 17 cases, patients noted a decline in the optical density of the solutions obtained during the processing of blood samples taken after 5 and 10 minutes after removal of the adenoma in 2 times in comparison with the optical density of the solution, obtained by treatment of the blood serum of the patient taken before the cut-off vessels adenomas, when the time of incubation in 4 minutes, in 3 cases - when the time of incubation in 5 minutes, in 3 cases - when the time of incubation in 7 mi the ut, in 7 cases, with the time of incubation for 8 minutes, in 2 cases - when the time of incubation in 10 minutes. A similar result was seen as showing the absence of a second adenoma of the parathyroid gland in a patient, and therefore surgical intervention was limited to selective parathyroidectomy, and bilateral revision of the cavity of the neck was not conducted. All patients in this group after 2 months after surgery remained normal levels of parathormone and ionized calcium blood, testified to the recovery. The average incubation time of the blood sample to obtain diagnostic response test was 5,14 minutes.
In 2 cases after removal of a lesion identified in the area of the expected location of the adenoma, the decline in the optical density of the solutions obtained by treatment of a patient's blood, taken after 5 and 10 minutes after removal of the adenoma was only 10% of baseline after 10 minutes of incubation, and in 1 case it was noted the increasing level of optical density. In these cases there was bilateral revision of the cavity of the neck. In 2 cases after revision cavity neck was revealed adenoma of the parathyroid gland, located near the site of the initial audit, but not the remote surgeon (the tissue that is deleted during the initial audit, subsequent the m histological examination was recognized as a lymph node), and in 1 case the identified second adenoma of the parathyroid gland, located on the opposite side of the neck. After removal of adenomas by bilateral revision of the decline in optical density corresponded diagnostic: in all patients the optical density of the solutions obtained by treatment of a patient's blood, taken after 5 and 10 minutes after removal of the adenoma, under cultivation for 5 minutes decreased 4 times. All patients who underwent bilateral revision cavity neck, 2 months after surgery remained normal levels of parathormone and ionized calcium blood, testified to the recovery.
The survey research of parathormone blood, expressed in absolute figures, showed similar results. In any case, there were no differences between the dynamics of reduction of the level of optical density and dynamics of the lower level of parathormone blood. However, the assessment of the absolute level of parathormone was possible only after 30-40 minutes after taking the sample.
Thus, the inventive method allows to reduce the analysis time while maintaining a high level of efficiency of operations, improve the accuracy of determining the dynamics of the decrease of optical density using a simultaneous laboratory analysis of all three samples is Ravi, that allows you to conduct research in the most similar conditions and the same calibration status of the instrument.
A modified method of treatment to reduce the morbidity of surgical intervention and improve cosmetic results while significantly reducing its duration compared to the prototype; to reduce the probability of persistence of hyperparathyroidism after surgical treatment.
1. A method of treating hyperparathyroidism comprising sampling the patient's blood before the operation, cut-off vessels adenoma of the parathyroid gland, removal of the adenoma, the sampling of blood after 5 and 10 min after clipping vascular pedicles of the prostate gland, the determination of parathormone enzyme-linked immunosorbent assay, comprising centrifuging samples, culturing the obtained supernatant tablets containing reagents for immunoassay, interrupt the immune response to achieve its stabilization phase by washing the wells followed by the addition of the Chromogen, the determination of the optical density of the solutions containing the serum of the patient, followed by a decision about the success of the operation and without bilateral revision cavity neck while reducing the optical density of the solution taken after resection of the adenoma what about the comparison with sample taken before surgery more than 2 times, characterized in that the blood samples are centrifuged for 30-40 C, blood samples are divided into several pieces and placed in different wells containing reagents for immunoassay, interruption of incubation and analysis of the optical density of the solution is carried out in parallel in three different samples, forming a series, and the incubation time of the first episode is 5 minutes and the duration of incubation following series differ from each other for 1 min, and as a criterion of success of the operation using a relative decline in the optical density of the solutions taken before and after resection.
2. The method according to claim 1, characterized that the result of the analysis is negative in the absence of reducing the optical density of the solutions taken before and after resection in the samples after 10 min culturing blood samples.
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.
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
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
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.
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.
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
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.
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.
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.
