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Endoscopy Jul 2024
Topics: Cholangiopancreatography, Endoscopic Retrograde; Humans; Catheterization; Bile Ducts
PubMed: 38936354
DOI: 10.1055/a-2252-4132 -
Endoscopy Jul 2024
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Catheterization; Bile Ducts
PubMed: 38936353
DOI: 10.1055/a-2234-8599 -
The Pan African Medical Journal 2024We report a case of a Morgagni hernia repaired by primary closure with an extra-abdominal suture. Moreover, we reviewed cases of laparoscopically repaired Morgagni... (Review)
Review
We report a case of a Morgagni hernia repaired by primary closure with an extra-abdominal suture. Moreover, we reviewed cases of laparoscopically repaired Morgagni hernia, in which the size of the hernia defect was known, to establish a size criterion for mesh utilization. An 87-year-old woman presented to our hospital with right upper abdominal pain and vomiting. She had no history of abdominal surgery or trauma. Chest radiography and computed tomography (CT) revealed a Morgagni hernia, with the stomach and transverse colon herniated into the right chest cavity. Initially, an endoscopic repair was performed for the herniated stomach due to her age, which was successful. However, she had a recurrence 2 days later, prompting us to perform a semi-emergent laparoscopic surgery. Laparoscopic examination revealed a Morgagni defect, with the omentum, transverse colon, and stomach herniated, with the stomach reduced by pneumoperitoneum. Fortunately, the herniated organs could be easily relocated into the abdomen with no adhesions. The hernia defect measured 6 x 3 cm. We performed primary closure with an extra-abdominal suture. No sac resection was performed. The operation lasted 98 min. Oral intake was initiated on postoperative day 1, and the patient was discharged on postoperative day 3 without complications. Chest radiography and CT scans at 1 month postoperatively showed no recurrence, and the patient remained asymptomatic at the 9-month follow-up examination. According to our review findings, primary closure is an efficient method for small hernia defects (rule of thumb: width, <4 cm; length, <7 cm).
Topics: Humans; Female; Laparoscopy; Aged, 80 and over; Tomography, X-Ray Computed; Herniorrhaphy; Suture Techniques; Abdominal Pain; Recurrence; Sutures; Vomiting
PubMed: 38933436
DOI: 10.11604/pamj.2024.47.150.43103 -
Medicina (Kaunas, Lithuania) May 2024Hepatobiliary ascariasis is caused by the entry of the nematode from the duodenum into the biliary duct. We report a case of an -induced extrahepatic biliary tract... (Review)
Review
Hepatobiliary ascariasis is caused by the entry of the nematode from the duodenum into the biliary duct. We report a case of an -induced extrahepatic biliary tract obstruction in a pediatric patient admitted to the hospital due to a wide spectrum of symptoms of biliary disease, which included abdominal pain in the upper abdominal quadrants, vomiting, and jaundice. Imaging tests-including ultrasound, magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP)-were performed to confirm the diagnosis of biliary ascariasis. The tests did, in fact, demonstrate signs of this disease. Nevertheless, during the ERCP, only the remains of parasites in the form of tissue fragments were extracted. We also aim to discuss the prevalence of ascariasis in children, the causes of migration of parasites into the bile ducts, together with its clinical manifestations, as well as the diagnostic and treatment methods of this disease.
Topics: Humans; Ascariasis; Lithuania; Cholangiopancreatography, Endoscopic Retrograde; Child; Animals; Male; Ascaris lumbricoides; Cholangiopancreatography, Magnetic Resonance; Female
PubMed: 38929533
DOI: 10.3390/medicina60060916 -
BMC Medical Imaging Jun 2024To assess the improvement of image quality and diagnostic acceptance of thinner slice iodine maps enabled by deep learning image reconstruction (DLIR) in abdominal...
Deep learning image reconstruction generates thinner slice iodine maps with improved image quality to increase diagnostic acceptance and lesion conspicuity: a prospective study on abdominal dual-energy CT.
BACKGROUND
To assess the improvement of image quality and diagnostic acceptance of thinner slice iodine maps enabled by deep learning image reconstruction (DLIR) in abdominal dual-energy CT (DECT).
METHODS
This study prospectively included 104 participants with 136 lesions. Four series of iodine maps were generated based on portal-venous scans of contrast-enhanced abdominal DECT: 5-mm and 1.25-mm using adaptive statistical iterative reconstruction-V (Asir-V) with 50% blending (AV-50), and 1.25-mm using DLIR with medium (DLIR-M), and high strength (DLIR-H). The iodine concentrations (IC) and their standard deviations of nine anatomical sites were measured, and the corresponding coefficient of variations (CV) were calculated. Noise-power-spectrum (NPS) and edge-rise-slope (ERS) were measured. Five radiologists rated image quality in terms of image noise, contrast, sharpness, texture, and small structure visibility, and evaluated overall diagnostic acceptability of images and lesion conspicuity.
