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International Journal of Surgery Case... Jun 2024A right side diaphragmatic injury was linked to serious trauma to the abdomen, pelvis, and chest. The most significant type of injury was blunt abdominal trauma...
INTRODUCTION
A right side diaphragmatic injury was linked to serious trauma to the abdomen, pelvis, and chest. The most significant type of injury was blunt abdominal trauma sustained in a car collision. The left side was more likely than the right to experience herniation. The stomach and colon were the most often herniated abdominal viscera. In the same location as the diaphragm rupture, there were rib fractures, hemothorax, and liver damage. Delayed diaphragmatic rupture with diaphragmatic hernia is rare and has a mysterious nature.
CASE PRESENTATION
A 68 years old female patient who has repeated history of shortness of breath, for which she treated as lung infection presented with sudden exacerbation of shortness of breath, she witnessed history of blunt trauma 20 years back and up on investigation bowel herniation to the chest cavity diagnosed. Posteriolateral thoracotomy done, the herniated bowel reduced and the diaphragmatic defect repaired. The patient significantly improved and discharged from the hospital smoothly on 4th postoperative day.
DISCUSSION
Careful recording of past history and physical examination are the best approaches in diagnosing delayed presentation of traumatic diaphragmatic rupture. CT scan with reconstruction of the diaphragm is helpful in both diagnosis and differential diagnosis. Surgical therapy after diagnosis is the best treatment.
CONCLUSION
Delayed right side diaphragmatic hernia is a rare entity resulting in grave consequences, In a patient with history of trauma there should be a high index of suspension and patients should undergo imaging and surgical management is the best treatment.
PubMed: 38943935
DOI: 10.1016/j.ijscr.2024.109973 -
Nigerian Journal of Clinical Practice Jun 2024Sex determination from the bones is of great importance for forensic medicine and anthropology. The mandible is highly valued because it is the strongest, largest and...
BACKGROUND
Sex determination from the bones is of great importance for forensic medicine and anthropology. The mandible is highly valued because it is the strongest, largest and most dimorphic bone in the skull.
AIM
Our aim in this study is gender estimation with morphometric measurements taken from mandibular lingula, an important structure on the mandible, by using machine learning algorithms and artificial neural networks.
METHODS
Cone beam computed tomography images of the mandibular lingula were obtained by retrospective scanning from the Picture Archiving Communication Systems of the Department of Oral, Dental and Maxillofacial Radiology, Faculty of Dentistry, İnönü University. Images scanned in Digital Imaging and Communications in Medicine (DICOM) format were transferred to RadiAnt DICOM Viewer (Version: 2020.2). The images were converted to 3-D format by using the 3D Volume Rendering console of the program. Eight anthropometric parameters were measured bilaterally from these 3-D images based on the mandibular lingula.
RESULTS
The results of the machine learning algorithms analyzed showed that the highest accuracy was 0.88 with Random Forest and Gaussian Naive Bayes algorithm. Accuracy rates of other parameters ranged between 0.78 and 0.88.
CONCLUSIONS
As a result of the study, it is thought that mandibular lingula-centered morphometric measurements can be used for gender determination as well as bones such as the pelvis and skull as they were found to be highly accurate. This study also provides information on the anatomical position of the lingula according to gender in Turkish society. The results can be important for oral-dental surgeons, anthropologists, and forensic experts.
Topics: Humans; Neural Networks, Computer; Male; Female; Mandible; Machine Learning; Retrospective Studies; Adult; Cone-Beam Computed Tomography; Sex Determination by Skeleton; Imaging, Three-Dimensional; Algorithms; Young Adult; Adolescent; Middle Aged
PubMed: 38943297
DOI: 10.4103/njcp.njcp_787_23 -
Journal of Neuroengineering and... Jun 2024Maintaining static balance is relevant and common in everyday life and it depends on a correct intersegmental coordination. A change or reduction in postural capacity...
