Вред УЗИ (Часть 7)
Вред УЗИ (для плода или новорожденного)
Здесь буду собирать статьи из Пабмеда и других мед. сайтов с серьёзными источниками о вреде УЗИ. Скорее всего, только по-англ. На момент июля 2010 г. вред УЗИ не доказан, а является медицинской гипотезой (эти слова я отметила жёлтым). Что это означает, то что не доказан ни вред, ни отсутствие оного. Написано ниже, что УЗИ может быть пренатально дополнительным фактором стресса в плане аутизма. Пока не доказано, что УЗИ не является таким стрессом, обратите внимание. В последнем предложении тоже выделенным жёлтым написано, что дальнейшие исследования о такой возможной связи требуются. Остаётся только ждать. Кстати, поскольку никаких доказательств безопасности УЗИ пока нет, разумеется, нельзя его считать НЕинвазивным и БЕЗопасным, что бы не говорили медики. Если они говорят, что это средство безопасно, они просто голословны.
Синди, Копирайт 2011
В ближайшее время буду в пабмеде перепроверять, всё ли верно про вред УЗИ. Пока предварительно, я нашла информацию на английском, что требуются дальнейшие исследования. Особо вред на человеческих плодах не доказан, а вот, на мышках крысках, я ещё не проверяла в пабмеде. Вред УЗИ в плане левшизма - доказан, вроде. В общем, поройтесь предварительно, если интересно, здесь и в пабмеде.
2010 Jul;75(1):53-8. Epub 2010 Feb 9.
Potential teratogenic effects of ultrasound on corticogenesis: implications for autism., .
Department of Psychiatry and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
AbstractThe phenotypic expression of autism, according to the Triple Hit Hypothesis, is determined by three factors: a developmental time window of vulnerability, genetic susceptibility, and environmental stressors. In utero exposure to thalidomide, valproic acid, and maternal infections are examples of some of the teratogenic agents which increase the risk of developing autism and define a time window of vulnerability. An additional stressor to genetically susceptible individuals during this time window of vulnerability may be prenatal ultrasound. Ultrasound enhances the genesis and differentiation of progenitor cells by activating the nitric oxide (NO) pathway and related neurotrophins. The effects of this pathway activation, however, are determined by the stage of development of the target cells, local concentrations of NO, and the position of nuclei (basal versus apical), causing consequent proliferation at some stages while driving differentiation and migration at others. Ill-timed activation or overactivation of this pathway by ultrasound may extend proliferation, increasing total cell number, and/or may trigger precipitous migration, causing maldistribution of neurons amongst cortical lamina, ganglia, white matter, and germinal zones. The rising rates of autism coincident with the increased use of ultrasound in obstetrics and its teratogenic/toxic effects on the CNS demand further research regarding a putative correlation.
Copyright 2010 Elsevier Ltd. All rights reserved.PMID: 20149552 [PubMed - indexed for MEDLINE]
А вот, ещё исследование, и оно тоже утверждает, что нужны дальнейшие исследования. Это про левшизм и УЗИ при Б.
1993 Jul 17;307(6897):159-64.
Routine ultrasonography in utero and subsequent handedness and neurological development., , , , .
Department of Gynaecology and Obstetrics, University Medical Centre, Trondheim, Norway.
Comment in:
Abstract
OBJECTIVE: To examine any associations between routine ultrasonography in utero and subsequent brain development as indicated by non-right handedness at primary school age and neurological development during childhood.
DESIGN: Follow up of 8 and 9 year old children of women who took part in two randomised, controlled trials of routine ultrasonography during pregnancy.
SETTING: Clinics of 60 general practitioners in Norway during 1979-81. Maternal and child health centres.
SUBJECTS: 2161 (89%) of 2428 eligible singletons were followed up, partly through a questionnaire to their parents and partly through information from health centres.
MAIN OUTCOME MEASURES: The dominant hand of the child was assessed by 10 questions. Deficits in attention, motor control, and perception were evaluated by five questions. Impaired neurological development during the first year of life was assessed by an abbreviated version of the Denver developmental screening test.
RESULTS: The odds of non-right handedness were higher among children who had been screened in utero than among control children (odds ratio 1.32; 95% confidence interval 1.02 to 1.71). No clear differences were found between the groups with regard to deficits in attention, motor control, and perception or neurological development during the first year of life.
CONCLUSION: Our data suggest a possible association between routine ultrasonography in utero and subsequent non-right handedness, whereas no association with impaired neurological development was found. As the question on non-right handedness was one of six initial hypotheses, the observed results may be due to chance. None the less, the results suggest that the hypothesis may have some merit and should be tested in future studies.
