FUNCTIONAL DIAGNOSIS

From Big Medical Encyclopedia

FUNCTIONAL DIAGNOSIS (Latin functio execution, commission; diagnosis) — the section of diagnosis based on use of tool and laboratory methods of a research of patients for objective assessment of a functional condition of various systems, bodies and body tissues at rest and at loadings and also for overseeing by dynamics of the functional changes happening under the influence of treatment.

The concept «functional diagnosis» is semantic distinguished from such concepts as clinical, topical, morphological, a patologoanatomicheska I am diagnosis (see Diagnosis). T. supplements the specified types of diagnosis. At the same time detection of the functional disturbances caused patol. process (along with the description caused by it morfol. changes), always was the most important part of clinical diagnosis.

Development F. by it is connected with the statement of the physiological direction in medicine. Originally methods of physical (physical) inspection of patients and diagnostic characters of diseases were fulfilled by kliniko-anatomic comparisons. Physiological representations and functional methods of a research began to develop quickly only from the second half of 19 century thanks to K. Bernard's works, Poiseuille (G. Poiseuille, 1799 — 1869), E. Du Bois-Reymond, G. Helmholtz, And. M. Sechenova, I. P. Pavlov, etc.

For development F. of disturbances of breath the invention in 1846 the spirocount (see the Spirography), and in the subsequent — a pneumotachometer (see Pnev-motakhografiya), an oksigemometr was of great importance (see Oksigemometriya). The fundamental works on measurement of stroke and minute output of heart (see Blood circulation) executed by Fick (A. Fick, 1870), Stewart (G. N. Stewart, 1897) became important milestones in studying of functions of the blood circulatory system; the invention of a sphygmograph (see Sfigmografiya) and development of the so-called indirect methods of determination of stroke (systolic) output of heart based on Frank's principle (see M an ekhanokardiografiya, Sfigmografiya), on Newton laws of motion (see Ballistokardiografiya, Dinamokardiografiya, Seysmokardiografiya), on measurement of fluctuations of an electric impedance (see Reo-kardiografiya); creation of invasive methods of a hemodynamometry (see) and especially noninvasive — widely implemented in a wedge, practice of an auskultativny method of measurement of the arterial pressure (see Sfigmomanometriya) developed by N. S. Korotkov (see t. 25, additional materials), and a takhoostsillogra-fichesky method of Savitsky (see M an ekhanokardiografiya)', development of methods of a pletizmografiya (see), in chas to Nosta M. V. Yanovsky and A. I. Igna-tovsky (1907), B. E. In otchaly, etc., and an impedance pletizmografiya (see Geography). Outstanding value for development F. of heart diseases development

by V. Eyntkhoven had (1895 — 1912) methods of an electrocardiography (see), domestic scientists A. F. Samoylov, V. F. Zelenin,

N. E. Lukomsky, etc., and also record of sound phenomena of heart brought in improvement to-rogo an essential contribution (see Fonokardiografiya). Use by Kussmaul (A. Kussmaul, 1868) a thick gastric tube, then Gross (M. of Gross, 1893) — the thin intestinal probe improved by M. A. Gorshkov (1921) and other researchers, laid the foundation for studying of secretory and motor function of a stomach with use of so-called trial breakfasts of Boas and Evald, Leporsky (1921), etc. (see the Breakfast trial, Sounding of a stomach), and also bile secretions (see. Duodenal sounding). To studying of function went. - kish. a path also development of methods of an elektrogastrografiya (see), endoradio sounding promoted (see). Powerful contribution to development F. of diseases of kidneys was brought by S. S. Zimnitsky who offered the functional trial which is widely applied and in a crust, time (see Zimnitsky test). Successfully methods F develop. in neurology, in particular an electroencephalography (see), an electromyography (see), etc., in endocrinology (a research of function of a thyroid gland, adrenal glands and other closed glands).

K F. in a broad sense belong any diagnostic testings which are objectively informing on a condition of function of various bodies and systems including a number of methods of laboratory diagnosis (see), radio isotope diagnosis (see), radiodiagnosis (see), etc.; with the purpose F. is used also endoscopy (see).

