Development of a support vector machine-based image analysis system for assessing the thyroid nodule malignancy risk on ultrasound

An SVM-based image analysis system was developed for assessing the malignancy risk of thyroid nodules. Ultrasound images of 120 cytology confirmed thyroid nodules (78 low-risk and 42 high-risk of malignancy) were manually segmented by a physician using a custom developed software in C++. From each nodule, 40 textural features were automatically calculated and were used with the SVM algorithm in the design of the image analysis system. Highest classification accuracy was 96.7%, misdiagnosing two high-risk and two low-risk thyroid nodules. The proposed system may be of value to physicians as a second opinion tool for avoiding unnecessary invasive procedures.     

Occult anterior-chamber metallic fragment post-phacoemulsification masquerading as chronic recalcitrant postoperative inflammation

PURPOSE: To report a case of an occult, metallic, anterior-chamber intraocular foreign body after uneventful phacoemulsification that was masquerading as chronic recalcitrant postoperative inflammation. DESIGN: Interventional case report. METHODS: A 73-year-old patient was referred to us for recalcitrant anterior-chamber inflammation after uneventful phacoemulsification; the patient presented with visual disturbances, anterior-chamber inflammation, and macular epiretinal membrane with concomitant cystoid macular edema. RESULTS: After meticulous evaluations and repeated clinical examinations, a metallic intraocular foreign body was discovered on the iris, which was surgically removed and analyzed. Chemical analysis revealed copper, aluminum, and zinc. Pars plana vitrectomy with epiretinal membrane and indocyanine-green-assisted internal limiting membrane peeling followed, with subsequent improvement of visual acuity. CONCLUSIONS: Intraocular foreign bodies should always be considered in the differential diagnosis of recalcitrant inflammation post-phacoemulsification. However, in the absence of intraocular inflammation, surgical removal of such particles is questionable.     

Conductive keratoplasty: histological study of human corneas

PURPOSE: To determine the morphologic changes in human corneas over time following radiofrequency-based conductive keratoplasty (CK) treatment. DESIGN: Prospective, observational case series. METHODS: In a single-center study six human corneas of six patients with localized peripheral keratoconus underwent CK treatment followed by penetrating keratoplasty. Three spots were applied in the periphery of each cornea (6 mm optical zone). Corneal buttons were examined with light and electron microscopy at different postoperative intervals up to 6 months post-CK. RESULTS: In samples assessed on day one post-CK, small areas of detachment between the basal layer of epithelial cells and Bowman's layer were observed. At 1 week after the CK procedure, the epithelium appeared almost normal. Endothelium and Descemet's membrane had no alterations. In all samples, thermally induced misconfiguration of collagen fibers, described as "crumpled" changes of collagen layers, was observed reaching 75% to 80% of the stromal depth. The area of alterations had a cylindrical shape with a diameter of 120 mum. CONCLUSIONS: The conductive keratoplasty procedure produced collagen "crumpling and splitting" changes in human corneas, which were observed during the follow-up of 6 months. Areas adjacent to treatment site were minimally damaged.     

Genetics of the Adrenal Gland

Reviews in Endocrine and Metabolic Disorders -     

Surgical repair of umbilical hernias in cirrhosis with ascites

The most common complications of umbilical hernias in patients with cirrhosis and ascites include leakage, ulceration, rupture and incarceration. If such a complication is present, there is a high mortality rate after surgical repair. Elective repair is the most effective choice, as it prevents complications with a lower mortality. However, the control of ascites before and/or after repair is mandatory but may not always be possible with diuretics and paracentesis. Portal decompression by transjugular intrahepatic portosystemic shunt (TIPS) with better control of ascites may allow these patients to undergo surgery. Patients with cirrhosis and umbilical hernias should be referred for consideration of an elective surgical repair with mesh, preferably after optimal management of ascites. There should be a low threshold for placement of a TIPS to facilitate surgery and reduce the chance of severe recurrence of ascites. If surgery is contraindicated, a TIPS must be considered for control of ascites.