RESULTS
The four reconstructions maintained the IC values unchanged in nine anatomical sites (all p > 0.999). Compared to 1.25-mm AV-50, 1.25-mm DLIR-M and DLIR-H significantly reduced CV values (all p < 0.001) and presented lower noise and noise peak (both p < 0.001). Compared to 5-mm AV-50, 1.25-mm images had higher ERS (all p < 0.001). The difference of the peak and average spatial frequency among the four reconstructions was relatively small but statistically significant (both p < 0.001). The 1.25-mm DLIR-M images were rated higher than the 5-mm and 1.25-mm AV-50 images for diagnostic acceptability and lesion conspicuity (all P < 0.001).
CONCLUSIONS
DLIR may facilitate the thinner slice thickness iodine maps in abdominal DECT for improvement of image quality, diagnostic acceptability, and lesion conspicuity.
Topics: Humans; Deep Learning; Prospective Studies; Female; Male; Middle Aged; Contrast Media; Aged; Tomography, X-Ray Computed; Radiographic Image Interpretation, Computer-Assisted; Radiography, Abdominal; Radiography, Dual-Energy Scanned Projection; Adult; Iodine; Aged, 80 and over
PubMed: 38926711
DOI: 10.1186/s12880-024-01334-0 -
Tomography (Ann Arbor, Mich.) Jun 2024Cystic echinococcosis is a zoonotic parasitic disease that affects the liver in more than 70% of cases, and there is still an underestimated incidence in endemic areas.... (Review)
Review
Cystic echinococcosis is a zoonotic parasitic disease that affects the liver in more than 70% of cases, and there is still an underestimated incidence in endemic areas. With a peculiar clinical presentation that ranges from paucisymptomatic illness to severe and possibly fatal complications, quality imaging and serological studies are required for diagnosis. The mainstay of treatment to date is surgery combined with antiparasitic agents. The surgical armamentarium consists of open and laparoscopic procedures for selected cases with growing confidence in parenchyma-sparing interventions. Endoscopic retrograde cholangiopancreatography (ERCP) is extremely useful for the diagnosis and treatment of biliary fistulas. Recent relevant studies in the literature are reviewed, and two complex cases are presented. The first patient underwent open surgery to treat 11 liver cysts, and during the follow-up, a right pulmonary cyst was diagnosed that was treated by minimally invasive surgery. The second case is represented by the peritoneal rupture of a giant liver cyst in a young woman who underwent laparoscopic surgery. Both patients developed biliary fistulas that were managed by ERCP. Both patients exhibited a non-specific clinical presentation and underwent several surgical procedures combined with antiparasitic agents, highlighting the necessity of customized treatment in order to decrease complications and successfully cure the disease.
Topics: Female; Humans; Biliary Fistula; Cholangiopancreatography, Endoscopic Retrograde; Echinococcosis, Hepatic; Laparoscopy; Liver; Tomography, X-Ray Computed
PubMed: 38921947
DOI: 10.3390/tomography10060070 -
Techniques in Coloproctology Jun 2024Patient selection is extremely important in obstructed defecation syndrome (ODS) and rectal prolapse (RP) surgery. This study assessed factors that guided the... (Observational Study)
Observational Study
Analysis of factors that indicated surgery in 400 patients submitted to a complete diagnostic workup for obstructed defecation syndrome and rectal prolapse using a supervised machine learning algorithm.
BACKGROUND
Patient selection is extremely important in obstructed defecation syndrome (ODS) and rectal prolapse (RP) surgery. This study assessed factors that guided the indications for ODS and RP surgery and their specific role in our decision-making process using a machine learning approach.
METHODS
This is a retrospective analysis of a long-term prospective observational study on female patients reporting symptoms of ODS who underwent a complete diagnostic workup from January 2010 to December 2021 at an academic tertiary referral center. Clinical, defecographic, and other functional tests data were assessed. A supervised machine learning algorithm using a classification tree model was performed and tested.
RESULTS
A total of 400 patients were included. The factors associated with a significantly higher probability of undergoing surgery were follows: as symptoms, perineal splinting, anal or vaginal self-digitations, sensation of external RP, episodes of fecal incontinence and soiling; as physical examination features, evidence of internal and external RP, rectocele, enterocele, or anterior/middle pelvic organs prolapse; as defecographic findings, intra-anal and external RP, rectocele, incomplete rectocele emptying, enterocele, cystocele, and colpo-hysterocele. Surgery was less indicated in patients with dyssynergia, severe anxiety and depression. All these factors were included in a supervised machine learning algorithm. The model showed high accuracy on the test dataset (79%, p < 0.001).
CONCLUSIONS
Symptoms assessment and physical examination proved to be fundamental, but other functional tests should also be considered. By adopting a machine learning model in further ODS and RP centers, indications for surgery could be more easily and reliably identified and shared.
