RU2394243C1 - Method for determining indications for tonsillectomy at chronic tonsillitis - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: to determine the indications for tonsillectomy at chronic tonsillitis a microscopic examination of samples of separated lacunae tonsils is conducted. In a month after the treatment an additional sample is taken. Taken samples were placed in a test tube containing 0.04 ml of physiological sodium chloride solution, then the mixture is applied in the amount of 0.01-0.02 ml on an object-plate in the form of a drop, it is dehydrated and patterns of samples are compared. If there are multirow traradiate cracks in a drop marginal zone repeating the pattern of the previous samples obtained from additional samples, tonsillectomy is recommend.

EFFECT: method enables to increase simplicity and objectivity of appointment of tonsillectomy prior to progression of possible complications.

5 dwg, 4 ex

Description

The invention relates to medicine, in particular to a laboratory research method.

Despite the effectiveness of treatment of patients with chronic tonsillitis, the appointment of surgery (tonsillectomy) is based on a subjective factor - the data of a clinical examination and a survey of the patient. As a rule, the appointment of tonsillectomy according to the clinical picture of the course of the disease requires a certain time period for monitoring the patient, and this, in turn, can lead to the development of complications not only in the local focus of infection, but also in various organs and systems of the body. Thus, the search for objective criteria for the timely appointment of tonsillectomy in patients with chronic tonsillitis is an urgent problem.

A known method for assessing the prognosis of chronic tonsillitis, including the determination of clinical criteria for the effectiveness of therapy. Moreover, if after the course of therapeutic treatment there is a decrease in the intensity of local signs of inflammation, intoxication (subfebrile condition, weakness, sweating, fatigue without exacerbation), then the treatment effect is regarded as positive and, in the future, the patient is monitored without prescribing tonsillectomy. If treatment is ineffective - the manifestation of general signs of intoxication, the occurrence of exacerbations of the disease within a short period after the course of treatment, tonsillectomy is recommended (Palchun V.T., Kryukov A.I. .257-282).

A known method for the diagnosis of chronic tonsillitis, including determining the severity of chronic tonsillitis and treatment tactics (US Pat. RU No. 2014103, class A61N 5700, 1994). In this method, the degree of circulatory disturbance of the tonsils is assessed using rheotonzillography by the rheographic index and treatment tactics are determined as conservative, semi-surgical and tonsillectomy. The disadvantage of this method is that it does not take into account the compensatory capabilities of the body of each individual patient. So, in patients with chronic tonsillitis with an initially identical degree of damage to the tonsils, the result of conservative therapy may be mixed and the question of the feasibility of tonsillectomy is controversial.

In accordance with this, there is a need to develop objective diagnostic criteria.

Closest to the claimed method is a method for determining indications for tonsillectomy for chronic tonsillitis, including a microscopic examination of samples of the separated tonsil lacunae (US Pat. RU 2254116, class A61H 23/00, 2005).

In this method, a cytological examination of the contents of tonsil lacunae is carried out before treatment and after application of the Tonsillor apparatus applicator-limiter to the tonsil. The disadvantage of this method is that the assessment of the state of the tonsil tissue in this method continues to be based on the cellular composition of their contents, and this does not always allow obtaining objective diagnostic information due to the presence in the preparations of a large amount of detritus, neutrophilic leukocytes in a state of degeneration. The cytological diagnostic method is widely used in clinical practice, methods for obtaining diagnostically valuable material are being improved, however, clear objective criteria for the appointment of tonsillectomy for the cellular composition of the tissue of the tonsils have not been obtained. It is known that a cell is a stable structure and shifts in its structural organization occur with prolonged exposure to an irritating factor or a short-term, but powerful (mostly damaging) effect. At the same time, all the integral information about the vital functions of cells (the intake of nutrients, the quality of the protein molecules produced by it, metabolic products, etc.), which can be obtained by phase transfer of this highly mobile tissue to a dehydrated state, enters the intercellular fluid (Shabalin V. N., Shatokhina S.N. Morphology of human biological fluids. M., 2001).

The task was to create an easily reproducible and reliable method for the objective appointment of tonsillectomy before the development of possible complications of both local and generalized inflammatory processes.

This problem is solved by the fact that in the method for determining indications for tonsillectomy for chronic tonsillitis, which includes a microscopic examination of the samples of the separated tonsil lacunae before and after treatment, it is suggested that patients take an additional sample one month after treatment, and the selected samples should be placed in a test tube containing 0.04 ml physiological solution of sodium chloride, then the resulting mixture is applied in an amount of 0.01-0.02 ml on a glass slide in the form of a drop, dehydrate, and if there is a drop in the edge zone obtained from additional samples, multi-row three-beam cracks, repeating the pattern of previous samples, recommend tonsillectomy.

Figure 1 (a, b, c, d) shows pictures of dehydrated drops obtained from samples taken before treatment in a healthy patient and patients with various forms of chronic tonsillitis.

Figure 2 (a, b, c) - pictures of dehydrated drops before and after treatment in a patient with chronic tonsillitis, simple form (Example 1).

