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The collection of proceedings of Institute Topical problems
of NLS diagnostics
(theoretical and clinical)
CONTENTS:
Computer non linear diagnostics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Clinic Tech Inc. — ascending into the XXI century . . . . . . . . . . . . . . . . . 7 Method of computer non linear analysis and its role in diagnostics . . . . . 9 Potentials of NLS method in diagnosing gastric and calonic cancers . . . . . . 12 New potentials of NLS method in colonic neoplasm diagnostics . . . . . 16 NLS method in vascular pathology diagnosis . . . . . . . . . . . . . . . . . . . . . 22 NLS diagnostics of lung abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 NLS diagnostics of degenerative changes in the spine . . . . . . . . . . . . . . 27 NLS diagnostics of diffuse infiltrative lung diseases . . . . . . . . . . . . . . . . 30 NLS diagnostics of prostate diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 NLS diagnostics of affected regional lymph nodes at amammary gland cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 NLS investigation in evaluating the conditionof knee joint affected by osteoarthritis deformans . . . . . . . . . . . . . . . . . . 41 Potentials of NLS investigation in the presurgical evaluationof intramural invasion of gastric cancer . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Potentials of NLS scopy in adrenal tumor diagnostics . . . . . . . . . . . . . . 49 Diagnosing rare instances of mammarygland diseases using NLS investigation . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Diagnostics of toxoplasmosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 The collection of proceedings of Institute of Practical Psychophysics (IPP) Nonlinear diagnostics of thyroid gland pathology . . . . . . . . . . . . . . . . . . 58 "Topical problems of NLS diagnostics (theoretical and clinical)" /Under editorship V.I.Nesterov. — Moscow: PROSPEKT Publishing house, 2006. — 88 pages Nonlinear computer diagnostics and the problem of pathology in the hepatopancreatoduodenal area . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 MECT and NLS in diagnosing myocarditis of mild or medium gravity . . . . 72 Importance of NLS method for diagnosing timorous diseasesof the segmented intestine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Computer non linear diagnostics
V.I. Nesterov
The Non linear Diagnostics Systems (NLS) have been extensively used lately and are gaining ever growing popularity. Even in the few cases, wherethe clinical symptoms look very typical the NLS diagnostics method providesextra information about the extent of the affection and allows to consider aprognosis. In most cases it is of vital importance for diagnostics and consequently 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 lineardiagnostics appears to be the most up to date of all methods of the hardwarebased diagnostics. At any rate, his discovery became a significant landmark indiagnostical medicine. Non linear analysis was originally employed in organic chemistry to determine the composition of complex compounds.
Sviatoslav Pavlovich Nesterov who introduced a trigger sensor in 1988 and thus framed the concept is acceptedly considered as the originator of theNLS diagnostics device (metatron). Active work was immediately started todevelop and improve the NLS diagnostical systems. Clinical testing of theearly equipment took the period from 1990 through 1995. The late 90s saw afast growth of commercial production of the device and a sudden surge in thequality of the results produced. The non linear diagnostics method is still in its developing stage. The diagnostical techniques are improving so fast, that the system versions have tobe updated every six months. Due to the introduction of some new devicesequipped with digital trigger sensors, the NLS diagnostics has become notonly far more time efficient but also quite different in terms of quality. It isobvious that some runtime techniques, for instance three dimensional visualization of investigation results will soon become a daily practice. The vegetive testing is just an example of a ready implementation. The method isemployed so widely that we should rather speak about a definite range ofindications for its use than just about its popularization.
Research centers continue their quest for some new investigation meth ods based on the non linear analysis systems. So far the results appear to bequite promising. Unlike NMR and computer tomography, the NLS analysis does not need strong fields. The method seems to have good prospects for metabolism studies, particularly on a cellular level. The NLS method advances along the Clinic Tech Inc. — ascending
path not only of technical innovations but also of new applications. Someminor surgical operations, biopsy for one, have been long monitored using into the XXI century
ultrasound, fluoroscopy or computer tomography. Today we have an opportunity to have biopsy monitored by NLS. By the way, many surgeons focus on D.V. Koshelenko, S.A. Letun
using this method to assist major surgeries. Head of Clinic Tech Inc. (USA)
The cost of equipment for NLS diagnostics is still very low as compared Moscow Office
to some other hardware based methods. This is supposed to promote moreextensive use of the method in countries with low living standards. Of allmethods of hardware based diagnostics the NLS provides representations The development of a new generation of non linear computer scanners most proximate to the pathologicoanatomic picture. This feature of the (metatrons) making use of multidimensional virtual imaging of the body of method along with its harmlessness, promotes rapid development of the interest, has allowed to substantially improve the effeciency 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 ofthe multidimensional NLS imaging. The data thus acquired are an integralarray, which facilitates reconstructing multidimensional virtual images ofanatomical structures of the body of interest. In this connection the virtualNLS is widely used especially for angiographic investigations with a threedimensional reconstruction of vascular formations.
Another promissing field of application of the three dimensional image reconstruction based on the data acquired by means of multidimensionalNLS is the study of hollow organs with a "virtual NLS scopy" involved. Thiskind of a system was developed by Clinic Tech Inc. 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 processors with a powerful computational capability andspeed of operation) allows to implement the principle of "virtual NLS scopy"on a Voxel Z multimodal DICOM compatible work station, which is thebasic system for imaging and subsequent data processing with Clinic TechInc. scanners. NLS images are made ready for visual analysis by means of the 4D Tissue, an original company developed method, that allows not only toobtain virtual multidimensional images of anatomical structures but alsoselect a particular biological tissue of interest giving it 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 vusualization of surfaces of cavatus and extramural formationslocated outside the lumen of the cavity under examination (e.g. lymph nodes,vessels). The acquired images form a natural sequence of virtual NLS shots,while special navigation programs automatically determine the path of the "virtual scanner" by center of the cavity under examination. The path of the Method of computer non linear analysis
motion can be chosen by operator using some other settings, which allow todetail the NLS picture by changing the view fields. A raised representation of and its role in diagnostics
the cavity surface is also achievable by shaping particular artificially shadedareas . The produced sequences of NLS shots can be easily converted into a V.D. Artyukh,
standard VHS video format by means of the epi Client program and thus be U.A. Shovkoplyas,
used in standard video systems, in particular for teleradiology.
A.A. Gavrilov
The Hunter system is primarilly designed for case detection of obstruc tive processes in the upper respiratory passages, bulky esophageal, gastric orcolonic formations, atherosclerotic lesions of large vessels, and disorders The computer based non linear analysis (NLS) as a dynamic non affecting paranasal sinuses, urinary bladder or spinal canal. The data gath invasive informative method is increasingly used to examine the status of ered by "virtual NLS scopy" allow to pick out the optimum spot for biopsy health affected by pathologies of different origin. The NLS can be and define the extent of the required surgical intervention in good time.
applied both in vivo (to acquire an NLS spectrum of one or another part This technique can be used both solely and as a useful linking element of an organ or tissue), and in vitro (to obtain an NLS spectrum of between tomographic, endoscopic and NLS investigations.
extracts from tissues, biological fluids or cells); while, rather often both The Clinic Tech Inc. latest development is its Pincers stereo tactic approaches can be combined for a more accurate data interpretation.
manipulator integrated into a computer scanner, which is a convenient tool The usage of NLS at a clinic requires devices producing an at least 20 30 for planning interventional procedures monitored by NLS. The Pincers com mT eddy magnetic field. The proceedings of the latest International prises a controlled stereo tactic manipulator ("arm"), a flat gentry mounted Congress of Medical Doctors (2000 and 2001), that dealt with new monitor, a cable system and software. The system provides the physician with methods of diagnostics give evidence of a growing number of NLS inves the means of simulating and performing interventional procedures through tigations used for the diagnostical purposes the 2000 summit heard 16 an interactive link between the virtual NLS and the real operational field. presentations on the subject, while in 2001 they were twice as many.
S.D. Tutin et al. informed of the possibility to use the NLS to diag nose abscesses in the encephalon. It appears, that at an abscess in theencephalon in the NLS spectrum, during the biochemical homeostasisevaluation some signals from lactate and amino acids are detected, whichdisappear in the course of treatment. The NLS data in vivo correlatedwell with the results of abscess sample tests made by means of MRC witha 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 vesselscaused by arteriosclerosis. In the course of treatment the muscle metabolism appears to improve. Another trend in the application of the NLSmethod is detection of metabolic disturbance of phosphorergic compounds at muscular atrophy related to a pathology in the musculoskeletal system. Some promissing prospects for myocardial infarction diagnosis by means of the NLS method were described by U.A. Shovkoplyas etal., who studied the ATP exchange in the myocardium. At a myocardial infarction its level was proven to decrease. The NLS analysis method was tor the biochemical responses to treatment. employed to study the dynamics of change in the metabolism of lipids in Summing up the above it can be concluded that the ever growing use the liver affected by cirrhosis. The NLS investigation of the pancreas of NLS analysis in different fields of clinical medicine, including its affected by malignant degeneration allows to diagnose tumor progres combination with MRT with contrast amplification involved, increases sion, judge of the efficiency of radiation or chemotherapy and also the efficiency and diagnostic accuracy and is indicative of a continuous adjust individual dosage schemes for inoperable patients. progress in the field of internal organ visualization techniques based on Moreover, NLS is reported to be used to diagnose CNS disorders, cardiovascular diseases, muscular system disorders, prostate tumors,mammary gland tumors and in addition to monitor radiation andmedicinal US therapies. The researchers have demonstrated the diagnostic importance of NLS for arteriosclerosis, apoplexy,encephalomyelitis and vasculitis. NLS allows to estimate the phase of apathology and activity of the nidus, determine a relationship betweengenetic characteristics, clinical symptoms and metabolic deviations inthe encephalon. NLS helps to differentiate between benign and malignant tumors in the mammary gland. The studies of abnormal changes inthe prostate gland by means of NLS showed that the method allowed toidentify 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 diseases (including histologically confirmed benign hypertrophy andAden carcinoma) by combining NLS and dynamic MRT with artificial"Magnevist" contrasting. According to the derived results, this kind ofcombination allows to define the pattern of a prostate pathology and substantially increases the diagnostic accuracy. In the recent years specialattention has been focused on a study of liver metabolism by means ofNLS necessitated by a growing number of transplantations of the organ(in Europe the annual number of liver transplantations is around 2000and in the USA it is 10000) and due to this method's noninvasive evaluation of the liver function in the course of implantation. The results indicate apropriateness of using the NLS analysis in these cases since theATP level in the liver mirrors an integrated picture of cell homeostasis.
