SU850045A1

SU850045A1 - Method of differential diagnosis of destructive pancreatitis

Info

Publication number: SU850045A1
Application number: SU792801789A
Authority: SU
Inventors: Иван Степанович Белый; Владимир Иванович Десятерик
Original assignee: Днепропетровский Ордена Трудовогокрасного Знамени Медицинскийинститут
Priority date: 1979-07-19
Filing date: 1979-07-19
Publication date: 1981-07-30

Description

Изобретение относится к медицине и может быть использовано в хирургической практике.·The invention relates to medicine and can be used in surgical practice.

Известен способ дифференциальной диагностики деструктивного панкреатита путем определения в сыворотке ⁵ крови титров неполных :гемагглютинирующих антител 01.A known method for the differential diagnosis of destructive pancreatitis by determining in serum ⁵ blood titers incomplete: hemagglutinating antibodies 01.

Однако известный способ не обеспечивает высокой точности.However, the known method does not provide high accuracy.

' Цель изобретения - повышение точ- ¹⁰ности способа.'The purpose of the invention - an increase ^{of 10} Nosta accurate method.

Эта цель достигается тем, что способ дифференциальной диагностики де- структивного панкреатита· осуществляют путем определения в сыворотке крови титров неполных гемагглютинирующих антител, определение титров проводят в течение первых 4-х дней и при нарастании их по сравнению с исходным^ диагносцируют деструктивную форму панкреатита, а при снижении - отечную.This goal is achieved by the fact that the method of differential diagnosis of destructive pancreatitis with a decrease - edematous.

Пример. Больная Г, 56 лет, поступила в отделение через 16 ч с мо2 мента заболевания с жалобами на боли в правом подреберье, тошноту, рвоту, }общую слабость. В анамнезе пневмония, • периодические умеренные боли в правом · подреберье. При поступлении состояние средней тяжести, пульс 80 в минуту. Местно: язык влажный, живот правильной формы, [участвует в акте дыхания, умеренное мышечное напряжение в правом подреберье и эпигастральной области. Положительный симптом Ортнера, симптом Щеткина отрицательный. Диагноз: острый холецистопанкреатит. Амилаза мочи ед. Определен титр неполных антител· 1/4, повторное определение - 1/16. Несмотря на массивную инфузионную терапию состояние больной продолжало ухудшаться и больная взята на операцию, во время которой обнаружен тотальяый геморрагический панкреонекроз, Исход - выздоровление.Example. Patient G, 56 years old, was admitted to the department after 16 hours with a disease moment with complaints of pain in the right hypochondrium, nausea, vomiting,} general weakness. A history of pneumonia, • periodic moderate pain in the right · hypochondrium. Upon receipt, a moderate condition, pulse 80 per minute. Locally: the tongue is moist, the stomach is of the correct form, [participates in the act of breathing, moderate muscle tension in the right hypochondrium and epigastric region. Positive symptom of Ortner, Shchetkin's symptom is negative. Diagnosis: acute cholecystopancreatitis. Amylase urine units. The titer of incomplete antibodies was determined · 1/4, repeated determination - 1/16. Despite massive infusion therapy, the patient's condition continued to deteriorate and the patient was taken for surgery, during which total hemorrhagic pancreatic necrosis was detected. The outcome is recovery.

Такое определение титра неполных /'емагглютинирующйх антител в динамике произведено у 34 больных острым панк- peaтИтом, у 21 с деструктивным и 13 с отечным панкреатитом. Из 21 больного, оперированного по поводу деструктивных панкреатитов, увеличение титра неполных антител при определении на ₅второй - четвертый день было у 17 больных, что составляет 81%. У 3 больных (14,2%) при последующем исследовании динамики обнаружить не удалось, титр оставался прежним. У 1 больной ц> (4,8%) имело место снижение титра антител, при последующем определении которое расценивалось как гипердиагностика деструктивного панкреатита во время оперативного вмешательства. 15 По всей видимости у больной имела место отечная форма панкреатита, ошибочно принятая хирургом за деструктивную. Из 13 больных с отечными панкреатитами снижение титра антител при ₂₀последующих определениях обнаружено у И больных - (84,6%). У двух больных при последующем определении титр оставался прежним (15,4%). Отсутствие динамики при повторных определениях ₂₅титра антител при отечных и деструктивных панкреатитах расценивают как низкую ответную реакцию организма на патологический процесс.Such a determination of the titer of incomplete / 'emagglutinating antibodies in dynamics was made in 34 patients with acute pancreatitis, in 21 with destructive and 13 with edematous pancreatitis. Of the 21 patients operated on for destructive pancreatitis, an increase in the titer of incomplete antibodies, as determined on the second, fourth day, was ₅ in 17 patients, which is 81%. In 3 patients (14.2%), a subsequent study did not detect dynamics, the titer remained the same. In 1 patient c> (4.8%) there was a decrease in antibody titer, with a subsequent determination which was regarded as overdiagnosis of destructive pancreatitis during surgery. 15 Apparently, the patient had an edematous form of pancreatitis, which was mistakenly accepted by the surgeon as destructive. Of 13 patients with edematous pancreatitis, a decrease in antibody titer with ₂₀ subsequent determinations was found in And patients - (84.6%). In two patients, with subsequent determination, the titer remained the same (15.4%). The lack of dynamics in repeated determinations of ₂₅ antibody titers in edematous and destructive pancreatitis is regarded as a low response of the body to the pathological process.

