Ubururu bwa metilene mu kubaga no mu bizamini by'isuzuma: kwerekana aho ingingo ziri, gupima aho amazi asohokera, no gukurikirana irangi

Umurwayi witegura kubagwa ibere asoma ko “irangi ry'ubururu” rizerekana aho imisemburo ye ya limufe iri. Umuvandimwe urimo gusuzumwa fisitile yumva bavuga “fistulografiya” maze akibwira ko hazakoreshwa irangi. Umuntu wafunguriwe umwenge mu muyoboro w'umwuka wo mu ijosi ahabwa “ikizamini cy'irangi ry'ubururu” kugira ngo harebwe niba kumira kwe bitekanye. Bose uko ari batatu bumva ijambo ubururu bakibwira ko ari igikorwa kimwe gikoresha irangi rimwe. Si ko bimeze.

Ubururu bwa metilene mu cyumba cyo kubagiramo bwumvikana neza iyo bufashwe nk'igitekerezo kimwe gikoreshwa ahantu hatandukanye kandi hatagize aho hahuriye: irangi rituma ibitagaragara biboneka. Bukurikira uko limufe itemba, bugasiga ibara imvubura ishakishwa, bugaha ibara amazi akoreshwa mu kizamini arimo gusohoka, bukerekana agapira katobotse ko ku muyoboro w'ubuhumekero, cyangwa bukagaragaza ihuriro ryihishe hagati y'imyanya ibiri yo mu mubiri. Ibimenyetso by'ubushakashatsi, ingano ikoreshwa, n'ibyago biratandukanye cyane muri iyi mikoreshereze. Kandi bimwe mu bikorwa byitwa “ibizamini by'irangi ry'ubururu” bikoresha andi marangi atandukanye rwose, naho fistulografiya ikoresha amashusho ntikoresha ubururu bwa metilene na gato. Iyi nyandiko isobanura buri mikoreshereze ukwacyo. Ku kibazo kigari cy'imikoreshereze mu buvuzi yamaze kwemezwa n'ikiri mu bushakashatsi, reba imikoreshereze mu buvuzi yemewe n'ikiri mu bushakashatsi.

Incamake y'ibikorwa: kugaragaza, si ukuvura

Nta na kimwe muri ibi ari ukuvura hakoreshejwe ubururu bwa metilene. Muri Leta Zunze Ubumwe za Amerika, imikoreshereze y'umuti uterwa mu mutsi yemejwe kandi iri ku kirango cyawo ni ukuvura methemoglobinemia umuntu yagize nyuma yo kuvuka, ubusanzwe hakoreshejwe 1 mg/kg IV, nk'uko bivugwa mu makuru ya DailyMed ku kwandika uyu muti. Gukoresha iri rangi mu gukurikirana inzira mu kubaga ahanini ni imikoreshereze itari mu yemejwe ku kirango cyangwa ijyanye n'igikoresho runaka, ishingiye kuri ubwo bushobozi bwo gutanga ibara.

Gufata urugero rw'umusemburo wa mbere wa limufe: gukurikira uko limufe itemba

Nyuma yo guterwa ahantu hamwe hafi y'ikibyimba, ubururu bwa metilene bwinjira mu miyoboro ya limufe bugasiga ubururu imiyoboro itwara limufe n'imisemburo ya mbere iyakira, kugira ngo umuganga ubaga ashobore kuyibona n'amaso. Muri kanseri y'ibere, irangi ry'ubururu riracyari ikimenyetso cyo gukurikirana cyemewe, kikaba cyari gisanzwe gihuzwa n'umuti wa technetium-99m radiocolloid, kandi amabwiriza ya NICE agezweho asaba gukoresha uburyo buhuza isotope n'irangi ry'ubururu. Zirikana ko “irangi ry'ubururu” rivugwa mu mabwiriza atari buri gihe ubururu bwa metilene by'umwihariko; patent blue V na isosulfan blue na byo birakoreshwa.

