Improved detection of synovial boundaries in ultrasound examination by using a cascade of active-contours

Rheumatoid arthritis (RA) is a chronic multisystemic autoimmune disease, with an unclear etiopathogenesis. Its early diagnosis and activity assessment are essential to adjust the proper therapy. Among the different imaging techniques, ultrasonography (US) allows direct visualization of early inflammatory joint changes as synovitis, being also rapidly performed and easily accepted by patients. We propose an algorithm to semi-automatically detect synovial boundaries on US images, requiring minimal user interaction. In order to identify the synovia-bone and the synovia-soft tissues interfaces, and to tackle the morphological variability of diseased joints, a cascade of two different active contours is developed, whose composition corresponds to the whole synovial boundary.The algorithm was tested on US images acquired from proximal interphalangeal (PIP) and metacarpophalangeal (MCP) finger joints of 34 subjects. The results have been compared with a consensus manual segmentation. We obtained an overall mean sensitivity of 85 ± 13%, and a mean Dice's similarity index of 80 ± 8%, with a mean Hausdorff distance from the manual segmentation of 28 ± 10 pixels (approximately 1.4 ± 0.5 mm), that are a better performance than those obtained by the raters with respect to the consensus.     

Gastric dysmotility after liquid bolus ingestion in systemic sclerosis: an ultrasonographic study

Gastric involvement appears quite commonly in systemic sclerosis (SSc). The aim of this study was to evaluate gastric wall motility using ultrasonography, a noninvasive method able to track both filling and emptying of fundus and antrum. The study was performed in 20 SSc patients and 20 healthy control subjects. Gastric filling and emptying were evaluated by transabdominal ultrasonography, measuring changes in fundus and antral areas over a 1-h period after ingestion of a liquid bolus (500 ml of mineral water). Areas of both gastric fundus and antrum at basal evaluation were found to be smaller in SSc patients than in healthy controls. Gastric filling was significantly reduced after ingestion of liquid bolus. Gastric emptying was delayed both in fundus and antrum. No significant differences of gastric wall motility have been observed in different subsets of SSc patients. Our findings show that gastric dysmotility is frequent and severe in SSc patients, contributing to the gastrointestinal disturbances which are very common in this disease.     

The relations between cognition and the independent living skill of shopping in people with schizophrenia

A great deal of interest has developed regarding the impact of cognitive deficits on the everyday functioning of people with schizophrenia. This study examined the relationships between cognitive functioning and the performance of a specific independent living skill (grocery shopping) in a sample of 73 individuals with schizophrenia or schizoaffective disorder. Cognitive variables included tests of verbal memory, executive functioning, verbal fluency, sustained attention and visual motor skill. Functional outcome was measured with the Test of Grocery Shopping Skills, which is an ecologically based performance measure that requires participants to shop for 10 items within an actual grocery store. Accuracy on the shopping task was significantly associated with fewer perseverative responses on the Wisconsin Card Sorting Test, better verbal memory and faster processing speed. Shopping efficiency (i.e. less redundancy) was associated with better performance on several cognitive tasks, including verbal memory, verbal fluency, sustained attention and executive functioning. Results of this study extend previous research by examining the relation between cognition and the actual performance of daily living skills under natural circumstances.     

Mechanical asphyxia by three different mechanisms

We report the case of death of a 75-year-old Caucasian woman, produced by three different ways of mechanical asphyxia: smothering and strangulation by hand and traumatic asphyxia by thoracic compression. All these criminal offences were carried out by one single assailant who compressed the mouth and the nose of the victim with the left hand, squeezed her neck with the right hand and pressed her thorax with the knees.     

High division of the median nerve in the carpal tunnel: anatomical observations

Here are analysed personal observation about high duplication of median nerve at the wrist. Here are reported 18 cases on 3300 operations for carpal tunnel. The results are compared with the literary casuistry.     

The nerves of the upper and lower extremities which are at a greater risk of compressive pathology. Anatomical topographical correlations. Our experience

The experience of numerous cases of surgical operations carried out over the ten years from 1990-2000, has meant we have been able to reflect on the fact that the median, ulnar, radial (upper extremity), tibial and external popliteal sciatic (lower extremity) nerves are more greatly exposed to compressive pathology. This is due to certain anatomical topographical relationships with canals, semi-canals, tunnels in well-defined and unchanging sites. From this point of view, a pathology with an etiopathogenic topographical tendency is emerging.