The way from diagnose to treatment is not usually short: a rare visitor of a very few specialists can afford to come to the doctor with a complaint and get out of the office being healthy, or at least in the process of recovery - especially if we are not talking about surgery. However, the combination of diagnosis and therapy - is not new either in the west or in the Far Eastern world, and it has even had its own specific term in the scientific literature - "theranostics".
In Russia theranostics has recently appeared, but St. Petersburg scientists from Peter the Great St. Petersburg State Polytechnical University and Acad. I.P. Pavlov First St. Petersburg State Medical University, developing teranostic device for ultrasonic obliteration (closure of the lumen) of veins have already got support from the Ministry of Education and Science of the Russian Federation in the Federal Program "Research and development on priority directions of scientific-technological complex of Russia for 2014-2020".
The project is directly related to the treatment of varicose veins - mostly on the legs of women, because women suffer from this disease more frequently (about 70% of women - just in Moscow). "The veins have valves to prevent reverse flow of blood, - Alexander Berkovich, head of the laboratory of medical ultrasound equipment in SPbPU and one of the key developers, says. - If a valve stops working, the blood is stagnant in the vein, and this pathological, abnormal blood flow should be eliminated". Today, it is done the most reliable invasively - with Troyanov-Trendelenburg surgery (ligation of the great saphenous vein). Or vein is simply obliterated by laser or by using of radiofrequency ablation (RFA): "Laser fiber or RFA-conductor is put in the great saphenous vein to the right place - the scientist explains. - Then, the laser burns the walls of the vessel from the inside to form a scar. Scar is being formed within 1.5-2 months, and all this time vein should be squeezed out by the outer bandage of elastic jersey".
The method proposed in the St. Petersburg Polytech is non-invasive: ultrasonic unit which "sees" bad valve is put outside, on foot, and then it focuses, concentrates the energy in the deepness of vein also non-invasively - and the vessel walls are cauterized.
The procedure takes place without damage to the skin, and therefore there is no possibility of penetration of the infection. And, therefore, there is no need in operating. "It's really an operation without cuts - Alexander Berkovich says. - We have to find out whether the operation is painless: then an anesthesiologist will not be required. Furthermore, if the laser is able to get not in any place in vein at all, then we can get to absolutely any perforating vein, any valve outside - and perform a coagulation".
Treatment with ultrasound have already been learnt in China, America, France, but
such a device will be a novelty for Russia, and it is "hardwired" by domestic know-how - the future ultrasonic sensor of the unit will show the image of the venous vessel in the volume:
"The doctor will see 2.5-3 cm of vein at once- it is very convenient - Berkowitz says. - And it's not standard flat image from a scanner, though its not a three-dimensional one, but an intermediate option: vessel will be real-time 'cut' on the set of planes, forming a three-dimensional image".
The device being developed for theranostics of varicose veins combines at least two technologies - all known US, as well as a therapeutic effect by ultrasound, through which high energy is concentrated inside the body without damaging the cover tissues. "That is the diagnosis is a vision, and ultrasound exposure is navigation within the body, which can be used for completely different things - the developer said. - It is possible, for example, to coagulate blood in the vessel, and the resulting clot will stop the bleeding. And you also can destroy cancerous or other breast or thyroid tumor by focusing high energy".
The application of focused ultrasound exposure for obliteration of veins has been offered by employees of the First St. Petersburg State Medical University, when they saw an ultrasonic sensor that combines diagnostics and HIFU power ultrasound developed in Polytechnic University. They wondered whether it is possible to use it for blood clotting, and Polytech scientists began to try: thus a joint project was born in which the SPbPU scientists are occupied with diagnostic technology, power and manipulation technologies whereas all the medical part of the project is charged to the surgeons of the department of general surgery SPbGMU - A.Y. Tsibin, assistant Anton Rebrov and O.V. Danil'chenko, doctor of ultrasonic diagnostics, led by Professor D.Y. Semenov and N.N. Petrishcheva, professor in the Department of Pathological Physiology. In the near future this joint team will conduct a series of experiments to select the parameters of HIFU influence, to study its effect on blood vessel walls, surrounding tissues.
Works under the supervision of Constantine Senchik, SPbPU professor and doctor of medical sciences, once held the laser obliteration of veins, are scheduled for three years: the team of scientists has managed to conduct a patent search, obtain a patent for utility model, make an analytical overview of information on the subject and prepare the stand for now. In the second stage the developers have to create a working stand, to collect data for the technology and to write the terms of reference for the model of the device, and in the third year it is supposed to create a physical model of the unit and to debug it. Ready unit will be transferred by higher education institutions participating in the project to its industrial partner - a "Neo" company, which produces diagnostic devices (for example, notorious "Valenta" telemedicine complex).
Scientists have already conducted the first experiments with rams. And now they proceed to experiments on rabbits. "We will check what signals are necessary exactly, of what extent and power to make obliteration process optimal, with what force it is necessary to affect the vessel wall, so as not to do anything too much, not to damage the tissues around - Berkowitz says. - Now we are in search of a future technology: it is possible that the process will be automatic, perhaps, therapist will keep a sensor in his hand. The level of treatments painfulness and necessity of anesthesiologist also should be examined. In any case, the prospects are good: the production of such equipment can be massive, and similar procedures will be performed on an outpatient basis, without having to go to the hospital".
In addition, Russian scientists have already received from the first experiments the necessary information about the possibility of using of high-intensity focused ultrasound not only to obliterate the veins, but also to stop bleeding and destroy cancer tumors.