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
SUBSTANCE: invention relates to medicine and is intended for creation of conditions for bone tissue regeneration during direct dental implantation. X-ray examination is performed. "Cause" tooth is anesthetised and extracted. Hole is processed with anseptics. Bone bed is prepared. Cylindrical nickelide-titanium implant is installed. Free space between implant and bone tissue in area of alveolus edges is filled with osteoplastic material "Bio-Oss", soaked with enriched with platelets patient's plasma. Bone wound with installed implant is covered with nickelide-titanium mesh with cell area 0.077 mm2 and position is fixed with nickelide-titanium pins. After that it is covered with resorbable membrane "Bio-Gide", overlapping defect edges on 4-5 mm. Mucous-periosteal flap is mobilised and wound is sutured hermetically without tightening. Antiseptic processing of oral cavity is carried out by 10 ml of 1% dioxydin solution. Outside part of face in projection of operated part is processed by polychromatic non-coherent polarised light with wavelength 400-2000 nm, density of light energy flow 2.4 J/cm2, degree of polarisation at outlet 95-98% for 2-4 minutes during 5-7 days. Sutures are removed after 8-12 days.
EFFECT: method makes it possible to perform bone plasty during direct dental implantation with restoration of lost bone in multiwall and single-wall defects.
4 dwg, 1 ex
SUBSTANCE: group of inventions relates to medicine. According to the first and second versions apparatus contains device for pumping bone-substituting material into vertebra body and bearing catheter tube with canal and connected with it supercharger of liquid under pressure into hermetically fixed in distal end of bearing catheter tube dilatation balloon from elastic stretchable material. According to the first version apparatus includes electric magnet with output to source of alternating current and made with possibility to be installed on patient's body along spine. Into distal part of dilatation balloon introduced are ferromagnetic elements. Electric magnet is made with possibility to create alternating magnetic field and influence with it on ferromagnetic elements in order to provide jerk-oscillatory movements in distal part of dilatation balloon. According to the second version apparatus has implementation of dilatation balloon with introduced into proximal part frame-like stopper of unfolding balloon from non-stretchable material. Liquid supercharger has hydropulse modulator, which has output to generator of electric pulses. Hydropulse modulator is made with possibility to create hydropulses for performing by them influence on dilatation balloon and creation of translational jerk-oscillatory movements in distal part of the latter.
EFFECT: inventions ensure treatment of compression fractures of vertebra bodies due to delicate impact on bone spongy tissue by soft, translational, jerk, oscillatory movements of distal part of dilatation balloon, which make it possible to overcome compression, impeding with complete restoration of vertebra body height, contributes to its smoothing, as well as denser "packing" of vertebra fragments around formed cavity.
7 cl, 2 dwg
SUBSTANCE: invention relates to medical equipment, in particular to instruments for traumatology, neurosurgery, vertebrology, and can be used for reconstruction of vertebra in process of performing surgery by technology of balloon kyphoplasty. Apparatus contains device for pumping bone-substituting material into vertebra body, bearing catheter tube with canal for pumping liquid under pressure into hermetically fixed in distal end of bearing catheter tube dilatation balloon from elastic stretchable material with located above it proportionate protective envelope, provided with fixers. Protective envelope is made proportionate to dilatation balloon from medical material, with cells, formed by crossing threads. Protective envelope does not let through particles of bone-substituting material and does not prevent flows of form elements of blood from passing through injured vertebra. Fixers are made in form of elongated elements from metal, fixed in places of threads crossing or are interweaved into protective envelope, and which protrude outwards from protective envelope with possibility of penetration into bone tissue.
EFFECT: invention ensures stable position of straightened and restored by means of dilatation balloon vertebra body, including position at the moment of balloon blowing out before pumping bone-substituting material.
3 cl, 4 dwg
SUBSTANCE: invention relates to medicine, namely to vertebrology. Into injured body of vertebra dilatation balloon is introduced under apparatus visual control. By unfolding dilatation balloon by liquid under pressure height of vertebra body is restored. After that dilatation balloon is blown out and removed from formed cavity inside vertebra and formed cavity is filled with bone-substituting material. Additionally, delicate impact on bone tissue during height recovery is performed by transmitting translational jerk-oscillatory movements to dilatation balloon.
EFFECT: method makes it possible to ensure maximally possible restoration of height of injured vertebra body.
2 cl, 4 dwg
SUBSTANCE: invention relates to medicine, namely to traumatology. Soft tissues are dissected on the centre of kneecap from its base to tibia tuberosity. After that, kneecap is exposed layer-by-layer. Wedge-shaped osteotomy is carried out by dissection in sagittal plane of quadriceps tendon, kneecap, its own ligament and tibia tuberosity with possibility to ensure separation from central portion of own kneecap ligament of autograft with two bone blocks from kneecap ligament and tibia tuberosity.
EFFECT: claimed operative access provides possibility to maximally visualise through one cut anatomic formations of anterior parts of knee joint cavity and carry out their complete revision, perform taking of autograft for plasty of anterior cruciate ligament, reduction of trauma and postoperative complications, reduction of treatment terms.
