The collection of proceedings of Institute of Practical
Psychophysics
Topical problems of NLS-diagnostic
(theoretical and clinical)
(Moscow 2003)
Computer non-linear diagnostics
V.I. Nestrov
The Non-linear Diagnostic System (NLS)has been extensively used lately
and are gaining ever growing popularity. Even in the few cases, where
the clinical symptoms look very typical the NLS diagnostics method
provides extra information about the extent of the affection and allows
to consider a prognosis. In most cases it is of vital importance for
diagnostics and quently for the right choice of treatment.
In 2000 it was 20 years since Theodore Van Hoven had developed the
theory of quantum entropy logic that underlies this method. So non-linear
diagnostics appears to be most up-to-date of all methods of the hardwarebased
diagnostics. At any rate, his discovery became a significant landmark
in diagnostic medicine.
Non-linear analysis was originally employed in organic chemistry to
determine the composition of complex compounds.
Sviatoslav Pavlovich Nesterov who introduce a trigger sensor in 1988
and thus framed the concept is acceptably considered as a originator
of NLS-diagnostics devices (metatron) Active work was immediately
started to develop and improve the NLS-diagnostics systems. Clinical
testing of the early equipment took the period from 1990 through 1995.
The late 90s saw a fast growth of commercial production of the device
and a sudden surge in the quality of the results produced.
The non-linear diagnostics is still in its developing stage. The diagnostical
techniques are improving so fast, that the system version have to
be updated every six months. Due to the introduction of some of new
devices equipped with digital trigger sensor, the NLS-diagnostics
has become not only far more time-efficient but also quiet different
in terms of quality. It is obvious that some runtime techniques, for
instance tree-dimensional visualization of investigation results will
soon become a daily practice. The vegetive testing is just an example
of a ready implementation. The method is employed so widely that we
should rather speak about a definite rang of indication for its use
than just about popularization.
Research centers continue their quest for some new investigation methods
based on the non-linear analysis system. So far the result appear
to be quiet promising.
Unlike NMR and computer tomography, the NLS-analysis does not need
strong fields. The method seems to have good prospect for metabolism
studies, particularly on a cellular level.
The NLS-method advances along the path not only of technical innovation
but also of new application. Some minor surgical operations, biopsy
for one, have been long monitored using ultrasound, fluoroscopy or
computer tomography. Today we have opportunity to hae biopsy monitored
by NLS. By the way, many surgeons focus on using this method to assist
major surgeries.
The cost of equipment for NLS-diagnostics is still very low as compared
to some other hardware-based methods. This is supposed to promote
more extensive use of the method in countries with low living standards.
Of all methods of hardware-based diagnostics the NLS provides representations
most proximate to the pathologicoanatomic picture. This feature of
the method along with its harmlessness, promotes rapid development
of the NLS-diagnostics.
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CLINIC TECH INC. - ascending into the
XXI century
D.V. Kosholenko, S.A. Letun
The development of the new generation of non-linear
computer scanners (metatrons) making use of multidimensional virtual
imaging of the body of interests, had allowed to substantially improve
the efficiency of the NLS-method and even expand its fields of application
despite the MRT competition. The originally volumetric pattern of
scanning is a distinctive feature of the multidimensional NLS imaging.
The data thus acquired are an integral array, which facilitates reconstructing
multidimensional virtual images of anatomical structures of the body
of interest. In this connection the virtual NLS is widely used especially
for angiographic investigation with the tree-dimensional reconstruction
of vascular formations.
Another promising field of application of the three-dimensional image
reconstruction based on the data acquired by means of multidimensional
NLS is the study if hollow organs with a "virtual-NLS-scopy"
involved. This kind of system was developed by Medintech Company for
their high-rate multidimensional Z-series non-linear scanners, and
was called Hunter. High resolution maintained during spiral scanning
and the use of LAPP system(a system of parallel processor with a powerful
computational capability and speed of operation) allows to implement
the principal of "virtual-NLS-scopy" on a Voxel Z multimodal
DICOM-compatible work station, which is the basic system for imaging
and subsequent data processing with Medinatch scanners.
NLs images are made ready for visual analysis by means of the 4D Tissue,
an original company-developed method, that allows not only to obtain
virtual multidimensional images of anatomical structures but also
select of particular biological tissue of interest giving an extra
dimension, and additionally visualize bones, soft tissues and vessels
at a time.
A specific feature of representing virtual data by Hunter system is
its simultaneous visualization of surfaces of cavatus and extramural
formations located outside the lumen of the cavity under examination
(e.g. lymph nodes, vessels). The acquired images from the natural
sequences of virtual NLS shots, while special navigation programs
automatically determine the paths of the "virtual scanner"
by center of the cavity under examination. The path of the motion
can be chosen by operator using some other settings, which allow to
detail the NLS picture by changing the view fields. A raised representation
of the cavity surface is also achievable by shaping particular artificially
shaded areas. The products sentences of NLS shots can be easily converted
into the standard VHS video system, in particular for teleradiology.
The hunter system is primarily designed for case detection of obstructive
processes in the upper respiratory passage, bulky esophageal, gastric
or colonic formation, atherosclerotic lesions of large vessels, and
disorders affecting paranasal sinuses, urinary bladder or spinal canal.
The data gather by "virtuall-NLS-scopy" allow to pick out
the optimum spot for biopsy and define the extent of the required
surgical intervention in good time.
The technique can be used both solely and as a useful linking element
between topographic, endoscopy and NLS investigations.
The Medintech's latest development is a convenient tool for planning
interventional procedures monitored by NLS. The Pincers comprises
a controlled stereo tactic manipulator ("mar"), a flat gentry-mounted
monitor, a cable system and software. The system provides the physician
with the means of simulating and performing interventional procedures
through an interactive link between the virtual NLS and the real operational
field.
METHOD O F COMPUTER NON-LINEAR ANALYSIS
AND ITS ROLE IN DIAGNOSTIC.
V.D.Artyukh, U.A Shovkoplyas, A.A Gavriov
The computer-based non-linear analysis (NLS) as a dynamic non-invasive
informative method is increasingly used to examine the status of health
affected by pathologies of different origin. The NLS can be applied
both in vivo ( to acquire an NLS-spectrum of one or another part of
any organ or tissue) and in vitro ( to obtain an NLS-spectrum of extracts
from tissues, biological fluids or cells); while, rather often both
approaches can be combined for a more accurate data interpretation.
The usage of NLS at a clinic requires devices production an at least
20-30 mT eddy magnetic field. The proceedings of the latest International
Congress of Medical Doctors (200 and 2001), that dealt with new methods
of diagnostics give evidence of of a growing number of NLS-investigations
used for the diagnostics purposes - the 2000 summit heard 16 presentation
ion the subject, while in 2001 there were twice as many.
S.D. Tutin et.al. informed of the possibility to use the NLS to diagnose
abscesses in the encephalon. It appears, that at an abscess in the
encephalon in the NLS-spectrum, during the biochemical homeostasis
evolution some signals from lactate and amino acid are detected, which
disappearing the course of treatment. The NLS data in vivo correlated
well with the result of abscess sample tests made by means of MRC
with the high resolution in vitro.
Using the NLS-method the dynamics of metabolic change in the encephalon
when treating epilepsy can be traced. Some data are available, that
indicate a possibility to register a decline in oxidative phosphorylation
in the lower limbs muscles with constriction of the vessels caused
by arteriosclerosis. In the course of treatment the muscles metabolism
appears to improve. Another trend in the application of the NLS method
is detection of metabolic disturbance of phosphoregic compounds at
muscular atrophy related to pathology in the musculoskeletal system.
some promising prospects for myocardial infraction diagnosis by means
of the NLS method were describe by U.A.Shovkoplyas et. al., who studied
the ATP exchange in the myocardium. At the myocardial infraction its
level was proven to decrease.