Uburyo bukunze gukoreshwa ku ibere bukoresha ubururu bwa metilene bwa 1% (10 mg/mL), akenshi hafi 1 mL, bugaterwa munsi y'uruziga rw'ibara rukikije imoko, hafi yarwo, mu ruhu, cyangwa hafi y'ikibyimba. Kwerekana aho imisemburo iri hakoreshejwe ubururu bwa metilene bwonyine birakora, ariko ibimenyetso by'ubushakashatsi byahurijwe hamwe bishyigikira kongeraho ikimenyetso gikoresha imirasire: isesengura ryahurije hamwe ubushakashatsi ku bururu bwa metilene bwonyine ryagaragaje igipimo cyo kubona imisemburo cya 91% n'igipimo cya 13% cy'ibisubizo bitagaragaza ikibazo kandi gihari, mu gihe uburyo buhuje ibimenyetso buyibona mu buryo bwizewe kurushaho. Muri melanoma, kwerekana aho imisemburo iri bishingira cyane ku gufata amashusho y'inzira za limufe hakoreshejwe technetium mbere yo kubaga, no ku gikoresho gipima imirasire ya gamma mu gihe cyo kubaga; irangi ry'ubururu ryo rirunganira. Amabwiriza ya tekiniki ya ASCO/SSO asobanura gutera 1–2 mL y'irangi ry'ubururu rishobora gusiga ibara ingirangingo zikiri nzima mu ruhu, hakategerezwa hafi 5–10 minutes kugira ngo rinyure mu miyoboro ya limufe, kandi akavuga ubururu bwa metilene na isosulfan blue nk'amahitamo.

Uburyo bushya bwo kwerekana inzira hakoreshejwe urumuri rutangwa na indocyanine green (ICG) bugaragaza imiyoboro ya limufe ako kanya budakoresheje imirasire ioniza, ariko busaba ibikoresho bikoresha urumuri rwegereye urwa infraruje, kandi kubushyira mu mabwiriza ntibiraba kimwe hose. Mu buryo bufatika: ubururu bwa metilene ni ikimenyetso cyo gukurikirana gihendutse kandi cyoroshye kubona n'amaso, ariko intege nke zabwo ni uko imisemburo igaragara gusa imaze gushyirwa ahagaragara mu kubaga.

Ubururu bwa metilene bufite ingaruka mbi zihariye muri iyi mikoreshereze. Bushobora gutuma uruhu n'ingirangingo bigumana ibara igihe kirekire, bugatera impinduka zijyanye n'ububyimbirwe, gupfa kw'ingirangingo z'ibinure, ndetse rimwe na rimwe gupfa kw'ingirangingo z'uruhu. Amashusho y'ibere afashwe nyuma yo kubaga ashobora no kwerekana ahantu hangiritse hadafite ishusho isanzwe haterwa n'irangi, hagasa n'aho kanseri yagarutse. Abaganga babaga bagomba kumenyesha abashinzwe gufata amashusho n'abasuzuma ingirangingo igihe cyose irangi ryatewe mu rugero rwafashwe cyangwa hafi yarwo. Amarangi y'ubururu ashobora kandi gutera ubwivumbure bw'umubiri bwihuse; isesengura ryahurije hamwe ibikorwa birenga 60,000 byo gusuzuma imisemburo ya mbere ya limufe ryasanze igipimo rusange cya anafilagisi iterwa n'irangi ry'ubururu kiri hafi 0.061%, kandi ubururu bwa metilene bwari bufitanye isano n'ibipimo biri hasi kurusha isosulfan blue. Amakuru yagutse ku mutekano ari mu nyandiko ingaruka mbi n'umutekano.

Kumenya aho imvubura za paratiroyide ziri: uburyo bwa kera bunyura mu maraso, ubu bukoreshwa mu bihe byatoranyijwe

Gutera ubururu bwa metilene mu mutsi kugira ngo haboneke imvubura za paratiroyide zidasanzwe ni uburyo bwa kera busigaye bukoreshwa gusa nk'ubwunganira mu bihe byatoranyijwe. Kera, ingano nini ugereranyije zaterwaga mu mutsi mbere yo gushakisha mu ijosi kugira ngo ingirangingo zidasanzwe zibe ubururu; uburyo bwatangajwe bukoresha ingano iri hafi ya 3 kugeza kuri 7.5 mg/kg IV. Isuzuma ry'ubushakashatsi ryakozwe mu buryo buhamye ryabonye ubushakashatsi 39 bushingiye ku kwitegereza, ariko nta gerageza na rimwe rigabanya abitabiriye mu matsinda ku buryo bwa tombola: havuzwe ko gusiga ibara byageraga ku gipimo cyo hejuru, ariko nta nyungu y'inyongera yari yaragaragajwe iyo ubwo buryo bwakoreshwaga hamwe n'uburyo bugezweho bwo kumenya aho imvubura ziri.

Imikorere y'ubu yishingikiriza ahubwo ku mashusho ya ekogarafi n'andi mashusho afatwa mbere yo kubaga, ku bumenyi bw'imiterere y'ingingo mu gihe cyo kubaga, no ku kugenzura imisemburo ikorwa na paratiroyide muri icyo gihe. Amabwiriza ya AAES ashyira ubururu bwa metilene mu buryo bwinshi bushobora kunganira kugaragaza ingingo, aho kubugira uburyo bw'ibanze bwo kumenya aho ziri.