BACKGROUND
Maintaining static balance is relevant and common in everyday life and it depends on a correct intersegmental coordination. A change or reduction in postural capacity has been linked to increased risk of falls. People with Parkinson's disease (pwPD) experience motor symptoms affecting the maintenance of a stable posture. The aim of the study is to understand the intersegmental changes in postural sway and to apply a trend change analysis to uncover different movement strategies between pwPD and healthy adults.
METHODS
In total, 61 healthy participants, 40 young (YO), 21 old participants (OP), and 29 pwPD (13 during medication off, PDoff; 23 during medication on, PDon) were included. Participants stood quietly for 10 s as part of the Short Physical Performance Battery. Inertial measurement units (IMU) at the head, sternum, and lumbar region were used to extract postural parameters and a trend change analysis (TCA) was performed to compare between groups.
OBJECTIVE
This study aims to explore the potential application of TCA for the assessment of postural stability using IMUs, and secondly, to employ this analysis within the context of neurological diseases, specifically Parkinson's disease.
RESULTS
Comparison of sensors locations revealed significant differences between head, sternum and pelvis for almost all parameters and cohorts. When comparing PDon and PDoff, the TCA revealed differences that were not seen by any other parameter.
CONCLUSIONS
While all parameters could differentiate between sensor locations, no group differences could be uncovered except for the TCA that allowed to distinguish between the PD on/off. The potential of the TCA to assess disease progression, response to treatment or even the prodromal PD phase should be explored in future studies.
TRIAL REGISTRATION
The research procedure was approved by the ethical committee of the Medical Faculty of Kiel University (D438/18). The study is registered in the German Clinical Trials Register (DRKS00022998).
Topics: Humans; Parkinson Disease; Postural Balance; Male; Female; Aged; Middle Aged; Adult; Antiparkinson Agents; Young Adult
PubMed: 38943208
DOI: 10.1186/s12984-024-01411-z -
Injury Jun 2024Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not...
Epidemiology and patient-reported measurement outcome of pelvic fractures in children and adolescents - A population-based cohort study from the Swedish fracture register.
BACKGROUND AND PURPOSE
Pediatric pelvic fractures are uncommon, representing 0.2-3% of total pediatric fractures. The long-term patient-reported outcome in the pediatric population has not been evaluated yet. The purpose of the study was to describe the epidemiology of pelvic and acetabular fractures in pediatric patients including long-term patient-reported outcomes.
PATIENTS AND METHODS
The Swedish Fracture Register (SFR) was used to identify all patients aged 6-17 years at injury with a pelvic fracture between 2015 and 2021. All patients were invited to answer Patient-Reported measurement instruments in 2021.
RESULTS
The study cohort consisted of 223 patients with a median age at fracture of 15 years and with 62 % boys. 201 sustained a pelvic and 22 acetabular fractures. Falls were the leading cause of fracture, followed by transport accidents. Most fractures (both pelvis and acetabulum) were type A (73 %), and 21 fractures (9 %) could not be classified according to AO. 85 % of fractures were treated non-surgically. All Type C fractures were treated surgically. Seven PROMIS® profile domains were completed by 31 % of the sample at a mean follow-up time of 3.5 years after pelvic/acetabular fracture. Most patients had "no concern" or "mild concern" but those who had surgery had an inferior t-score in most domains.
CONCLUSION
Most fractures occurred in older individuals, with falls during sports activities being the most common cause. This raises important questions about prevention strategies. The PROMIS-Pain-Interference scale indicated that the younger the age at fracture, the more pain was reported at follow-up.
PubMed: 38941910
DOI: 10.1016/j.injury.2024.111700 -
PloS One 2024Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and...
OBJECTIVE
Obesity is a high-morbidity chronic condition and risk factor for multiple diseases that necessitate imaging. This study assesses the relationship between BMI and same-year utilization of CT and MR imaging in a large healthcare population.
