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Techniques in Coloproctology May 2024Visualising the course of a complex perianal fistula on imaging can be difficult. It has been postulated that three-dimensional (3D) models of perianal fistulas improve... (Comparative Study)
Comparative Study
INTRODUCTION
Visualising the course of a complex perianal fistula on imaging can be difficult. It has been postulated that three-dimensional (3D) models of perianal fistulas improve understanding of the perianal pathology, contribute to surgical decision-making and might even improve future outcomes of surgical treatment. The aim of the current study is to investigate the accuracy of 3D-printed models of perianal fistulas compared with magnetic resonance imaging (MRI).
METHODS
MRI scans of 15 patients with transsphincteric and intersphincteric fistulas were selected and then assessed by an experienced abdominal and colorectal radiologist. A standardised method of creating a 3D-printed anatomical model of cryptoglandular perianal fistula was developed by a technical medical physicist and a surgeon in training with special interest in 3D printing. Manual segmentation of the fistula and external sphincter was performed by a trained technical medical physicist. The anatomical models were 3D printed in a 1:1 ratio and assessed by two colorectal surgeons. The 3D-printed models were then scanned with a 3D scanner. Volume of the 3D-printed model was compared with manual segmentation. Inter-rater reliability statistics were calculated for consistency between the radiologist who assessed the MRI scans and the surgeons who assessed the 3D-printed models. The assessment of the MRI was considered the 'gold standard'. Agreement between the two surgeons who assessed the 3D printed models was also determined.
RESULTS
Consistency between the radiologist and the surgeons was almost perfect for classification (κ = 0.87, κ = 0.87), substantial for complexity (κ = 0.73, κ = 0.74) and location of the internal orifice (κ = 0.73, κ = 0.73) and moderate for the percentage of involved external anal sphincter in transsphincteric fistulas (ICC 0.63, ICC 0.52). Agreement between the two surgeons was substantial for classification (κ = 0.73), complexity (κ = 0.74), location of the internal orifice (κ = 0.75) and percentage of involved external anal sphincter in transsphincteric fistulas (ICC 0.77).
CONCLUSIONS
Our 3D-printed anatomical models of perianal fistulas are an accurate reflection of the MRI. Further research is needed to determine the added value of 3D-printed anatomical models in preoperative planning and education.
Topics: Humans; Printing, Three-Dimensional; Rectal Fistula; Magnetic Resonance Imaging; Models, Anatomic; Reproducibility of Results; Anal Canal; Female; Male; Adult; Imaging, Three-Dimensional; Middle Aged
PubMed: 38801550
DOI: 10.1007/s10151-024-02925-3 -
Journal of Echocardiography Dec 2021Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with...
The prevalence and characteristics of candidates for percutaneous left atrial appendage occlusion using a WATCHMAN device among patients who underwent atrial fibrillation ablation in a Japanese population.
BACKGROUND
Percutaneous left atrial appendage occlusion (LAAO) using a WATCHMAN device could be a treatment option for patients with non-valvular atrial fibrillation (AF) with thromboembolic and bleeding risk. We sought to determine the prevalence and characteristics of patients with AF ablation who are potential candidates for WATCHMAN implantation in a Japanese population.
METHODS
We enrolled 2443 consecutive patients who had previously undergone AF ablation and transesophageal echocardiography (TEE). We assessed their clinical characteristics and measured their LAA orifice diameter and depth retrospectively using the obtained TEE images. We defined patients who met both anatomical criteria (LAA orifice max diameter: 17-31 mm and LAA max depth > LAA orifice max diameter) and clinical criteria (CHADS-VASc score ≥ 2 and HAS-BLED score ≥ 3) as LAAO candidates.
RESULTS
Among the 2443 enrolled patients, 361 (15%) met the clinical criteria, and 1928 (79%) met the anatomical criteria. Thus 12% (293/2443) of the total patient group met the criteria of LAAO candidates. LAAO candidates showed larger left atrial (LA) volume (77.6 ± 30.1 vs. 67.7 ± 29.1 mL, P < 0.001), larger LAA orifice diameter (22.5 ± 3.2 vs. 22.0 ± 4.3 mm, P = 0.026), and larger LAA depth (28.9 ± 4.6 vs. 27.0 ± 4.8 mm, P < 0.001). LAAO candidates made up only 23% of patients with CHADS-VASc score ≥ 2 (N = 1295), whereas 78% of patients with a HAS-BLED score ≥ 3 (N = 378) were LAAO candidates.