SUBSTANCE: invention relates to field of medicine, namely to reconstructive surgery and traumatology. Into composition of autograft in a single complex included are periosteum of tibia, tibia fragment, fragment of long extensor of the first toe, portion of anterior tibial muscle, anterior tibial artery and commitant veins. In projection of intermuscular furrow of anterior group of shin muscles exposed is anterior tibial vascular-nervous fascicle with mobilisation and bringing aside of deep peroneal nerve. On vascular connections from anterior tibial vascular fascicle in the single complex on muscular branches exposed is portion of anterior tibial muscle, fragment of long extensor of the first toe in form of muscular sleeve, septal vascular branches from anterior tibial vascular fascicle, and perforans branches through fragment of long extensor of the first toe, periosteum of tibia, which includes large periostal vascular branches. After that, periosteum is dissected with formation of section with desired size. Cortical plate of tibia is perforated to required depth, ligated and anterior tibial vascular fascicle is intersected more distally than formed tissue complex. Bone fragment is separated on perforation lines and autograft is taken.
EFFECT: group of inventions ensures obtaining qualitatively new tissue complex with reparative and osteogenic properties, possibility to cover large defects of recipient area, reduction of postoperative complications, reduction of treatment terms.
2 cl, 2 ex, 4 tbl, 1 dwg
SUBSTANCE: group of inventions relates to reconstructive microsurgery. Free revascularised anterior tibial skin-bone autograft on the basis of anterior tibial vascular fascicle includes in a single complex tibial periosteum, fragment of tibia, fragment of long extensor of the first toe, section of skin with fascia on perforans vessels, anterior tibial artery and commitant veins. Group of inventions also includes method of said autograft taking.
EFFECT: group of inventions makes it possible to improve functional results applying autograft, reduce functional and cosmetic disorders in donor zone.
2 ex, 1 dwg
SUBSTANCE: invention relates to field of medicine, namely to traumatology and orthopedics. Fixation of femoral bone fragments is performed by means of metal constructions. Into proximal fragment of femoral bone transcervically thread rods are introduced and into distal fragment at the level of middle third at an angle to longitudinal axis of femoral bone - one thread rod. Through distal fragment at the level of lower third two crossed pins are passed and fixed outside metal construction in supports of apparatus for external fixation. After that, osteotomy is performed in interthrochanteric area with formation of bed in distal fragment of femoral bone for carrying out rotational displacement. Then, greater trochanter with attached muscles is cut off with their displacement with possibility to provide tension of gluteal muscles. In postoperative period stage-by-stage dosed rotational displacement of neck nad head of femoral bone is carried out.
EFFECT: method ensures complete recovery of biomechanically correct shape of femoral bone head with reduction of rehabilitation period terms.
3 cl, 1 ex, 1 dwg
SUBSTANCE: invention relates to method of surgical formation of invaginating single-row closed anastomosis in case of colon resection. Colon resection is performed. Closing of anastomosed segments of adducting and abducting intestines is carried out by apparatus suture. Immediately under mechanical suture serous-muscular layer is dissected circularly. Sero-muscular sheath is separated from mucous-submucous layer on 1.5-2 cm and sero-muscular cushion is created on both anastomosed segments of adducting and abducting intestines. On exposed mucosa with catgut thread applied is suture which closes intestine lumen. Mechanical clips are cut off and anastomosis "end-to-end" is formed with closed lumens by Matestchuk sutures with atraumatic suture material vicryl No 4/0. Before tightening the last suture of formed anastomosis ligature is removed from mucosa of ends of anastomosed adducting and abducting intestines, excess of mucous-submucous layer of adducting anastomosed intestine is freely invaginated into lumen of abducting anastomosed intestione, covering with the excess line of formed anastomosis sutures. Last mucous-submucous suture is tightened.
EFFECT: method makes it possible to reduce trauma, reduce risk of abdominal cavity infection, increase anastomosis reliability.
2 ex, 5 dwg
SUBSTANCE: invention relates to surgery and can be used for formation of areflux esophageal-enteric anastomosis. T-shaped loop is formed on sutured abduction small intestine at the distance 50-60 cm from the level of transaction. Esophageal-enteric anastomosis is formed by dissection of adduction and abduction parts of intestine of adjacent sleeve with length equal to two its diameters, sewing esophagus end with adjacent edges of opened loops in upper part with interrupted sutures. Valve is created by sewing from above edges of dissected parts of small intestine on value of esophageal orifice diameter. Muco-serous uninterrupted suture of small intestine is applied lower than formed esophageal-intestinal anastomosis. Reservoir in form of ring-shaped adduction loop of small intestine is formed by application of interintestinal anastomosis side-to-side between displaced sutured end of adduction part of small intestine and lumen of abduction and adduction loops of small intestine lower than formed valve. Formed reservoir is anastomosed into duodenum by application of duodeno-jejunal anastomosis end-to-side.
EFFECT: method makes it possible to improve physiology of digestion, prevent development of damping-syndrome.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg