Method for assessing limb distal circulation reserves

FIELD: medicine.

SUBSTANCE: radionuclide indicator is administered to record the dynamics of its distribution in limb tissues by a radionuclide method. The examination is performed at rest and during a load test. The load test represents an epidural block by gradual administration of bupivacaine 25-30 mg between L2-L3 vertebrae for 5-7 minutes. That is followed by measuring a blood flow as a percentage of its value to the same level in an analogous segment of a collateral limb.

EFFECT: qualitative assessment of the circulation reserve in various categories of patients, including disabled ones by inhibiting sympathetic and minimally sensory activity with maintaining the patients' motor activity.

2 dwg, 2 ex

 

The invention relates to medicine and is used to estimate reserves circulation of the extremities.

It is known that damage to the trunk or microvascular segments of the arterial bed is the basis of pathophysiological changes in the blood supply to various organs and tissues and in particular the limbs, which often leads to disability of patients. The choice of conservative or surgical treatment of such patients depends on the degree of preservation of the reserve capacity of the circulation of the extremities.

Solutions to this problem are using different load tests: physical (treadmill or cycle ergometry) and pharmacological (intravenous vasoactive drugs)that are presented in the monograph D.M. Arons and VP Lupanov "Functional tests in cardiology", M - Medpress-inform, 2002 str-147.

However, many patients suffering from, for example, heart failure or critical limb ischemia, exercise, usually impossible, and pharmacological stress tests are often dangerous or uninformative, not only because of the system, but local restrictions.

In the patent (RU 2197172, 27.01.2003) for patients with atherosclerosis of vessels of lower extremities, often suffering from latent coronary insufficiency, a method Prov is tion Bicycle ergometry (VEM), which is the basis of the load test. For 1-1 .5 hours until the load is preparing infusion trental (400 mg).

Therefore, physical exercise is carried out on the background changed the answered state of the vascular bed. And in this situation it is almost impossible to evaluate the significance of the subsequent physical activity.

In another patent (RU 2207801, 10.07.2003) the study presents the assessment of regional blood flow to the extremities by means of ultrasound. In particular, all available arteries of the limb is estimated volumetric rate of blood flow. Further, it is proposed calculation of an index of their relative magnitude in relation to the magnitude of the minute volume. Then compare the magnitude of changes in these indices in the arteries of different levels before and after the chosen therapy.

However, the proposal of this kind of approach in relation to the knowledge of the absolute values of blood flow in the same vessel does not maintain any criticism. Moreover, the proposed method creates conditions research on the effectiveness of treatment, but not the reserve capacity of the blood circulation in the study limb.

In the patent (RU 2215479 10.11.2003) presents a method for diagnosing the functions of the microvasculature of the lower limbs in their chronic arterial insufficiency. In a patient by ultrasound at rest and after fischerkowalski determine blood flow velocity in major arteries and veins of the leg. Load - in for one minute run rhythmic flexion and extension of the foot in the mode of one movement per second. The method is relatively simple, but not suitable for judging the state of microcirculation in the study limb. Moreover, this approach is feasible in patients with critical limb ischemia in stage Fontain III-IV.

The patent (No. 2304926, 27.08.2007) as a load test using hyperthermic effect, providing the location of the limbs in thermally shell, which is heated to a temperature not below the threshold for tissue damage. Hyperthermic exposure is carried out at a temperature not to exceed 41°C for 20 to 45 minutes. Cavity thermostatic shell shaped limbs.

The disadvantage of this method is the impossibility of physical activity in the vast majority of invalidizirovannyh patients, pharmacological load is limited because of the risk of adverse systemic effects.

Object of the invention is the diagnosis in all groups of patients.

The problem is solved by a method of assessing the state reserve circulation, consisting in the introduction of radionuclide indicator and registration of the dynamics of its distribution in the tissues of the limb scintigraphic method at rest and during zagruzochnogo test characterized in that the load test is used epidural blockade carried out by fractional introduction between the vertebrae L2-L3within 5-7 minutes 25-30 mg of bupivacaine with subsequent calculation of volumetric blood flow as a percentage of its value to the level of this indicator in the same segment of collateral limbs.