CONCLUSION
Twelve percent of patients who underwent AF ablation were potential candidates for LAAO using a WATCHMAN device in this Japanese population. It is imperative to evaluate bleeding risk when considering the indications for LAAO.
Topics: Atrial Appendage; Atrial Fibrillation; Cardiac Catheterization; Echocardiography, Transesophageal; Humans; Japan; Prevalence; Retrospective Studies; Treatment Outcome
PubMed: 34296416
DOI: 10.1007/s12574-021-00538-5 -
Advances in Oto-rhino-laryngology 2020Treating malignant tumors of the anterior skull base (ASB) is a challenging task, given their late presentation, diverse histology, and involvement of an intricate... (Review)
Review
Treating malignant tumors of the anterior skull base (ASB) is a challenging task, given their late presentation, diverse histology, and involvement of an intricate anatomical space requiring complex surgery. Advances in imaging, gradual refinement of surgical and reconstruction techniques, and improvement of perioperative care during recent decades have resulted in improved clinical outcomes for patients. In addition, assessing functional outcomes and quality-of-life issues have become a fundamental part in the holistic care of patients with ASB tumors. Once dominated by open procedures, the modern field of skull base surgery is rapidly incorporating endoscopic techniques. These techniques have been previously reserved for sinonasal inflammatory diseases, but in recent years they have sequentially and increasingly been applied to more complex disorders. The list of indications includes intracranial pathologies and malignant sinonasal neoplasms with skull base involvement. Open ASB surgery in this new era is reserved for selected cases, yet it is still considered the "gold standard" for treating ASB malignancy. The paucity of evidence-based data regarding the management of ASB tumors is still a major limit of the discipline of ASB surgery, resulting from the rarity and high degree of heterogeneity of these tumors. Therefore, no guidelines exist and prospective large cohort collaborative studies are required in order to consolidate our knowledge of the behavior of each histology encountered, and to assess the clinical and quality-of-life outcomes of the different treatment modalities currently used.
Topics: Endoscopy; Humans; Natural Orifice Endoscopic Surgery; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Preoperative Care; Skull Base; Skull Base Neoplasms
PubMed: 32731242
DOI: 10.1159/000457925 -
European Journal of Case Reports in... 2020Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body...
UNLABELLED
Body packing was first described in 1973 and refers to the intracorporeal concealment of illegal drugs, which are swallowed or placed in anatomical cavities and/or body orifices. The body packer can be asymptomatic or can have signs of systemic drug toxicity (neurological, cardiac, abdominal, renal and cutaneous) due to rupture of the packet(s) or symptoms of gastrointestinal obstruction or perforation. The diagnosis is established based on a suggestive history, findings on physical examination and laboratory findings and/or imaging. The vast majority of patients are asymptomatic and are treated conservatively. However, complex situations may require surgical intervention. We present a case of a 50-year-old man who was admitted in the emergency department with a generalized tonic-clonic seizure and vomiting with plastic film, which raised the suspicion of foreign body ingestion, confirmed by imaging and laboratory tests. He underwent exploratory laparotomy to remove the packages.
LEARNING POINTS
Body packing is a potentially lethal activity.Body-packers can be asymptomatic, or have signs/symptoms of systemic drug toxicity or gastrointestinal obstruction or perforation.It is essential to recognize this condition so that the correct clinical approach, diagnosis and management can be established.
PubMed: 32908836
DOI: 10.12890/2020_001750 -
World Neurosurgery Jan 2020Interest in endoscopic transnasal access has increased with continued technological advances in endoscopic technology. The goals of this study were to review the normal...
OBJECTIVE
Interest in endoscopic transnasal access has increased with continued technological advances in endoscopic technology. The goals of this study were to review the normal anatomy in transnasal endoscopic neurosurgery and outline the anatomical basis for an expanded surgical approach. Defining anatomical aspects of surgical endoscopy helps guide the surgeon by defining normal anatomy of the access vector.