Предлагаемый способ позволяет проводить точную дифференциальную диагности ку между деструктивными и отечными формами острого панкреатита и на ранних стадиях определить характер необходимого лечения - оперативный или консервативный. При применении способа точность диагностики составляет 8184,6%.The proposed method allows for accurate differential diagnosis between destructive and edematous forms of acute pancreatitis and, in the early stages, to determine the nature of the necessary treatment - surgical or conservative. When applying the method, the diagnostic accuracy is 8184.6%.

Claims

(54) DIFFERENTIAL DIAGNOSTIC METHOD The invention relates to medicine and can be used in surgical practice. A known method for the differential diagnosis of destructive pancreatitis by determining the titers of incomplete tomagglutin serum: serum antibodies Dl However, the known method does not provide high accuracy. The purpose of the invention is to improve the accuracy of the method. This goal is achieved by the fact that the method of differential diagnosis of destructive pancreatitis is carried out by determining the titer of incomplete hemagglutinating antibodies in blood serum, the determination of titers is carried out during the first 4 days and with increasing them compared to the initial one, the destructive form of pancreatitis is diagnosed, and while decreasing, an edematous P. prymere Volna G, 56 years old, posttummed into the ward after 16 hours from my DESTRUCTIVE PANCREATITIS disease with complaints of pain in the right hypochondrium, nausea, vomiting, general weakness . In the history of pneumonia, periodic moderate pain in the right hypochondrium. On admission, the state of average gravity, pulse 80 per minute. Locally: the tongue is wet, the stomach is of the correct form,: it participates in the act of breathing, moderate muscular tension in the right hypochondrium and epigastric region. Positive symptom Ortner, symptom Shchetkina negative. Diagnosis: acute cholecystopachsreatitis. Urine amylase 32 units. The titer of incomplete antibodies 1/4 was determined, the repeated determination was 1/16. In spite of massive infusion therapy, the patient's condition continued to deteriorate and the patient was taken to the operative room during which hemorrhagic pancreatic hemorrhagic was detected, Exodus recovery. Such a determination of the titer of incomplete Emagglutinin antibodies in dynamics was made in 34 patients with acute punk3. reatitis, with 21 with destructive and 13 with “gene pancreatitis. Of the 21 patients who were operated on for destructive pancreatitis, an increase in the titer of incomplete antibodies was determined in the second to fourth day in 17 patients, which is 81%. In 3 patients (14.2%), the follow-up study of the dynamics could not be detected. the titer remained the same. In patient I (4.8%), there was a decrease in antibody titer, which was subsequently determined as overdiagnosis of destructive pancreatitis during surgery. Apparently, the patient had a swollen form of pancreatitis, mistakenly accepted by the surgeon as destructive. Of the 13 patients with edematous punk reatitis, a decrease in antibody titer in subsequent determinations was found in 11 patients (84.6%). In two patients, the subsequent determination of the titer remained the same (15.4%). Lack of dynamics in the repeated determination of antibody titer in edematous and destructive pancreatitis is regarded as a low response of the body to the pathological process. The proposed method allows for accurate differential diagnosis between the destructive and edematous forms of acute pancreatitis and, at early stages, to determine the nature of the treatment required, whether operative or conservative. When applying the method, the diagnostic accuracy is 8,184.6%. Claims of the method for differential diagnosis of destructive pancreatitis by determining the titers of incomplete hemagglutinating antibodies in blood serum, characterized in that, in order to improve the accuracy of the method, the titers are determined during the first days and when they increase compared to the original, the destructive form of pancreatitis is diagnosed4 while decreasing, it is swollen. Sources of information taken into account during the examination 1. Dz to VN, Mitrokhina LA, Kid N.E. Guidelines on the method of determining and clinical evaluation of indicators of hypersensitivity, Dnipropetrovsk, 1979, p.6-14.