The NLS-analysis method was employed to study the dynamics of change
in the metabolism of lipids in the liver affected by cirrhosis. The
NLS -investigation of the pancreas affected by malignent degeneration
allows diagnosing tumor progression, judge of the efficiency of radiation
or chemotherapy and also adjusting individual dosage schemes for inoperable
patients.
Moreover, NLS is reported to be used to diagnose CNS disorder, cardiovascular
discase, muscular system disorder, prostatic tumor, mammary gland
tumors, and in addiction to monitor radiation - and medicinal US therapies.
The researches have demonstrated the diagnostic importance of NLS
for arteriosclerosis, apoplexy, encelophalomyclitis and vacuities.
NLS allows estimating the phase of a pathology and activity of the
nidus, determining a relationship between genetic characteristics,
clinical symptoms and metabolic deviations in the encephalon. NLS
helps to differentiate bengin and malignant tumors in the mammary
gland. The studies of abnormal changes in the prostate gland by means
of the NLS showed that the method allowed to identify an incipient
change in the gland tissue and pick out the appropriate therapy in
good time.
K.A.Kvasov et. al, presented some data about diagnosing prostate discases
(including histologically confirmed bengin hypertrophy and Aden carcinoma)
by combining NLS and dynamic MRT with artificial "Magnevist"
contrasting. According to the derived results, this kind of combination
allows to define the pattern of the prostate pathology and substantially
increase the diagnostic accuracy. In the recent years special attention
has been focused on a study of liver metabolism by means of NLS necessitated
by a growing number of transplantation of the organs ( in Europe the
annual number of liver transplantation is around 200 and in the USA
it is 1000) and due to this method's noninvasive evaluation of the
liver function in the course of implantation. The result indicate
appropriateness of using the NLS-analysis in this case since the ATP
level in the liver mirrors an integrate picture of sell homeostasis.
There is a close correlation between the disturbed metabolism of phosphorergic
compounds and extend of liver decompensation.
Apart from diagnosing liver disorders in vivo, the NLS allows to judge
on the state on the transplanted liver in vitro by acquiring spectral
characteristics of the organs metazodes. This is based on a good correlation
between the pathology change in the liver but also monitor the biochemical
responses to treatment.
Summing up the above it can be concluded that the ever growing use
of NLS-analysis in different fields of clinical medicine, including
its combination with MRT with contrast amplification involved, increases
the efficiency and diagnostic accuracy and its indicative of a continuous
progress in the field of internal organ visualization techniques based
on the NLS -analysis phenomenon
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Potential of NLS method in diagnosing
gastric and calonic cancers.
P.A.Svetlova, N.A Sorokina, T.G. Kuznetsova, V.I. Nesterova,
L.A.Yankina, N.V. Tatisova
The non-linear diagnostics method (NLS) use in the Oberon device has
been actively practiced lately as many medical institutions. The most
tangible results were achieved by using the NLS method as a means
of dispensary observation. In the course of its development and advancement
the method the method has become a foremost tool of diagnostic and
observation with respect of widespread digestive organs diseases :
it allows to promptly collect detailed information about the lesion
and its pattern and asses the treatment efficiency. That kind disease
include gastrodoudenal ulcer, chronic gastritis, and also benign and
malignant gastric and colonic tumors. The specific character and working
conditions of the therapeutic an dl=clinical institutions in Russia
allow extensively employ the NLS method not only for diagnosing disease
with some symptoms but also for dispensary observation and what is
more, practically all the patients in need of examination can be placed
under observation. So physician now can cover patients with the changes
that are latent and can only be verified by means of NLS. Specifically,
such patients include those having precancerous disease or mucous
disturbances in the upper and/or lower sections latent in a certain
phases.
According to the data acquired by some medical specialists, using
the devices for NLS-diagnostics, and based on annual research in thousands
of cases, the frequency of detecting focal or diffuses changes, typical
for chronic atrophic gastritis in patient over 50 years old, is within
30-40%.the analysis of the spectral examination of pattern-different
section of focal changes in stomach mucosa shows that different symptoms
of diseases including intestinal metaplasia and epithelia dysplasia
can be detected in them just as often. During the NLS analysis symptom
of gastric ulces where recorded in about 5% of cases, polyps in stomach
in 7%, and polyps in colons in 45% of cases. Thus, even NLS analysis
result alone, without other risk factors taken into account, include
the most of the patients in the respective age group appear to be
among those who need dynamic observation because of potential gastric
cancer (GC) or colonic cancer (CC).
According to the cancer register for 1999-2000, the values of gastric
an colons cancer cases were 80.9 and 53.1 respectively per 100000
patients and the death according to the mortality statistics was 47.35
and 19.5%. According to conclusion of the therapy-diagnosis unit,
with about 70% patients under active dispensary observation, the pathologies
of this kind are likely to be detected as often as in 0.4-0.8% of
cases. Therefore, the NLS screening would allow to detect GC or CC
in about every 15th-20th examinee.
Considering that emergence of clinical sings is one of the incentives
for a patient to take medical advices and a reason for hardware-based
examination, some clinical implication and their pattern were evaluated
in the case of the above mentioned diseases. As fallow in the results,720
patient affected by CG or CC the condition appeared to be symptoms
free in 42% and 32% of cases respectively or there were some sings
characteristic of previous chronic digestive track diseases that was
a case in 77% and 92% for the 1 phase, 56% and 68% for the 2nd phase,
23% and 32% for the 3rd phase, and 8% for the 4th phase of this diseases.
The clinical implication at a gastric cancer were of a point-dyspepsia
syndrome nature typical for the lesion in the upper section in digestive
track. At a colonic cancer subgroups were segregated with dominating
sings of intestinal hemorrhage, disturbed evacuation or abdominal
pain. A certain interrelationship was proven between the pattern of
the clinical implications lasted less than 3 months in 26% of patients
the CC developed actually within a few days. It should be noted that
so-called "minor sing syndrome" correspond to some later
phases of the disease. The same was true fro lab examination data
where the change became evident during phases III and IV (2).
The result for NLS0daignostics for the initial phases of gastric cancer
in a series of 104 examination showed that in 72@ of cases the physicians
on the assumption of the spectral similarity to the reference standard,
regarded the lesion as benign and indicative of focal mucosa hyperplasia,
polyp, and area of local information, wall deformation or small ulcer.
The probability for detection sings of malignant changes found out
in the elimination mode was under 1%. Of 134 cases of colonic cancer
in phase 1 malignant adenomas were detected in 58% of patients. The
rest of the patients were found to have the so-called "minor"
changes of cancer, like polyps, atrophic gastritis or atrophic-hyper
plastic gastritis. The endoscopic verification of GC and CC with reference
to the diacrisis of phases II,III and IV of the discases completely
confirmed the results of the NLS-investigation.
172 patients were found to have to have GC or CC discovered by NLS
examination conducted within a less than a year interval. among them
62% of patients. Among 62% of patients had an initial phase of gastric
cancer and 38% of the patients during previous observation were found
to have some or other sings of chronic gastritis in the form of focal
mucos hyperplasia, local inflamination or wall deformation. According
to morphological investigation, the said sections were of a benign
nature and cancer development therein over the last year only. In
the rest of the patients the macroscopic changes corresponding to
malignant affection (spectrial similarity to "gastric carcinoma"
reference standard D<0.425) occurred in the span between the last
examination. This preceding endoscopy detected atrophic gastritis
free focal changes in the area of the development tumor. Similar NLS
data were acquired for 38 patients who during a year's observation
were diagnosed to have developed a tumor corresponding to phases II
and III.
The NLS of the colon and straight intestine was performed a year before
tumors were diagnosed in 21 patients affected by malignant polyps,
of whom 17 had been under active observation because of polyposis,
while no formation of that kind was in evidence during the initial
examination. In addition, within the same time span 13 patients were
examined who were diagnosed with precancerous condition (spectral
similarity to straight intestine carcinoma, reference standard D>0.7)
an minor form of cancer. In 6 of the patients the tumor developed
in area of endoscopic polypectomy after they had a large villous adenoma
removed. Thus, in 34 (27%) of 121 patients, who were diagnosed to
have a malignant polyp conditions in phase I or a small size tumor,
colonic cancer developed within a year.
