RU1817024C - Method of diagnostics of disease of salivary glands - Google Patents

Abstract

Usage: in medicine, namely in the diagnosis of diseases of salivary glands. SUMMARY OF THE INVENTION: Ascorbic acid is orally administered into a patient’s body, and then a water-soluble contrast medium in the composition (methylene blue and citric acid) is injected into the duct of the parotid or submandibular gland and sialosis is diagnosed for less than 60 s, more than 60 with - Sjogren's syndrome. The method allows to increase the accuracy of diagnosis by detecting an early stage of the disease, to eliminate radiation exposure and reduce the time of the study. 2 ill.

Description

The invention relates to medicine, in particular to dentistry, and can be used to diagnose diseases of the salivary glands.

Closest to the proposed technical essence and the achieved positive effect is a method for the diagnosis of diseases of the salivary glands using water-soluble X-ray substances, adopted for the prototype.

In this method, to determine the functional activity of the salivary gland and the nature of the pathological changes in its parenchyma, a radiopaque substance (verographin, urotrust) was introduced and its excretion rate was estimated from serial X-ray photographs taken 15 seconds and 45 seconds after the substance was introduced into the gland through the duct as well as 120 seconds after removal of the catheter from the duct. In total, 6 photographs were taken in each patient in the direct and lateral projections.

The introduction of a radiopaque substance in an amount of 1.5-2.5 ml was carried out using a specially designed device for 45 s under a pressure of 180-200 mm Hg.

To prevent air from entering the gland in order to avoid erroneous interpretation of the sialograms, the author flushes the gland with saline. Diagnosis is by sialography. Thus, the diagnosis of Sjogren's syndrome is established on the basis of a typical x-ray picture: by the presence of spherical clusters and the symmetry of the lesion of the gland. But it is known that sialoses also exhibit a symmetrical increase in the parotid and submandibular glands. Nodular clusters are also observed with parenchymal mumps, Danso

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This method does not allow to reveal the early stages of Sjogren's syndrome and sialosis only by the sialogram, as the author of the prototype does not try to determine. He describes the characteristic changes in the sialogram for various diseases of the salivary glands, which are usually visualized only in the clinical picture of the diseased and late stages.

The disadvantages of the prototype are the inability to detect the early stages of sialosis and Sjögren’s syndrome due to the fact that initially functional changes develop, only with further development of the process do morphological changes revealed by sialography occur; radiation load on the patient, as a series of X-ray photographs are taken (6 photographs) and the load may increase due to recommendations and sialograms in the dynamics of treatment; the duration of the prototype study in one patient is on average 2.5-3 hours (see table 1), as well as the long-term administration of a large amount (1.5-2.5 ml) of a water-soluble X-ray contrast substance for 45 c, which can lead to overflow, overstretching and trauma to the ductal system of the gland.

The cost of time (timing) for the study of the salivary gland according to the prototype and the proposed method are presented in table 1.

Thus, the time required to carry out the method according to the prototype is from 168-218 minutes, according to the proposed method - 3 min 3 s - 5 min 5 s, i.e. the reduction of the examination time for patients is more than 10-30 times.

The disadvantage of the prototype is that there are no criteria for introducing the required amount of radiopaque material according to the prototype. The administration of a large amount of a radiopaque preparation causes deformation of the ducts; contrast may enter the interstitial tissue, especially with Schengen syndrome, which leads to blurred images of the parenchyma on the sialogram. Also, a prolonged delay (up to several days and weeks) of the contrast medium in iron is possible. The introduction of less contrast leads to filling only the duct system and it is not possible to judge the nature of the pathological process, as a result of which the diagnostic value of sialography is reduced. As well as the presence of contraindications to sialography: acute processes or exacerbations of the inflammatory process, hypersensitivity to the drug (allergic reactions), thyroid disease, especially at the stage of decompensation.

The aim of the invention is to increase the accuracy of diagnosis by identifying an early stage of the disease, eliminating radiation exposure, and shortening the time required to complete the procedure.