There is a close correlation between the disturbed metabolisms of phosphorergic compounds and the extent of liver decompensation. Apart from diagnosing liver disorders in vivo, the NLS allows to judge on the state of the transplanted liver in vitro by acquiring spectralcharacteristics of the organ's metazodes. This is based on a good correlation between the pathological liver metabolism defined by means of NLSand the disease prognosis. The authors would like to emphasize that NLSallows not only to define pathological change in the liver but also moni According to the cancer register for 1999 2000, the values of gastric and Potentials of NLS method in diagnosing
colonic cancer cases were 80.9 and 53.1 respectively per 100000 patients, and the gastric and calonic cancers
death rate according to the mortality statistics was 47.35 and 19.5%. Accordingto the conclusions of therapy diagnosis unit, with around 70% of patients under P.A. Svetlova, N.A. Sorokina,
active dispensary observation, the pathologies of that kind are likely to be detected as often as in 0.4 0.8 % of cases. Therefore, the NLS screening would allow to T.G. Kuznetsova, V.I. Nesterova,
detect GC or CC in about every 150th 200th examinee.
L.A. Yankina, N.V. Tatisohev
Considering that the emergence of clinical signs is one of the incentives for a patient to take medical advice and a reason for hardware based exami The non linear diagnostics method (NLS) used in the Oberon device has nation, some clinical implications and their pattern were evaluated in the been actively practiced lately at many medical institutions. The most tangible cases of the above mentioned diseases. As followed from the results, in 720 results were achieved by using the NLS method as a means of dispensary patients affected by GC or CC the condition appeared to be symptom free in observation. In the course of its development and advancement the method 42% and 32% of cases respectively or there were some signs characteristic of has become a foremost tool of diagnostics and observation with respect to a previous chronic digestive tract diseases. That was the case in 77% and 92% number of widespread digestive organs diseases; it allows to promptly collect for the 1st phase, 56% and 68% for the 2nd phase, 23% and 32% for the 3rd detailed information about a lesion and its pattern and assess the treatment phase, and 8% for the 4th phase of the disease. The clinical implications at a efficiency. That kind of diseases include gastrodoudenal ulcer, chronic gastri gastric cancer were of a pain dyspepsia syndrome nature typical for the lesion tis, and also benign and malignant gastric and colonic tumors. The specific in the upper section of the digestive tract. At a colonic cancer subgroups were character and working conditions of the therapeutic and clinical institutions segregated with dominating signs of intestinal hemorrhage, disturbed evacu in Russia allow to extensively employ the NLS method not only for diagnos ation or abdominal pain. A certain interrelationship was proven between the ing diseases with some symptoms present but also for dispensary observation, pattern of the clinical implications and the process localization. In more than and what is more, practically all the patients in need of examination can be 50% of cases the clinical implications lasted less than 3 months and in 26% placed under observation. So the physicians can now cover patients with the of patients the CC developed acutely within a few days. It should be noted changes that are latent and can only be verified by means of NLS. Specifically, that the so called "minor sign syndrome" corresponded to some later phases such patients include those having precancerous diseases or a mucous distur of the disease. The same was true for lab examination data where the change bance in the upper and/or lower sections of the digestive tract and patients became evident during phases III and IV (2).
who developed a tumor, which still remains latent in a certain phase.
The results of NLS diagnostics for the initial phases of gastric cancer in According to the data acquired by some medical specialists, using the a series of 104 examinations showed that in 72% of cases the physician on the device for NLS diagnostics, and based on annual research in thousands of assumption of a spectral similarity to the reference standard, regarded the cases, the frequency of detecting focal or diffuse changes, typical for chronic lesion as benign and indicative of focal mucosa hyperplasia, polyp, an area of atrophic gastritis in patients over 50 years old, is within 30 40%. The analy local inflammation, wall deformation or a small ulcer. The probability for sis of the spectral examinations of pattern different sections of focal changes detecting signs of malignant change found out in the elimination mode was in stomach mucosa shows that different symptoms of diseases including under 1%. Of 134 cases of colonic cancer in phase 1 malignant adenomas intestinal metaplasia and epithelial dysplasia can be detected in them just as were detected in 58% of patients. The rest of the patients were found to have often. During NLS analysis symptoms of gastric ulcer were recorded in about the co called "minor" forms of cancer, like polyps, atrophic gastritis or 5% of cases, polyps in stomach in 7% and polyps in colon in 45% of cases.
atrophic hyper plastic gastritis. The endoscopic verification of GC and CC Thus, even the NLS analysis results alone, without other risk factors taken with reference to the diacrisis of phases II, III and IV of the diseases com into account, indicate that most of the patients in the respective age group pletely confirmed the results of the NLS investigation.
appear to be among those who need dynamic observation because of poten 172 patients were found to have GC or CC discovered by NLS examina tial gastric cancer (GC) or colonic cancer (CC). tion conducted within a less than a year interval. Among them 62% of patients had an initial phase of gastric cancer and 38% of the patients during previous detection. The analysis of the available data allows to assume that tumor may observation were found to have some or other signs of chronic gastritis in the develop within a short time interval reaching the size of either "minor cancer" form of focal mucosa hyperplasia, local inflammation or wall deformation.
or extensive lesion. All that confirms the idea that the tumor growth dynam According to morphological investigation, the said sections were of a benign ics in different patients and in different phases of the disease is likely to vary nature and cancer developed therein over the last year only. In the rest of the and be of both continuous and discrete pattern. So a possible scenario of patients the macroscopic changes corresponding to malignant affection (spec tumor development could be the emergence of "early" gastric cancer against tral similarity to "gastric carcinoma" reference standard D<0.425) occurred in the background of precancerous gastric diseases with a subsequent prolonged the span between the last two examinations. The preceding endoscopy detect period of existence in the initial phase which allows to diagnose it after a year ed atrophic gastritis free of focal changes in the area of the developed tumor.
or a longer time later. At the same time, this "benign" scenario of disease Similar NLS data were acquired for 38 patients who during a year's observation progress is not typical for some patients and because of the rapid tumor growth were diagnosed to have developed a tumor corresponding to phases II and III. we just fail to detect the initial phase of the condition in advance. The colonic The NLS of the colon and straight intestine was performed a year before cancer development through the benign phase and then through a malignant tumors were diagnosed in 21 patients affected by malignant polyps, of whom 17 adenoma is not the only possible scenario it can proceed. Tumor can develop had been under active observation because of polyposis, while no formation of de novo and here too, a variant of a comparatively slow or fast growth is poten that kind was in evidence during the initial examination. In addition, within the tial. This provides an explanation for an "accidental" detection of patients with same time span 13 patients were examined who were diagnosed with a precan fairly large tumors during dispensary observation and a great number of cerous condition (spectral similarity to straight intestine carcinoma, reference patients with a short clinical anamnesis and late phases of the disease. standard D>0.7) and minor forms of cancer. In 6 of the patients the tumor Thus, NLS can be considered as an adequate method for diagnosing gas developed in the area of endoscopic polypectomy after they had a large villous tric and colonic cancers. The difficulties in dealing with NLS interpretation adenoma removed. Thus, in 34 (27%) of 121 patients, who were diagnosed to largely concern the initial phases where the frequency of disease detection have a malignant polyp condition in phase I or a small size tumor, colonic can depends in the long run on how keen the physicians are on performing a spec cer developed within a year. 36 patients examined within the same time interval tral verification of any focal changes in the mucosa in the case of a chronic were found to have the conditions in phase II and III just as frequently. 28 of gastritis and on keeping the patients under dynamic observation at the given them were subjected to regular medical check ups with no clinical signs of the modes of elimination and NLS analysis involved. The submitted results allow disease in evidence in any of them. 8 patients, within 3 7 months prior to tumor to segregate two principal variants of the disease diagnosis. The first one sug diagnosis, began to show signs of growing anemia or progressing stool retention.
gests "accidental" tumor detection during NLS investigation; neither clinical The dispensary observation data for these patients, with the NLS method nor other familiar signs of disease are in evidence or their intensity is an insuf employed a year before the cancer was detected, had indicated no tumor .
ficient reason for the patient to see a doctor. The second variant occurs when There are two very essential factors known to be of paramount importance for the patients develop clinical implications which impell the physician to carry malignant disease diagnosis; they are the quality of clinical and diagnostic techniques out the respective investigations for them. The results of diacrisis of gastric and and the specific pattern of the disease progress which actually determine the dynam colonic cancers indicate that for most patients the problem of early diagnosis ics of the disease progression. Considering the capabilities and working conditions in can not be solved, not only because of certain organizational factors but also the therapeutic institutions, the presented data on gastric and colonic cancer diag and primarily because of the specific pattern of the disease progress and its noses may to a certain extent be regarded as optimum. It implies, that even if all the manifestations. However, the actual opportunities for improving the well patients were readily diagnosed with the disease during the dispensary observation timed disease diagnosis in practical public health conditions lie, primarily, in (actually it is a matter of 60%), the phase I condition could have been detected only increasing the number of patients to be examined by means of the NLS in 40% of them. The analysis of causes of the late diagnosis cases suggests that such method within the frameworks of a health survey and also in a timely and cases could be prevented by improving organizational and methodical work.
complete examination of the patients who are suspected to have the disease.
Furthermore, the focus should be placed on the specific features of the disease progress which are of great, and possibly of vital importance for tumor International Anticancer Association in 1997 (the 5th revision). Phase T1 New potentials of NLS method
was diagnosed in 13 patients (21%), phase T2 in 26 patients (43%), phase in colonic neoplasm diagnostics
T3 in 17 patients (28%) and phase T4 in 5 patients (8%).
