Real-time automatic extraction of lumen region and boundary from endoscopic images

A new approach to the automatic extraction of the lumen region and its boundary for gastrointestinal (GI) endoscopic images is presented. First, a quasi region of interest, the darker regions of the image, is segmented using a region splitting scheme termed progressive thresholding. The centre of mass of this segmented region acts as a seed for further processing. Then the lumen region is obtained using a region growing technique called the integrated neighbourhood search (INS). A new quad structure based technique is introduced to enhance the INS speed significantly. A back projection algorithm is suggested to optimise the search for pixels belonging to the lumen region and boundary. A boundary-thinning algorithm is also proposed to remove the redundant pixels from the lumen boundary and to generate a connected single pixel width boundary. The proposed approach does not need a priori knowledge about the image characteristics. The experimental results indicate that the proposed technique enhances the speed of conventional INS by 45.5% to 28.6% based on the lumen size varying from 22,709 pixels to 4947 pixels. The main advantage of the proposed technique is its high-speed response that facilitates real-time analysis of endoscopic images.     

Plasticity of the central nervous system—a neurosurgeon's experience of cerebral compensation and decompensation

Summary Cerebral plasticity constitutes one of the most decisive factors in recovery and readaptation after cerebral lesions. In contrast to the considerable progress in current studies on normal neuronal plasticity including the idea of l'homme neuronal, the concept of plasticity postulated by Albrecht Bethe in 1929 received little attention. The author, as a neurosurgeon, has tried to describe cranial morphological plasticity, morphological and functional plasticity in infantile encephalopathies and especially in hemiatrophic lesions. It is supposed that a true morphological substrate exists due to compensatory hyperplasia of the uninvolved hemisphere.Modern neurosurgical techniques have demonstrated that the functional plastic capacity is much larger than has been supposed, even in the elderly. Some aspects of the mechanisms of compensation and decompensation of cortical and subcortical structures as well as of the central regulation systems are discussed. The full extent of the amazing recovery and functional reorganization is reached by plastic capacity, personal motivation, adequate training and sufficient time.The contribution ends with an exposition of a personal philosophy concerning psycho-somatic dualism, the body-mind problem, the future of the human brain and the ethical outlook, based on the progressive biological evolution of the basal neocortex and the immanent functional development (H. Spatz).In grateful memory of my paternal friends, the great German brain researchers Julius Hallervorden (1882–1965) and Hugo Spatz (1888–1969).     

Dysphagia lusoria: proposal of a new treatment

Summary Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.     

超声内镜与胃镜检查对上消化道黏膜下肿瘤的诊断效果分析

目的探讨超声内镜与胃镜对上消化道黏膜下肿瘤的诊断效果。方法选择2015年3月至2018年2月确诊的60例上消化道黏膜下肿瘤患者,均行胃镜检查和超声内镜检查,分析其与病理检查的符合率以及超声内镜检查的回声特点,并记录超声内镜检查的敏感性和特异性。结果以病理检查结果为标准,超声内镜检查的符合率为90.00%,明显高于胃镜检查的73.33%(P <0.05)。超声内镜检查对黏膜肌层肿瘤诊断的敏感性为90.32%,特异性为93.55%;对黏膜下层肿瘤诊断的敏感性为93.33%,特异性为93.75%;对固有肌层肿瘤诊断的敏感性为85.71%,特异性为97.87%。结论与胃镜检查相比,超声内镜在上消化道黏膜下肿瘤中的诊断价值更高,能够对病变的性质、部位及来源作出准确的诊断。     

经皮内镜下胃造瘘术的临床应用

目的 :进一步总结经皮内镜下胃造瘘术 (PEG)的临床应用 ,强调PEG是内镜治疗学中可以完全替代传统剖腹胃造瘘术的成功典型。方法 :采用非剖腹经皮内镜下胃造瘘术 38例操作过程及注意事项进行了分析总结。结果 :PEG成功率高 ,38例中 37例成功 ,并发症少 ,放置时间较长。结论 :PEG安全、便捷、有效、经济 ,为患者提供了一个不需剖腹手术旋转胃造瘘管的新方法 ,颇具推广价值     

内镜粘膜切除术在结直肠肿瘤诊治中的临床应用价值

目的：探讨内镜粘膜切除术（Endoscopic Mucosal Resection:EMR)在结直肠肿瘤诊治中的临床应用价值。方法：对1996年6月－1998年2月间电子肠镜检出的34例38个病变行EMR,并比较EMR标本与普通活检标本对早期癌的检出率。结果：对34例38个病变施行EMR成功37次,失败1次,成功率97．4％（37／38）。成功的37次中包括分割切除（Endoscopic Picemeal Mucosal Resecton;EPMR)9次。EPMR术中并发少量出血2例（5．4％）。病理检查发现多发息肉癌变率（100％）高于单发息肉（29．41％）,P＝0．001,肿瘤最大径＜1．5cm腺瘤癌变率为36．37％（8／22）、≥1．5cm为73．33％（11／15）,P＝0．045;EMR标本与普通活检标本对早期癌的检出率分别是52％和26％（P＜0．001）,而且普通活检的漏检率达50％（8／16病变）。结论：内镜下大肠粘膜切除术能够对常规圈套法不能摘除的肿瘤样病灶切取活检,以达到病理学诊断定性质、定范围、定深度的理想要求,且对早期大肠癌的检出率优于普通活检。     

Abordajes en cirugía tiroidea

Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIX^th century, has become the “gold standard”. It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat.Endoscopic and robotic surgery have developed “new approaches” to thyroid in order to improve the cosmetic results, looking even for invisible scars.We have done a thoughtful review of most of them trying to understand their benefits and drawbacks.Currently none of these “new approaches” have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.     