The study of the circulation is performed using radionuclide diagnostics using drugs type of Perfotech,99mTc" or "Technical,99mTc, providing the opportunity to study the relative volumetric blood flow in selected segments of the limbs and distribution of blood volume. Volumetric flow is calculated as a percentage of its value in the study limb to the level of this indicator in the same segment of the contralateral limb.

We offer a load test performed by epidural blockade, provides a previously unknown possibility of relying on the combination of suppression of the sympathetic and the minimum level of sensory activity, then how is motor activity, suppressed in the classical performing epidural blockade.

The technique of verification epidural and achievements neuroaxial blockade generally accepted in anestes the ideological practice.

Puncture is performed between the vertebrae L1-L3with the installation of the catheter in the epidural space.

After performing the test dose to exclude subarachnoid injection is injected fractionally over 5-7 minutes 25-30 mg (10-12 ml) of bupivacaine, in contrast to "standard" intraoperative epidural blockade provides, in General, the interruption of the sympathetic innervation of the vessels of the lower extremities and clinically insignificant achievement of hypalgesia in this area.

The implementation of such effects on the blood vessels of the lower extremities intended to explore using radionuclide methods, which makes it possible to study their microvasculature.

Hemodynamic criteria of sympathetic blockade manifest positive and negative reactions.

The positive reaction of lumbar epidural sympathetic blockade on the circulation of the lower extremities in a patient with G-VA, 57 years old, suffering from stenosis of the iliac and femoral arteries and chronic ischemia of the right limb.

The patient complains of pain in the legs when walking at a distance of 10-20 meters, numbness and cold toes, as well as a feeling of heaviness and fatigue in the legs. In the right foot and lower leg pain, and feel during the night.

In the rest astatically parts (left and above) scintigrams (Fig.1) clearly visible right) and left (left) leg of the patient, not practically separable from one another. While blood flows in the right and left feet (left and below) are almost identical, while the volume of blood in the right foot is greater in the left foot at 134%.

During loading (epidural block), both legs were also very similar to each other (right and top), while the dynamics have changed dramatically (right and bottom). Noted a significant predominance of blood flow and blood volume in the right foot relative to the size of these indicators in the left foot - 756% and 630%, respectively.

Therefore, the reaction of the blood flow in the right foot, experiencing chronic ischemia, positive reaction to epidural blockade may be, in the absence of external pathology. Accordingly, it is possible and necessary various medical processes that affect the circulation of this leg.

The negative reaction of the lumbar sympathetic blockade on the circulation of the lower extremities of the patient To the Islands, 78 years, with occlusion of the superficial femoral artery to the left on the 3rd day after thrombosis crural arteries and femoral-popliteal bypass of left leg.

Complaints at admission: pain in the left leg, cold, numbness and swelling of her leg and foot.

In contrast to the previous patient To-suffered a more serious injury to the blood supply of the lower konechno the th, that fixed the methodology used here. In particular, in the statics shows that the blood supply to the left (the patient) of the foot (figure 2, right, and top) are significantly lower perfusion of the right foot. In the dynamics of epidural blockade (figure 2, right and bottom) prevalence of blood flow in the right foot from 2877,5% compared with the left foot increases almost twofold to 4091,1%.

Accordingly, fixed sharply negative reaction of the left foot on the sympathetic blockade.

Note that here the methodology creates opportunities for quantitative and qualitative assessment of the reserves of the microcirculation, which is necessary and feasible in most invalidizirovannyh sick.

Naturally, the proposed method is applicable not only in patients with critical lower limb ischemia, but also in people who have had any damage or injury, which is rather important when choosing the treatment process.