This goal is achieved by the fact that 0.1-0.3 g of ascorbic acid is orally administered 5-10 minutes before the procedure, a composition consisting of the following ingredients, wt.%: 2% solution is used as a contrast medium methylene blue 60-75; 1% citric acid solution - the rest, which is administered in an amount of 0.4-0.6 ml for 3-5 s, and when the saliva is discolored for

30-60 s are diagnosed with sialosis, more than 60 s - Sjogren's syndrome.

The method is carried out as follows. The patient is given orally 0.1-0.3 g 5-10 minutes before the start of the study

5 ascorbic acid in powder or tablet form.

A contrast medium composition is prepared containing wt.%: 2% methylene blue solution (aqueous solution)

0 60-75; 1% citric acid solution (aqueous solution) - the rest, which is collected in a syringe with a capacity of 1-2 ml in an amount of 0.6 ml.

The patient is seated in a chair, head

5 turn in the direction of the investigated gland (parotid or submandibular), open their mouths, pull the cheek with a dental mirror, determine the location of the mouth of the stenic duct on it,

In the sublingual region, the mouth of the varton duct is determined. A metal cannula or polyethylene catheter is inserted into the duct and the contrast medium is rapidly injected within 3-5 s in the amount of 0.45 0.6 ml. It is administered until a mild sensation of the salivary gland is expanding. Then the catheter cannula was quickly removed, the time of removal was noted, and visual observation of the evacuation of contrast from the duct was continued.

0 When discoloration of saliva occurs, the time of complete emptying of the administered contrast medium is recorded.

In sialoses, a membrane-destructive process is noted leading to the formation of calcifications, lipid aggregates, edema and fatty degeneration of epithelial cells, while the epithelium is damaged again. The time of evacuation of the contrast medium from the gland is normally 10-29 s (average 20.5 + 4.5 s), and with sialoses 30-60 s (average 35 ± 2.3 s).

In Sjogren's syndrome, dystrophy and atrophy of the epithelium are also noted, but it is primary in nature, and the disease is characterized by increased permeability of the ducts. Therefore, upon the introduction of the proposed composition into the gland, its exit into the interstitial space, which is not observed during sialoses, can be noted. The time of evacuation of contrast medium from the gland in Sjögren’s syndrome is delayed for a long period compared with sialosis and is more than 60 s (average 78 ± 6.3 s).

A comparative estimate of the time of evacuation of contrast medium from the salivary gland in healthy individuals with sialoses and Sjögner syndrome is presented in Table. 2.

The selected parameters of the proposed method are justified in this way.

1. Oral administration of ascorbic acid in an amount of 0.1-0.3 g. Of all the salivary stimulants, it is the most effective and physiological, not accompanied by side effects. It cleans the ducts of the gland well from stagnant saliva, which contains a large amount of microflora, and is a non-invasive method, unlike the prototype, where the duct is washed with saline by introducing it using a special device.

The dose of ascorbic acid is selected taking into account the degree of dryness of the oral cavity, accompanying both sialosis and Sjogren's syndrome. With xerostomia of the first degree, 0.1 g is used, with the second degree - 0.2 g, with the third degree - 0.3 g.

2. The introduction of a salivary stimulant 5-10 minutes before the start of the study is due to the fact that ascorbic acid, in addition to stimulating salivation, also eliminates the permeability of capillaries, thereby normalizing the formation of saliva. A time of 5-10 minutes is required for the absorption of ascorbic acid in the stomach and its appearance in the bloodstream.

3. The choice of methylene blue as a contrasting dye is determined by the ability of the dye to dye transparent saliva blue, mix with it, as a result of which it can be visualized.

Methylene blue is an aniline dye that has a weak anti-inflammatory effect and at a 1-2% concentration does not cause an irritating effect on the mucous membrane of the ducts of the gland and oral cavity. It is well visualized during evacuation from the duct, not merging with the background - the mucous membrane of the cheek or hyoid

areas

Citric acid is incorporated into the composition to cause disaggregation and excretion of calcium lipid aggregates, which, precipitated on the walls of the ducts, inhibit saliva outflow and may lead to erroneous interpretation of the test results.

4. The amount of the administered composition, 0.4-0.6 ml, depends on the anatomical volume of the duct, which is determined by the patient's feeling of fullness in the salivary gland.