Iyi ni na yo mikoreshereze umuburo wo gukorana nabi kw'imiti ugiramo akamaro kanini kurusha ahandi. Ubururu bwa metilene ni umuti ukomeye uhagarika by'agateganyo imikorere ya anzime monoamine oxidase. Isuzuma ry'ubushakashatsi ryavuze ko abarwayi 25 bagize uburozi bwangiza urwungano rw'imyakura, bose bakaba barafataga imiti igira ingaruka kuri serotonine. Irindi suzuma ry'inyandiko ku ihuriro ry'ibimenyetso biterwa na serotonine ryari rifitanye isano n'ubururu bwa metilene ryabonye abantu 50, bose bakoreshaga imiti y'agahinda gakabije igira ingaruka kuri serotonine, abenshi bikaba byari bifitanye isano no kubaga paratiroyide cyangwa kuvura vasoplegia. Ingano zakoreshwaga kera kuri paratiroyide zishobora kurenza cyane ingano y'ubu ya 1 mg/kg ikoreshwa mu kuvura; bityo uku gukorana nabi kw'imiti kureba irangi ryinjiye mu maraso, si igitonyanga cy'irangi kiri ku ngirangingo.

Hari ubundi buryo butandukanye, bukoresha ingano nto cyane, bwasobanuwe ku majosi yongera kubagwa cyangwa afite inkovu: gutera irangi mu buryo butaziguye ahantu hazwi hashakishwa, hagendewe ku mashusho ya ekogarafi. Ubushakashatsi buto bwakoresheje hafi 0.2 mL y'umuti wa 1% wavanzwe ku kigereranyo cya 1:5 (ukaba hafi 0.2%) mbere gato yo kubaga. Ibimenyetso bigarukira ku bushakashatsi buto bushingiye ku kwitegereza.

Ikizamini cyo gutera amazi y'umunyu mu ngingo: irangi si ryo rituma ikizamini gikora

Mu kizamini cyo gutera amazi y'umunyu kugira ngo harebwe niba igikomere cyafunguye ingingo, amazi y'umunyu aterwa mu ngingo maze igikomere kikagenzurwa kugira ngo harebwe niba amazi asohoka. Rimwe na rimwe ubururu bwa metilene bwongerwamo gusa kugira ngo amazi asohoka arusheho kugaragara. Icyagaragaye cy'ingenzi ni uko bitigeze byerekanwa ko irangi rituma ikizamini kiba cyiza kurushaho: mu bushakashatsi bwakurikiranye abarwayi 58 ku ivi, bagabanyijwe mu matsinda ku buryo bwa tombola, ibipimo by'ibisubizo bitagaragaza ikibazo kandi gihari byari 69% hakoreshejwe ubururu bwa metilene, ugereranyije na 66% hakoreshejwe amazi y'umunyu gusa. Ingano z'amazi zasabwaga kugira ngo ikizamini kigaragaze ikibazo zari zisa. Isuzuma ry'ubushakashatsi ryo mu 2025 ryasanze ubushakashatsi 8 muri 23 ku bizamini byo gutera amazi y'umunyu bwarakoresheje irangi, ariko imikorere y'ikizamini yashingiraga ku ngingo, aho igikomere kiri, ingano y'amazi yatewe, n'uburyo bwakoreshejwe, aho gushingira ku kongeramo irangi. Nta gipimo rusange cy'ubwinshi bw'irangi mu mazi cyemejwe kuri iyi ntego. Aha ubururu bwa metilene ni ikinyabutabire gitanga ibara gishobora kongerwamo mu buryo bwa kera cyangwa bw'igerageza, si cyo gituma ikizamini kigira ubushobozi bwo kubona ikibazo.

Imiyoboro y'ubuhumekero ikoreshwa mu kubaga na lazere: irangi rifungiye mu gapira

Iyi mikoreshereze itandukanye n'indi yose iri kuri uru rupapuro: ubusanzwe irangi rishyirwa mu gapira ko ku muyoboro winjizwa mu muyoboro w'umwuka, ntirishyirwa mu murwayi. Mu kubaga imyanya y'ubuhumekero hakoreshejwe lazere, amabwiriza yo kwirinda inkongi mu gihe cyo gutera ikinya asaba umuyoboro ukwiye ushobora kwihanganira lazere kandi, aho bishoboka, kuzuza agapira amazi y'umunyu aho kukuzuzamo umwuka. Guha ayo mazi y'umunyu ibara ukoresheje ubururu bwa metilene bituma, iyo lazere itoboye agapira, amazi y'ubururu asohoka ahita agaragara. Nta gipimo kimwe cy'ubwinshi bw'irangi mu mazi giteganyijwe hose; intego ni ugutanga ibara rigaragara, nk'uko bisobanurwa mu nama z'imikorere za ASA ku nkongi mu cyumba cyo kubagiramo.