Method of assessment reserve circulation, consisting in the introduction of radionuclide indicator and registration of the dynamics of its distribution in the tissues of the limb scintigraphic method at rest and during a load test, characterized in that as the load test is used epidural blockade carried out by fractional introduction between the vertebrae L2-L3within 5-7 minutes 25-30 mg Bujak the ina with the subsequent calculation of volumetric blood flow as a percentage of its value to the level of this indicator in the same segment of collateral limbs.



 

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7 dwg, 1 ex

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1 ex

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1 ex

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1 ex

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4 dwg, 3 ex

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3 ex

FIELD: medicine.

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1 ex

FIELD: medicine.

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23 cl, 12 dwg

FIELD: medicine.

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1 tbl, 1 dwg, 3 ex

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to anaesthesiology, and may be used as an anaesthesia care of a surgical intervention for carotid endaterectomy or internal carotid artery resection after pathological deformation thereof. That is ensured by general anaesthesia in a combination with deep and superficial cervical plexus blockade. Pre-medication is used the day before the operation and on the operative day in the morning. Diazepam is introduced intramuscularly 30 minutes before the operation in a combination with phentanyl; the introduction is followed by ECG monitoring and heart rate count, plethysmography with arterial blood saturation, non-invasive blood pressure measurement and neuromonitring according to a bispectral index or entropy. Catheterisation of patient's peripheral or central vein is followed by an infusion therapy, an ionotropic therapy, a cardiotropic therapy, peripheral resistance maintenance. If heart rate is no more than 80 beats per minute, the anaesthesia is induced to reach an anaesthetic depth according to the bispectral index or entropy within 40-60 units. Analgesia is provided by the intravenous introduction of 0.005% phentanyl; myoplegia is ensured by the intravenous introduction of a myorelaxant. After tracheal intubation, the patient is transferred to forced volumentic artificial pulmonary ventilation with the CO2 level within 35-45 mm Hg according to capnography. The anaesthesia is maintained by supplying an inhalation anaesthetic to the steam level of 0.8-1.0 MAK 0.8-0.9 litre of the air and oxygen flow containing 50% oxygen with controlling the inhalation anaesthetic volume by the level of the anaesthetic depth according to the bispectral index or entropy. That is followed by deep cervical plexus blockade. A tubercle of the VI cervical vertebra (a carotid tubercle) and a mastoid process are localised; thereafter a line connecting the above reference points is drawn on skin. The second line is drawn 1 cm below the first one in parallel. To verify an injection point of a local anaesthetic, the spines of IV, III, II cervical vertebras being at 1.5 cm from each other are palpated, and the reference point is the VI cervical vertebra. The needle is inserted perpendicularly to the skin and slightly in the caudal direction to reach the spines. The anaesthetic is introduced in a dose of 5-7 ml in each point C4, C3, C2. Another 5-7 ml of the anaesthetic is introduced in a point found in an apex of the mastoid process. The superficial cervical plexus blockade requires introducing he fan-shaped introduction of the anaesthetic solution in a dose of 15 ml in a point found in the middle of a lateral crus of the nodding muscle under the above muscle, 4-5 ml in each direction from the same point; the first and following injections are performed at a depth of a usual intramuscular needle perpendicularly to nodding muscle.

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4 cl, 3 ex

FIELD: medicine, pharmaceutics.

SUBSTANCE: claimed is a pharmaceutical composition for peroral introduction for treatment of malignant tumours in a patient, excluding non-Hodgkin's lymphoma, myelodysplastic syndrome, leukemia and malignant tumours with leukocyte infiltration, which contains up to 400 mg of the solid drug form of suberoylanilide hydroxamic acid (SAHA), or its pharmaceutically acceptable salt, or a hydrate.

EFFECT: solid drug form of SAHA, which has a crystalline structure was characterised by stability and provided partial reaction of a malignant tumour of the larynx with metastases or shrinkage of the solid tumour by results of CT-scanning.

22 cl, 12 dwg, 7 tbl

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