RU2457773C1 - Device for sampling of biological material from lacunae of palatine tonsils - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to otolaryngology. Device for sampling of biological material from lacunae of palatine tonsils contains syringe, connected with hollow rod. Hollow rod has bluntly sharpened working end, on which section which covers crypt orifice during sampling of its content is located. Hollow rod is made from metal, with working end in form of a tube with 1.2 mm diameter, with a hole with 1 mm diameter, and 5 mm long. Section, which covers crypt orifice, is located in the place, where working end transits into rod, and is made in form of conic section, on which two holes with 1 mm diameter are located in diametrically opposite manner.

EFFECT: accurate determination of causative agent and sensitivity to antibiotics makes it possible to realise more rational and efficient selection of medications, their reduction, minimise damage to patient's health resulting from intake of medications and prevents development of antibiotic-resistant forms of bacteria.

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Description

The invention relates to medicine, namely to otorhinolaryngology.

Palatine tonsils belong to nasopharyngeal associated lymphoreticular tissues - nasopharyngeal-associated lymforeticular tissues (NALT) (Naumenko N.N., Konoplev O.I., Samotokin MB, Shkabarova E.V. Adrenergic innervation of palatine tonsils // Russian otorhinolaryngology . - 2009. - No. 6 (43) - S.124-127), providing local immunological protection of the upper respiratory tract. Tonsils represent a significant part of the lymphoid tissue associated with mucous membranes (The Waldeyers ring / Hellings P. [et. Al.] // Acta Otorhinolaryngol. Belg. - 2000. - Vol. 54 - No. 3 - P.237-241) , and are considered inductive zones for the mucous membrane of the oral cavity, pharynx and upper respiratory tract, where the recognition, presentation, inactivation and destruction of antigens takes place.

Palatine tonsils are an accumulation of lymphoid tissue between the non-lingual and non-pharyngeal arches. Due to these accumulations, the own plate of the pharyngeal mucosa is significantly thickened. The multilayer flat non-keratinized epithelium of the tonsil surface of the tonsil is immersed in the underlying lymphoid tissue, forming primary and secondary crypts, which can be so extensive that they reach a dense connective tissue base localized on the lateral side of the tonsil. Lymphoid tissue, which forms the tonsil parenchyma, is located directly below the epithelium, penetrating deep into the sides of the crypts.

The immunocompetent cells that formed in the tonsils and entered them from the bloodstream pass through the epithelium into the lumen of the gaps in a significant amount (B.S. Preobrazhensky, G.N. Popova, 1970). Thus, the lacuna turns out to be the area of primary concentration of the active factors of cellular and humoral immunity, supplied by the tonsils to the external environment. The subject of their main impact is primarily the local microbial flora. Thus, very favorable conditions are created in the gaps for the conservation and cultivation of virulent microbial flora. The bacteria in the lacunae under appropriate conditions (cooling, lowering the body's resistance, etc.) become irritants of various receptor formations of the tonsils, which entails a response. Then there are sore throats, local and general complications.

A known method of checking the contents of gaps by squeezing their contents with a spatula (Preobrazhensky BS Diseases of the ear, nose and throat. - M., Medgiz, 1960, C.230-231).

The disadvantages of this method:

- with excessively rough pressure, you can damage the mucous membrane of the palatine arch and contribute to the spread of infection,

- tonsils are not isolated from the oropharynx, therefore, when sampling the studied material, the microflora of the oral cavity can enter the nutrient medium and suppress the growth of microflora contained in the gaps,

- material for research may contain a washout from the surface of the tonsils or be absent in the contents of the gaps.

There is a method carried out using the Tonsillor apparatus by applying an applicator-limiter with a waveguide in the center onto the tonsil, irradiating at a vibration frequency of 26.5 kHz and an oscillation amplitude of 40-50 μm for 2-3 seconds. At the end of the exposure time of the ultrasound for 2-3 seconds, the device turns off and the contents of the applicator-limiter in the amount of ~ 1.0 ml are sent for examination (Lifanova N.A., Orlova N.S., 2005, http: // ntpo .com / patents_medicine / medicine_11 / medicine_234.shtml).

The disadvantages of this method:

- the presence of the Tonsillor apparatus is required,

- the material for the study may contain a washout from the surface of the tonsils (the microflora of the surface of the tonsil, as a rule, differs from that in the gaps and can inhibit the growth of flora from gaps in bacteriological research).