Administration of less contrast agent than 0.4 ml will not result in

0 filling the duct system, and the introduction of more than 0.6 ml can cause overflow of ducts and acini, and rupture of the walls.

5. The need for rapid administration of a contrast medium is due to the fact

5 that with prolonged administration, it can be resorbed in the duct and go beyond it, especially in Sjogren's syndrome.

PRI me R 1. Patient D., 22l., Was admitted

0 to the Department of Surgical Dentistry with complaints of constant dull sensations under the earlobe on both sides, periodic dry mouth. Sick for 3 years. The disease is not associated with anything.

5 I turned to the therapist, ENT doctor, oncologist, neurologist, dentist. Directed at the examination with a diagnosis of Sjogren's syndrome.

On examination, an increase was found

0 and compaction of the parotid salivary glands. The tongue is coated with white plaque. Free saliva in a small amount, foam.

A study of the parotid salivary gland by the proposed method. 5 minutes before the start of the study, the patient was given 0.1 g of ascorbic acid. Then, with a syringe and cannula, the composition of the aqueous solution in the amount of 0.4 ml, containing a 2% solution of methylene blue 0.24 ml and a 1% solution of citric acid 0.16 ml, was injected into the duct of the gland within 3 s . Full evacuation of contrast medium was noted in 30 s.

5 Diagnosed with sialosis of the parotid glands.

Subsequently, a number of studies were carried out in the patient’s clinic: sialometry, cytological examination of saliva smears, sialoscintigraphy, ultrasound, sialography, blood and urine tests. The diagnosis is confirmed: sialosis.

Thus, the diagnosis of this patient by the proposed method took 5 min 33 s without the use of bulky and expensive installations.

PRI me R2. Patient K., 37l, was admitted to the therapeutic department with complaints of cough, shortness of breath, weakness, enlargement of the parotid glands. Suffers from chronic bronchitis with periodic exacerbations for 5 l. The last exacerbation occurred a week ago. He was admitted to the clinic for treatment. He did not go to the dentist for an increase in the salivary glands, since there was no pain.

Objectively: the parotid and submandibular salivary glands are enlarged, painless on palpation. The tongue and gums are covered with white coating, a small amount of saliva is secreted from the excretory ducts of the salivary glands.

A course of anti-inflammatory therapy was given to the patient, however, salivary gland size was not noted. Consulted by a dentist who performed sialography of the right parotid gland, 4.0 ml of 76% verografin were injected. In the sialogram (see Fig. 1), the shadow of the parenchyma is heterogeneous, and deformation of the intragland ducts is noted.

Diagnosed with Sjögren’s syndrome, after which the patient was transferred to the Department of Maxillofacial Surgery,

However, a thorough clinical examination did not reveal signs of Sjögren’s syndrome (xerophthalmi, rheumatoid arthritis). In this connection, the left parotid salivary gland was studied by the proposed method to clarify the diagnosis. It was found that the evacuation time of the contrast medium was 50 s with the introduction of 0.6 ml of contrast medium containing a 2% solution of methylene blue 0.45 ml, a 1% solution of citric acid 0.15 ml for 5 s. The diagnosis of Sjogren's syndrome was not confirmed, but the diagnosis was made: sialosis of the parotid and submandibular glands. The changes found in the sialogram made according to the prototype were misinterpreted due to the introduction of a large amount of verographin (4.0 ml), which had to be taken into account when describing the image.

After establishing the correct diagnosis by the proposed method and prescribing appropriate therapy, the patient noted recovery: swelling

the salivary glands are eliminated, the secretion of saliva from the ducts is good, the cough has passed, and efficiency has been restored. Frozen

selected options). Sick A., 33 years old, was admitted with complaints to the clinic of maxillofacial surgery for general weakness, decreased performance, crunch in the temporomandibular joints, dryness

0 in the mouth, an increase in the parotid salivary glands.

Objectively: both parotid salivary glands are significantly enlarged, dense and painful on palpation. Tongue

5 dry, hyperemic, there is no free saliva. When massaged, saliva is not excreted from the ducts of the salivary glands.

A study of the right parotid gland by the proposed method.