According to a pathomorphological examination, metastases into V.I. Nesterova, T.G. Kuznetsova,
regional lymph nodes were detected in 11 of 61 cases. All the patients underwent NLS investigation and ultrasound colonoc V.I. Metlushko, N.L. Ogluzdina
sopy to diagnose and localize new growths, define their size, growth patternsand approximate morphological characteristics, and also ultrasound scan Introduction
ning of the abdominal cavity and small pelvis organs to assess the condition Colonoscopy is successfully used today to diagnose colon new growths.
of the organs adjacent to the colon and diagnose distant metastases.
Based on a number of indications endoscopic investigation allows to get reli The NLS investigation used the Oberon 4011 device equipped with a able information about the colonic growth surface in order to correctly clas 4.9 GHz nonlinear sensor manufactured by the Institute of Practical sify its pattern and take a sample for morphological identification. Yet, Psychophysics (Russia) and Clinic Tech Inc. (USA). The endoscopic ultra colonocsopy does not give an idea of the kind of internal structure the new sonography made use of the endoscopic ultrasonographic system UM 20 growth has, nor does it allow to assess the depth of the invasion of the colon complete with the ultrasonic colonoscope CF UM20 (Olympus, Japan). The wall by a malignant tumor, determine its proliferation to adjacent organs or echographia of the abdominal cavity made use of the diagnostic unit SSD metastases to regional lymph nodes. Besides, colonocsopy does not provide 630 (Aloka, Japan) and Logiq 700 (General Electric, USA).
information about extra intestinal new growths unless they have already permeated the intestinal wall. Discussion of results
The NLS investigation of the colon using a 4.9 GHz high frequency We know from experience that every NLS investigation should be pre nonlinear sensor can help clear up all of these issues.
ceded by diagnostic colonocsopy, which evaluates anatomic characteristics of The NLS investigation allows to examine intestinal wall layers and the the colon and defines the number, localization and macroscopic characteris tics of the new growths, and by ultrasound scanning of the abdominal cavity This research aimed to define the potentials of the NLS method in a as well. A thorough transabdominal ultrasound scanning is required to assess more specific diagnostics of straight and segmented intestine tumors.
the condition of the organs adjacent to the colon and diagnose remote metastases.
The matter and investigation methods
A comparison of the NLS results with those of pathomorphological In order to achieve the set goal 87 patients were examined in whom 91 investigations was made in order to define the potentials of the NLS method new growths were investigated by means of the NLS method. The examinees in differential diagnostics of benign and malignant colonic new growths.
included 41 men and 46 women aged from 31 to 83 with most of them (82%) The results of the NLS investigation coincided with the pathomorpho aged 50 and over. All the patients affected by colon new growths were given logical investigation in 87 of 91 cases. Most of the errors occured in diagnos one or another kind of surgical treatment depending on the pattern, size and ing colon adenomas. In 6 of 31 cases the patient was suspected of having can localization of the growth. Among them in 23 cases endoscopic polypectomy cer. The analysis of the observations noted that difficulties in diagnostics were was performed, in 61 cases a resection was done on different parts of the related to the deformation of intestinal wall layers due to the pressure of a colon and in 3 patients transanal endomicrosurgery was performed. All of the nodal villous tumor rather than to a genuine invasion. Two false negative NLS investigation results were verified by a pathomorphological examina results were obtained in the case of malignant adenoma and cancer diacrises. tion of macro preparations according to which the colonic new growths were Thus, the accuracy of the NLS method in differential diagnostics of represented by simple tumors in 30 cases and by glandular cancers with dif malignant and benign colon tumors amounted to 81.3% and sensitivity to ferent degrees of differentiation in 61 cases. The stages of the malignant 79.8%, while the specificity made 76.4%. The method of treatment to be process were defined according to TNM classification adopted by the chosen for patients affected by colon cancer depends on the tumor process phase. A comparison was made to the pathomorphological investigation data At this essay the greatest group were the tumours sized from 2 to 5 cm, in 61 cases in order to assess the diagnostic effeciency of the NLS method in where the results proved to be lower, than in two first groups. The NLS data classifying the colonic cancer phase.
and those of the pathomorphologic essays coincided in 66,7 % of cases. An The correct definition of the phase of tumor process was possible in appreciable share of mistakes (60 %) occurred in phase Т2, where the intes 68.4% of the observations. The best results were obtained in defining phases tinal wall invasion depth was overestimated in all observations. T3 and T4, where the diagnostic accuracy was 78.2% and 81.2% respective The great value has the fact, that according to pathomorphologic essay, ly. It should be noted that most of the errors occurred in determining phases in 5 of 6 cases of hyperdiagnostics apart from the tumoral infiltration an T1 and T2, where the data of NLS and pathomorphological investigations expressed inflammation was detected in deeper layers of the intestinal wall.
coincided only in 54.2% and 47.4% of the observations respectively. The relatively low accuracy of diagnosed depth of the intestinal wall invasion In diagnosing phase T1 mistakes were made in 4 cases with 3 of the by a tumour sized from 2 to 5 cm is due to the fact that 24 of 30 observations errors toward overstating the phase; in one case signs of intestinal wall inva of this group corresponded to phases Т2 and ТЗ. A differential diagnostics of sion were not found and the tumor was taken for adenoma. In the analysis of the tumoral infiltration depth in these phases is complex.
phase T2 diagnostic errors in overstated phases were noted in 7 of 9 cases; an At the next research stage we made comparative analysis of the effect of understatement of phase of the tumor process occurred in one case and yet in the form of growht of the neoplasm for accuracy of defining the phase of one case no evidence of invasion proved to be found. The analysis of the post tumoral invasion in the intestinal wall. All neopasms were classified into three surgical morphological conclusions made it clear that in 6 of 7 false positive groups In function of the shape of the tumor growth: polypiform, saucer results the pathomorphological investigation of a macro preparation detect ed a deeper infiltration into the intestinal wall. However, according to micro The highest results were obtained when diagnosing the phase of the scopic examination, the infiltration was of inflammatory rather than of a saucer shaped growth cancer process where the accuracy of defining the tumorous kind. It should also be noted that in all of the cases it had to do with tumoral invasion in the intestinal wall was 78.3 %.
an infiltrative tumorous process in the inferior ampullar section of the It seems however impossible to fully estimate the accuracy of the NLS straight intestine free of serous membrane while the inflammatory infiltration method in defining the depth of a tumoral invasion at neoplasms with saucer area was located in adrectal cellular tissue. shaped growth because of its dismall occurrence among other forms in To find out the causes that present difficulties for diagnosis the efficien cy of the NLS method was analysed in function of the size, localization and The polypiform of the growth was noted in 30 neoplasms. The growths form of germination of neoplasms. The best results were obtained in diag had a distinct interface with unaltered sections of the intestinal wall and did nosing new growths sized under 2 cm and over 5 cm. not block the intestine lumen by more than half, which created favorable The epithelial tumour over 5 cm in size is represented by phases ТЗ and conditions for the survey. The accuracy of NLS method in defining the depth Т4 in 12 of 17 cases. It has to be noted, that at large neoplasms the data of of tumoral invasion in the intestine wall was as high as 65 %. It has to be NLS essay did not coincide with pathomorphologic data only in phase Т2, noted, that half of all cases divergent with the pathomorphologic conclusions where the process phase was overestimated because of the presence of inflam is due to the overestimated depth of tumoral infiltration at defining the phase matory infiltration in deeper layers, than the layers where the tumoral inva Т2, which is connected with the presence of a perifocal inflammation.
sion occured. Thus, at neoplasms larger than 5 cm in size the diagnostics of This fact suggests difficulties in defining the phase of a cancer process in the invasion degree of the intestinal wall is feasible in 78.2 % of observations.
cases where the tumoral invasion is compounded by the inflammatory com High results were also obtained at the estimation of depth of tumoral inva ponent penetrating deeper layers of the intestinal wall and beyond its limits.
sion by neoplasms sized up to 2 cm. Most of them are represented by a The neoplasms with an infiltrative growth shape have proved to be most tumour in phases Т1 and Т2. The results of ultrasonic colonoscopy have difficult in defining the degree of the tumoral invasion into the intestinal wall.
coincided with those of pathomorphologic conclusions in 76.7 % of the In this this group the results of NLS method and those of the pathomorpho observations. It should also be noted, that tumours sized up to 2 cm are most logic essays coincided only in 49,8 % of observations. It was due to the fact convenient for examination since they have the least number of artefacts.
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 we estimated the 3. The diagnostic efficiency of NLS method in defining the phase of accuracy of the NLS method in defining the degree of the intestinal wall tumoral process in the rectum is lower, than in segmented intestine.
invasion depending on the tumour location in the colon.
4. The diagnostical accuracy of the cancer phase in colon depends as In 40 cases the tumour was localized in the rectum and in 21 cases in the much on the size as on the anatomic shape of the tumour growth. The best segmented intestine. The accuracy of diagnosing the phase of the tumoral results were obtained at defining depth of invasion of the intestinal walls by a process in the colonic intestine is significantly higher, than at finding the tumour sized under 2 cm and over 5 cm.
tumoral invasion depth with the neoplasms located in the rectum andamounts to 71 and 62,5 % resppectively. This high result can be most likelyexplained by the fact, that this department of colon contains a serous membrane, which distinctly separates the muscular layer from the abentericorgans and tissues. Also it is noted, that the serous membrane of the intestineis less subjected to penetration of the inflammatory infiltration, than thepararectal cellular tissue. The majority of mistakes falls on the cases of overestimated depth of the invasion at defining Phase Т2.