36 patients examined within the same time interval were found to have
the condition in phase II and II just as frequently. 28 of them were
subjected to medical regular check -ups with no clinical sings of
the disease of evidence in any of them. 8 patients, within 3-7 months
prior to tumor diagnosis, began to shows sings of growly anemia or
progression stool retention. This dispensary observation data for
these patients, with the NLS method employed a year before the cancer
was developed, had indicated the tumor.
There are two indicated factors known to be paramount importance for
malignant disease diagnosis hey are the quality of clinical and diagnostic
techniques and the specific pattern of the disease progress which
actually determine the dynamic of the disease progression. Considering
capabilities and working condition in the therapeutic institutions,
the presented data on gastric and colonic diagnoses may to certain
extent be regarded as optimum. It implies, that even if all the patients
were readily diagnose with the disease during the dispensary observation
(actually it is a matter of 60%), the phase I condition could been
detected only in 40% of them. The analysis of causes of the late diagnosis
cases suggests that such cases could prevented by improving organizational
and methodical work.
Furthermore, the focus should be placed on the specific features of
the diseases progress which are of great, and possibly of vital importance
for tumor detection. The analysis of the available data allows to
assume that tumor may develop within the short time interval reaching
the size of either "minor cancer" or extensive lesion. All
that confirms the idea that the tumor growth dynamics in different
patients and in the different phases of the diseases id likely to
very and be both continuous and discrete pattern. So a possible scenario
of tumor development could be the emergence of "early" gastric
cancer against the background of precancerous gastric diseases with
the subsequent prolonged period of existence in the initial phase
of the condition in advance. The colonic cancer development through
the benign phase and then through a malignant adenoma is not the only
possible scenery it can processed. Tumor can develop de novo and here
too. a variant of comparatively slow or fast growth in potential.
This provides an explanation for an "accidental" detection
of patients with fairly large tumors during dispensary observation
and a great number of patients with short clinical anamnesis and late
phases of the diseases.
Thus, NLS can be considered as an adequate method for diagnosis gastric
and colonic cancers. The difficulties in dealing with NLS interpretation
largely concern the initial phases were the frequency of diseases
detection depends in the long run on any focal changes in the mucosa
in the case of chronic gastritis and on keeping the patient under
dynamic observation on the given modes of elimination and NLS analysis
involved. The submitted results allow to segregate two principal variants
of the diseases diagnosis. The first one suggest "accidental"
tumor detection during NLS-investigation; neither clinical nor other
familiar sings of disease are in evidence or their intensity ia an
insufficient reason for the patient to see the doctor. The second
variant occurs the patient develop clinical implications which impel
physician to carry out the respective investigation for them. The
result of diacrisis of gastric or colonic cancers indicate that for
most patient the problem of early diagnosis can not be solved, not
only because of certain organization factors but also and primarily
because of the specific pattern of the disease process and its manifestation.
However, the actual opportunities for improving the well-timed diseases
diagnosis in practical public health conditions lie, primarily, in
increasing the number of patients to be examined by means of the NLS-method
within the framework of health survey and also in a timely and complete
examination of the patients who are suspected to have the disease.
Malignant Tumor
New potentials of NLS-method in colonic
neoplasm diagnostic.
V.I.Nesterova, T.G.Kuznetsova, V.I.Metlushko, N.L.Ogluzdina
Introduction
Colonoscopy is successfully used to diagnose colon new growths. Based
on the number of indications endoscopy investigation allows to get
reliable information about the colonic growth surface in order to
correctly classify its pattern and take a sample for morphologiacal
identification. Yet, colonoscopy does not give an idea of the kind
of internal structure the new growth has, nor does it allow to assess
the depth of the invasion of the colon wall by a malignant tumor,
determine its proliferation to adjacent organs or metastases to regional
lymph nodes. Beside, colonoscopy does not provide information about
extra intestinal new growths unless they have already permeated the
intestinal wall.
The NLS-investigation of the colon using 4.9 GHz high frequency nonlinear
sensor can help clear up all of these issues.
The NLS-investigation allows to examine intestinal wall layers and
the adrectal cellular tissue.
The research aimed to define the potential of the NLS-method in a
more specific diagnostics of straight-and segmented intestine tumor.
The matter and investigation methods
In order to achieve the set goal 87 patients were examined by in whom
91 new growths were investigated by means of the NLS-method. The examinees
included 41 men and 46 women age from 31 to 83 with most of them (82%)aged
from 50 and over. All the patient affected by colon new growths were
given one or another kind of surgical treatment depending on the pattern,
size and localization of the growth. Among them in 23 cases endoscopic
polypectomy was performed, in 61 cases a resection was done on different
parts of the colon and in 3 patients transanal endomicrosurgery was
performed. All of the NLS-investigation results were verified by a
pathomorphological examination of macro preparation according to which
the colonic ne growths were represented by simple tumors in 30 cases
and by glandular cancers with different degrees of differentiation
in 61 cases.
The stage of the malignant process were defined according to TNM classification
adapted by International Anticancer Association in 1997 (the 5th revision)
Phase T1 was diagnosed in 13 patients (21%), phase T2 -in 26 patients
(43%), phase T3 in 17 patients (28%) and phase T4 in5 patients (8%).
According to a pathomorphological examination, metastases into regional
lymph nodes were detected in 11 of 61 cases.
All the patient underwent NLS-investigation and ultrasound colonoscopy
to diagnose and localize new growths, define their size, growth patterns
and approximate morphological characteristics, and also ultrasound
scanning of the abdominal cavity and small pelvis organs to assess
the condition of the organs adjacent to the colon and diagnose distant
metastases.
The NLS-investigation used the Oberon-4011 device equipped with a
4.9 GHz nonlinear sensor manufactured by the Institute of Practical
Psychophysics (Russia) and Clinic Tech Inc. (USA). The endoscopic
ultrasonography made use of the endoscopic ultrasonographic system
UM-20 complete with the ultrasonie colonoscope CF-UM20 (Olympus, Japan).
The echographia of the abdominal cavity made use of the diagnostic
unit SSD-630 (Aloka, Japan) and Logiq-700 (General Electric, USA)
Discussion of results
We know from experience that every NLS-investigation should be preceded
by diagnostic colonoscopy, which evaluates anatomic characteristic
of the colon and defines the number, localization and macroscople
characteristic of the new growths, and by ultrasound scanning of the
abdominal cavity aw well. A through transabdominal ultrasound scanning
is required to assess the condition of the organs adjacent to the
colon and diagnose remote metastasizes.
A comparison of the NLS results with those of pathomorphological investigation
was made in order to define the potentials of the NLS-method in differential
diagnostics of benign and malignant colonic new growths.
The result of the NLS-investigation coincided with the apthomorphological
investigation in 87 of 91 cases. Most of the errors occurred in diagnosing
colon adenomas. In 6 of 31 cases the patient was suspected of having
cancer. The analysis of the observation noted that the difficulties
in diagnostics were related to the deformation of intestinal wall
layers due to the pressure of a nodal villous tumor rather than to
a genuine invasion. To false-negative results were obtained in the
case of malignant adenoma and cancer decreases,
Thus the accuracy of the NLS method in differential diagnostics of
malignant and benign colon tumors amounted to 81.33% and sensitivity
to 79.8%, while the specificity made 76.4%.
The method of treatment to be chosen for patients affected by colon
cncer depends on the tumor process phase. A comparison was made to
he pathomorphological investigation data in 61 cases in order to assess
the diagnostic efficiency of the NLS-method in classifying the colonic
cancer phase.