0 3 minutes before the start of the study, the patient was given ascorbic acid at a dose of 0.05 g, however, salivation was not obtained. In this regard, she was again given ascorbic acid at a dose of 0.3 g, after

5 why her mouth was moisturized, and after 12 minutes a contrast medium composition of 0.3 ml was added to the duct of the right parotid gland; 2% solution of methylene blue 0.2 ml, 1% solution of citric acid 0.1 ml. However

no evacuation was noted for 600 s. AT

the next day

research on the proposed method.

0.6 ml of a composition containing a 2% solution of methylene blue 0.36 ml, a 1% solution of citric acid 0.24 ml was introduced into the duct of the left parotid gland5 for 4 s after 6 minutes after giving 0.3 g of ascorbic acid. Evacuations were noted after 67 s, which corresponds to Sjogren's syndrome.

In connection with the presence of pronounced changes. it was decided to produce

duct contrast followed by

5 sialography according to the method described in the prototype. In order to confirm the diagnosis of patient A., 0.6 ml of a 38% verograph solution was introduced into the duct of the right parotid gland. On the sialogram (see Fig. 2)

0, there is an uneven distribution of the contrast medium and its extension beyond the ducts of the gland, characteristic of Sjogren's syndrome.

Clinical examination noted an increase in ESR to 42 mm / h, rheumatoid factors are positive. Consultation with an ophthalmologist: keratococioctivitis. Consultation with a physician: re-emptoid arthritis, achilic gastritis, spastic colitis, which is characteristic of Sjogren's syndrome. The patient was diagnosed with Sjogren's syndrome, an early stage (using the proposed method), which was confirmed by other additional research methods. Referred to a rheumatologist for appropriate treatment.

Example 4 (going beyond the selected parameters). Sick S., 49 years old, was admitted to the clinic of the maxillofacial surgeon and complained of periodic dry mouth, a slight increase in the right parotid gland.

According to the proposed method, 6 minutes before the start of the study, ascorbic acid was given in a dose of 0.5 g. 0.8 ml of a contrast medium containing the following ingredients was introduced into the duct of the right parotid gland, containing 2 ml of a methylene blue solution of 0.4 ml ( 50 wt.%) And a 2% solution of citric acid 0.4 ml (50 wt.%), Which was accompanied by the appearance of pain in the gland and the appearance of a feeling of fullness, after which the introduction of contrast was immediately stopped.

The next day, a study of the left parotid gland was performed. 8 minutes before the start, the study was given ascorbic acid in an amount of 0.2 g, a contrast agent was introduced in an amount of 0.5 ml for 4 s, the content of the composition: 2% -

0.37 ml methylene blue solution; 0.13 ml 1% citric acid solution. Evacuation of contrast was noted for 40 s. Diagnosed with sialosis of the right parotid gland.

A course of appropriate treatment has been carried out. Discharged from the hospital in satisfactory condition with recovery.

Claims (1)

SUMMARY OF THE INVENTION A method for diagnosing diseases of the salivary glands by introducing a water-soluble contrast agent into their ducts and then observing it in dynamics, characterized in that, in order to increase the accuracy of the method by identifying an early stage of the disease, eliminating radiation exposure and shortening the study time 5-10 minutes before administration of the contrast medium, 0.1-0.3 g of ascorbic acid is orally administered to the patient, and 0.4-0.6 ml of the mixture containing the following components, wt.%: 2% solution of methylene blue 60-75 and 1% solution of citric acid - the rest, and sialosis is diagnosed with sialosis for 30-60 s, and Sjögren’s syndrome for more than 60 s. Operations Prototype. Preparation of a device for introducing a water-soluble X-ray contrast medium, X-ray equipment for charging 6 cassettes with an X-ray film Insertion of material into the duct of the gland with sialograms taken after 15.45 s and 2 min Development of 6 images Drying of the X-ray images Description of the images and conclusion Summary The proposed method Preparing the composition and putting it into a syringe Visualization of the evacuation of contrast medium Total Table 1 Time min thirty 3 10-15 120-160 5-10 168-218 2 3-5 1-3 min 3 s - 5 min 5 s figure 1 table 2