PMID: 7688253 [PubMed - indexed for MEDLINE]PMCID: PMC1678377
В этом исследовании оценивается в основном не ультразвук, а рентген, опять же, ещё надо исследовать и исследовать, однако предполагают, что увеличение случаев рака у детей связано с рентгеновским облучением матери во время беременности, а также у детей нежного возраста - в возрасте до 100 дней.
2011 Feb 10;342:d472. doi: 10.1136/bmj.d472.
Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case-control study., , , , , , , .
Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 6120 Executive Blvd, Bethesda, MD 20892-7238, USA.
AbstractOBJECTIVE: To examine childhood cancer risks associated with exposure to diagnostic radiation and ultrasound scans in utero and in early infancy (age 0-100 days).
DESIGN: Case-control study.
SETTING: England and Wales.
PARTICIPANTS: 2690 childhood cancer cases and 4858 age, sex, and region matched controls from the United Kingdom Childhood Cancer Study (UKCCS), born 1976-96.
MAIN OUTCOME MEASURES: Risk of all childhood cancer, leukaemia, lymphoma, and central nervous system tumours, measured by odds ratios.
RESULTS: Logistic regression models conditioned on matching factors, with adjustment for maternal age and child's birth weight, showed no evidence of increased risk of childhood cancer with in utero exposure to ultrasound scans. Some indication existed of a slight increase in risk after in utero exposure to x rays for all cancers (odds ratio 1.l4, 95% confidence interval 0.90 to 1.45) and leukaemia (1.36, 0.91 to 2.02), but this was not statistically significant. Exposure to diagnostic x rays in early infancy (0-100 days) was associated with small, non-significant excess risks for all cancers and leukaemia, as well as increased risk of lymphoma (odds ratio 5.14, 1.27 to 20.78) on the basis of small numbers.
CONCLUSIONS: Although the results for lymphoma need to be replicated, all of the findings indicate possible risks of cancer from radiation at doses lower than those associated with commonly used procedures such as computed tomography scans, suggesting the need for cautious use of diagnostic radiation imaging procedures to the abdomen/pelvis of the mother during pregnancy and in children at very young ages.
PMID: 21310791 [PubMed - in process]
А в этой статье про Допплера, сказано, что это не игрушка, особенно по сравнению с обычным УЗИ (B-mode), и надо держать термальный параметр на отметке не выше единицы, и как можно меньше времени чтобы занимала процедурка.
2010 Dec;53(4):842-50.
Fetal Doppler: how to keep it safe?.
Department of Obstetrics and Gynecology and Rush Fetal and Neonatal Medicine Center, Rush University, Chicago, Illinois, USA. Jacques_abramowicz@rush.edu
AbstractUltrasound's record of safety seems to be perfect, with no undisputed reports of adverse effects in humans. However, all epidemiologic studies published so far are based on information obtained with pre-1992 machines, when allowed maximal in-situ intensity for fetal use was increased. Many fetuses are examined very early in pregnancy, a time of greater vulnerability. Doppler can generate much higher level of acoustic energy than B-mode. The thermal index and the mechanical index are indicators of the 2 main potential effects of ultrasound including Doppler. To keep the fetus safe, knowledge of these potential bioeffects is mandatory as is understanding of how instrument controls alter the output. The 2 most important rules are: keep thermal index below 1 and use the lowest possible output for the shortest possible time compatible with obtaining diagnostic information.
PMID: 21048451 [PubMed - in process]
Здесь написано, что раньше-де, при Царе Горохе, УЗИ, что женщинам делали, было гораздо слабее по мощности. А что же до современной аппаратурки, так безопасность акушерского/родовспомогательного УЗИ (допплера, трёхмерного, четырёхмерного УЗИ) по состоянию на 2009 г. не доказана или не известна. Полного текста не раздобыла, это, видать, денег стоит, а там они рассуждают о том, что да как, в плане последствий.
2009 Dec;29(13):1204-12.
The safety of obstetrical ultrasound: a review., , .
Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO 63110, USA. houstonl@wudosis.wustl.edu
AbstractUltrasound is a commonly employed imaging modality in obstetrics and is generally regarded as safe to the fetus. Current ultrasound technology, however, has significantly higher output potential than older machines used in most clinical studies, and the safety profile for the increasing use of Doppler, 3-dimensional (D) and 4-D ultrasound with modern machines is unknown. This article reviews the current status of ultrasound safety within obstetrics, including proposed mechanisms of harm, existing scientific and clinical evidence regarding those mechanisms, and considerations of safety for the clinical user.