METHODS
In this retrospective population-based study, all patients aged ≥18 years with a documented BMI in the multi-institutional Cosmos database were included. Cohorts were identified based on ≥1 documented BMI in 2021 within pre-defined ranges. For each cohort, we assessed the percentage of patients undergoing head, neck, chest, spine, or abdomen/pelvis CT and MR during the same year. Disease severity was quantified based on emergency department (ED) visits and mortality.
RESULTS
In our population of 49.6 million patients, same-year CT and MR utilization was 14.5 ±0.01% and 6.0±0.01%, respectively. The underweight cohort had the highest CT (25.8±0.1%) and MR (8.01 ± 0.05) imaging utilization. At high extremes of BMI (>50 kg/m2), CT utilization mildly increased (18.4±0.1%), but MR utilization decreased (5.3±0.04%). While morbidity differences may explain some BMI-utilization relationships, lower MR utilization in the BMI>50 cohort contrasts with higher age-adjusted mortality (1.8±0.03%) and ED utilization (32.4±0.1%) in this cohort relative to normal weight (1.5±0.01% and 25.7±0.02%, respectively).
CONCLUSION
Underweight patients had disproportionately high CT/MR utilization, and high extremes of BMI are associated with mildly higher CT and lower MR utilization than the normal weight cohort. The elevated mortality and ED utilization in severely obese patients contrasts with their lower MR imaging utilization. Our findings may assist public health efforts to accommodate obesity trends.
Topics: Humans; Body Mass Index; Magnetic Resonance Imaging; Male; Female; Tomography, X-Ray Computed; Middle Aged; Retrospective Studies; Adult; Obesity; Aged; Emergency Service, Hospital; Morbidity
PubMed: 38941332
DOI: 10.1371/journal.pone.0306087 -
Journal of Medical Radiation Sciences Jun 2024Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with...
INTRODUCTION
Image quality reduction due to metallic artefacts is a significant challenge during vascular computed tomography (CT) imaging of the lower extremities in patients with hip prostheses. This study aims to analyse various reconstruction algorithms' ability to reduce metal artefacts due to two types of hip prostheses during lower extremity CT angiography examinations.
METHODS
A pelvis phantom was fabricated with the insertion of a tube filled with contrast media to simulate the femoral artery, and the phantom was then CT scanned with and without hip prostheses. Multimodal images were acquired using different kilovoltage peak (kVp) settings and reconstructed with different algorithms, such as filtered back projection (FBP), iterative reconstruction (iDose), iterative model-based reconstruction (IMR) and orthopaedic metal artefact reduction (O-MAR). Image quality was assessed based on image noise, signal-to-noise ratio (SNR) and Hounsfield unit (HU) deviation.
RESULTS
The IMR approach significantly improved image quality compared to iDose and FBP. For the vascular region, O-MAR improves SNR by 5 ± 1, 23 ± 5 and 42 ± 9 for FBP, iDose and IMR respectively, and improves HU precision towards the baseline values by 49% and 83% for FBP and IMR, respectively. The noise reduction was 71% and 89% for FBP and IMR, and 57% for iDose. O-MAR greatly enhances SNR corrections among the most severe artefacts, with 29 ± 1 and 43 ± 4 for FBP and IMR, compared to iDose by 37 ± 7.
CONCLUSION
IMR combined with O-MAR could improve the CT angiography of the lower extremities of patients with a hip prosthesis.
PubMed: 38941235
DOI: 10.1002/jmrs.797 -
Medeniyet Medical Journal Jun 2024The gluteus maximus (GM) is a big quadrilateral musculature that lines the rear portion of the pelvis. It is innervated by the inferior gluteal nerve. The sciatic nerve,...