These researchers have noted, that accuracy of diagnosing the phase of a tumoral process was higher in colonic intestine, than in rectum. The greatest number of mistakes occures in Phase Т2, which is conditioned by thepresence of abscesses, inflammatory infiltraion or radial therapy in the neoplasm area. Damaged regional lymph glands are an important prognostic factor in diagnosing rectum cancer . To define the capabilities of the method indiagnosing metastases in regional lymph glands, the results of the NLSmethod were compared with those of the pathomorphologic essay. In the latter the malignant damage to the regional lymph glands was detected in 11observations from 22 cases.
The analysis of the derrived data proved that the NLS essay had correct ly 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 in inflammatory changes the results of the ultrasoniccolonoscopy and those of the pathomorphologic essay coincided only in 45.5% of observations. In 6 from 11 of cases the presence of metastasises in lymphnodes was assumed (false positive result). Such mistakes can be attributed tooncologic vigilance of the researcher and complexity of differential diagnostics of inflammatory and metastatically altered lymph glands.
Conclusions
1. NLS diagnostics is a highly efficient method of diagnosing the neo
plasms of the colon, allowing to diagnose neoplasms and regional lymphglands.
2. The NLS method allows to detect the colon adenoma and cancer by the presence or absence of the tumoral invasions in the intestinal wall.
because NLS does not allow to provide a vessel's image and hence to meas NLS — method in vascular pathology
ure the vessel's diameter. This kind of information may be acquired with the diagnosis
help of Doppler systems with 2D imaging, that offer duplex and triplex scanning (the so called Doppler chromatic charting).
S.M. Patrushev,
The NLS method was developed in the mid 90 s and played an essential role in vascular pathology diagnosis. The main advantage of the NLS method A.D. Sluzky, V.M. Vagulin
was that it facilitated search and locating the vessels and allowed to very quickly differentiate vessels from nonvascular structures, arteries from veins and Today the world faces a constant trend of a growing rate of mortality very accurately detect signs of disturbed vascular permeability caused by caused by occlusive vascular diseases, especially by cerebrovascular disorders stenosis or occlusion of the vessel lumen by an atherosclerotic patch or a which are in the third place among death causes. On the one hand the trend thrombus which are generally not visible at scanning in B mode alone.
is caused by a growing number of elderly and aged patients. On the other In addition the NLS method allows to diagnose portal hypertension, hand many men even already at 45 have atherosclerotic damage of main the extent of its intensity, and permeability of Porto systemic bypasses. NLS head arteries, causing the need for a dispensary observation.
is very sensitive in defining the extent of peripancreatic vessel involvement The most simple and at the same time informative method of noninvasive with pancreas cancer which is essentially important for choosing the diagnosis of occlusive damage of peripheral vessels appeared to be the NLS method which has been used in clinical practice not long since. The first NLS NLS allows to detect the damaged renal vessels (both veins and arteries), devices equipped with analog trigger sensors, operating in 1.4 GHz frequency which is very important for the correct choice of a hypotensive drug at arte mode and used in clinical practice since the late 90 s have not lost their impor tance yet. They can help determine the condition of certain sections of the Some effecient hypotensive drugs, i.e. inhibitors of angiotensin convert main vessels in the lower limbs and that of the brachiocephalic vessels.
ing enzyme (ACE) such as capoten, enalapril, berlipril, ect., became very Not only the condition of the vessels but also that of the valvular system popular lately, but they have counter indications at renal artery stenosis. So of deep veins can be studied. 102 patients were examined in 1997 1998 to physicians should bear in mind that checking for stenosis is a must before detect valvular insufficiency of deep veins affected by varicosis. The patients prescribing this kind of medicine. The NLS method is likely to be the choice were from 21 to 67 years old. The examined patients included 25 men (24.5%) and 77 women (75.5%). The study was carried out by means of the The NLS method is indispensable for differential diagnostics of benign Oberon device using a 1.4GHz analog trigger sensor. In 32 patients a valvu and malignant hepatic diseases. Its sensitivity is comparable with the poten lar insufficiency of the femoral vein was detected, in 44 patients failure of tials of conventional or digital angiography and computer assisted amplified both femoral and popliteal veins. NLS allows to assess the condition of the tomography. In addition, the NLS method is much cheaper, simpler and valvular system of deep veins in low limbs on a noninvasive and objective basis more intelligible. It can be employed directly at the patient's bedside if which is very important point for the surgery tactics to be selected, and can required. The NLS method may be used in ophthalmology to check ocular be used as an alternative to phlebography analysis. hemodynamics before or after surgical intervention, in obstetrics to detect The NLS signal spectral analysis method has no counterindications and the disturbed blood current in umbilical cord arteries with a view to diagnose in terms of informational content is comparable to angiography. It can be a retarded fetus development and predict a negative perinatal produce. used to perform screening in the course of polyclinical examination with a Yet another potential of NLS method lies in cranial scanning which view to detect early or latent forms of vascular pathology and also as a pre allows to detect intracranial hematomas, aneurisms, cysts and tumors in the liminary method for selecting patients for angiosurgical treatment, since according to some angiologists, angiography should only be performed on These are far from all potentials of the NLS method.
candidates for surgery picked out after a preliminary NLS investigation.
Summing up, the NLS method is one of the most dynamic techniques However, this method does not allow to assess bulk index of the bloodstream, and within the next few years it is bound to bring some new discoveries.
The chromogenic density of the lung tissue around the nidus was some NLS diagnostics of lung abscess
what higher (due to infiltration), and the folia of the visceral and parietalpleuras were blackened in the lower sections of the right lung.
S.N. Makarova
The patient was offered a further therapy in a specialized surgical department, which he turned down. 3 weeks later, after some anti inflamma A screening NLS investigation detected two cases of lung abscess in tory therapy a check NLS examination was performed. During the exami feverish patients who were complaining of pain in the right hypochondriac nation the patient complained of coughing with a profuse sputum discharge.
region. The patients were subjected to echography in order to preclude an His temperature was normal, the clinical blood analysis indicated a leukocyte count of 8.6x109, and the differential blood count was within the standard, The NLS examination was conducted by means of "Oberon 4009" and ESR grew up to 37 mm/h. The NLS investigation visualized a rounded device equipped with a digital trigger sensor. (1,4GHz).
formation with even outlines, increased chromogenic density and heteroge Patient N., aged 57, was admitted to the therapeutic department. He was neous internal structure sized 47x43. The chromogenic density of the lung complaining of a week long fever with a temperature of up to 40?C, a mod tissue around the perimeter decreased (because of reduced infiltration).
erate non productive cough and pain in the right hypochondriac region as a At the patient's urgent appeal he was discharged from hospital for further result of catching a cold. He came to see a doctor ten days after falling ill. The outpatient treatment. Later he underwent two check examinations conducted. anamnesis read a bilateral pneumonia 14 years before. The clinical blood Patient M., aged 63, was examined by means of the NLS method in analysis indicated an increased leukocyte content up to 18.7 x 109 with a order to preclude a liver or gall bladder pathology.
flush left leukogram. The common urinalysis showed no deviations. Physical An NLS investigation of the lung and pleural cavities was carried out. In examination: vesicular pulmonary respiration, weakened in the lower sec the left lung and pleural cavities it found no signs of pathology in evidence.
In the right lung in the IX, X and XI hypochondria (from the paravertebral Tongue dry, white furred. Belly soft, with frank painfulness in the right line to the scapular one) it parietally visualized a formation having an hypochondriac region. No symptoms of peritoneum irritation in evidence.
increased chromogenic density and sized 85x60 mm with uneven outlines Pasternatski symptom negative on the right and left.
and heterogeneous structure (due to inclusions of a decreased chromogenic The NLS investigation of the abdominal cavity did not detect any signs density) sized 3 4 mm. The chromogenic density of the lung tissue was not of pathology in the liver, gall bladder or pancreas. On the right there are visu increased. NLS conclusion: signs of abscess in the right lung? alized blackenings in the diaphragmatic pleura (4 5 points according to Radiological conclusion: abscess in the lower lobe of the right lung.
Flandler's scale) and an image of voluminous formation in the right lung was The patient had check NLS investigations conducted against the back acquired (5 6 points). On the dorsal thoracic wall there was an image of a ground of anti inflammatory therapy. With the NLS investigation performed enhanced chromogenic formation (6 points) of a heterogeneous internal 10 days later the formation looked rounded, had even outlines, an increased structure, sized 80x65x54 cm. The lung tissue around the nidus had a higher chromogenic density (4 5 spoints) and a heterogeneous internal structure.
chromogenic density (4 5 points) on account of infiltration. A spectral simi Around the perimeter of the nidus the lung tissue had an increased chro larity to the "lung abscess" reference standard (D=0.312) was detected. The mogenic density (3 4 points) because of infiltration. The formation meas investigation of the left lung and pleural cavities did not detect any structur ured 73x50x60 mm. The NLS investigation 2 weeks later did not detect any al changes. NLS conclusion: certain signs of developing abscess in the right positive dynamics from the administered anti inflammatory therapy.
The submitted clinical observations once again confirm that the NLS The check radiological investigation arrived at the conclusion: an investigation with lung diseases is not used in clinical practice as often as it abscess in the lower lobe of the right lung in progress. A repeated NLS examination was conducted 10 days later. It visualized Besides, the dynamic NLS observation of the patients affected by lung a rounded hyporchromogenic formation with uneven outlines with some diseases allows to assess the efficiency of the employed therapy and reduce hyporchromogenic zones inside, sized 81x60x51 mm.
the radiation load both on patients and on the medical personnel.
did not show any changes. According to some literary evidence, in this phase NLS diagnostics of degenerative
the histology detects a substitution of the fat bone marrow for the red bone changes in the spine
marrow often accompanied by enlarged trabeculae. This phase generally precedes an osteochondrosis development which can be diagnosed a little while A.G. Brusova, P.A. Manokhin,
The spectral similarity to the reference standard "intervertebral osteo T.K. Puzanovskaya, T.A. Shyshkovets
chondrosis" was frank (D 0.246 to 0.360).