Copyright (c) 2009 John Wiley & Sons, Ltd.PMID: 19899071 [PubMed - indexed for MEDLINE]
Вот, тоже интересные выводы, по поводу успехов в учёбе 15-16 подростков в зависимости от того, были ли они внутриутробно подвергнуты ультразвуку. Оказалося, что большинство ислледуемых было подвергнуто ультразвуку в течение второго триместра. В итоге у тех, кто подвергся ультразвуку, немножко хуже успеваемость, чем у тех, кого не подвергали ультразвуку. Эта успеваемость хуже как в обычных предметах, так и по физкультуре. Однако же, это различие статистически не очень значимо, написано в заключении.
2009 Sep;34(3):297-303.
Prenatal ultrasound exposure and children's school performance at age 15-16: follow-up of a randomized controlled trial. , , , , , . Department of Women's and Children's Health, Obstetrics and Gynaecology, Uppsala University, Uppsala S-751 85, Sweden. karin.stalberg@kbh.uu.se Abstract OBJECTIVE: To evaluate the association between prenatal ultrasound exposure and school performance at 15-16 years of age. METHODS: The study population consisted of children born to women who participated in a randomized controlled trial on the second-trimester ultrasound examination in Sweden from 1985 to 1987. Information about the children's grades when graduating from primary school and information on socioeconomic factors was obtained from Swedish nationwide registers. Comparisons were made using linear and logistic regression analyses according to randomization to ultrasound, ultrasound exposure in the second trimester and ultrasound exposure at any time during pregnancy. Boys and girls were analyzed separately. RESULTS: Of the 4756 singleton children from the randomized trial, we identified 4458 (94%) in the National School Register. There were no statistically significant differences in school performance for boys or girls according to randomization or exposure to ultrasound in the second trimester. Compared to those who were unexposed, boys exposed to ultrasound at least once at any time during fetal life had a tendency towards lower mean school grades in general (-4.39 points; 95% CI, -9.59 to 0.81 (max possible, 320) points) and in physical education (-0.45 points; 95% CI, -0.91 to 0.01 (max possible, 20) points), but the differences did not reach significance. CONCLUSION: In general, routine ultrasound examination in the second trimester had no effect on overall school performance in teenagers. PMID: 19705400 [PubMed - indexed for MEDLINE]
Вот, интересные данные про цыплят, Допплер на поздних сроках (за два дня до вылупления) повлиял негативно на способности цыплят к обучению. В общем, дебиловатые получились цыплятки, по сравнению с контрольной группой: повторное обучение не давало положительных результатов, а с памятью у цыплят было худо, как с короткой, так и с длительной.
2009 Nov;27(7):677-83. Epub 2009 Aug 5.
Ultrasound exposure of the foetal chick brain: effects on learning and memory., , , , , .
Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, School of Biomedical Science, Monash University, Clayton, 3800 Victoria, Australia. michal.schneider-kolsky@med.monash.edu.au
AbstractUltrasound imaging of the brain is routinely used to monitor the development and resolution of brain lesions among premature and compromised newborn human babies. However, animal studies have shown that ultrasound can cause damage to developing foetal and neonatal tissues. In this study we investigated if ultrasound of the chick brain can lead to learning and memory impairment after hatch. We exposed the brains of chicks on day 19 of a 21 day incubation period to 5 or 10 min of B-mode, or to 1, 2, 3, 4 or 5 min of pulsed Doppler ultrasound in ovo. Learning and memory function were assessed at day 2 post-hatch. Our results show that B-mode exposure at E19 does not affect memory function. On the other hand, 2h after training, significant memory impairment occurred following 4 and 5 min of pulsed Doppler exposure at E19. In separate groups of chicks, short-, intermediate- and long-term memory was equally impaired suggesting an inability to learn. Further, the chicks were still unable to learn with a second training session 5 min after completion of the initial testing. These results demonstrate that extended exposure to pulsed Doppler ultrasound can adversely affect cognitive function in the chick when exposure occurs close to the time of hatch.
PMID: 19664703 [PubMed - indexed for MEDLINE]
Здесь написано, что про механическое влияние ультразвука на плод не известно пока, но нужны дальнейшие исследования, вследствие того, что модели на животных и на людях показывают некоторый низкий эффект влияния на развитие (плода).
2008 Apr;27(4):597-605; quiz 606-9.
Fetal ultrasound: mechanical effects., , , .
Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, US Food and Drug Administration, 9200 Corporate Blvd, HFZ-120, Rockville, MD 20850 USA. melvin.stratmeyer@fda.hhs.gov
AbstractIn this discussion, any biological effect of ultrasound that is accompanied by temperature increments less than 1 degrees C above normal physiologic levels is called a mechanical effect. However, one should keep in mind that the term mechanical effect also includes processes that are not of a mechanical nature but arise secondary to mechanical interaction between ultrasound and tissues, such as chemical reactions initiated by free oxygen species generated during cavitation and sonoluminescence. Investigations with laboratory animals have documented that pulsed ultrasound can produce damage to biological tissues in vivo through nonthermal mechanisms. The acoustic output used to induce these adverse bio-effects is considerably greater than the output of diagnostic devices when gas bodies are not present. However, low-intensity pulsed ultrasound is used clinically to accelerate the bone fracture repair process and induce healing of nonunions in humans. Low-intensity pulsed ultrasound also has been shown to enhance repair of soft tissue damage and accelerate nerve regeneration in animal models. Although such exposures to low intensity do not appear to cause damage to exposed tissues, they do raise questions about the acoustic threshold that might induce potentially adverse developmental effects in the fetus. To date, bioeffects studies in humans do not substantiate a causal relationship between diagnostic ultrasound exposure during pregnancy and adverse biological effects to the fetus. However, the epidemiologic studies were conducted with commercially available devices predating 1992, having outputs not exceeding a derated spatial-peak temporal-average intensity (ISPTA.3) of 94 mW/cm2. Current limits in the United States allow an ISPTA.3 of 720 mW/cm2 for obstetric modes. At the time of this report, available evidence, experimental or epidemiologic, is insufficient to conclude that there is a causal relationship between obstetric diagnostic ultrasound exposure and adverse nonthermal effects to the fetus. However, low-intensity pulsed ultrasound effects reported in humans and animal models indicate a need for further investigation of potentially adverse developmental effects.
PMID: 18359910 [PubMed - indexed for MEDLINE]
Здесь написано, что повышение температуры у плодов в следствие ультразвучивания плохо изучено, и поэтому невозможно утверждать, что исключены всякие негативные эффекты. Написано конкретно, что эксперименты на лабораторных животных показали, что ультразвук может повысить температуру в организме и повредить тем самым ткани, особливо, если там присутствуют кости. При этом используется обычный диагностический ультразвук, хотя и в течение более длительного времени, чем обычно в клинической практике. Сказано, что на людях-то не замечено было никаких негативных эффектах, но беда в том, что эксперименты-то были проведены до 1992 года, тогда параметры были 94 mW/cm. А сейчас-то параметры, разрешающие в США 720 mW/cm2. А это уже совсем другая песнЯ, какая никто не знает толком на момент 2008 года, и поныне, февраль 2011.
2008 Apr;27(4):541-59; quiz 560-3.
Fetal thermal effects of diagnostic ultrasound., , , , , .
Department of Obstetrics and Gynecology, Rush University Medical Center, 1635 W Congress Pkwy, Chicago, IL 60612 USA. jacques_abramowicz@rush.edu
AbstractProcesses that can produce a biological effect with some degree of heating (ie, about 1 degrees C above the physiologic temperature) act via a thermal mechanism. Investigations with laboratory animals have documented that pulsed ultrasound can produce elevations of temperature and damage in biological tissues in vivo, particularly in the presence of bone (intracranial temperature elevation). Acoustic outputs used to induce these adverse bioeffects are within the diagnostic range, although exposure times are usually considerably longer than in clinical practice. Conditions present in early pregnancy, such as lack of perfusion, may favor bioeffects. Thermally induced teratogenesis has been shown in many animal studies, as well as several controlled human studies; however, human studies have not shown a causal relationship between diagnostic ultrasound exposure during pregnancy and adverse biological effects to the fetus. All human epidemiologic studies, however, were conducted with commercially available devices predating 1992, that is, with acoustic outputs not exceeding a spatial-peak temporal-average intensity of 94 mW/cm2. Current limits in the United States allow a spatial-peak temporal-average intensity of 720 mW/cm2 for fetal applications. The synergistic effect of a raised body temperature (febrile status) and ultrasound insonation has not been examined in depth. Available evidence, experimental or epidemiologic, is insufficient to conclude that there is a causal relationship between obstetric diagnostic ultrasound exposure and obvious adverse thermal effects to the fetus. However, very subtle effects cannot be ruled out and indicate a need for further research, although research in humans may be extremely difficult to realize.
PMID: 18359908 [PubMed - indexed for MEDLINE]
