Surgery – Truss – Pad
Patent
1989-12-01
1993-03-09
Aschenbrenner, Peter A.
Surgery
Truss
Pad
128691, 128742, A61B 502
Patent
active
051918951
DESCRIPTION:
BRIEF SUMMARY
The present invention relates to a method and an apparatus for determining whether a subject has nerve damage (polyneuropathy) and/or the degree of the nerve damage.
With numerous diseases polyneuropathy syndrom (PNS) arises as a frequent complication. Above all diabetes mellitus should be named here. In an extensive investigation by Canal et al. (Canal N, Pozza G(eds): Peripheral neuropathies. Elsevier North-Holland, Amsterdam, pages 247 to 255) it was found that after a period of more than five years for patients requiring insulin for diabetes mellitus only 18% were still not suffering from a manifest polyneuropathy syndrome. As further frequent causes consideration should be paid, above all, to other metabolic disturbances, such as for example in the context of chronic alcoholism (ethylismus) with various poisons or also neoplastic and inflamatory processes.
The clinical study of PNS is very diverse and numerous subdivisions have been proposed in recent years (Brown M. J. Asbury AK (1984) Diabetic neuropathy. Ann.Neurol 15: 2-12). The customary course shows generally a start at the lower extremities in the form of painful malsensations which initially occur primarily at night. In further succession sock-like and glove-like sensibility disturbances, loss of depth of sensitivity, areflexia starting with the achilles cord reflex and finally pareses should be named, of which the most frequent is the peroneal paresis.
As a result of this diversity of symptoms which mainly occur in combined form with different dominance numerous attempts have also been made to objectify the PNS in the last three decades, see for example Hoffmann A., Conen D., Leibundgut U., Berger W. (1982) A skin test for automatic neuropathy. Eur Neurol 21: 29-33; Kennedy W.R., Sakuda M. Sutherland D. Goetz F.C. (1984) The sweating deficiency in diabetes mellitus: methods of quantification and clinical correlation Neurology 34: 758-763; and Ward J. D., Fisher D. J., Barnes C. G., Jessop J. D. (1971) Improvement in nerve conduction following treatment in newly diagnosed diabetes. Lancet i: 428). As one of the few investigations which can be carried out routinely there remains the measurement of the motoric nerve conduction speed by Ward et al which takes place in the clinical routine at the nervus peronaeus since this is the nerve which is most frequently affected. This diagnostic route however mainly only shows changes when severe disturbances are already present. However it is precisely at this stage that the possibilities of therapy are no longer satisfactory.
The object of the present invention is thus to propose a diagnostic method and an apparatus for carrying out this method which makes it possible to recognise neuropathic or polyneuropathic changes at an early stage, which can be carried out and used in routine operation and which thus makes a timely therapeutic treatment of the neuropathy possible. Furthermore the method and apparatus should make it possible to achieve an objective judgement of the pain sensed by the patient.
The present invention starts from the consideration that the autonomous nerve fibers are generally also affected at a very early stage with polyneuropathic changes, so that it should be possible to detect the state of the autonomic nerve fibers via a possible dysfunction of the skin. Thereafter it was speculated that a dysfunction of the skin could eventually be determined by a change in the microcirculation.
After carrying out microcirculation measurements with several subjects having different stages of polyneuropathic diseases it was however determined that the perfusion values which were found suffers from a very large scatter and that no evaluatable correlation was present with the degree of the illness. It was then however surprisingly found that on heating the skin of the individual subject in order to provoke an increase of the microcirculation the time from the increase of the skin temperature up to the start of the increase of perfusion had a very reliable correlation with the state of illness found b
REFERENCES:
patent: 4228805 (1980-10-01), Rosen et al.
patent: 4569355 (1986-02-01), Betterly
patent: 4763666 (1988-08-01), Strian et al.
patent: 4859078 (1989-08-01), Bowman et al.
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