Degree 3, a frank hyperchromous response (6 points), which corre Computer Nonlinear Diagnostics (NLS) is a new highly informative sponds to a far advanced vertebral body sclerosis, was detected in 312 method provided to examine the spine and spinal marrow. The NLS advan patients. Some secondary symptoms, like local bulging and vertebral asteo tages are noninvasiveness, scalability of the image field, a capability to obtain phytes, were detected with a far advanced degenerative lesion of the disks and sections of any orientation and virtual imaging of radicular canals and par a substantial similarity to the reference standard "osteochondrosis" (D from avertebral zone. Undoubtedly the use of NLS in diagnostics of degenerative 0.152 to 0.218). NLS allows to differentiate between a protrusion and pro spine diseases has apparent prospects.
lapse of the disk and existence of rupture of the fibrotic ring and the condition of longitudinal and other ligaments.
Subject and methods
A protrusion is defined as a bulging of the disk tissue beyond the poste The investigation was conducted by means of "Oberon 4009" metatron rior outline of the vertebral body into the spinal canal. The fibrotic ring tissue equipped with a 1.5 GHz digital trigger sensor. 1217 patients affected by endures though becomes very thin and NLS only reveals a zone of slight degenerative changes in the lumbar region of the spine were investigated. The destructive change in the structure (3 4 points). The pulpous nucleus shifts NLS of the spine and spinal marrow was performed for all patients, 112 dorsally much farther in the disk. The protrusion has a wide base and can patients had NLS and CT, and myelography was performed for 10 patients.
spread as far as intervertebral foramina with the inferior part of the foraminafilled with disk tissue. The compression of the intraforaminal structures can Analysis of results
cause irritation of the nerve root. Normally, the nerve root uninvolved in the In 87% of cases in the examinee group we found disks affected by process gives a moderate response (3 4 points). With compression it gives an degenerative changes. The earliest degenerative change in intervertebral disks acutely frank hyperchromous response (6 points).
(ID) was a hyperchromous lesion (6 points on Flandler's scale) in zone Protrusion may be accompanied by a slight caudal shift which is quite between the pulpous nucleus and the fibrous annulus. Along with the degen often defined by means of the NLS method at L5 S1 intervertebral disk level.
erative changes NLS has detected an increased chromogenic density of the NLS detected protrusion in 729 patients.
signal from the bone marrow in the adjacent regions of the vertebral bodies The rupture of the fibrotic ring fibers results in the prolapse of the (4 5 points according to Flandler's scale). 3 degrees of degenerative changes pulpous nucleus on a subligamentary level and the ligament rupture results in could be distinguished depending on the process intensity.
the prolapse inside the cerebrospinal canal. As can be seen from NLS, the Degree 1, a hyperchromous zone appraised at 4 5 points on Flandler's longitudinal ligaments look well delimited and are represented as hyperchro scale, was detected in 90 patients. Conventional radiographs did not display mous band like structures (5 6 points) which adjoin the bones and the fibrot any changes. Formation of fibrovascular tissue followed by its penetration ic ring. The extraligamentary prolapse can shift either in a caudal or a cranial into the bone marrow is believed to underlie the changes. Some authors relate direction. The extraligamentary prolapses of the disk that lost contact with these changes to the lack of stability in this segment.
the host disk become sequesters. Occasionally, we observed some very small The histograms displayed a spectral similarity to the reference standard extraligamentary sequesters which shifted far into the cerebrospinal canal, "intervertebral osteochondrosis" (D 0.396 to 0.425) Degree 2, a hyperchromous responce in the affected zone at 5 6 points The NLS investigation detected prolapse in 445 patients. In 68% of cases on Flandler's scale was detected in 215 patients. Conventional radiographs the hernia of intervertebral disk was combined with other degenerative dystroph ic spinal changes on this level. The hernia of the intervertebral disk was detected NLS diagnostics of diffuse
at L4 5 level in 83%, at L5 S1 level in 15% and at L3 4 level in 2% of cases. Alesion of several disks was found in 50 patients. 196 patients underwent surgery, infiltrative lung diseases
among them 114 had lateral hernia, 76 patients had median lateral hernia and 6had median hernia. 5 patients had surgery for hernia recurrence. The NLS diag V.I. Nesterova,
nosed extraligamentary sequestrated hernia in 38 patients, and intradural hernia T.G. Kuznetsova,
was diagnosed in 3 persons. Multiple sequesters were detected in 5 patients. N.L.Ogluzdina
The clinical symptomatology for the prolapse of intervertebral disks was vari able and did not always depend on their size. In some cases we observed medianprotrusions which did not result in any clinical implications. The clinical sympto Among different kinds of lung disorders special attention has been paid matology for small sequestrated hernia was no less than for large sequesters.
over the last years to diffuse infiltrative lung diseases (DILD), which is large In evaluating the NLS data not only the size of hernia but also the reserve area ly accounted for by some problems in their timely diagnostics and treatment. of the cerebrospinal canal and their prepositions should be taken into account.
Most diffuse lung diseases involve in the pathological process both the With a suspected hernia the NLS investigation should be performed at interstitial tissue and the respiratory tract and alveola. In this connection this least in two planes, sagittal and paraxial, i. e., parallel to the disk plane, and type of pathological processes should be defined rather as diffuse infiltrative the sagittal investigation in T1w SE can be combined with other sequences.
than as interstitial diseases. Despite of the polymorphism of clinicomorpho The median prolapses of intervertebral disks in sagittal shots could be logical manifestations of DILD, most of them start off with productive alve seen quite clearly. The signal content of the hernia predominantly corre olitis (in contrast to the exudative alveolitis in the case of a pneumonia) with sponded to the NLS signal content of the pulpous nucleus. The external part fairly stereotyped changes in the lung interstice in the form of inflammatory of the fibrotic ring, posterior longitudinal ligament and the dura matter give infiltration with different degrees of intensity. Subsequently a fibrosis devel a frank hyperchromous response and do not differentiate from one another.
ops that can have different rates of progression. A 'cellular lung' pattern is the Thus, the NLS method sometimes fails to present a direct proof of a rupture final phase of the development. It should be noted, that some infectious dis in the external part of the fibrotic ring.
eases of certain etiology (like tuberculosis, histoplasmosis, etc.) and particu It is largely a lesion of the pulpous nucleus on the side of the back edge lar malignant tumors (lymphogenous carcinomatosis, bronchioloalveolar of the vertebral body that speaks in favor of the protrusion in axial shots.
cancer) do not directly belong to interstitial lung diseases but are similar to Displacement and compression of the spinal marrow can well be seen in both The clinical evaluation of patients with a suspected DILD is a complex Sagittal shots have an advantage in deciding on the disk prolapse, the size of problem. Nonspecific symptoms and in some cases signs detected during intervertebral foramina and the condition of the cerebrospinal canal and bones.
chest examination may be characteristic of a multitude of acute or chronic These shots are not significant for detecting an intradural process with the cone lung diseases that involve the interstitial tissue, respiratory tract or alveola.
especially poorly visible in them. Frontal shots have drawbacks in determining the DILD are represented by an extremely heterogeneous group of diseases. The condition of the pulpous nucleus and fibrotic ring. To that end paraxial virtual mod DILDs have been described in over a hundred possible versions, however in els are used, for they allow to differentiate the process between the pulpous nucleus clinical practice only about 10 or 15 conditions are most common and it and the fibrotic ring and sometimes make it possible to differentiate between the should be noted that sarcoidosis and various cases of lung fibrosis occur in fibrotic ring rupture and the protrusion free of the rupture. Thanks to virtual dimen clinical practice in 35 50% of all DILDs. Besides, acute diffuse lung process sional scaling sagittal shots allow to well delimit the subarachnoid space. es 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 found to be difficult. Unfortunately, the capabilities of conventional roentgenography for patients 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 row transplant and clinical symptoms of fever of obscure genesis. The authors with a histologically confirmed DILD were studied. The chest radiographs demonstrated high reliability of the NLS in determining fungal infection in for 10% of the cases turned out to be normal. Among 86 patients affected by 20 of 24 cases. Besides, the fact that no changes were detected during NLS DILD no pathological change was detected in 50% of the patients with his lung examination allows to assume that the the fever was caused by bacterial tologically proven bronchiectasia and in over 20% of the patients with or fungal infection of extra pulmonary genesis.
emphysema shown on X ray shots. Radiography may equally show false pos It is also a proven fact that the sensitivity with NLS is higher than with itive results of the investigation. We have discovered that in 10 20% of the standard computer tomography. We examined 150 patients. Using conven patients with the x ray confirmed signs of DILD no changes were detected tional CT (10 mm collimation) and NLS we found that NLS had a higher sensitivity in recognizing pathological changes in the lung tissue.
The computer nonlinear diagnostixs (NLS) is one of the promising Due to its high sensitivity, NLS should be used to define lung diseases in methods of diagnosing lung diseases of today. NLS appreciably improves the patients with a normal or obscure aspect of disease who have a pulmonary communication of the fine morphological elements in the lung tissue and disturbance or symptoms that suggest an acute or chronic diffuse lung dis opens up new opportunities for recognizing interstitial diseases of the bron choalveolar system. NLS has a high sensitivity in detecting fine interstitial Even with certain clinical signs in evidence the diagnostic accuracy of lesions of the parenchyma and small nodules.