Figure 3 (a, b, c), figure 4 (a, b, c), figure 5 (a, b, c) are pictures of dehydrated drops before and after treatment in patients with chronic tonsillitis, various toxic-allergic forms ( Example 2, 3.4, respectively).

The idea of developing this method was based on the morphological features of the tonsil lacunae released in healthy people, patients with a simple form of chronic tonsillitis (rare exacerbations, lack of general intoxication phenomena), patients with a toxic-allergic form (frequent exacerbations, general intoxication, the risk of complications in the form paratonsillar abscesses, etc.).

The results of our studies showed that before treatment in healthy people, the morphological picture of the separated tonsil lacunae was characterized by the presence of dendritic salt crystals (Fig. 1, a). In patients with a simple form of chronic tonsillitis - the presence of two zones: an edge protein and a central one, made with salt crystals (Fig. 1, b). The presence of the phenomenon of crystallization of salts in the marginal zone of the separated tonsil lacunae in patients with a simple form of chronic tonsillitis is explained by protective biomineralization, that is, the body's ability to bind the vital products of pathogenic microflora (Fig. 1, c). In patients with the toxic-allergic form of chronic tonsillitis, the edge protein zone is made by multirow three-beam cracks, there are no salt crystals in it (Fig. 1, d). To date, it has been established that a three-beam crack is a marker of congestion, in which the rapid development of acute inflammatory process and intoxication is possible.

As a rule, in most patients, a positive shift is noted immediately after treatment, however, the stability of this condition (a sufficient reserve of the body's defenses) can be assessed only a month after treatment.

The method is as follows.

In chronic tonsillitis in patients, the discharge of tonsil lacunae is taken in a test tube containing 0.04 ml of physiological sodium chloride solution. The tube is shaken for one minute, then the mixture is applied in an amount of 0.01-0.02 ml onto a glass slide in the form of a drop, dried at a temperature of 20-25 ° C for 18-20 hours and the sample is microscopically fixed (photo or description). Then, a course of conservative therapy is carried out and the study is repeated immediately after the end of the course of treatment and a month after treatment, subject to the patient's preventive recommendations. Then, the morphological pictures of the obtained samples are compared, and when the morphological picture of the sample is returned to the initial one in the form of multi-row three-beam cracks in the marginal zone one month after the course of treatment, tonsillectomy is recommended.

The implementation of the method shown in specific clinical examples.

Example 1

Patient F., 16 years old. Diagnosis: Chronic tonsillitis, simple form.

The study of the morphological picture of the separated tonsil lacunae in this way showed the presence in the marginal zone of the sample: before treatment - the protein zone (figure 2, a); after treatment - the phenomenon of crystallization of salts (Fig.2, b), a month later - dendritic crystals of salts (Fig.2, c).

Conclusion: observation and a course of preventive conservative therapy are recommended.

Example 2

Patient P., 22 years old. Diagnosis: Chronic tonsillitis, toxic-allergic form.

The study of the morphological picture of the separated tonsil lacunae in this way showed the presence in the marginal zone of the sample: before treatment - multirow three-beam cracks (figure 3, a); after treatment - the phenomenon of crystallization of salts (Fig.3, b), a month later - the protein zone (Fig.3, c).

Conclusion: observation and a course of preventive conservative therapy are recommended.

Example 3

Patient R., 19 years old. Diagnosis: Chronic tonsillitis, toxic-allergic form.

The study of the morphological picture of the separated tonsil lacunae in this way showed the presence in the edge zone of the sample: before treatment - multirow three-beam cracks (Fig. 4, a); after treatment - the phenomenon of crystallization of salts (Fig.4, b), a month later - multirow three-beam cracks (Fig.4, c). Conclusion: tonsillectomy is recommended.

Example 4

Patient A., 17 years old. Diagnosis: Chronic tonsillitis, toxic-allergic form.

The study of the morphological picture of the separated tonsil lacunae in this way showed the presence in the marginal zone of the sample: before treatment - multirow three-beam cracks (Fig. 5, a); after treatment - multi-row three-beam cracks (Fig. 5, b), a month later - multi-row three-beam cracks (Fig. 5, c).

Conclusion: tonsillectomy is recommended.

Thus, the picture of the tonsil lacunae removed allows us to recommend timely surgical treatment based on objective morphological criteria, that is, before the development of possible complications of the disease.

The method is technically simple, does not require expensive reagents and equipment, can be used in the practice of an otolaryngologist.

Claims (1)

A method for determining indications for tonsillectomy in chronic tonsillitis, including a microscopic examination of samples taken from the tonsil lacunae being separated, characterized in that an additional sample is taken from patients one month after treatment, and the selected samples are placed in a test tube containing
0.04 ml of physiological solution of sodium chloride, the resulting mixture is applied in an amount of 0.01-0.02 ml on a glass slide in the form of a drop, dehydrate, compare the patterns of samples and in the presence in the edge zone of a drop obtained from an additional sample, multirow three-beam cracks , repeating the pictures of previous samples, recommend tonsillectomy.

Images