SU1649443A1 - Method for differential diagnostication of obstructive jaundices - Google Patents

Abstract

The invention relates to medicine and can be used to diagnose obstructive jaundice. The purpose of the invention is to improve the accuracy of the method. In patients with obstructive jaundice, blood is collected from a vein, serum is isolated by blood centrifugation, and the content of immunoglobulin G and E is determined. Moreover, by increasing the concentration of immunoglobulin G by 4-10% and immunoglobulin E by 30-38% compared with the norm, they diagnose obstructive jaundice of benign genesis, and with an increase in immunoglobulin E by 500% and higher, while reducing the concentration of immunoglobulin G by 30-36% compared with the norm, they diagnose obstructive jaundice of malignant about genesis. Compared to the prototype, the accuracy of the method is increased by 43%.

Description

The selection is related to medicine and can be used to diagnose obstructive jaundice.

The aim of the invention is to improve the accuracy of the method.

The method is carried out as follows.

In patients with an established diagnosis of obstructive jaundice, serum is collected from the vein by centrifuging the blood and the content of IgG and Igg is determined in it.

The increase in fgG concentration by 4-10% and IgE by 30-38% compared with the norm indicates the presence of obstructive jaundice - a complication of cholelithiasis and inflammatory processes, and an increase in IgE by 500% and higher while reducing the concentration of IgG by 30- 36% indicates the presence of obstructive jaundice - a complication of the tumor process.

The content of IgG is determined by the method of Mangini (in mg%), and IgE - by radio immunosorbent test (in ME / ml).

Example 1. Patient F, 59 years old, was admitted to the surgical department for surgery 16.XI.88, with a presumptive diagnosis of chronic calculous cholecystitis, obstructive jaundice.

In the study of IgE and IgG in serum, it was found that the content of IgE was 267.5 ME / ml (at a rate of 53.4 ME / ml), i.e. in this case the concentration of IgE increased by 500.94%, and the content of IgG 780 mg%, The norm is 1,160.0 mg%, that is, the IgG content has decreased by 32.76%.

Based on the data obtained, obstructive jaundice of malignant genesis was diagnosed in this patient.

22.XI.88, an operation was performed: laparotomy, liver biopsy. When revision of the abdominal cavity is as follows:

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both lobes of the liver are covered with multiple whitish formations, the gallbladder is rocky, dense, it is impossible to pass to the collar of the liver due to dense adhesions.

Postoperative diagnosis: bladder cancer with sprouting of the liver and biliary tract, mechanical jaundice. Histological examination of the liver tissue - adenocarcinoma, liver metastasis.

Example 2. Patient T., 75 years old, was admitted on 25.11.88 to the surgical department for surgical intervention with a presumptive diagnosis: acute calculous cholecystitis, choledocholithiasis, mechanical jaundice.

Immunograms of blood serum from 11/28/88: the IgE content was 72 IU / ml, the norm was 53.4 IU / ml, i.e. 35% above normal, the IgG concentration was 1270.0 mg%, the norm was 1160.0 mg%, there are 9.5% above normal. Based on these indicators, obstructive jaundice of benign genesis was diagnosed in the patient.

12/05/88, an operation was performed: cholecystectomy, choledochotomy, transduodenal papillosphincteromy, draining of the choledochus according to Kerr and abdominal cavity according to Redond. The revision of the abdominal organs revealed the following: the liver is stagnant, dark greenish, covered with sclerotic lesions, the gallbladder 7x4x4 cm, reflux changed, choledoch up to 2.0 cm in diameter, pancreas without pathology. After removal of the gallbladder, intraoperative cholangiogram is performed.

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phi, on which choledoch is up to 3.0 cm in diameter, in the distal part of its shadows there is suspicion of calculus. Produced choledocholithotomy, transduodenal papilosphincterotomy, Keron choledoch drainage and Redon abdominal cavity.

Postoperative diagnosis: acute calculous cholecystitis, choledocholithiasis, mechanical jaundice.

The proposed method provides a differential diagnosis of obstructive jaundice of malignant and benign genesis.

At the same time, in clinical conditions out of 100 patients with obstructive jaundice, all were correctly diagnosed using the proposed method, while the prototype was only in 57% of patients, therefore the accuracy increased by 43%.

Claims (1)

Invention Formula The method of differential diagnosis of obstructive jaundice by examining a patient, characterized in that, in order to increase the accuracy of the method, the content of immunoglobulins G and E is determined in the blood serum and by increasing the concentration of immunoglobulin G by 4-10% and immunoglobulin E by 30-38% in comparison with healthy people, obstructive jaundice of benign genesis is diagnosed, and with an increase in immunoglobulin E by 500% and higher and a decrease in immunoglobulin G by 30-36% compared with healthy people, obstructive jaundice is diagnosed with malignancy of this genesis.