The closest is a method of obtaining contents from the gaps of the palatine tonsils, allowing sampling the contents of the gaps of the palatine tonsils isolated from the oropharynx (Popov E.L., Pushchina P.N. Journal of ear, nose and throat diseases. Kiev, "Health", 1987, No. 4, pp. 84-85). The contents of the gaps are taken using a device consisting of a microsyringe, a cannula of 150 mm long and a thickness of 1.2 mm. The end of the cannula is bluntly sharpened, the needle is smoothly bent at an angle of 120 ° 10 mm from the end and is equipped with a hemispherical shield 6-8 mm from the end to overlap the mouth of the crypt at the time of collection of its contents. When sampling the material, a portion of the liquid is fed into the crypt and the suspension formed in the crypt cavity is sucked off. The manipulation is repeated several times. The resulting material is sent for analysis.

The disadvantages of this method:

- a sterile flushing fluid is required, neutral with respect to microflora;

- the syringe needles are discontinued, it is difficult to bend the needle without violating its clearance. Bending makes it difficult to clean and disinfect the needle.

The present invention is the development of a device for taking biological material from tonsil lacunae for bacteriological studies, which allows to obtain cleaner material for bacteriological and immunological studies, which increases the reliability of the studies.

The problem is solved using a device for taking biological material from the gaps of palatine tonsils, containing a syringe connected to a hollow rod having a bluntly sharpened working end, on which there is a section that overlaps the mouth of the crypt at the time of collection of its contents. The hollow rod is made of metal, the working end in the form of a tube with a diameter of 1.2 mm, with a hole with a diameter of 1 mm, 5 mm long. The section that overlaps the crypt's mouth is located at the transition point of the working end to the rod and is made in the form of a conical section, on which two holes with a diameter of 1 mm are diametrically opposed.

The novelty of the invention.

- A hollow metal rod with a working end in the form of a tube with a diameter of 1.2 mm, with a hole with a diameter of 1 mm, a length of 5 mm. This increases its strength, allows you to repeatedly sterilize.

- A section that overlaps the crypt's mouth is located at the transition point of the working end to the rod and is made in the form of a conical section, on which two holes with a diameter of 1 mm are diametrically opposed. The implementation of the conical section avoids bending of the working end, which simplifies the design. Holes are made on its surface, which when creating a vacuum, due to the movement of the piston of the syringe, attract the walls of the lacunae, narrow the mouth of the lacunae and thereby prevent the ingress of microflora from the oral cavity.

The significance of the differences of the claimed device to achieve the task is confirmed by the absence in the patent and scientific literature of information about similar devices with the same set of features.

The proposed device allows to obtain biological material from tonsil lacunae, providing a sufficient amount of bacteria from the depths of the tonsils.

The set of essential features of the invention allows to obtain a new technical result.

- The content of tonsils is taken directly from the tonsils lacunae themselves, without mixing with another liquid medium, which allows to obtain a cleaner microbial flora.

- There are holes on the tube, which, when creating a vacuum, due to the movement of the syringe piston, attract the walls of the lacunae, narrow the mouth of the lacunae and thereby prevent the ingress of microflora from the oral cavity.

- Simplification of the design, ease of use for the doctor and for further disinfection. The procedure is more easily tolerated by the patient, as the sampling time is reduced.

- The possibility of collecting material not only for bacteriological, but also for immunological research.

The invention is illustrated by the device shown in figure 1, which shows a view of the proposed device from the side.

A device for collecting biological material from palatine tonsil lacunae contains a hollow metal rod 1 with a total length of 103 mm, at the working end 2 of which there is a tube with a diameter of 1.2 mm 3 with an opening with a diameter of 1 mm and a length of 5 mm. The section overlapping the mouth of the crypt 4 is located at the place of expansion of the tube and the transition of the working end 2 to the rod 1. Section 4 is made conical and has two diametrically opposite holes 5 with a diameter of 1 mm. With the free end 6, the hollow metal rod 1 is connected, using a standard adapter, to a disposable syringe. The device is made of metal intended for use in medicine - stainless steel 40X13.

The device is used as follows. The free end 8 of the hollow metal rod 1 is attached to a sterile disposable syringe. The syringe piston is retracted. Without touching the walls of the pharynx, the device is inserted into the pharyngeal cavity, the working end 2 is immersed in the lacuna of the palatine tonsil until it contacts the conical section 4. While holding the device with one hand, the piston of the disposable syringe is moved with the other hand, as a result of which a vacuum is formed in the device and the rod cavity is released 1 is filled with biological material. The device is removed, its working end 2 is placed in the sample container, and the obtained material is placed in a test tube with a transport medium or buffer solution, moving the syringe plunger to the working end, empty the rod.