Hari imiburo ibiri y'ingenzi. Imwe mu miyoboro ya kera yakoreshwaga mu kubaga na lazere yari ifite kristalo z'irangi mu gapira cyangwa mu gice gikoreshwa mu kukuzuza no kukagenzura. Hari inkuru y'ibyabaye ku murwayi yatangajwe isobanura ko kristalo zitashonze zafunze umuyoboro wo kugenzura agapira, bituma kadashobora gusohorwamo amazi cyangwa umwuka; ni yo mpamvu amabwiriza yihariye y'igikoresho ari ingenzi. Kandi ubururu bwa metilene ubwabwo ntibutuma umuyoboro usanzwe ushobora kwihanganira lazere; kwirinda inkongi bishingira kandi ku buryo umuyoboro wakozwe, ku kurinda agapira, no ku kugabanya uko bishoboka ubwinshi bw'ibintu bifasha umuriro kwaka.

Ibizamini byo kumira: “irangi ry'ubururu” rishobora kutaba ubururu bwa metilene

Mu kizamini gisanzwe gikorerwa hafi y'igitanda cy'umurwayi wafunguriwe umwenge mu muyoboro w'umwuka wo mu ijosi, ibiryo cyangwa ibinyobwa bihabwa ibara, maze ururenda rwo mu muyoboro w'umwuka rugasuzumwa harebwa niba rufite ibara ry'ubururu; igisubizo kigaragaza ubururu gishyigikira ko ibyo yamize byinjiye mu myanya y'ubuhumekero. Aya mazina ashobora kumvikana nabi: uburyo bwatangajwe bw'“ikizamini cy'irangi ry'ubururu” n'Ikizamini Cyahinduwe cy'Irangi ry'Ubururu bwa Evans bwakoresheje Evans blue, ubururu bwa metilene, n'amarangi y'ibiribwa; bityo “ikizamini cy'irangi ry'ubururu” ntigihita gisobanura ubururu bwa metilene.

Ikibazo cy'ingenzi ni ibisubizo bitagaragaza ikibazo kandi gihari. Ubushobozi bwo kubona ikibazo mu buryo butandukanye bw'iki kizamini buri hafi ya 38% kugeza kuri 95%, kandi amabwiriza afata iki kizamini ahanini nk'ikimenyetso cyunganira kwemeza ko ikibazo gihari iyo cyakigaragaje: igisubizo kitagaragaza ikibazo ntigihakana ko ibyo umuntu yamize byinjiye mu myanya y'ubuhumekero. Isuzuma ryizewe kurushaho, iyo rikenewe, rikoresha ibikoresho, nko gusuzuma kumira hakoreshejwe kamera ya endosikopi ifite fibre optique cyangwa amashusho ya videwo akoresha imirasire. Nta ngano y'irangi yemejwe ko ari yo ikwiye kurusha izindi.

Ntukitiranye ibi n'imikorere ya kera yo guhora baha ibara ibyo kugaburira binyuzwa mu muyoboro ujya mu rwungano rw'igogora, bakoresheje FD&C Blue No. 1. Iryo ni irangi ritandukanye n'imikorere itandukanye, byari bifitanye isano no kwinjira kw'irangi mu maraso n'uburozi bukomeye mu barwayi barembye cyane, maze nyuma biza kugirwa inama yo kutabikora.

Gukurikirana fisitile si fistulografiya

Gukurikirana fisitile ahantu hamwe ukoresheje ubururu bwa metilene na fistulografiya ikoresha amashusho ni uburyo bubiri butandukanye bw'isuzuma, ariko bukunze kwitiranywa. Mu gukurikirana ahantu hamwe, irangi rishyirwa mu mwenge ukekwa ko ari uwa fisitile cyangwa mu mwanya w'imbere mu rugingo, maze umuganga akareba niba ubururu busohoka ahandi cyangwa agakurikira ingirangingo zasizwe ibara mu gihe cyo kubaga: urugero ni ugutera irangi mu mwenge wo hanze kugira ngo haboneke inzira ya fisitile yo ku kibuno, guha ibara amazi yo koza uruhago kugira ngo hagaragare niba asohokera mu gitsina cy'umugore igihe hakekwa fisitile ihuza uruhago n'igitsina, n'indi mikoreshereze isa n'iyo ijyanye n'ahantu runaka. Uburyo bukoreshwa bushingira ku hantu hasuzumwa, kandi nta bipimo rusange byemejwe by'ubwinshi bw'irangi mu mazi.