The correct definition of the phase of tumor process was possible
in 68.4% of the observations. The best results were obtained in defining
phases T3 and T4, where the diagnostic accuracy was 78.2% and 81.2%
respectively. It should be noted that most of the errors occurred
in determining phases T1 and T2, were the data of NLS and pathomorphological
investigations coincided only in 54.2% and 47.4% of the observations
respectively.
In diagnosing phase T1 mistakes were made in 4 cases with 3 of the
errors toward overstating the phase; in once case sings of intestinal
wall invasion were not found and the tumor was taken for adenoma.
In the analysis of phase T2 diagnostic errors in overstated phases
were noted in 7 of 9 cases; an understatement of phase of the tumor
process occurred in one case and yet in one case no evidence of invasion
proved to be fond. The analysis of the post surgical morphological
conclusions made it clear that in 6 of 7 false positive result pathomorphological
investigation of macro preparation detected a deeper infiltration
into the intestinal wall. However according to microscopy examination,
the filtration was on inflammatory rather than of a tumorous kind.
It should also be noted that in all of the cases it had to do with
an infiltrative tumorous process in the inferior ampullar section
of the straight intestine free of serous membrane while the inflammatory
infiltration area was located in adrectal cellular tissue.
To find out the causes the present difficulties for diagnosis the
efficiency of the NLS method was analyzed in function of the size,
localization and form of germination of neoplasms. The best results
were obtained in diagnosing new growths size under 2 cm and over 5
cm.
The epithelia tumor over 5 cm in sizes is represented by phases T3
and T4 in 12 of 17 cases. It has to be noted, that the large neoplasms
the data of NLS essay did not coincide with pathomorphological data
only in phase T2 where the process phase was overestimate because
of the presence of the inflammatory infiltration in deeper layers,
than the layers where the tumoral invasion occurred. Thus, at neoplasms
larger than 5 cm in size the diagnostic of the invasion degree of
the intestinal wall is feasible in 78,2% of observation. High result
was also obtained at the estimation of depth of tumoral invasion by
neoplasms sized up to 2 cm. most of them are represented by a tumor
in phases T1 and T2. The results of ultrasonic colonoscopy have coincided
with those pathomorphologic conclusions in 76.7% of the observation.
It should also be noted, the tumours up to 2 cm are most convenient
for examination since they have the least number of artefacts.
At this essay the greatest groups were the tumours sized from 2 to
5 cm, where the result proved to be lower, than in two first groups.
The NLS data and those of the pathomorphological essays coincided
in 66.7% of cases. An appreciable share of mistake (60%) occurred
in phase T2, where the intestinal wall invasion depth was overestimated
in all observation.
The great value has the fact, according to the pathomorphologic essay,
in 5 of 6 cases of hyperdiagnostics apart fro the tumoral infiltration
an expressed inflammation was detected in deeper layers of the intestinal
wall. The relatively low accuracy of diagnosed depth of the intestinal
wall invasion by tumor sized from 2 to 5 cm is due to the fact that
24 of 30 observations of this group corresponded to phases T2 and
T3. The differential diagnostics of the tumoral infiltration depth
in this phases is complex.
At the next research stage we made comparative analysis of the effect
of the form of growth of the neoplasm for accuracy of defining the
phase of the tunoral invasion in the intestinal wall. All neoplasms
were classified into three groups, in function of the shape otf the
tumor growth: polipiform, saucer shaped and infiltrative.
The highest results were obtained when diagnostic the phases of the
caucer-shaped growth cancer process where the accuracy of the defining
the tumoral invasion in the intestinal wall was 78.3%.
It seems however impossible to fully estimate the accuracy
ot the NLS method in defining the depth of a tumoral invasion at neoplasms
with saucershaped growth because of its dismall occurrence among other
forms n patients surveyed by us.
The polipiform of the growth was noted in 30 neoplasms. The growths
had a distinct interface with unaltered sections of the intestinal
wall and did not block the intestine lumen by more than half, which
created favorable condition conditions for the survey. The accuracy
of NLS method in defining the depth of tumoral invasion in the intestine
wall was as high as 65%. It has to be noted, that half if all cases
divergent with the pathomorphologic conclusions is due to the overestimate
depth of tumoral infiltration at defining the phase T2, which is connected
with the presence of perifocal inflammation.
This fact suggest difficulties in defining the phase of cancer process
in cases where the tumoral invasion is compounded by the inflammatory
component penetrating deeper layers of the intestinal wall and beyond
its limits.
The neoplasms with in infiltrative growth shape have proved to be
most difficulty in defining the degree of the tumoral invasion in
to the intestinal wall. tn this group the result of NLS-method and
those of the pathomorphologic essays coincided only in 49.8% of observations.
It was due to the fact that these neoplasms, as a rule, had a large
size and occupied more than a half of the intestine wall circle.
In the next investigation phase was estimated the accuracy of the
NLS method in defining the degree of the intestinal wall invasion
depending on the tumor location in the colon.
In 40 cases the tumor was localized in the rectum and in 21 cases
in the segmented intestine. The accuracy of diagnosing the phase of
the tumoral process in the colonic intestine is significantly height
that at finding the tumoral invasion depth with the neoplasms located
in the rectum and amounts to 71 and 62.5% respectively. This high
result can be most likely explained by the fact, that this department
of colon contains a serious membrane, which distinctly separates the
muscular layer from the abenteric organs and tissues. Also is noted
that the serous membrane of the intestine is less subjected to penetration
of the inflammatory infiltration, than the pararectal cellular tissue.
The majority of mistake falls on the cases overestimated depth of
the invasion at defining Phase T2.
These researches have noted that accuracy of diagnosing the phase
of a tumoral process was higher in colonic intestine than in rectum.
The greatest number of abscesses, inflammatory infiltration or radial
therapy in the neoplasm area.
Damage regional lymph glands are an important prognostic factors in
diagnosing rectum cancer. To define the capabilities of the method
in diagnosing metastases in regional lymph glands, the results of
the NLS method were damage with those of the pathomorphologic essay.
In the letter the malignant damage to the regional lymph glands was
detected in11 observation from 22 cases.
The analysis of the derived data proved that the NLS essay had correctly
defined the pattern of damage to the lymph glands in 63.6% of cases.
The metastatic pattern of damage to the lymph nodes was defined in
74.8% of cases, and an inflammatory changes the results of ultrasonic
colonoscopy and those of the pathomorphologic essay coincided only
in 45,5% of observation. In 6 from 11 of cases the presence of metastasizes
in lymph nodes was assumed (false-positive result). Such mistake s
can be attributed to oncologic vigilance of the researcher and complexity
of differential diagnostic of inflammatory and metastatically -altered
lymph glands
Conclusion
1 NLS diagnostics is a highly efficient method of diagnosing the neoplasm
of the colon, allowing to diagnose neoplasms and regional lymph glands.
2 The NLS method allows to detect the colon adenoma and cancer by
presence or absence of the tumoral invasion in the intestinal wall.
3 The diagnostic efficiency of NLS method in defining the phase of
tumoral process in the rectum is lower then in segmented intestine.
4 The diagnostical accuracy of the cancer phase in colon depends as
much on the size as on the anatomic shape of the tumor growth. The
best results were obtained at defining depth of invasion of the intestinal
walls be a tumor sized under 2 cm and cover 5 cm.
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NLS-method in vascular pathology diagnosis
S.M. Patrushev
A.D. Sluzky, V.M. Vagulin
Today the world faces a constant trend of a growing rate of morality
caused by occlusive vascular diseases, especially by cerebrovascular
disorders which are in the third place among death causes. On the
one hand the trend is caused by a growing number of elderly and aged
patients. On the other many men even already at 45 have atherosclerotic
damage of main head arteries =, causing the need for a dispensary
observation.
The most simple and at the same time informative method of noninvasive
diagnosis of occlusive damage of peripheral vessels appeared to be
the NLS-method with has been used in clinical practice not long since.