The gluteus maximus (GM) is a big quadrilateral musculature that lines the rear portion of the pelvis. It is innervated by the inferior gluteal nerve. The sciatic nerve, inferior gluteal nerve, and posterior cutaneous nerve of the thigh are branches of the sacral plexus. The superior and inferior gluteal arteries are the chief arterial supply to the gluteal region. In the present case, there was a dual innervation of the GM. The superior gluteal artery and the superior gluteal nerve was piercing the piriformis and the inferior gluteal artery was running between the posterior cutaneous nerve of the thigh and the inferior gluteal nerve. According to our literature review, anatomical studies in which this cadaveric procedure has been performed have not been previously reported. The anatomical variations of the gluteal region are important to surgeons, physicians, anatomists, and nurses.
PubMed: 38940504
DOI: 10.4274/MMJ.galenos.2024.83652 -
Annals of Laparoscopic and Endoscopic... Jan 2024Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery...
BACKGROUND AND OBJECTIVE
Flaps and grafts are used for filling dead space, ureteral substitution, and as mesh alternatives. The surgical robot is invaluable in urologic reconstructive surgery due to the ability of the robot to reach the deep pelvis, its minimally invasive access, the ability to use indocyanine green to identify structures and assess tissue perfusion and viability, and ergonomics for the surgeon. Robotic reconstruction can involve tissue transfer in the form of flaps and grafts to provide form and function to organs that have been damaged by iatrogenic injuries, trauma, infections, cancer, radiation injury, or congenital abnormalities. Common flaps and grafts can be readily adapted to the robotic approach. In this literature review, we examine the robotic use of flaps and grafts in reconstructive urology.
METHODS
A thorough literature review was conducted via a PubMed search for predefined terms.
KEY CONTENT AND FINDINGS
Flaps and grafts in reconstructive urology are used for interposition, ureteral substitution, and as mesh alternatives. Omental flaps are used for tissue interposition, or to provide structure and nutrients, and are easily employed with the robot. Various robotic applications of peritoneal flaps have been described. Vascular rectus abdominis musculocutaneous flaps are well-vascularized flaps that occupy dead space and provide structural support, which can be harvested readily with the robot. Sigmoid epiploica are an excellent flap for pelvic reconstruction. Gracilis flaps and fascia lata grafts are well-tolerated and provide space occupying tissue. Boari flaps aid in robotic ureteral reconstruction, especially in the setting of long defects. Oral mucosa is excellent for ureteral or bladder neck reconstruction. Rectal mucosa is well-tolerated and easy to harvest robotically for a variety of urinary tract reconstructive applications. The appendix or ileum can be interposed for repair of damaged ureters.
CONCLUSIONS
Various flaps and grafts have been adapted for robotic reconstructive urology. As the field develops, refinement of techniques and innovation in flaps and employment of the robot will propel this field forward. More studies, especially comparative studies, are needed to elucidate the flaps and grafts that are most likely to be successful with the least morbidity for each use case.
PubMed: 38938988
DOI: 10.21037/ales-23-36 -
Respirology Case Reports Jul 2024Pelvic tumours are a rare cause of pleural effusion. We describe an approach to a case of Meigs syndrome with recurrent unilateral pleural effusion. A woman in her 60s'...
Pelvic tumours are a rare cause of pleural effusion. We describe an approach to a case of Meigs syndrome with recurrent unilateral pleural effusion. A woman in her 60s' presented with recurrent right-sided pleural effusion, leading to cough and shortness of breath. Thoracentesis yielded exudative pleural fluid with cytology negative for malignancy. Pleuroscopy revealed inflamed pleura, and pleural biopsy was consistent with inflammatory changes. The patient's cancer antigen 125 level was elevated at 256 U/mL. Given the high suspicion of malignancy, a computed tomography scan of the chest, abdomen, and pelvis was performed and revealed ascites and a large left ovarian and uterine mass. The patient underwent a total abdominal hysterectomy and bilateral salphingo oophorectomy after experiencing three additional episodes of pleural effusion. Histological examination revealed the left ovarian mass to be a cellular fibroma and the uterine masses to be leiomyomata. Following the operation, there was no recurrence of pleural effusion.