Topics: Humans; Female; Middle Aged; Rectal Prolapse; Retrospective Studies; Constipation; Aged; Supervised Machine Learning; Syndrome; Defecation; Adult; Prospective Studies; Defecography; Patient Selection; Algorithms; Clinical Decision-Making
PubMed: 38918256
DOI: 10.1007/s10151-024-02951-1 -
Medicina 2024
Topics: Humans; Pancreatic Diseases; Male; Cholangiopancreatography, Endoscopic Retrograde
PubMed: 38907986
DOI: No ID Found -
Medicine Jun 2024The split filter CT can filter X-ray beam. Theoretically, the split filter CT not only provides a good low-energy beam, but also provides a more robust CT value. The aim... (Observational Study)
Observational Study
The split filter CT can filter X-ray beam. Theoretically, the split filter CT not only provides a good low-energy beam, but also provides a more robust CT value. The aim of this study was to compare conventional single-energy computed tomography (SECT) and twin-beam dual-energy (TBDE) CT regarding the quantitative consistency and stabilities of HU measurements at different abdominal organs. Forty-four patients were prospectively enrolled to randomly receive SECT and TBDE protocols at either body part of a thorax-abdominal examination. Their overlapping scan coverage was subjected to further image analysis. For TBDE scans, composed images(c-images) and virtual monoenergetic images (VMIs) at 60, 70, 80, and 90 kiloelectron volt (keV) were reconstructed. The attenuations were measured at 5 abdominal organs and compared between SECT and TBDE to characterize quantitative consistency by intraclass correlation coefficients (ICCs), whereas their standard deviations were used to assess the Hounsfield Unit (HU) stability. The c-images, 70 keV and 80 keV VMIs from TBDE provided consistent HU values (all ICCs > 0.8) with the SECT measurements; moreover, these TBDE images had superior HU stability over SECT images in all abdominal measurements except for fat tissue. The best HU stability can be achieved in 80 keV VMIs with the lowest noise level. The c-images and VMIs derived from TBDE can produce consistent values as SECT. The 80 keV images displayed better HU stability and a lower noise level across various abdominal organs.
Topics: Humans; Female; Male; Tomography, X-Ray Computed; Middle Aged; Prospective Studies; Aged; Adult; Radiography, Dual-Energy Scanned Projection; Radiography, Abdominal
PubMed: 38905426
DOI: 10.1097/MD.0000000000038276 -
BMC Medical Imaging Jun 2024Abdominal CT scans are vital for diagnosing abdominal diseases but have limitations in tissue analysis and soft tissue detection. Dual-energy CT (DECT) can improve these...
BACKGROUND
Abdominal CT scans are vital for diagnosing abdominal diseases but have limitations in tissue analysis and soft tissue detection. Dual-energy CT (DECT) can improve these issues by offering low keV virtual monoenergetic images (VMI), enhancing lesion detection and tissue characterization. However, its cost limits widespread use.
PURPOSE
To develop a model that converts conventional images (CI) into generative virtual monoenergetic images at 40 keV (Gen-VMI) of the upper abdomen CT scan.
METHODS
Totally 444 patients who underwent upper abdominal spectral contrast-enhanced CT were enrolled and assigned to the training and validation datasets (7:3). Then, 40-keV portal-vein virtual monoenergetic (VMI) and CI, generated from spectral CT scans, served as target and source images. These images were employed to build and train a CI-VMI model. Indexes such as Mean Absolute Error (MAE), Peak Signal-to-Noise Ratio (PSNR), and Structural Similarity (SSIM) were utilized to determine the best generator mode. An additional 198 cases were divided into three test groups, including Group 1 (58 cases with visible abnormalities), Group 2 (40 cases with hepatocellular carcinoma [HCC]) and Group 3 (100 cases from a publicly available HCC dataset). Both subjective and objective evaluations were performed. Comparisons, correlation analyses and Bland-Altman plot analyses were performed.
RESULTS
The 192nd iteration produced the best generator mode (lower MAE and highest PSNR and SSIM). In the Test groups (1 and 2), both VMI and Gen-VMI significantly improved CT values, as well as SNR and CNR, for all organs compared to CI. Significant positive correlations for objective indexes were found between Gen-VMI and VMI in various organs and lesions. Bland-Altman analysis showed that the differences between both imaging types mostly fell within the 95% confidence interval. Pearson's and Spearman's correlation coefficients for objective scores between Gen-VMI and VMI in Groups 1 and 2 ranged from 0.645 to 0.980. In Group 3, Gen-VMI yielded significantly higher CT values for HCC (220.5HU vs. 109.1HU) and liver (220.0HU vs. 112.8HU) compared to CI (p < 0.01). The CNR for HCC/liver was also significantly higher in Gen-VMI (2.0 vs. 1.2) than in CI (p < 0.01). Additionally, Gen-VMI was subjectively evaluated to have a higher image quality compared to CI.
CONCLUSION
CI-VMI model can generate Gen-VMI from conventional CT scan, closely resembling VMI.
Topics: Humans; Tomography, X-Ray Computed; Female; Male; Middle Aged; Radiography, Abdominal; Aged; Adult; Radiographic Image Interpretation, Computer-Assisted; Liver Neoplasms; Signal-To-Noise Ratio; Radiography, Dual-Energy Scanned Projection; Carcinoma, Hepatocellular; Aged, 80 and over; Contrast Media
PubMed: 38890572
DOI: 10.1186/s12880-024-01331-3