The first NLS devices equipped with analog trigger sensors, operating
in 1.4 GHz frequency mode and used in clinical practice since the
late 90-s have not their importance yet. They can determine the condition
of certain sections of the main vessels in the lower limbs and that
of the brachiocephalic vessels.
Not only can the condition of the vessels but also of the valvular
system of deep venis can be studied. 102 patients were examined in
19997-1998 to detect valvular insufficiency of deep venis affected
by varicosis. The patients were from 21 to 67 years old. The examined
patients included 25 men (24.5%) and 77 women (74.5%). The study was
carried out by means of the Oberon devices using a 1.4GHz analog trigger
sensor. In 32 patients a valvular insufficiency of the femoral vein
was detected, in 44 patients failure of both femoral and popliteal
venis. NLS allows s to asses the condition of the valvular system
of deep venis in low limbs on a noninvasive and objective basis which
is very important point for the surgery tactic to be selected, and
can be used an alternative to phlebography analysis.
The NLS-signal spectral analysis method has no counterindications
and in terms of informational content is comparable angiography. It
cn be used to perform screening in the course of polyclinical examination
with the view to detect early or latent forms of vascular pathology
and also as a preliminary method of selecting patient for angiosurgical
treatment, since according to some angiologists, angiography should
only be performed on candidates for surgery pick up after a preliminary
NLS investigation. However the method does not allow to asses bulk
index of the bloodstream, because NLS does not allow to provide vessel's
image and hence to measure the vessels diameter. This kind of information
can be acquired with the help of Doppler system with 2D-imaging, that
offer duplex and triplex scanning (the so-called Doppler chromatic
charting).
The NLS-method was developed in the mid 90-s played an essential role
in in vascular pathology diagnosis. The main advantage of the NLS-method
was that differentiate vessels from nonvascular structures, arteries
from venis and very accurately detect sings of disturbed vascular
permeability caused by stenosis or occlusion of the vessel lumen by
an atheroscierotic patch or thrombus which are generally not visible
on screening in B-mode alone.
In addition the NLS-method allows to diagnose portal hypertension,
the extant of its intensity, and permeability of Porto systemic bypasses.
NLS is very sensitive in defining the extend of peripancreatic vessel
involvement with pancreas cancer which is essentially important for
choosing the approach for surgical treatment. NLS allows to detected
the damage renal vessels (both veins and arteries), which is very
important for the correct choice of a hypotensive drug at arterial
hypertension.
Some efficient hypertensive drugs, i.e. inhibitors of angoitensin-convering
enzyme (ACE) such as capoten, enalapril, berliptil, cet., became very
popular lately, but they have counter-indications at renal artery
stenision. So physicians should bear in mind that checking for stension
is a must before prescribing this kind of medicine. NLS-method is
likely to be the choice method in such cases.
The NLS-method is indispensable fro differential diagnostics
of benign and malignant hepatic diseases. Its sensitivity is comparable
with the potential of conventional or digital angiography and computer
assisted amplified tomography. In addition, the NLS-method is much
cheaper, simpler and more intelligible. In can be employed directly
at the patient's bedside if required. The NLS-method can be used in
ophthalmology to check ocular hemodynamics before or after surgical
intervention, in obstetrics to detect the disturbed blood current
in umbilical cord arteries with a view to diagnose a retarded fetus
development and predict a negative perinatal produce.
Yet another potential of NLS method lies in cranial
scanning which allows to detect intracranial hematomas, ancurisms,
cysts and tumors in the encephalon.
These are far from potential of the NLS method.
Summing up, the NLS-method is one of the most dynamic techniques
and within the next few years it is bound to bring some new discoveries.
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NLS-diagnostic of lung abscess
S.N. Makarova
A screening NLS-investigation detected two cases of lung abscess in
feverish patients who were complaining of pain in the right hypochondriac
region. The patient were subjected in order to preclude an abdominal
cavity pathology.
The NLS examination was conducted by means of "Oberon-4009"
device equipped with digital trigger sensor. (1,4GHz).
Patient N., age 57, was admitted to therapeutic department. He was
complaining of a week-long fever with the temperature of up to 40?C,
a moderate non-productive cough and pain in the right hypochondriac
region as a result of catching a cold. He came to see the doctor tan
days after falling ill. The anamnesis read a bilateral pneumonia 14
days before. The clinical blood analysis indicated an increased leukocyte
content- up to 18.7 x 109 with a flush left leucogram. The common
urinalysis showed no deviation. Physical examination vesicular pulmonary
respiration, weakened in lower section on the right with no rhonchi.
Tong drt, with furred. Belly soft, with frank painfulness in the right
hypochondriac region. No symptoms of peritoneum irritation in evidence.
Pasternatski symptom negative on the right and left.
The NLs-investigation on the abdominal cavity did not detect any sings
of pathology in the liver, gallbladder or pancreas. On the right there
are visualized blackening in the diaphragramatic pleura (4-5 points
according to Flandler's scale) and an image of voluminous formation
in the right lung was acquired (5-6 points). On the dorsal thoracic
wall there was an image of a enhanced chromogenic formation (6 points)
of a heterogeneous internal structure, sized 80x65x54 cm. the lung
tissue around the nidus had a higher chromogenic density (4-5 points)
on account of infiltration. A spectral simillirality to the "lung
abscess" reference standard (D=0.312) was detected. The investigation
of the left lung and pleural cavities did not detect any structural
changes. NLS conclusion: certain sings of developing abscess in the
right lung.
The check radiological investigation arrived at the conclusion: abscess
in the lower lobe of the right lung in progress.
A repeated NLS examination was conducted 10 days later. It visualized
a rounded hyporchromogenic formation with uneven outlines with some
hyporchromogenic zones inside, sized 81x60x51 mm.
The chromogenic density of the lung tissue around the nidus was somewhat
higher ( due to infiltration), and the folia of the visceral and parictal
pleuras were blackened in the lower section of the right lung.
The patient was offered the further therapy in the specialized surgical
department, which he turned down. 3 weeks later, after some anti -inflammatory
therapy a check NLS examination was performed. During the examination
the patient complained of coughing with a profuse sputrum discharge.
His temperature was normal, the clinical blood analysis indicated
a leucocytecount of 8.6x109, and the differential blood count was
within the standard and ESR grew up to 37 mmr/h. the NLS-investigation
visualized rounded formation with even outlines, increased chomogenic
density and heterogenous internal structure sized 47x43. The chromogenic
density of the lung tissue around the perimeter decreased (because
of reduced infiltration).
At the patient's urgent appeal he was discharged from hospital from
further outpatient treatments. Later he underwent two check examinations
conducted.
Patient M. age 63, was eliminated by means of the NLS method in order
to preclude a liver or gall bladder pathology.
An LNS-ivestigation of the lung and pleural cavities was carried out.
In the left lung and pleural cavites it found no sings of pathology
in evidence. In the right lung in the IX, X AND XI hypochondria (from
the paravertebral line to the scapular one) it parietally visualized
a formation having an increased chromogenic density and sized 85x60
mm uneven outlines and heterogenous structures (due to inclusions
of a decreased chromogenic density0 sized 3-4 mm. the chromogenic
density of the lung tissue was not increased. NLS conclusion: sing
o abscess in the right lung?
Clinical conclusion: abscess in the lower lobe of the right lung.
The patient had check NLS-investigation conducted against background
of anti-inflammatory therapy.
With the NLS-investigation performed 10 day later the formation looked
rounded, had even outlines, and increased chromogenic density (3-4
points) because of infiltration. The formation measured 73x50x60 mm.
The NLS-investigation 2 weeks later did not detected any positive
dynamies from the administered anti-inflammatory therapy.
The submitted the clinical observations once again confirmed the NLS-investigation
with lung diseases is not used in clinical practice as often as it
deserves.