Fistulogramu cyangwa sinogramu nyayo ni igikorwa cyo gufata amashusho: umuti ugaragara ku mashusho y'imirasire uterwa mu nzira ya fisitile, maze fluoroskopi cyangwa CT bikerekana imiterere yayo. Si ikizamini cy'ubururu bwa metilene. Nta na bumwe muri ubu buryo busimbura byanze bikunze MRI, CT, endosikopi, cyangwa isuzuma rikozwe umurwayi yatewe ikinya, mu gihe fisitile ifite imiterere igoranye.

Hari ikosa rishobora guterwa n'inzira irangi ryanyujijwemo rikwiye kwitabwaho cyane: ubururu bwa metilene bushyizwe mu mara ya nyuma bushobora kwinjira mu maraso hanyuma bugasohoka mu nkari. Ubushakashatsi ku bakorerabushake bwabigaragaje nyuma yo gukoresha umuti wa 50-mg unyuzwa mu kibuno, maze bwanzura ko irangi rishyizwe mu mara ya nyuma ridakwiye gukoreshwa mu kwemeza fisitile ikekwa guhuza urura runini n'uruhago, kuko inkari zishobora kuba ubururu nta fisitile ihari. Garagaza ahantu ho mu mubiri hasuzumwa n'uburyo bwo gufata amashusho, aho gufata ibibazo byose bya fistulografiya nk'ikizamini kimwe.

Imbogamizi rusange zikwiye kwibukwa

Kwinjira kw'irangi mu maraso bisaba kwita ku ngaruka zaryo nk'umuti, bitandukanye no kurikoresha mu gukurikirana inzira ahantu hamwe. Iyo ubururu bwa metilene mu maraso buhagije, bunyunyuza urumuri rukoreshwa n'ibikoresho byo kugenzura umurwayi; bityo igikoresho gipima uko amaraso yuzuyemo ogisijeni hifashishijwe urumuri n'imikubito y'umutima gishobora kwerekana igipimo kiri munsi y'icy'ukuri. Gutanga ubururu bwa metilene bukagera mu maraso bishobora gutera isenyuka rikomeye ry'uturemangingo dutukura tw'amaraso mu bantu bafite ubuke bwa G6PD, kandi ikirango cy'umuti uterwa kiriho ubu kivuga ko ubuke bwa G6PD ari impamvu ibuza kuwukoresha. Nanone, ibyago biterwa no gutera ingano nto cyane ahantu hamwe cyangwa n'irangi rifungiye mu gapira ko ku muyoboro w'ubuhumekero ntibihwanye n'iby'ingano ya mg/kg nyinshi iterwa mu mutsi. Ariko “ahantu hamwe” ntibihita bisobanura ko nta rangi na rimwe ryinjira mu maraso: inzira rinyuzwamo, ingano, n'uko ingirangingo zimeze biragira uruhare.

Ingingo ya nyuma ireba kumenya irangi nyirizina. Kugaragaza ingingo mu kubaga bisaba kumenya neza irangi riri mu rushinge: ubururu bwa metilene, isosulfan blue, patent blue V, Evans blue, n'amarangi y'ibiribwa bikora mu buryo butandukanye kandi bifite ibyago bitandukanye, nyamara byose bikoreshwa mu bikorwa bikunze kwitwa gusa ibizamini by'“irangi ry'ubururu”. Uko kwitonda ni ngombwa no hanze y'ibitaro. Ibicuruzwa bigurishwa nk'ubururu bwa metilene biratandukanye cyane mu rwego rw'ubuziranenge no mu nyandiko zibiherekeza, kandi ibikoresho byagenewe gusiga imyenda ntibisimbura ibyakozwe kandi bigapimwa ku bw'intego yabyo yatangajwe. Iyo ubuziranenge ari ingenzi, shaka ibikorerwa mu buryo bugenewe imiti, byakorewe ibipimo byose bya USP kandi bifite icyemezo cy'isesengura cyihariye kuri buri tsinda ry'ibyakozwe, hamwe n'igenzura ryigenga, aho kwishingikiriza gusa ku isuzuma ry'ibyuma biremereye. Amabwiriza yo gusoma icyemezo cy'isesengura asobanura ibice ugomba kugenzura. Inkomoko z'amakuru yimbitse zashyizwe ku rutonde mu bubiko bw'inyandiko z'ubushakashatsi.