classic radiography in patients affected by DILD appears to be limited. The The results of the investigations prove that NLS has a better sensitivity in reason is both superposition of the image in the radiograph and low contrast detecting both acute and chronic diffuse lung diseases. The sensitivity of the of minute lung structures. NLS is free of these aspects, which is why it is NLS diagnosis in detecting lung diseases makes 85% as compared to 70% in reputed to be a more efficient method for recognizing diffuse lesions of lung tissue as compared to both radiographic survey and conventional computer The accumulated experience too, gives additional grounds to assert that NLS is a highly efficient method for diagnosing a wide range of various dif Besides, having a higher sensitivity, specificity and diagnostic accuracy, fuse lung diseases, DILD included, and excels the 'classic' chest radiography the NLS method can become a determining factor in evaluating the activity of a pathological process in patients affected by DILD. In certain cases NLS It should be noted that the high sensitivity of the NLS method is can be used not only to define the presence or absence of a pathological achieved without sacrifising the specificity and diagnostic accuracy of the process or the extent to which it has spread, but also to collect information method. In patients affected by DILD the NLS specificity amounted to 86% about the reversibility of changes (in an acute or active phase) as compared to as opposed to 76% in radiography. In particular, the high sensitivity (87 88%) irreversible (fibrotic) changes in the lung tissue. Moreover, since NLS can and specificity (83 89%) of NLS were demonstrated in bronchiectasia diag accurately identify the imponderable activity of a pathological process in the lungs, it can be employed to evaluate the efficiently of the treatment given to Although NLS is a more sensitive method as compared to chest radiog raphy, its sensitivity in lung disease diagnostics is not absolute and the fact The conventional methods for evaluating disease activity, such as trans that no radiological changes were detected by NLS may lead to precluding bronchial lung biopsy (TBLB), bronchoalveolar lavage (BAL), chest radiog lung disease in patients who actually suffer from DILD. 100 patients were raphy, gallium lung scanning and functional lung tests are insufficiently reli examined by means of the NLS with 86 of them affected by DILD and 14 able in evaluating the activity and in terms of prognostication. So the open having no pathological change in the lungs.
lung biopsy (OLB) is still the choice method for both diagnosing and evalu Despite a high value of NLS sensitivity and specificity, for 4% of the ating the process activity. We were able to prove, that signs detected in patients with biopsy detected lung diseases the results were interpreted as patients by means of NLS can provide some valuable information and be sig being normal. On the other hand, the NLS was proven to be a high accura nificantly important in defining the activity of a pathological process.
cy technique for precluding acute lung diseases in patients with immunode In terms of its prognostic value NLS is now advancing to the foreground ficiency. Some examination data were studied for patients with a bone mar leaving behind some functional lung tests, BAL and even OLB, because it allows to assess a lesion of actually the whole lung parenchyma as compared Conclusion. Radiography still remains the most accessible method for to a separate biopsy sample. Moreover, NLS can become an accurate nonin diagnosing DILD yet its informational content appears to be not sufficient. vasive method for evaluating the efficiency of the administered treatment. Making a correct diagnosis necessitates a combination of laboratory, Sarcoidosis is one of the most common interstitial lung diseases of functional and radiological investigations as well as some invasive methods , unknown etiology. In typical cases granulomas are formed in fine lymph ves each of them having its own substantial limitations.
sels or beside them, afterwards the granulomas self organize which causes NLS diagnostics is a method that greatly improves identification of dif fuse infiltrative lung diseases and as such it should become a part and parcel A number of researchers considered the NLS potentials in defining the process activity in patients affected by sarcoidosis. The main activity indicator is the presence of small nodules and to a lesser degree their distributionand occurence in the lung tissue. Unfortunately, despite the differencebetween reversible and irreversible changes detected by NLS for patients having sarcoidosis, the potentials of NLS in assessing the process activity havenot been studied well enough. Among different indications in favor of NLS application, the use of this method in lung biopsy is probaly the most important one. Biopsy is a veryessential diagnostics technique which allows to define the nosology of a lungdisease, 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 provedthat 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 forpatients having sarcoidosis or lymphogenous carcinomatosis, because theselesions have largely peribronchial tissue involved and are therefore mostaccessible to TBLB. Diagnostically OLB appears to be more accurate, but italso 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 thelung tissue. Many diffuse diseases affect lung tissue irregularly so the pathologically altered parts of lung parenchyma may be located among normallung tissue. Besides, the same lung may contain both active manifestations ofthe disease and fibrotic changes of long standing. For an accurate diagnosisand assessment of the clinical progress of the disease the right choice of abiopsy sample is very important. During biopsy NLS helps to collect moreaccurate data indicating active areas of a pathological process. By using NLS,the areas affected by lung fibrosis in its final phase, with 'honeycomb lungformed, could be skipped during biopsy sampling. In addition, NLS mayprove to be vitally important for choosing the most effective technique(TBLB, BAL or OLB) for making a histological diagnosis. 1) Anterior fibro muscular stoma (AFS).
NLS diagnostics of prostate diseases
2) Unstriated muscular fibers of the urethra (UMFU).
3) Preprostatic sphincter (PPS), which is an extension of the muscula V.A. Toropova,
ture of the inferior part of the urcter and prevents inverse emission of seminal S.N. Petrenko
4) Postprostatic sphincter (PPS), which is responsible for retaining An ever growing number of physicians enjoy an opportunity of a screen urine in the bladder and blocks incontinent micturition.
ing NLS diacrisis of prostate gland and urinary bladder. This aricle attempts The gland can be conventionally subdivided into 2 parts: to consider some particulars of morphological changes occuring in a prostate — external part consisting of CZ, PZ, TZ and affected by pathology, based on the results of NLS investigations. — internal part comprising AFS, PPS and PoPS.
In the West prostate cancer makes 20% of the total cancer diseases and According to NLS investigation, the external part looks like a structure ranks second to lung tumors as a death cause. of normal chromogenic density (2 3 points on Flandler's scale), and the According to some autopsy findings with a histological investigation of internal one is hypochromogenic (1 2 points). The two parts are divided by a the prostate, 12 47% of men aged over 50 appeared to have cancerous nidi.
fibro muscular layer, the so called surgical capsule, along which an incision is Clinically, cancer is diagnosed more rarely because a high percentage of that made during surgical intervention, and calcium salts deposit (calcium incrus number corresponds to 'minor forms' of cancer that have low invasiveness, so tation of the gland). In the NLS investigation those formations can well be the patients suffering from it die of another kind of pathology.
seen as fairly hypochromogenic structures (3 4 points) of different size.
To enhance the quality of prostate diseases diagnostics it is important to The analysis of the prostatic gland image on the NLS virtual model is comprehend the specifics of topographic and zonal anatomy of a particular made according to the following quantity and quality characteristics: 1. Size: front to back — 2 2.5 cm, across — 3 4.5 cm, from top to bot The prostate gland is located in the small pelvis between the bladder and anterior abdominal wall, anterior rectum wall and secondary urogenital diaphragm. The gland has a chestnut shape and tightly envelops the bladder 3. Symmetry. The urethra is the reference point.
cervix and prostatic urethra. The gland base is tightly connected with the If any pathological changes are detected in the NLS graph it is recomm bladder into a coherent mass. Its anterior surface is directed to the symphysis, and the posterior one to the rectum ampulla. The posterior surface of the gland has an expressed sulcus, which allows to conventionally subdivide the — perform histography of the pathological area and area of the tissue gland into the left and right lobes. Besides, there is a protruding middle cone shaped lobe confined anteriorly by the prostatic urethra and by the It will be helpful for the case follow ups. At a benign hyperplasia NLS allows to detect the direction of the principal germination. In case of hyper According to zonal anatomy theory usually 4 glandular zones are distin trophic transitory zones the gland proliferates inwards. Though darkened lat guished in the prostate. The correct interpretation of NLS data largely eral zones are formed ( 4 5 points on Flandler's scale), the nodes can still be depends on the knowledge of their topical pattern. 20% of the glandular tis always visualized. The trans rectal NLS offers the most detailed and authen sue correspond to the central zone (CZ). The peripheral zone (PZ) occupies 75%. The intermediate (transitory) zones (TZ) make up 5% of the total Enlarged lateral lobes squeeze PZ and CZ causing their atrophy. With proliferation of the paraurethral zones a massive fibro muscular PPS layer Perurethral glands (PUG) take a relatively small amount of the tissue, restricts their hyperplasia, so with this kind of pathology the gland prolifer however exactly this area of the gland is very important for explaining the ates along the urethra forming a middle darkened zone pushing back the changes at a benign hyperplasia. Apart from the glandular area, 4 fibro mus bladder wall. Virtual scanning makes this pathology clearly visible in longitu dinal sections. At the beginning of the proliferation a relationship between the internal and external glandular parts is disturbed. Apart from some dis With an oncological pathology, analysis of the gland picture helps local tinctions in the zones of principal proliferation, the clinical signs will be dif ize the process in different projections and assess the extent of prevalence and ferent as well. In the case where a globe shaped gland is formed (TZ prolif involvement of adjacent organs. The minimum size of tumor determinable by eration) the gland is chiefly hyperchromogenic and the dysuric means of NLS investigation is about 8 10 mm. 80% of the tumorous nodes manifestations are minimal while with a 'middle zone' formed the gland is are represented by markedly hyperchromogenic structures (6 points on slightly darkened and dysuria appears to be frank. Sphincter decompensation leads to the development of urinary incontinence and dilatation of the upper Analysis of histograms of the nidi helps differentiate an oncoprocess.
urinary tract followed by the atrophy of the cortical layer of kidneys, which The method's sensitivity becomes higher with both 'elimination' and 'NLS gradually adds to frequent urination, nycturia, reduced pressure of the urine analysis' modes in use. Peripheral zones have first place as far as cancer inci or slowed down urination occuring in the initial phase of the disease. dence rate is concerned. Their share makes 70 80% of cases. Transitory zones In case of a squeezed cervix of the bladder an NLS graph allows to visu (TZ) are affected in 10 20% and CZ in less than 5% of cases. In transitory alize signs of an infravesical obstruction, that causes some morphological zones a tumorous nidus should be looked for within 3 4 mm from the cap and functional changes in the lower and upper urinary tracts. Specifically, in sule. In case of an oncological alertness the symmetry in the lobe affection is the initial phases of benign hyperplasia a darkened wall in the bladder can be assessed w.r.t. the sagittal axis and intensity of the black patch (4 5 points on observed. Dark patches result from compensatory hypertrophy of the detru Flandler's scale), in the adjacent organs, especially seminal vesicles and blad der because in 25% of cases metastizing occures through the gland apex and These 3 phases of benign hyperplasia of the prostate can be distinguished seminiferous tracts. Considering the fact that cancer often develops with depending on the intensity of the changes: some diffuse changes occuring on the background, for example, with chron 1. hyperchromogenic density of the gland with no residual urine; ic prostatitis or adenomatosis, it is not always possible to visualize newly formed cancerous areas. In such cases the results of PSA level definition and 3. all of the above mentioned plus dilatation of the upper urinary tract digital rectal examination should be considered. The PSA level is defined with the cortical layer of kidneys involved in the process.
considering the patient's age and gland volume.