Beside, the dynamic NLS-observation of the patient affected by lung
diseases allow to assess the efficiency of the employed therapy and
reduce the radiation load both on patient and the medical personnel
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NLS-diagnostics of the degenerative changes in the
spine.
A.G. Brusova, P.A. Manokhin, T.K. Puznovskaya, T.A. Shyshkovetes.
Computer Nonlinear Diagnnostics (NLS) is a new highly
informative method provided to examine the spine and the spinal morrow.
The NLS advantages are noninvasiveness, scalability of the image field,
a capability to obtain section of any orientation and virtual imagining
of reticular canals and paravertebral zone. Undoubtedly the use of
NLS in diagnostic of degenerative spine diseases has apparent prospects.
Subject and methods
The investigation was conducted by means of "Oberon 4009"
metatron equipped with a 1.5 GHz digital trigger sensor. 1217 patient
affected by degenerative changes in the lumbar region of the spine
was investigated. The NLS of the spine and spinal marrow was performed
for all patients, 112 patient had NLS and CT and myleography was performed
for 10 patients.
Analysis of result
In 87% of cases in the examinee group we found disks affectes by degenerative
changes. The elierst degenerative change in intervertebral disks (ID)
was a hyoerchromous lesion (6p point on Flandler's scale) in zone
between the pulpous nucleus and the fibrous annulus. Alonge with the
degenerative changes NLS has detected an increased chromogenic density
of the spinal from the bone marrow in the adjacent regions of the
vertebral bodies (4-5 points according to Floander's scale). 3 degrees
of the degenerative changes could be distinguished depending on the
process intensity.
Degree1, a hyperchromous zone apprised at 4-5 on Flandler's scale,
was detected in 90 patients. Conventional radiograph did not display
any changes. Formation of fibrovascular tissue followed by its penetration
into the bone marrow is believed to underline the changes. Some author
relate these changes ro the lack of stability in the segment.
The histogram displayed a spectral similarity to the reference standard
"intervertebral osteochondrosis" (D 0.396 to 0.425)
Degree 2, a hyperchromous response in the affected zone at 5-6 points
in Flandler's scale was detected in 215 patients. Conventional radiograph
did no showed any changes. According to some literary evidence, in
this phase the histology detects a substitution of the fat bone marrow
for the red bone marrow often accompanied by enlarged trabeculae.
This phase generally precedes an osteochondrosis development which
can be diagnosed a little while later by conventional radiographs.
The spectral similarity to the references standard "intervertebral
osteochondrosis" was frank (D0.246 to 0.360)
Degree3, a frank hyperchromous response (6 points), which corresponds
to a far advance vertebral body sclerosis, was detected in 312 patients.
Some secondary symptoms, like local bulging and vertebral asteophytes,
were detected with a far advance degenerative lesion of the disk and
substantial similarity to the references standard "osteochondrosis"
(D from 0.152 to 0.218). NLS allowed to differentiate between a protrusion
and prolpse of the disk and existence of rupture of the fibrotic ring
and condition of longitudinal and other ligaments.
A protrusion is defined as a bulging of disk tissue beyond the posterior
out line of the vertebral body into the spinal canal. The fibrotic
ring tissue endures through becomes very thin and NLS only revels
zone of slight destructive changes in the structure (3-4 points0.
With compression it gives an actually frank hyperchromous response(6
points).
Protrusion may be accompanied by slight caudal shift which is quiet
often defined by means of the NLS-method at L5-S1 intervertebral disk
level. NLS detected protrusion in 729 patients.
The rupture of the fibrotic ring fibers result in the prolapsed of
the pulpous nucleus on a subligamentary level and the ligaments rupture
results in the prolapsed inside the cerebrospinal canal. As can be
seen from NLS, the longitudninal ligaments look well delimited and
are represented as hyperchromous band-like structures (5-6 points)
which adjoin the bones and fibrotic ring. The extraligamentary prolapsed
can shift either in a caudal or cranial direction. The extraligamentary
prolapses of the disk that lost contact with the host disk become
sequesters. Occasionally, we observe some very small extraligamentary
sequesters which shifted far into the cerebrospinal canal, which made
it hard to detect them.
The NLS investigation detected prolapsed in 445 patients. In 685 of
cases the hernias of intervertebral disk was combined with other degenerative
dystrophic spinal changes on this level. The hernia of the intervertebral
disk was detected at 1.4 -5 level in 83% and 1.3-4 level in 2% of
cases. A lesion of several disk was found in 50 patients. 196 underwent
surgery, among the 114 had lateral hernias, 76 patients had median
lateral hernia and 6 had median hernia. 5 patient had surgery for
hernia recurrence. The NLS diagnosed extraligamentary sequestrated
hernia in 38 patients and intradural hernia was diagnosed in 3 patients.
Multiple sequesters were detected in 5 patients.
The clinical symptomatology for the prolapsed of intervertebral disk
was variable and did not always depend on their size. In some case
we observed median protrusions which did not result in any clinical
implication. The clinical symptomatology for small sequestrated hernia
was no less then for large sequesters.
In evaluating the NLS data not only the size of hernia but also the
reserve area of the cerebrospinal canal and their preposition should
be taken in to account.
With a suspected hernia the NLS-investigation should be performed
at least in two planes, sagittal and paraxial, i.e., parallel to the
disk plane, and the sagittal investigation in T1w-SE can be combined
with others sequences.
The median prolapses of intervertebral disks in sagittal shots could
be seen quiet clearly. The signal content of the hernia predominantly
corresponded to the NLS signal content of the pulpous nucleus. The
external part of the fibrotic ring, posterior longitudinal ligament
and the dura matter give a frank hyperchromous response and did not
differentiate from one another. Thus,, the NLS method sometimes fails
to present a direct proof of a rupture in the external and axial projections.
Sagittal shots have an advantage in deciding on the disk prolapsed,
the size of intervebral foramina and the condition of the cerebrospinal
canal and bones. These shots are not significant for detecting an
intradural process with the cone especially poorly invisible in them.
Frontal shots have drawbacks in determining the condition of the pulpous
nucleus and fibrotic ring. To that and paraxial virtual models are
used, for they allow to differentiate the process between the fibrotic
ring rupture and protrusion free of the rupture. Thanks to virtual
dimensional scaling sagittal shots allow to delimit the subarachnoid
space.
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NLS-diagnostics of diffuse infiltrative
lung diseases
V.I.Nesterova, T.G.Kuznetsova, N.L.Ogluzdina
Among different kinds of lungs disorders special attention has been
paid over the last years to diffuse infiltrative lung diseases (DILD),
which is largely accounted or by some problems in their timely diagnostics
and treatments.
Most diffuse lung diseases involved in the pathological process both
the interstitial tissue and the respiratory tract and alveola. In
this connection this type of pathological processes should be defined
rather diffuse infiltrative than as interstitial diseases. Despite
of the polymorphism of clinicomorphological manifestation of DILD,
most of them star off with productive alveolitis (in contrast to the
exudative alveolitis in the case of pneumonia) with fairly stereotyped
changes in the lung interstice in the form of inflammatory infiltration
with different degrees of intensity. Subsequently fibrosis develops
that can have differen rates of progression. A "cellular lung"
pattern is the final phase of development. It should be noted, that
some infection diseases of certain etiology (like tuberculosis, histoplasmosia,
etc.) and particular malignant tumors (lymphogenous, carcinomatosis,
brioncholoalveolar cancer) do not directly belong to interstitial
lund diseases but are similar to them in terms of manifestation.
The clinical evaluation of patients which are suspected DILD is a
complex problem. Nonspecific symptoms and in some cases sing detected
during chest examination may be characteristic of a multitude acute
or chronic diseases that involve interstitial tissue, respiratory
tract or alveola. DILD are represented by extremely heterogeneous
group of diseases. The DLIDs have been describe in over than a hundred
possible versions , however in clinical practice only about 10 or
15 condition are the most common and it should be noted that sarcoidosis
and various cases of lung fibrosis occur in clinical practice in 35-50%
of all DILDs. Besides, acute diffuse lung processes in patients with
reduced immunity (also in combination with HIV-infection) are likely
to have a great number of infectious and non-infectious varieties,
which X-ray evaluation is forum to be difficult.