Example.

Patient S., 22 years old, a student, turned to the ENT doctor complaining of a feeling of a “foreign body” in the throat, sore, dry, bad breath. A history of frequent sore throats in childhood.

On examination, the general condition is satisfactory. The submandibular lymph nodes are enlarged, soft, with palpation - moderate soreness. The mouth opens freely, there is no trismus. The mucous membrane of the pharynx is pink, moist. The palatine arches are roll-shaped thickened, hyperemic, swollen. Palatine tonsils of the first degree, loose, in the gaps - caseous masses. Concomitant somatic pathology was not detected. The diagnosis is chronic tonsillitis, a compensated form. To conduct effective conservative therapy, it is necessary to establish the causative agent of this disease in the patient. For this purpose, a secret was taken from the gaps of the tonsils of the proposed device. Without touching the walls of the pharynx, a device with a length of a hollow shaft of 103 mm is inserted into the oropharynx. The length of the shaft is selected taking into account the average size of the cavity of the oropharynx, namely the distance from the teeth to the tonsils. The length of the rod allows you to bring the working end 2 to the gaps of the tonsils, while the other end remains available for connection to the syringe. The working end 2 of the tube with a diameter of 1.2 mm with an opening of 1 mm and a length of 5 mm is immersed in the lacuna of the palatine tonsil until it contacts the conical section 4. The diameter of the working end of the tube corresponds to the average size of the diameter of the lacunae. The length of the working end of 5 mm allows you to immerse it in the lacuna without injuring it. In this case, the conical section 4 overlaps the hole of the gap, isolating it from another liquid medium, which ensures a cleaner microbial flora. Two holes 5 with a diameter of 1 mm, located diametrically opposite on the conical section 4 of the working end, also contribute to this. When the syringe piston moves, during sampling, a vacuum is created at the working end, the walls of the lacunae are attracted to the conical section 4, which enhances the sealing of the lacunae during sampling and ensures the purity of the sample. Holding the device with one hand, with the other pulling, the piston of the disposable syringe is moved, as a result of which a vacuum forms in the device, and the cavity of the rod 1 is filled with biological material. The device is removed, its working end 2 is placed in the sample container, and the obtained material is placed in a test tube with a transport medium or buffer solution, moving the syringe plunger to the working end, empty the rod.

For control, the contents of the tonsils crypts were taken with a microbiological sterile probe (diameter 3 mm) for bacteriological examination.

The data of bacteriological research, after taking the material with the proposed device and microbiological probe, were different. So, when sampling the material with the proposed device - β-hemolytic streptococcus and Staphylococcus aureus, and when sampling with a microbiological probe - Staphylococcus aureus and non-pathogenic neisseria. When seeding the studied microbiological material on nutrient media, more pathogenic strains are able to inhibit the growth of other microflora. In our case, when taking material from tonsil lacunae using a microbiological probe, Staphylococcus aureus suppressed the growth of β-hemolytic streptococcus. And as you know, it is β-hemolytic streptococcus that contributes to the development of chronic tonsillitis, pathology of the heart, kidneys, joints. Streptococcal infections are among the most common diseases of a bacterial nature in all countries of the world (NN Briko Epidemiology and Infectious Diseases // Scientific and Practical Journal. - 2001. - No. 5. - P.59-61).

The patient underwent complex conservative treatment, including antibiotic therapy according to the results of bacteriological studies and sensitivity to antibiotics.

Thus, the proposed device allowed to obtain a cleaner material for bacteriological and immunological studies, due to the sealing of the lacunae at the sampling, which increases the reliability of the studies.

Accurate determination of the pathogen and sensitivity to antibiotics allows for a more rational and effective selection of drugs, their reduction, minimizing damage to the patient’s health from taking medications and prevents the development of resistant forms of bacteria to antibiotics.

The proposed method for producing biological material from tonsil lacunae was used in 15 patients, which significantly increased the reliability of bacteriological studies of microflora contained in the gaps of the tonsils.

Claims (1)

A device for collecting biological material from palatine tonsil lacunae, containing a syringe connected to a hollow rod having a bluntly sharpened working end, on which there is a section that overlaps the crypt's mouth at the time of its content collection, characterized in that the hollow rod is made of a metal length of 103 mm, the working end in the form of a tube with a diameter of 1.2 mm with an opening with a diameter of 1 mm, a length of 5 mm, the section overlapping the mouth of the crypt is located at the transition of the working end to the rod and is made in the form of a conical section, on which Two holes with a diameter of 1 mm are diametrically opposed to the rum.

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