In narrow sense the concept «functional diagnosis» began to be applied to designation of that part of functional diagnostic testings, edges the hl is carried out. obr. tool me todam in special divisions to lay down. - the prof. of institutions — the offices or departments of functional diagnosis organized according to the approved structure and states of institutions of this profile. In large advisory policlinics and in hospitals of the general profile such divisions carry out planned diagnostic testings of function of the blood circulatory systems, external respiration and, as a rule, a nervous system (with use of an electroencephalography).

For assessment of function of external respiration by means of spirometry, spirographies, pneumotachometry investigate structure of vital capacity of lungs (see) and function of bronchial passability, using various tests (see. In an otchal — Tiffno test). In advisory institutions and in hospitals in the presence of specialized pulmonary departments the spirocounts with gas analyzers (see the Spirography) allowing to study structure of total capacity of lungs, uniformity of ventilation use (on time of cultivation of indicator gas in lungs); investigate oxygen absorption blood, diffusion capacity of lungs, gas composition of blood and an alveolar air (see Gasometry, Oksigemometriya), in some cases apply a separate bronkhospirografiya, a pnevmotakhografiya (see), a pletizmografiya of all body (see Pletizmografiya). Portable devices with the computer analysis of at the same time measured flow and air volume are developed that gives valuable diagnostic information.

For F. of cardiovascular system equipment of offices of functional diagnosis at least turns on devices for carrying out an electrocardiography, a phonocardiography and a sfigmografiya. The electrocardiography (see) as an independent research is intended generally for functional assessment of a rhythm and conductivity сердг^а (see), diagnoses of hyperfunction and a hypertrophy of its departments, diagnoses of coronary insufficiency (see) and for identification of the disturbances of electric activity of a myocardium helping to distinguish its various defeats (a heart attack, dystrophy, a sclerosis etc.), including caused by an imbalance of electrolytes (see the Hyperpotassemia, the Hypopotassemia). The phonocardiography (see) has independent value for clarification of the nature of changes of cardiac sounds (see) and noise of heart (see Noise cordial) that is especially important for diagnosis of heart diseases (see Heart diseases inborn, the Heart diseases acquired). The possibility of synchronous registration of the electrocardiogram (ECG), phonocardiogram (FKG) and the sphygmogram allows to make the phase analysis of a systole of a left ventricle of heart (see Polikardiografiya), and instead of the arterial sphygmogram can be registered a venous pulse (see Sfigmografiya) or an apekskardiogramma (see the Cardiography), to-rye give additional diagnostic information. Apply a reo-vazografiya to a research of function of vessels of extremities (see Reografiya), vessels of the head — a rheoencephalography (see), is more rare (because of labor input of a method) — a pletizmografiya (see).

Creation and production of new diagnostic units continuously expands possibilities of divisions of functional diagnosis. From 70th widely are implemented into daily practice of offices and departments of functional diagnosis a reokardiografiya (see) and methods of ultrasonic diagnosis (see), in particular an echocardiography (see). The multichannel (printing) devices allowing to elect purposefully structure of synchronously registered curves depending on the purposes of diagnosis, reliability are improved the cut in this regard considerably raises. So, synchronous record FKG together with apekskardiogrammy and ekhokardiogrammy allows not only to reveal, e.g., a prolapse of shutters of the mitral valve, but also to establish connection of an origin of systolic noise with this dysfunction of the valve.

Unlike the period of formation F. when its tasks were limited to identification of functional deviations and overseeing by their dynamics at inspection of the patient in the conditions of rest, in a crust, time with a main content of F. assessment of functionality in the conditions of the loading specific to the studied function or in the conditions of influence on links of regulation of this function became. Depending on the purposes and a type of a research apply orthostatic tests (see), food, cold test, test with a hyperventilation, Valsalva's tests (see the Varicosity), Müller (see Rentgenokimografiya), etc. In cardiology and pulmonology functional tests with an exercise stress and pharmacological tests have the greatest use. Tests with the dosed exercise stress are specific to a research of functions of the blood circulatory systems and breath and for diagnosis of coronary insufficiency. Use special devices to quantitative dosing of loading — the stationary bicycle, «the running path» (the thread - is lovely), etc.; their use allows to carry out registration during loading of various parameters of blood circulation and breath and to precisely determine that level of loading, at Krom there come deviations of the studied parameters from fiziol. norms (tolerance to loading).