Unfortunately, the capabilities of conventional peonthenography for
patient with a suspected DILD appear to be limited for the sensitivity
and specificity of the method prove to be insufficient. The data on
458 patients with a histological confirmed DILD were studied. The
chest radiographs for 10% of the cases turned out to be normal. Among
86 patients affected by DILD no pathological change was detected in
50% of the patients with histologically proven bronchiectasia and
over 20% of the patients with emphysema shown on X-ray shot. Radiography
may equally show false positive results of the investigation. We have
discovered that 10-20% of the patients with the x-ray-confirmed sings
of DILD no changes were detected during the lung biopsy.
The computer nonlinear diagnostics (NLS) is one of the promising methods
of diagnosing lung disease of today. NLS appreciably improves the
communication of the fine morphological elements in the lungs tissue
and opens up new opportunity for recognizing interstitial discases
of the broncholveolar system. NLS has a high sensitivity in detecting
fine interstinal lesions of the parenchyma and small nodules.
The result of investigations prove that NLS has a better sensitivity
in detecting both acute and chronic diffuse lung diseases. The sensitivity
of NLS diagnosis in detecting lung disease make 85% as compared to
79% in chest radiography.
The accumulated experience too, give additional grounds to assert
that NLS is a highly efficient method for diagnosing a wide range
of various diffuse lung diseases, DILD included, and excels the classic:
chest radiography by sensitivity.
It should be noted that the high sensitivity of the NLS-method is
achieved without sacrificing the specific and diagnostic accuracy
of the method. In patients affected by DILD the NLS specificity amounted
to 86% as opposed to 76% in radiography. In particular, the high sensitivity
(87088%) and specificity (83-89%) of NLS were demonstrated in bronchiectasia
diagnostic.
Although, NLS is a more sensitive method as compared to the chest
radiography, its sensitivity in lung diseases diagnostic is not absolute
and the fact that no radiological changes were detected by NLS may
lead to precluding lung disease in patients who actually suffer from
DILD. 100 patients were examined by means of the NLS with 86 of them
affected by DILD and 14 having no pathological changes in the lungs.
Despite the high value of NLS sensitivity and specificity, for 4%
of the patients with biopsy-detected lung disease the result were
interpreted as being normal. On other hand, the NLS was proven to
high-accuracy technique for precluding acute lung disease in patients
with immunodeficiency. Some examination data were studied for patients
with a bone marrow transplant and clinical symptoms of fever of obscure
genesis. The authors demonstrated high reliability of the NLS in determining
fungal infection in 20 of 24 cases. Beside, the fact that no changes
were detected during NLS lung examination allows to assume that the
fever was caused by bacterial or fungal infection of extra pulmonary
genesis.
It is also a proven fact that the sensitivity with NLS is higher than
with standard computer tomography. We examined 150 patients. Using
conventional CT (10 mm collimation) and NLS we found that NLS had
higher sensitivity in recognizing pathology changes in the lung tissue.
Due to its high sensitivity, NLS should be used to define lung diseases
in patients with a normal or obscure aspect of disease who have a
pulmonary disturbance or symptoms that suggest acute or chronic diffuse
lung disease.
Even with certain clinical sings in evidence the diagnostic accuracy
of classic radiography in patients affected by DILD apperes to be
limited. The reason is both superposition of the image in the radiograph
and low contrast of minute lung structure. NLS is fee of these aspects,
which is why it is reputed to be a more efficiency method for recognizing
lesions of lung tissue as compared to both radiographic survey and
conventional computer tomography.
Beside having a higher sensitivity, specificity and diagnostic accuracy,
the NLS method can become a determining factor in evaluating the activity
of a pathological process in patient affected by DILD. In certain
cases NLS can be used not only to define the presence of a pathological
process or the extent to which it has spread, but also to collect
information about the reversibility of changes (in acute or active
phase) as compered to irreversible (fibriotic) changes in the lung
tissue. Moreover, since NLS can accurately identify the imponderable
activity of a pathological process in the lungs, it can be employed
to evaluate the efficiency of the treatment given to the patients.
The conventional methods for evaluating disease activity, such as
transbronchial lung biopsy (TBLB), bronchoalveolar lavage (BAL), chest
radiography, galliumlung scanning and functional lung tests are insufficient
reliable I evaluating the activity and in terms of prognostication.
So the open lung biopsy (OLB) is still the choice method for both
diagnosing and evaluating the process activity. We were able to prove,
that sings detected in patients by means of NLS can provide some valuable
information and be significantly important in defining the activity
of a pathological process.
In terms of this prognostic value NLS is advancing to the foreground
leaving behind functional lung tests, BAL and even OLB, because it
allows to assess a lesion of actually the whole lung paranchymes as
compared to a separate biopsy sample. Moreover, NLS can become an
accurate noninvasive method for evaluating the efficiency of the administered
treatment.
Sarcoidosis is one of the most common interstitial lung disease of
unknown etiology. In typical cases granulomas are formed in fine lymph
vessels or beside them, afterwards the granulomas self organize which
causes lung tissue fibrosis.
A number of researches considered the NLS potential in defining the
procsess activity in patients affected by sarciodosis. The main activity
indicator is the presence of small nodules and to lesser degree their
distribution and occurrence in the lung tissue. Unfortunately, despite
the difference between reversible and irreversible changes detected
by NLS for patients having sarcoidosis, the potential of NLS is assessing
the process activity have not been studied well enough.
among differential indications in favor of NLS application, the use
of this method in lung biopsy is porbable the most important one.
Biopsy is very essential diagnostics technique which allows to define
the nosology of lung disease, its activity level and phase. The diagnostic
value of biopsy to a certain degree depends on its method and the
type of DILD. The authors proved that TBLB was diagnostically informative
for only 20 patients of 53 (38%) who had DILD in evidence; in 33 such
patients (62%) TBLB displayed normal lung tissue or nonspecific changes.
At the same time OLB made a specific diagnosis of DILD in 92% of cases.
In DILD-affected patients TBLB proved to be most informative for patients
having sarcoidosis or lymphogenous carcinomatosis, because this lesions
have largely peribronchical tissue involved and are therefore most
accessible to TBLB. Diagnostically OLB appears to be more accurate,
but it also has certain complexities because lung tissue is sampled
from a small sector of the lung which might not reflect the changes
occurring in the rest of the lung tissue. Many diffuse diseases affect
lung tissue irregularly so the pathologically altered parts of the
lung may contine both actibe manifestations of te disease and fibriotic
changes of long standing. For any accurate diagnostis and assessment
af the clinical progres of the disease the rifht choice of a biopsy
smaple is very important. During biopsy NLS helps to collect moere
accurate data indicating active areas of a pathological process. By
using NLS, the areas affected by lung fibrosis in its final phase,
with honeycomb lung formed, could be skipped during biopsy sampling.
In addition, NLS may prove to be vitally important for choosing the
most effective technique ( TBLS, BAL, OLB) for making a histological
diagnosis.
Conclusion. Radiography still remines the most/accessiable method
for diagnosing DILD yet its informational content apperes to be not
sufficient.
Making correct diagnosis necessitates a combination of laboratory,
functional and radiological investigations as well as some invasive
methods, cach of them having it sown substantial limitations.
NLS-diagnostics is the method that greatly improves
identification of diffuse infiltrative lung disease and as such it
should become a part and parcel of an integrate investigation.
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NLS-DIAGNOSTICS OF PROSTATE DISEASES
V.A. Toropova, S.N. Petrenko
An ever growing number of physicians enjoy an opportunity of screening
NLS diacrisis of prostate gland and urinary bladder. This article
attempts ti consider some particular of morphological changes occurring
in a prostate affected by pathology, based on the results of NLS-investigations.
