[Experience in the complex evaluation of fetal condition during pregnancy].
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Biomedical subjects
Publications and source records attributed to V N Demidov.
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Available are the results of ultrasonic investigations for 11 women with embryonal anomalies in the I pregnancy trimester. Echography was demonstrated to detect gross CNS malformations (anencephaly, exencephaly), lymphangiomas, omphalocele, conjoined twins, acardia of amorphic embryo, etc. Transvaginal sensors proved highly informative.
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The paper shows that echography can be used in the diagnosis of most congenital fetal limb developmental defects. The detection accuracy for severe anatomic defects was 83.3%. That for mild hand and foot developmental defects was achieved in 54.8% of the cases. Bilateral coxofemoral joint dislocation was diagnosed only in 2 fetuses. The paper also presents echograms of most malformations detected and emphasizes that it is essential to make a comprehensive and detailed examination of all fetal limbs.
An examination was made to define the significance of echography in the diagnosis of the polycystic ovary syndrome. A total of 276 patients with the morphologically verified disease and 70 healthy females of reproductive age were studied. It was found that the reliable results in detecting the disease might be obtained when the ovarian-uterine index (OUI) proposed by the authors was calculated. The OUI is the quotient obtained when the mean ovary volume was divided by the uterine thickness. It was ascertained that the OUI greater than 3.5 was indicative of the polycystic ovary syndrome in 91%. The index lower than the threshold value was suggestive of normal ovaries in 85%. In general, the accuracy of the presence or absence of the polycystic ovary syndrome was 87% when the OUI was estimated.
Sonographic potentials in the diagnosis of uterine sarcomas have been evaluated. Sarcomas were identified in 9 patients. Their populational incidence was 0.67:100,000. Specific sonographic signs of this disease were absent. The most characteristic presentation of uterine sarcomas were an anecho enic area in the myomatous node in the absence of acoustic effects of dorsal accentuation, appearance of cystic degeneration of the tumor, and a marked uterine enlargement during a follow up. It is suggested that these criteria may provide a diagnosis accuracy in a number of cases.
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Analysis is made of the results of ultrasound diagnosis of developmental abnormalities of the alimentary tract. It has been established that the information content of echography is dependent on the anatomic intensity of an abnormality and the period of pregnancy at which the examination was done. It has been shown that the method is not of high diagnostic significance in revealing developmental abnormalities of the upper lip and hard palate, atresia of the esophagus, large intestine and rectum. At the same time atresia of the duodenum, small intestine, omphalocele, gastroschisis, diaphragmatic and inguino-scrotal hernia are detectable in practically 100% of cases. The authors provide echograms of the majority of abnormalities, indicate the minimal times of detection, analyze the causes of diagnostic errors.
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Ten-year experience with ultrasonography was gained at an outpatient center. Within this period, 27000 examinations were performed in 11996 females. The credibility of the method in diagnosing endometrial pathology was 85.8%. Cancer morbidity for the last 5 years was compared in the ultrasonography and no ultrasonography groups. Endometrial cancer morbidity was 6.2 times higher in the latter group. Large-scale application of the procedure followed by adequate treatment assures significantly lower incidence of said pathology.
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Within the last 10 years, ultrasonic screening was carried out in 11,996 females (27,000 examinations on the whole) on an outpatient basis. The reliability of the procedure in diagnosing ovarian tumors proved as high as 94.1%. Cancer morbidity for the last 5 years was compared in the ultrasonography and no ultrasonography groups. The occurrence of cancer in the former group was 7 times lower which was attributed to timely detection and removal of tumors capable of malignant transformation. It was concluded that large-scale application of ultrasonography assures significantly lower incidence of ovarian cancer.
Findings of 55 ultrasound examinations have been evaluated in 35 fetuses with various facial malformations detected by ultrasound and confirmed at birth. Ultrasonographic presentations and diagnostic criteria are given for major facial, palate and lip clefts, abnormal nasal shape, hypo and hypertelorism, microphthalmia, exophthalmia, micro and macrogenia, macroglossia. Ultrasonography proves to be a highly revealing diagnostic study with the provision of a good structural visualization and physicians' skill.
A total of 351 females with physiological pregnancies repeatedly (1928 examinations) underwent ultrasonic fetometry. The investigations revealed clear-cut correlations between the term of gestation and biometric parameters such as the mean diameter of the fetal head, abdomen, heart as well as the length of its foot, femur and humerus. The average mistake in the identification of pregnancy terms which was performed on the basis of simultaneous analysis of the parameters considered was 5.73 days in all terms of gestation.
Careful consideration is given to such important practical problems as the emergence and features of artefacts and acoustic phenomena arising in ultrasonic images. These are reverberation, comet's tail, hyperbolic artefacts, artefacts of reflection, refraction, focal distance, beam length, changes in velocity, marginal rays, etc.. Principles of uniform reading of ultrasound images are suggested.
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Altogether 34 patients with corticosteroma were examined. In 29 (85%) of them accurate topical diagnosis was established as a result of ultrasonic investigation. All erroneous results were obtained only for corticosteromas of small sizes (4 cm and less in diameter). Tumors not exceeding 4 cm in diameter were benign in 88% of cases. If tumor sizes were over 4 cm, they were malignant in 89%. The earliest possible investigation for the presence or absence of a tumor was indicated to patients with hypercorticism.