Diagnosis of acute prostatitis is made on the basis of histograms (simi larity to the reference standard process "prostatitis" D<0.425).
Conclusions:
Diagnostication should be done in combination with dactylar rectal exami 1. NLS method allows to diagnose most prostate diseases and being a nation (painfulness during palpation) with clinic lab data taken into account.
screening diagnostics method, it should be supplemented by biopsy, should In the case of abscessed lesion a still higher hyperchromous area (6 any pathological changes be detected.
points) is visible against the general dark patch (4 5 points according to 2. The final diagnosis should be made on the basis of the clinic lab data Flandler's scale). Areas of frank blackening correspond to necrotic changes.
and the results of digital rectal examination in combination with biopsy only. With an abscess in progress one can notice a reduced infiltration of the tissuearound the cavity with the dark patch gradually getting lighter in the courseof dynamic observation (up to 3 4 points). With adequate therapy employedthe postinflammatory cyst may fall into regression. As can be seen from NLS investigation, chronic prostatitis does not give a common characteristic picture, however the morphological processes indifferent phases of the disease are reflected in histograms. With a long lastingdisease the chromogenic density tends to rise due to a postinflammatory substitution for the glandular component and in histograms, in the'organopreparations' mode destructuring of the fibrous component starts topredominate.
these days makes the NLS investigation even more important. Our own prac NLS diagnostics of affected regional lymph
tical experience can confirm that. Patient B., 63 years old was admitted to the nodes at a mammary gland cancer
clinic with regard to right mammary gland cancer in its early phase IIa afteran ischemic stroke in combination with ischemic heart disease and hyper O.P. Dergatch, Y.A. Somov,
tension III. Palpation did not detect any lymph node enlargement. The NLSinvestigation did not detect metastasis affected lymph nodes which allowed a M.A. Kolesnikov, L.V. Chernyshov
tumorectomy for this patient at a low hazard to life.
Thus, the NLS investigation of regional lymph nodes with mammary Mammary gland cancer is one of the most common women's oncologic gland cancer may become a sufficiently reliable method for assessing their diseases. Its annual growth rate in the developed countries is about 3%. In metastatic affection which allows to pick out the most efficient tactics in addition, this pathology proves to be the primary cause of mortality among treating patients with this kind of pathology.
females affected by oncologic diseases. The tactics of treatment and diseaseprognosis largely depend on the presence or absence of any regional metastases. In this connection the problem of competent diagnosis of affectedregional lymph nodes becomes especially pertinent. With that end in view anumber of methods have been used, from physical to hardware based examinations. However, in 40% of the patients metastatic lesion of the lymphnodes in the axillary area is not determined clinically and false positive datawere observed in 25% of cases. Instrumental diagnosis methods do not havea rich informational content either. The NLS investigation of regional lymphnodes has been more extensively used lately.
Subject and methods of investigation
We have examined regional lymph nodes by means of the Oberon device
using a 4.9 GHz nonlinear trigger sensor in 25 patients affected by mammary gland cancer in Phases I III. The obtained data were compared with theresults of histological investigation of the macropreparations removed duringsurgery.
Investigation results
According to the NLS investigation results, of 25 patients examined
prior to surgery as many as 1 3 affected lymph nodes were detected in 20patients. The derrived results were practically fully confirmed by histologicalinvestigation of the macropreparations removed during surgery. Only in onecase NLS graphy did not detect affected nodes which we account for theirsmall size.
During the NLS investigation the metastatic lymph nodes were found to have pathological changes with quite a high degree of intensity. Flandler'sscale indicated 5 6 points in 80% of cases. The fact that organosaving surgeryand in some cases tumorectomy are being more and more extensively used ed in virtual shots in sagittal planes above and below the kneecap and along the pos NLS investigation in evaluating
terior surface of the joint. Frontal planes along the lateral surfaces of the joint were the condition of knee joint affected
used to define the exact condition of menisci, articular cartilages and changes in thesynovium.
by osteoarthritis deformans
It is traditioanally believed that in the articular cartilage degenerative changes start off with a rupture of the articular matrix and degeneration of M.S. Petrov, L.A. Voroshilova,
chondrosites. Therefore during the NLS examination special attention was V.M. Kartuzov, A.Y. Vesnin,
paid to changes in the articular cartilage. In the examinees of the test group G.V. Derevyanko, A.P. Guglya
the articular cartilage looked like a hyperchromous strip (1 2 points according to the Flandler's scale). Two patients were found to have an articular cartilage of a heterogeneous chromogenic pattern, 3 5 points, in the initial Introduction
phase of the disease with small hyperchromogenic nidi (1 2 points) present.
Primary osteoarthritis deformans of the knee joint is one of the most No radiological changes in the joints were detected for this group of patients. pertinent problems in modern medicine due to its prelevance, great loss of In 14 (28.0%) patients in the second clinical phase of the disease the working time and treatment expenses. In addition, in many cases an early or chromostructure of the cartilage was heterogeneous and some high hyper differential diagnosis of the knee joint lesion is impeded, which complicates chromogenic structures (4 5 points) were detected as well as hyperchro selecting the most efficient therapeutical and rehabilitation measures and mogenic inclusions (1 3 points) of a small diameter.
evaluating the patient's disability.
In 21 (42%) examinees in the third phase of the disease the hyaline car Today diagnostics of knee joint disorders comprises conventional radiogra tilage looked as a hyperchromogenic strip (5 6 points).
phy as well as sonographic evaluation of the joints, used to examine soft tissues of In 10 (20.0%) patients in the same clinical phase of the disease the articu the locomotorium. The existing techniques used to examine the knee joint allow lar cartilage was visualized as a distinctly hyperchromogenic linear structure (6 to determine dominance of pathological process in the joint, including degenera points) with vertical fissures present (4 5 points). In three patients the higher tive ones. However, the relationship between the intensity of pathomorphological line cartilage was not visualized mostly in the middle departments of the joint.
changes and the severity and dynamics of the process have not been studied yet.
Depending on the phase and duration of the disease a spectral similari This article aims to demonstrate the efficiency of the NLS investigation ty (D 0.189 to 0.621) could be visualized to the reference standard process in diagnosing osteoarthritis deformans, especially in the early (subclinical) The X ray pictures detected a moderate constriction and deformity of the joint space as a primary sign of the articular cartilage distraction in 22 Subjects and methods
patients and considerable constriction in 12 patients. Subcartilaginous osteo To define a normal relationship of the knee joint anatomical structures phyte was very important for osteoarthritis patagenesis. Formation of subcar 10 healthy persons aged from 25 to 55 (test group) were examined. The main tilaginous and epiphyseal sycts started off already in the initial phases of the group consisted of 50 patients with clinical implications of osteoarthritis disease (71.0% of the patients). According to NLS investigation, the cysts deformans of knee joints in different phases. The average duration of the dis were located subcartilaginously in the lateral regions of the bone, 1.0 3.0 mm ease was 7.0±3.0 years. All patients were routinely radiologically examined in deep and were as many as 4 to 12 15. Standard X ray pictures of knee joints displayed some changes in the subcartilaginousregions of the bone, like cysts The X ray pattern analysis took into account the joint space amount of and fibrosis, only in the second phase of the disease.
narrowing, existence of marginal osteophytes and deformation of osseous A very important role in the osteoarthrosis deformans development was structures with cysts and fibrosis areas present in the subcartilaginous bone attributed to the condition of the synovium and articular capsule. With the department. The NLS investigation was carried out using "Oberon" device progress of the disease and changes in its phases, a cartilaginous detritus with equipped with a 1.5 GHz trigger sensor. Changes in the joint capsule were evaluat antigenicity was formed on the articular surfaces. That often led to the inflammation of the synovium and its fibrosis. As a result, the synovium pro Potentials of NLS investigation
duced an inadequate fluid, which in turn impaired the cartilagan nutritionwith its ensuing degeneration.
in the presurgical evaluation
The synovium in healthy persons (test group) was visualized as a hyper of intramural invasion of gastric cancer
chromogenic linear structure (1 2 points). The first and second phases of thedisease saw a steady rise in its chromogenic pattern in 14 (28%) patients (3 K.P. Vasov, S.D. Setkin,
4 points). In 32 (62%) patients in the third phase of the disease the chromogenic density of the membrane reached 4 5 points throughout the phase S.A. Skvortsova, G.F. Maretskaya
with at most 3 or 6 hyperchromogenic inclusions. In three patients with anaggravated form of the osteoarthrosis deformans (the forth clinical phase) the Gastric cancer in Russia as well as in some other countries all over the synovium looked like a distinctly hyperchromogenic structure (4 points) with world reamains one of the most acute medical problems. Most researchers areas of a reduced entropic density (3 4 points).
engaged in the diagnostics and treatment of gastric cancer have concluded Changes in the membrane structure were always concomitant with syn that a timely and early diagnosis can promote cancer treatment and improve ovitis with a limited amount (mostly in the upper enstrophe in 28.0% of the patients) or a great amount (in all regions of the joint in 68% of the patients) For many decades radiology and endoscopy remained the principal of fluid free of sediment and additional inclusions.
methods for diagnosing gastric cancer. The main shortcoming of these meth Depending on the phase and extent of pathological changes in the joint ods of investigation is their inability to obtain a picture of the thick layers of affected by osteoarthrosis a change in the joint capsule structure also took place.
the stomach wall and hence a more exact data about the extent of tumor inva Only in the first phase of the disease did the joint capsule structure remain normal.
sion into the stomach wall, i. e., the phase of the tumor process in the presur In the second phase of the disease, especially with synovitis in evidence, gical period. The first attempts to establish phase gradation in stomach tumor the chromostructure was assessed at 4 5 points in 14 (28%) patients and in were made when such investigation methods as computer tomography (CT), the third and forth phases of the disease up to 6 points in 34 (68%) patients.