PubMed: 38938762
DOI: 10.1002/rcr2.1421 -
PeerJ 2024Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require... (Randomized Controlled Trial)
Randomized Controlled Trial
Squatting biomechanics following physiotherapist-led care or hip arthroscopy for femoroacetabular impingement syndrome: a secondary analysis from a randomised controlled trial.
BACKGROUND
Femoroacetabular impingement syndrome (FAIS) can cause hip pain and chondrolabral damage that may be managed non-operatively or surgically. Squatting motions require large degrees of hip flexion and underpin many daily and sporting tasks but may cause hip impingement and provoke pain. Differential effects of physiotherapist-led care and arthroscopy on biomechanics during squatting have not been examined previously. This study explored differences in 12-month changes in kinematics and moments during squatting between patients with FAIS treated with a physiotherapist-led intervention (Personalised Hip Therapy, PHT) and arthroscopy.
METHODS
A subsample ( = 36) of participants with FAIS enrolled in a multi-centre, pragmatic, two-arm superiority randomised controlled trial underwent three-dimensional motion analysis during squatting at baseline and 12-months following random allocation to PHT ( = 17) or arthroscopy ( = 19). Changes in time-series and peak trunk, pelvis, and hip biomechanics, and squat velocity and maximum depth were explored between treatment groups.
RESULTS
No significant differences in 12-month changes were detected between PHT and arthroscopy groups. Compared to baseline, the arthroscopy group squatted slower at follow-up (descent: mean difference -0.04 m∙s (95%CI [-0.09 to 0.01]); ascent: -0.05 m∙s [-0.11 to 0.01]%). No differences in squat depth were detected between or within groups. After adjusting for speed, trunk flexion was greater in both treatment groups at follow-up compared to baseline (descent: PHT 7.50° [-14.02 to -0.98]%; ascent: PHT 7.29° [-14.69 to 0.12]%, arthroscopy 16.32° [-32.95 to 0.30]%). Compared to baseline, both treatment groups exhibited reduced anterior pelvic tilt (descent: PHT 8.30° [0.21-16.39]%, arthroscopy -10.95° [-5.54 to 16.34]%; ascent: PHT -7.98° [-0.38 to 16.35]%, arthroscopy -10.82° [3.82-17.81]%), hip flexion (descent: PHT -11.86° [1.67-22.05]%, arthroscopy -16.78° [8.55-22.01]%; ascent: PHT -12.86° [1.30-24.42]%, arthroscopy -16.53° [6.72-26.35]%), and knee flexion (descent: PHT -6.62° [0.56- 12.67]%; ascent: PHT -8.24° [2.38-14.10]%, arthroscopy -8.00° [-0.02 to 16.03]%). Compared to baseline, the PHT group exhibited more plantarflexion during squat ascent at follow-up (-3.58° [-0.12 to 7.29]%). Compared to baseline, both groups exhibited lower external hip flexion moments at follow-up (descent: PHT -0.55 N∙m/BW∙HT[%] [0.05-1.05]%, arthroscopy -0.84 N∙m/BW∙HT[%] [0.06-1.61]%; ascent: PHT -0.464 N∙m/BW∙HT[%] [-0.002 to 0.93]%, arthroscopy -0.90 N∙m/BW∙HT[%] [0.13-1.67]%).
CONCLUSION
Exploratory data suggest at 12-months follow-up, neither PHT or hip arthroscopy are superior at eliciting changes in trunk, pelvis, or lower-limb biomechanics. Both treatments may induce changes in kinematics and moments, however the implications of these changes are unknown.
TRIAL REGISTRATION DETAILS
Australia New Zealand Clinical Trials Registry reference: ACTRN12615001177549. Trial registered 2/11/2015.
Topics: Humans; Femoracetabular Impingement; Arthroscopy; Male; Female; Biomechanical Phenomena; Adult; Range of Motion, Articular; Hip Joint; Middle Aged; Treatment Outcome; Physical Therapy Modalities
PubMed: 38938616
DOI: 10.7717/peerj.17567