METHODS
This anatomic study was conducted on 15 adult male cadaver specimens using various microsurgical tools and endoscopic instruments and 1 intraoperative case. The vasculature was injected with colored silicone to aid visualization. Different transnasal approach techniques were used, with angles of endoscope access at 0°, 30°, 45°, and 70° accordingly for extensive anatomical mapping.
RESULTS
The proximity of critical structures is different in each approach degree. A full understanding of the possible structures to be met during transnasal access is described. As a result of the study, anatomical aspects and important structures were outlined, and a surgical protocol was defined for minimal risk access in respect to normal anatomy of the area.
CONCLUSIONS
Thorough knowledge of topographic anatomy of the craniovertebral junction is required for performing minimal-risk surgical intervention in this region. It is important to know all anatomical aspects of the transnasal approach in order to reduce the risk of damage to vital structures. Transnasal endoscopic surgery of the craniovertebral junction is a relatively new direction in neurosurgery; therefore, anatomical studies such as the one described in this article are extremely important for the development of this access method.
Topics: Adult; Cadaver; Cervical Vertebrae; Humans; Male; Nasal Cavity; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Skull
PubMed: 31520764
DOI: 10.1016/j.wneu.2019.09.011 -
The Journal of Contemporary Dental... Jul 2022The aim of this study is to identify the prevalence of C-shaped root canal systems in mandibular first and second molars in a Lebanese population, and to determine the...
AIM
The aim of this study is to identify the prevalence of C-shaped root canal systems in mandibular first and second molars in a Lebanese population, and to determine the relationship between C-shaped root canal systems and different factors (age, gender, and tooth location) and to examine the root canal system's morphology along the root.
MATERIALS AND METHODS
The presence of C-shaped root canal systems in 648 mandibular molars from 257 patients was analyzed using cone-beam computed tomography (CBCT). The sample included 296 and 352 mandibular first and second molars, respectively. The frequency of C-shaped canals, their relationship to gender, age, and tooth location, and unilateral or bilateral occurrences were noted. A 3D Slicer 4.10.1 was then used to classify teeth with identified C-shaped anatomy according to Fan's configuration and to determine the distance between the orifice and the cementoenamel junction (CEJ).
RESULTS
C-shaped root canal systems were detected in 1.01 and 9.09% of mandibular first and second molars, respectively. In mandibular second molars, the most prevalent configurations were as follows: C1 at the orifice level, C3 at orifice-2 mm, C2 and C3 in the middle third, and C3 at the apical level. There was no correlation with age, gender, and tooth position. The bilateral occurrence happened in 60% of cases. Orifices were at a mean distance of 3.32 mm below the CEJ. The deepest groove was mostly lingual.
CONCLUSION
The prevalence of C-shaped root canal systems in the Lebanese population is 1.01 and 9.09% in the first and second mandibular molars, respectively. The CBCT slices showed that the configuration varies along the root and that the orifices are at various distances below the CEJ. Therefore, pre-operatory scans can be beneficial for better understanding and preparation of root canal treatment.
CLINICAL SIGNIFICANCE
In the Lebanese population, C-shaped mandibular molars are not a rare finding. Clinicians should consider the different configurations and the possible changes along the root.
Topics: Humans; Dental Pulp Cavity; Tooth Root; Spiral Cone-Beam Computed Tomography; Molar; Cone-Beam Computed Tomography
PubMed: 36440518
DOI: No ID Found -
Computerized Medical Imaging and... Jun 2023Left atrial appendage (LAA) occlusion (LAAO) is a minimally invasive implant-based method to prevent cardiovascular stroke in patients with non-valvular atrial...