transabdominal ultrasound scanning (US) and the most recent NLS investi Roentgenographic evidences of synovitis and changes in the paraarticular soft gation were put into clinical practice. In today's medicine the NLS investiga tissues were detected in some patients only in the third and forth phases of the disease. tion may become an essential method for diagnosing abdominal cavity dis Thus, the analysis showed that the NLS investigation had an advantage ease because of its extreme simplicity, accessibility and non invasiveness.
over conventional roentgenologic methods in terms of early detection of However, in view of the fact that this investigation method has been used in degenerative changes in the articular cartilage.
medical practice since the late 90s, the amount of the published literature On the whole, the NLS method sensitivity in the early phase of the dis dealing with potentials of the NLS in diagnosing parenchymal organs is still ease amounted to 82%, specificity to 85% and accuracy to 86%. The sensi tivity of standard radiography in two projections was 68%, specificity 54% Rather explicit methods of NLS stomach investigation have been already developed and some NLS signs of cancer, benign and malignant gastric ulcers have been described (V.I. Nesterova et al., 2002). An attempt was Conclusion
made to establish phase gradation of gastric cancer by means of NLS investi The extensive use of NLS investigation of knee joints in everyday clini gation which resulted in a fairly high accuracy (75.8%) of the diagnosis most cal practice allows to diagnose osteoarthrosis deformans in its early phases. ly due to diagnosing much earlier phases of the tumor process. According tosome authors, NLS offers some incontestable opportunities in defining phases of gastric tumor mostly located in distal regions of stomach.
Yet, according to most researchers, until recently the NLS had been largely used as a method for specifying the extent of cancer proliferation, fordefining metastases and malignant invasions beyond the stomach, in other words, the NLS investigation method allows to diagnose stomach tumors patients' posture in the course of scanning allowed to visualize all the regions even in early phases of the disease.
of the stomach very well. The location of the tumorous infiltrate as to the Most literature dealing with the use of radiological computer tomogra stomach wall layers was assumed as a principal criterion whose analysis phy to diagnose stomach tumors provides a proof that this method can poten allowed to suggest the extent of the intramural invasion of the gastric cancer tiality be used to diagnose gastric cancer, especially its endophytic forms.
during NLS investigation, while in computer tomography the main point However, most authors still believe that the principal role of this method lies was to define the thickness and elasticity of the stomach wall at the lesion in acquisition of certain very important information about the extent of stom ach lesion and spread of the process to some adjacent organs. According to The point is that NLS investigation allowed to differentiate tumor quite different researchers, the early gastric cancer, that only affects the mucosa clearly w.r.t. the layers of the stomach wall, while in computer tomography and submucous layer can not be detected on the computer tomograms. In the the most diagnostically important factor was the degree of the stomach wall authors' opinion, this is beyond 'the resolution capabilities' of this investiga thickening at the lesion spot with respect to the neighboring unaffected areas (thickening ratio) along with some other sings (rigidity, roughness, uneven This work attempted to evaluate the potentials of the noninvasive radia ness). Based on the analysis of the results of the surgical intervention and tion methods of investigation (trans abdominal ultrasound scanning and morphological investigation of post surgical material as well as their compar radiological computer tomography) in detecting intramural invasion of gas ison with NLS and CT data the following conclusions were reached: both tric cancer, and to draw their comparison characteristics. methods are quite potent in presurgical determination of the extent of intra The analyse included 72 cases of gastric cancer. All the cases were com mural invasion of gastric cancer, however the NLS investigation demon pared with the surgical intervention data and the morphological studies of strates a higher specificity as compared to computer tomography in detecting post surgical evidence. According to the latest gastroenterological TNM clas early phases of gastric cancer due to visualization of lesion zones in the stom sification of tumors (1997), the group of gastric cancer carriers in phase T1 made 9 (12.5%) cases, T2 8 (11.1%) cases, T3 22 (30.6%) cases and T4 33 The analysis of the the performed investigations allowed to discriminate (45.8%) cases. Computer nonlinear diagnostics (NLS) and radiological the NLS signs that allowed to define the extent of intramural invasion of gas computer tomography (CT) of the stomach were performed as supplemen tary investigation methods deliberately after a preliminary integrated 1. T1 phase: presence of tumorous infiltrate within the first layer of the stomach wall, which is accompanied by hyperchromogenic density of the Computer tomography of the stomach was done after expanding the wall at the lesion spot lesion spot (5, less often 6 points on Flandler's color stomach walls with a gas (pneumoscanning) in standard projections (lying on the back and belly); the transabdominal NLS investigation of the stomach 2. T2 phase: tumorous infiltrate within the first and second layers of the was performed using the standard procedure. stomach wall accompanied by hyperchromogenic density of the first two lay In order to more clearly comprehend the NLS and CT signs underlay ers (5 6 points at the lesion spot).
ing the presurgical diagnosis of the T phase of gastric cancer (i.e., invasion 3. T3 phase: a frank chromogeneity of the inner layers of the stomach degree) one needs to have a clear idea of the image of a 'normal' stomach wall wall (6 points) except for the serous layer, which is evaluated at 4 or more visualized by means of the investigation method.
Thus, in CT investigation the stomach walls (adequately expanded) were 4. T4 phase: lesion of all layers of the stomach wall accompanied by at most 0.3 cm thick in normal conditions (test group of 50 persons) in all chromogeneity of the serous membrane (6 points) and signs of tumorous regions with few exceptions in cardiac and prepiloric regions where the walls invasions into the neighboring anatomical structures accompanied by a frank were 0.4 cm thick, whereas at an intramural tumorous effect the stomach wall chromogeneity (4 5 points) of the adjacent organs. authentically thickened over 0.6 cm (p < 0.01). In most cases it proved to be Detection of some affected peregastric (regional) lymph nodes and dis impossible to differentiate the lamellar structure of the stomach wall by com tant metastases in the course of investigation allowed to analyze the N and M puter tomography. Changing the section thickness, pitch of the table and the With respect to the potentials of computer tomography in presurgical So, an integrated approach to the use of NLS investigation and radio determination of the extent of intramural invasion of gastric cancer, it should logical computer tomography has proved to be more preferable for more be admitted that it had a less specific pattern and was essentially based on the accurate presurgical diagnostics of intramural invasion of gastric cancer, extent of the stomach wall thickening at the lesion spot.
however the order of priority and efficiency in their use somewhat depend on Thus, since the CT signs are indicative of one or another degree of gas the results of primary radioendoscopic investigation of the stomach. In addi tric cancer invasion, they could be conditionally classified in the following tion it should be noted, that contradistinction of these methods of investiga tion in diagnosing and phasing of gastric cancer against each other would be • It proved practically impossible to distinguish between tumors in T1 and T2 phases. So their diagnostics was based on the analyses of non multi In conclusion, it should be emphasized that despite their subordinate ple stomach wall thickenings from 0.3 to 05 cm, with the external outlines use with reference to radiological and endoscopic methods of gastric cancer investigation, the NLS investigation and radiological computer tomography • The T 3 phase typically had integer multiple thickenings of the stom should be brought into line with primary methods of stomach investigation.
ach wall over 0.5cm not accomapanied by deformed external outlines of the The conclusion is based on the facts that unlike some conventional radi stomach wall and with no signs of the tumor spreading beyond the stomach ological and endoscopic methods of investigation they allow to evaluate the internal structure of the stomach wall, which is a master factor in the presur • The T4 phase had multiple thickenings of the stomach wall (two, gical detection of intramural invasion.
three or more times as thick) over 0.1cm with a disturbed integrity of the This allows to work out the proper approach for treating patients affect external outlines of the stomach wall at the lesion spot and with some signs ed by gastric cancer, and based on the well founded data reject the explo of tumorous invasion into the adjacent anatomical structures. rative laparatomy in case of a frank process. Considering general accessibili According to our information, the NLS investigation proved to be the ty, lack of radiation exposure and application simplicity it appears more most accurate and specific method of investigation in presurgical diagnosis of apropriate to use NLS investigation as the most preferable of the above men gastric cancer in its early phases (T 1, T 2) while CT results appeared to be more convincing in detecting later phases of tumorous lesion (T 3, T 4). Itshould be noted, that, in our opinion NLS is the most accurate method ofinvestigation in detecting remote metastases (p > 0.05). Based on the statistical analyses, the specificity of the NLS method of the investigation indetecting the T phase of gastric cancer (with calculations made with reference to T 1, T 1 phases) amounted to 76%, sensitivity to 74.3% and accuracy to 78.2%, w.r.t the computer topography the specificity, sensitivity andaccuracy were 70% each (in this case calculations were made w.r.t. T4 phaseof gastric cancer, because differentiating the lamellar structure of the stomach wall was found impossible in CT investigation).
Thus, as compared to computer tomography, the NLS investigation proved to be a more specific method for diagnosing gastric cancer in its earlyphases although in a number of cases it was found difficult to differentiatebetween T1 T3 phases of a tumorous lesion. In CT investigation T1 T2 phases were defined conventionally based on the degree of stomach wall thickening at the lesion spot. NLS did not succeed in imaging anatomical structuresbeyond the stomach wall as distinctly as CT investigation did, but NLS wasmore efficient in evaluating such characteristics as M and N.

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Human factors & aviation medicine september-october 1994

F L I G H T S A F E T Y F O U N D A T I O N HUMAN FACTORS & AVIATION MEDICINE For Everyone Concerned with the Safety of Flight Air Crews Face Stomach and Intestinal Illness Risks at Many Layover Sites Around the World Medications are available to help prevent and treat intestinal illnesses caused by bacteria and viruses. Pilots should consult an aviation medical examiner

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COMMISSION REGULATION (EC) No 134/2009 of 16 February 2009 amending Regulation (EC) No 1907/2006 of the European Parliament and of the Council on the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) as regards Annex XI (Text with EEA relevance) THE COMMISSION OF THE EUROPEAN COMMUNITIES,Based on experience gained through the development ofguidance for the c

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