In the West prostate cancer makes 20% of the total cancer diseases
and ranks second to lung tumors as a depth cause.
According to some autopsy finding with a histological investigation
of the prostate, 12-47% of men aged over 50 appeared to have cancerous
nidi. Clinically, cancer is diagnosed moer rarely because a high percentage
of that number corresponds to "minor forms" of cancer that
have low invasiveness, so the patients suffering from it die of another
king of pathology.
The enhance the quality of prostate disease diagnostics it is important
to comprehend to specifics of topographic and zonal anatomy of particular
organ
The prostate gland is located in a small pelvis between the bladder
and anterior abdominal wall, anterior rectum wall and secondary urgenital
diaphragm. The gland has a chestnut shape and tightly envelops the
bladder cervix and prostatic urethra. The gland base is tightly connected
with the bladder into a coherent mass. Its anterior surface is directed
to the symphisis, and the posterior one - to the rectum ampulla. The
posterior surface of the gland has an expressed sulcus, which allow
to conventionally subdivide the gland into the left and right lobes.
Beside, there is a protruding middle cone-shaped lobe confined anteriorly
by the prostatic urethra and by the spermatic duets posteriorly.
According to zonal anatomy theory usually 4 glandular zones are distinguished
in the prostate. The correct interpretation of NLS data largely depends
on the knowledge of their topical pattern. 20% of the glandular tissue
correspond to the central zone (CZ). The peripheral zone (PZ) occupies
75%. The intermediate (transitory) zones (TZ) make up 5% of the total
amount of the glandular tissue.
Peruretharal glands (PUG) take a relatively small amount if the tissue
however exactly this area of the gland is very important for explaining
changes at a benign hyperplasia.
Apart from the glandular area, 4 fibro muscular zones can be disconnected:
1) Anterior fibro muscular stoma (AFS).
2) Unstriated muscular fibers of the urethra (UMFU)
3) Preprostatic sphineter (PPS), which is an extension of the musculature
of the inferior part of the urecter and prevents inverse emission
of semifliud
4) Postprostatic sphincter (PPS), which is responsible for retain
urine in the bladder and blocks incontinent micturition
The gland can be conventionally subdivided into 2 parts:
-external part consisting of CZ, PZ, TZ and
-internal part comprising AFS, PPS and PoPS.
According to NLS-investigation, the external part looks like a structure
of normal chromogogenic density( 2-4 points on Flandler's scale),
and internal one is hypochromogenic (1-2 points). The two parts are
divided fibro muscular layer, the so called surgical capsule, along
which an incise made during surgical intervention, and calcium salts
deposit (calcium imitation of the gland).in the NLS investigation
those formations can be seen as fairly hypochromogenic structures
(3-4 points) od different size.
The analysis of the prostatic gland image on th NLS virtual moc mae
according to the fallowing quantity characteristics:
1 size: front to back - 2-2.5 cm, across - 3-4.5 cm, from top to bottom
- 2.5-4 cm;
2 volume: up to 29 cm;
3 symmetry. The urethra is the reference point.
If any pathological changes are detected in the NLS-graph it is recognized
to:
-specify their extra location
- perform histograph of the pathological area and area of the tumor
with a normal structure.
It will be helpful for the case fallow-ups. At the begging hyperplasia
allows to detect the direction of the principal germination. In case
of hypertrophic transitory zones the gland proliferates inwards. Though
darkened lateral zones are formed ( 405 points on Flandler's scale),
the nodes can still always visualized. The trans-rectal NLS offers
the most detailed and automatic information.
Enlarged lateral lobes squeeze PZ and CZ causing their atrophy. With
proliferation of the paraurethral zones a massive fibro muscular PPS
layer restricts of their hyporplasis, so with this kind of pathology
the gland proliferates along the urethra forming a middle darkened
zones pushing back the bladder wall. Visrtual scanning makes this
pathology clearly visible in longitudinal sections. At the beginning
of the proliferation a relationship between the internal and external
glandular parts id disturbed. Apart from some distinctions in the
zone of principal proliferation, the clinical sings will be different
as wee. In the case where a globe-shaped gland is formed (TZ prolification)
the gland is chiefly hyperchromogenic and the dysuric manifestations
are minimal while with a "middle zone" formed the gland
is slightly darkened and dysuria appears to be frank. Sphincter decompensation
leads to the development of urinary incontinence and dilation of the
upper urinary track fallowed by the atrophy of the cortical layer
of kidneys, which gradually adds to frequent urination, nycturia,
reduced pressure of the urine or slowed-down urination occurring in
the initial phase of the disease.
In case of squeezed cervix of the bladder an NLS-graph allows to visualized
sings of an infravesical obstruction, that causes some morphological
and functional changes in the lower and upper urinary tracks. Specifically.
In the initial phases of benign hyperplasia a darkened wall in the
bladder can be observed. Dark patches result from compensatory hyprthropy
of the detrusor.
These 3 phases of benign hyperplasia of the prostate can be distinguished
depending on the intensity of the changes:
1. Hyperchromogenic density of the gland with no residual urine;
2. Residual urine present;
3. All of the above-mentioned plus dilatation of the upper urinary
tract with the cortical layer of kidneys involved in the process.
Diagnosis of the acute prostatitis is made in the basis of histograms
(similarity to the reference standard process "prostatitis"
D<0.425). diagnostication should be done in combination with dactylar
rectal examination ( painfulness during papation) with clinic lab
data taken into account.
In this case oc abscessed lesion a still higher hyprchromous area
(6 points) is visible against the general dak patch ( 4-5 point according
to Flandler's scale). Areas of frank blackening correspond to necrotic
changes. Which an abscess in progress one can notice a reduced infiltration
of the tissue around the cavity with the dark patch gradually lighter
in the course of dynamic observation ( up to 3-4 pints). With adequate
therapy employed the postinflamentory cyst may fall into regression.
As can been seen from NLS-investigation , chronic prostatits dose
not give a common characteristic picture, however the morphological
processes in different phases of the disease are reflected in histograms.
With a long-lasting diseases the chromogenetic density tends to rise
due to a postinflammatory substitutions mode destructing of the fibrous
component starts to predominate.
With an oncological pathology analysis of the gland picture helps
locate the process in different projections and assess the extent
of prevalence and involvement of adjacent organs. The minimum size
of tumor determinate by means of NLS-investigation is about 8-10 mm.
805 of the timorous nodes are represented by markedly hyperchromogenic
structures (6 points on Flandler's scale)
Analysis of histogram of the nidid helps differentiate an oncoprocess.
The method's sensitivity becomes higher with both 'elimination' and
NLS-anaysis'modes in use. Peripheral zone shape first place as far
as cancer incidence rate s concerned. Their shape make 70-80% of cases.
In transitory zones (TZ) are affected in 10-20% and CZ in less than
5% of cases. In transitory zones a timorous nidus should be looked
for within 3-4mm from the capsule. In case of any oncological alertness
the symmetry in the lobe affection is assessed w.r.t the sagittal
axis and intensity of the black patch (4-5 point on Flandler's scale)
in the adjacent organs, especially seminal vesicles and bladder because
in 25% of cases metasitzing occurs through the gland apex and seminiferous
tracks. Considering the fact that cancer often develops with some
diffuse changes occurring on the background, foe example, with chronic
prostatic or adenomatosis, it is not always possible to visualize
newly formed cancerous areas. In such cases the result if PSA level
definition and digital rectal examination should be considered. The
PSA level is defined considering the patient's age and gland volume.
Conclusions:
1NLS-method allows to diagnose most prostate disease and being a screening
diagnostic method, it should be supplemented by biopsy, should any
pathiological changes be detected.
2. the final diagnostic should be made on the basis the clinical lad
data and the result of digital rectal examination in combination with
biopsy only.
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