Automated segmentation of the injured spleen

Purpose

To develop a novel automated method for segmentation of the injured spleen using morphological properties following abdominal trauma. Average attenuation of a normal spleen in computed tomography (CT) does not vary significantly between subjects. However, in the case of solid organ injury, the shape and attenuation of the spleen on CT may vary depending on the time and severity of the injury. Timely assessment of the severity and extent of the injury is of vital importance in the setting of trauma.

Methods

We developed an automated computer-aided method for segmenting the injured spleen from CT scans of patients who had splenectomy due to abdominal trauma. We used ten subjects to train our computer-aided diagnosis (CAD) method. To validate the CAD method, we used twenty subjects in our testing group. Probabilistic atlases of the spleens were created using manually segmented data from ten CT scans. The organ location was modeled based on the position of the spleen with respect to the left side of the spine followed by the extraction of shape features. We performed the spleen segmentation in three steps. First, we created a mask of the spleen, and then we used this mask to segment the spleen. The third and final step was the estimation of the spleen edges in the presence of an injury such as laceration or hematoma.

Results

The traumatized spleens were segmented with a high degree of agreement with the radiologist-drawn contours. The spleen quantification led to \(86\pm 5\,\%\) volume overlap, \(92.5\pm 3.11\,\%\) Dice similarity index, \(89.05\pm 5.29\,\%/96.42\pm 2.55\) precision/sensitivity, \(8\pm 5\,\%\) volume estimation error rate, \(1.09\pm 0.62/1.91\pm 1.45\,\hbox {mm}\) average surface distance/root-mean-squared error.

Conclusions

Our CAD method robustly segments the spleen in the presence of morphological changes such as laceration, contusion, pseudoaneurysm, active bleeding, periorgan and parenchymal hematoma, including subcapsular hematoma due to abdominal trauma. CAD of the splenic injury due to abdominal trauma can assist in rapid diagnosis and assessment and guide clinical management. Our segmentation method is a general framework that can be adapted to segment other injured solid abdominal organs.

     

Effects of lornoxicam on the physiology of severe sepsis

Introduction  

The purpose of the present study was to evaluate the effects of intravenous lornoxicam on haemodynamic and biochemical parameters, serum cytokine levels and patient outcomes in severe sepsis.     

The influence of <Emphasis Type="Italic">N</Emphasis>-acetyl-L-cystein infusion on cytokine levels and gastric intramucosal pH during severe sepsis

Introduction  

The purpose of the present study was to evaluate the effects of continuously infused N-acetyl-L-cystein (NAC) on serum cytokine levels and gastric intramucosal pH in humans suffering from severe sepsis.     

Incidence of congenital hemolytic anemias in young cholelithiasis patients

AIM: To clarify the incidence of congenital hemolytic anemias (CHA) in young cholelithiasis patients and to determine a possible screening test based on the results. METHODS: Young cholelithiasis patients (< 35 years) were invited to our outpatient clinic. Participants were asked for comorbidities and family history. The number of gallstones were recorded. Blood samples were obtained to perform a complete blood count, standard Wright-Giemsa staining, reticulocyte count, hemoglobin (Hb) electrophoresis, serum lactate dehydrogenase and bilirubin levels, and lipid profile. RESULTS: Of 3226 cholecystectomy patients, 199 were under 35 years, and 190 with no diagnosis of CHA were invited to take part in the study. Fifty three patients consented to the study. The median age was 29 years (range, 17-35 years), 5 were male and 48 were female. Twelve patients (22.6%) were diagnosed as thalassemia trait and/or ?ron-deficiency anemia. Hblevels were significantly lower (P = 0.046), and mean corpuscular volume (MCV) and hematocrit levels were slightly lower (P = 0.072 and 0.082, respectively) than normal. There was also a significantly lower number of gallstones with the diagnosis (P = 0.007). CONCLUSION: In endemic regions, for young cholelithiasis patients (age under 35) with 2-5 gallstones, the clinician/surgeon should pay attention to MCV and Hb levels as indicative of CHA.     

Comparison of the classic limberg flap and modified limberg flap in the treatment of pilonidal sinus disease: A retrospective analysis of 416 patients

Purpose  

Pilonidal sinus disease (PSD) is usually seen on the sacrococcygeal region in adolescent patients. The current study analyzed the outcome of the rhomboid excision and the Limberg flap procedure (cLF) in comparison to the modified Limberg flap procedure (mlF) for PSD.     

Is HBOT treatment effective in recovering zone of stasis? An experimental immunohistochemical study

Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Hypoxia and oedema at that zone may cause irreversible changes. Due to anti-oedematous and antihypoxic effects of hyperbaric oxygen treatment (HBOT), it may be beneficial in recovering the zone of stasis. We performed an experimental study using 20 Sprague–Dawley rats, each weighing 350–450 g. The rats were first divided into two groups as 24 h and 5 days. Subsequently, control and treatment groups (five rats in each group) were formed. For burn wounds, we used the burn comb model, which was described by Regas and Ehrlich. In the treatment group, 2.5 ATA HBOT was applied for 90 min twice daily. A 0.8-cm punch biopsy was performed and samples for histological examination were taken from the centre of burn area. The rats were sacrificed by administering ‘3 mci technetium-99m methoxy butyl nitrite’ (⁹⁹Tc^m MIBI) through the femoral vein. Biopsy materials were evaluated by histological and immunohistochemical methods. Dorsal skin fragment, excised to 1 cm margin, was imaged by scintigraphic measurements with a gamma camera. Wet and dry weight measurements of excised skin fragments were taken. As a result, HBOT showed a positive effect at the cellular level in the first 24 h. It increased recovery potential by augmenting neovascularisation and decreasing oedema in the 5-day group.