Endoscopic Anterior Transposition of Ulnar Nerve (EATUN) for Treatment of Tardy Ulnar Nerve Palsy

BackgroundTardy ulnar nerve palsy is the development of late onset ulnar nerve dysfunction and is usually treated by open anterior transposition of ulnar nerve. Open technique is done using a longitudinal incision about 6–8 inch. in length with chances of development of medial antebrachial cutaneous nerve neuromas.PurposeIn this study, we describe the technique of Endoscopic Anterior Transposition of Ulnar Nerve (EATUN procedure) to treat tardy ulnar nerve palsy and analyze the results.MethodsSeven patients diagnosed to have tardy ulnar nerve palsy was treated by EATUN. The humerus-elbow-wrist angle (HEW), pre- and post-operative intrinsic muscle power and sensory assessment, Dellon scores, and the Q-DASH was analyzed.ResultsThe minimum follow-up was 12 months (Mean 27.4 months, Range 12–36 months). Improvement in Dellon and Q-DASH scores following EATUN procedure was statistically significant. There was objective improvement of intrinsic muscle power and sensation on follow-up, though not statistically significant. No instance of neuroma of the medial cutaneous nerve of forearm was noted.ConclusionsThe endoscopic anterior transposition of the ulnar nerve is a good option in surgical management of tardy ulnar nerve palsy.Level of evidenceTherapeutic Level IV.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43465-021-00366-w.     

单侧双通道内镜下减压治疗腰椎管狭窄症的早期疗效观察

【摘要】 目的：观察单侧双通道内镜下进行单侧椎板切除双侧减压治疗腰椎管狭窄症的早期临床疗效。方法：回顾性分析我院2020年4月1日~2021年1月31日应用单侧双通道内镜技术进行单侧椎板切除双侧减压治疗单节段腰椎管狭窄症且随访3个月以上患者的临床及影像学资料。共纳入64例单节段腰椎管狭窄症患者,其中中央椎管狭窄患者28例,男15例,女13例,年龄57~77岁（67.79±6.29岁）,体质指数（BMI）为22.31±2.89kg/m2;随访3~9个月（3.86±1.80个月）;双侧侧隐窝狭窄36例,男17例,女19例,年龄50~79岁（62.75±8.02岁）,BMI 23.14±2.73kg/m2,随访3~9个月（4.83±2.30个月）。中央椎管狭窄组患者术前病变节段Schizas分级B级14例,C级13例,D级1例;侧隐窝狭窄组患者术前A级8例,B级17例,C级11例。统计所有患者术前与术后次日、1个月、3个月及末次随访时的腰腿痛视觉模拟评分（visual analogue scales,VAS）和Oswestry功能障碍指数（Oswestry disability index,ODI）,手术前后的硬脊膜囊截面积、血常规血红蛋白量,手术时间、术后下地时间和出院时间。通过配对样本t检验对比分析手术减压前后临床评分结果。结果：两组患者术后次日、1个月、3个月及末次随访时的腰痛和腿痛VAS评分均明显小于术前（P<0.05）;两组患者术后1个月、3个月及末次随访ODI均明显小于术前（P<0.05）。中央椎管狭窄组和侧隐窝狭窄组患者术后血红蛋白分别下降21.54±7.24g/L和21.00±7.67g/L,手术时间分别为120.75±9.79min和106.40±12.99min,术后下地时间分别为1.61±0.63d和1.47±0.61d,术后住院时间分别为4.39±1.77d和3.69±1.70d,硬脊膜囊截面积改善率分别为（108.21±38.28）%和（62.20±53.10）%。中央椎管狭窄组术后病变节段Schizas分级均恢复至A级;侧隐窝狭窄组1例患者由术前C级恢复至B级,其余35例均恢复至A级。两组患者术中均未更改手术方式,术后均未出现严重并发症,均未行二次手术。结论：单侧双通道内镜下单侧椎板切除双侧减压技术对腰椎管狭窄症患者的腰椎中央椎管狭窄和双侧侧隐窝狭窄能够实现充分的减压,早期随访临床效果确切,且安全性亦较高。     

经内镜逆行胰胆管造影术后十二指肠穿孔的治疗进展

随着微创外科的发展,经内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)因创伤小、恢复快、花费少等优势已经成为诊断和治疗胆胰疾病的重要手段之一。但作为一项侵入性操作,在诊断与治疗的同时会发生一系列相关并发症。其中,十二指肠穿孔是ERCP术后少见却严重的并发症,如果不能尽早处理将会产生严重的后果,甚至危及病人生命。其治疗方式包括保守治疗、内镜治疗和手术治疗,但目前临床上尚缺乏高质量的证据指导治疗方案的选择。作者通过阅读相关文献并结合国内外的治疗进展,对ERCP术后十二指肠穿孔的治疗进行了综述,以期为临床提供参考。