Left atrial appendage (LAA) occlusion (LAAO) is a minimally invasive implant-based method to prevent cardiovascular stroke in patients with non-valvular atrial fibrillation. Assessing the LAA orifice in preoperative CT angiography plays a crucial role in choosing an appropriate LAAO implant size and a proper C-arm angulation. However, accurate orifice localization is hard because of the high anatomic variation of LAA, and unclear position and orientation of the orifice in available CT views. With the major research focus being on LAA segmentation, the only existing computational method for orifice localization utilized a rule-based decision. Nonetheless, using such a fixed rule may yield high localization error due to the varied anatomy of LAA. While deep learning-based models usually show improvements under such variation, learning an effective localization model is difficult because of the tiny orifice structure compared to the vast search space of CT volume. In this paper, we propose a centerline depth-based reinforcement learning (RL) world for effective orifice localization in a small search space. In our scheme, an RL agent observes the centerline-to-surface distance and navigates through the LAA centerline to localize the orifice. Thus, the search space is significantly reduced facilitating improved localization. The proposed formulation could result in high localization accuracy compared to the expert annotations. Moreover, the localization process takes about 7.3 s which is 18 times more efficient than the existing method. Therefore, this can be a useful aid to physicians during the preprocedural planning of LAAO.
Topics: Humans; Atrial Appendage; Echocardiography, Transesophageal; Atrial Fibrillation; Computed Tomography Angiography
PubMed: 36848765
DOI: 10.1016/j.compmedimag.2023.102201 -
Scientific Reports Mar 2020The purpose of this study was to investigate the effectiveness and practicality of 3D-printed model-guided endoscopic surgery for the treatment of basal ganglia...
The purpose of this study was to investigate the effectiveness and practicality of 3D-printed model-guided endoscopic surgery for the treatment of basal ganglia hemorrhage. The authors retrospectively analyzed the data of all patients who underwent endoscopic evacuation of basal ganglia hemorrhage in the Department of Neurosurgery at Dalang Hospital and Shipai Hospital between December 2017 and February 2019. Twelve patients, in whom the 3D-printed model guidance was used for endoscopic evacuation, were included in this investigation. Using 3D reconstructed technology, we designed the appropriate surgical approach. Then, an individualized facial model with the guide orifice was printed by a 3D printer. Further, the 3D-printed model was employed to guide the insertion of the endoscope sheath. As a result, the average evacuation rate was 97.2% (range 90.1-100.0%). The GCS and mRS score were improved in each patient from admission to discharge examination. All patients had a good prognosis based on their functional independence measure (FIM) scores at the 6-month follow-up. The 3D-printed model-guided endoscopic evacuation was effective and safe for basal ganglia hemorrhage. This technique deserves further investigation to determine its role in intracerebral hemorrhage management.
Topics: Adult; Aged; Basal Ganglia Hemorrhage; Blood Loss, Surgical; Endoscopy; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Male; Middle Aged; Models, Anatomic; Neuroimaging; Neurosurgical Procedures; Operative Time; Printing, Three-Dimensional; Prognosis; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 32251343
DOI: 10.1038/s41598-020-62232-3 -
Acta Oto-laryngologica Apr 2020Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations. The aim of this study was to evaluate the operation method and...
Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations. The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients. This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success. The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively ( < .005). The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn't require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.
Topics: Adolescent; Adult; Child; Female; Humans; Male; Middle Aged; Myringoplasty; Natural Orifice Endoscopic Surgery; Retrospective Studies; Young Adult
PubMed: 32125220
DOI: 10.1080/00016489.2020.1730949 -
Arthroscopy Techniques Jun 2021In anterior cruciate ligament (ACL) reconstruction, fixation of the graft with hardware is a routine procedure. However, in some cases when the hardware is not intended...
In anterior cruciate ligament (ACL) reconstruction, fixation of the graft with hardware is a routine procedure. However, in some cases when the hardware is not intended to be used or is unavailable, ACL reconstruction with hardware-free fixation must be the treatment of choice. We introduce a single-bundle anatomical hardware-free ACL reconstruction technique in which a set of Y-shaped femoral tunnels is created for the fixation of the proximal end of the graft over the bone bridge between the 2 outer orifices, and a transtibial ridge tunnel is created to set a suture loop with a knot for the fixation of the distal end of the graft at the suture loop. We believe the introduction of this technique will provide a reasonable option for single-bundle anatomical ACL reconstruction.
PubMed: 34258211
DOI: 10.1016/j.eats.2021.03.002