Pharmakol. tests apply as for the purpose of recognition of pathology and specification of the pathogenetic diagnosis, napr, adrenalinic test (see), and to assessment of functional reserves, napr, eufillinovy test (see), and definitions of indications to medicinal treatment, e.g. stanzas aniline test (see), and also to detection of advantages - whom - or means from same on action (see Pharmacotherapy).

Value F. continuously increases in the general structure of diagnostic testings. Use of methods F is especially important. for early diagnosis of a row hron. diseases, at to-rykh morfol. signs, often secondary in relation to functional frustration, are found late. Functional methods allow to make easy for the patient dynamic observation during treatment and rehabilitation, help to estimate objectively efficiency of medical actions, to timely reveal adverse shifts, to korrigirovat therapy.

To increase efficiency F., it is necessary to define indications to use of available techniques of inspection of the patient, it is correct to estimate value of the acquired information, to objektivizirovat a wedge, symptoms of a disease, to specify a phase of a disease and extent of functional disturbances. It is important to unify functional methods of a research, load and pharmakol. tests to achieve comparability of results of inspection of the different groups inspected.

Departments and offices of functional diagnosis are staffed by specially trained doctors and medical staff, are equipped with the necessary equipment and provided with funds of acute management for a case of possible complications owing to use of loading tests. In in-ta of improvement of doctors special cycles on F are created. for training of therapists on a wedge, physiology and T. At the same time the doctor of any specialty shall own knowledge of methods F. within the specialty independently to find and estimate the most important symptoms of the diseases revealed by means of an electrocardiography, a phonocardiography and other methods F.

The preventive direction of the Soviet medicine in combination with opportunities of the state health system of the countries of socialism considerably expands scope of methods F. They allow to provide adequate professional selection (see) persons for those fields of activity, to-rye impose special requirements to the state of health of specialists. to make dispensary observation behind them during work and to reason conclusions of the expert. At load tests those are found patol. reactions and processes, to-rye demonstrate restriction of reserves of compensation and adaptation, about instability and incompleteness of adaptive reactions, about a premorbidal state (predisease) or existence of the latent form of a disease (see Diagnosis donozologichesky). It opens ways for medical justification of recommendations about the organization of work and rest, holding actions of primary and secondary prevention of diseases (see Prevention, Prevention primary).

The automatic analysis of results by means of computers expands opportunities F., provides its higher precision, eliminating errors of subjective character, and saves time. Creation of the universal diagnostic devices equipped with the mini computer and microprocessors that allows to make synchronously 4 — 6 types of a research is perspective.

Bibliography: Bogolyubov V. M. Paj

dioizotopny diagnosis of heart diseases and lungs, M., 197e; Demboa. G. Nedostatochnost of function of external respiration, L., 1957; it, Urgent

problems of modern sports medicine, M., 1980; E. I. Heats and And r-sh and to at N and R. O. Use of radioisotopes for studying of a hemodynamics, Cardiology, t. 7, No. 5,

page 23, 1967; 3 and p e c to and y V. V., Bob

of V. V. k and About l and N with to and I am L. I. Clinical echocardiography, Atlas, M., 1979; History of medicine, under the editorship of B. D. Petrov, t, 1, M., 1954; Fundamentals

of pulmonology, under the editorship of A. N. Kokosov, M., 1976; P and l of e e in H. River and Kayev and - c of e r I. M. The atlas of hemodynamic researches in clinic of internal diseases, M., 1975; The Guide to cardiology, under the editorship of E. I. Chazov, t. 2, page 9, 139, M., 1982; The Reference book on functional diagnosis, under the editorship of I. A. Kassirsky, M., 1970. E. E. Gogin.

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