Feature-based tracking of urethral motion in low-resolution trans-perineal ultrasound

This paper describes a novel algorithm for tracking the motion of the urethra from trans-perineal ultrasound. Our work is based on the structure-from-motion paradigm and therefore handles well structures with ill-defined and partially missing boundaries. The proposed approach is particularly well-suited for video sequences of low resolution and variable levels of blurriness introduced by anatomical motion of variable speed. Our tracking method identifies feature points on a frame by frame basis using the SURF detector/descriptor. Inter-frame correspondence is achieved using nearest-neighbor matching in the feature space. The motion is estimated using a non-linear bi-quadratic model, which adequately describes the deformable motion of the urethra. Experimental results are promising and show that our algorithm performs well when compared to manual tracking.

Feature-based tracking of urethral motion in low-resolution trans-perineal ultrasound

This paper describes a novel algorithm for tracking the motion of the urethra from trans-perineal ultrasound. Our work is based on the structure-from-motion paradigm and therefore handles well structures with ill-defined and partially missing boundaries. The proposed approach is particularly well-suited for video sequences of low resolution and variable levels of blurriness introduced by anatomical motion of variable speed. Our tracking method identifies feature points on a frame by frame basis using the SURF detector/descriptor. Inter-frame correspondence is achieved using nearest-neighbor matching in the feature space. The motion is estimated using a non-linear bi-quadratic model, which adequately describes the deformable motion of the urethra. Experimental results are promising and show that our algorithm performs well when compared to manual tracking.

IS A VISIBLE (HYPOECHOIC) LESION AT BIOPSY AN INDEPENDENT PREDICTOR OF PROSTATE CANCER OUTCOME?

The aim of this study was to evaluate the prognostic implications of the sonographic appearance of prostate cancers. All patients with biopsy-proven prostate cancer between January 2003 and July 2004 (and at least 5 years of follow-up) were selected retrospectively. After exclusions, 101 patients constituted our study population and were divided into isoechoic (or nonvisible) and hypoechoic (or visible) lesion. The clinical outcomes of these two groups were compared. The outcomes for the two groups were significantly different (p < 0.01). For nonvisible lesions, 37 of the 41 patients (90.2%) had no disease relapse and 2 (4.9%) had biochemical failure. For the visible lesions, 37 of the 60 (61.6%) patients were free of recurrence, 7 (11.7%) had systemic metastases and 10 (16.7%) died of complications related to prostate cancer. Our data show that patients with nonvisible prostate cancer had significantly better outcomes than patients with visible lesions during a five-year period of evaluation. (E-mail: fmuglia@fmrp.usp.br) (c) 2012 World Federation for Ultrasound in Medicine & Biology.

Analyse de la fertilité des vaches laitières Holstein «Repeat Breeder»

L’importance de la problématique des vaches laitières non gestantes avec multiples inséminations (› 3) communément appelées « Repeat Breeder » (RB), au Québec, repose sur deux facteurs: son incidence et son impact économique. Actuellement, l’incidence du syndrome RB au Québec est de ± 25% (Rapport annuel, juin 2008, www.dsahr.ca). Les pertes monétaires associées à ce problème proviennent des frais vétérinaires et d’insémination, de la diminution de productivité ainsi que des pertes en lien avec la réforme involontaire. Afin d’avoir de meilleures connaissances sur ce syndrome, nous devons connaître les facteurs de risques généraux impliqués et ensuite explorer la condition individuelle de ces vaches problèmes. Dans la première partie de ce mémoire, une banque de données informatisées répertoriant 418 383 lactations fut analysée. L’objectif de ce projet de recherche était d’évaluer l’impact des problèmes reproducteurs post-partum et l’effet du nombre de lactations comme facteurs de risques de la vache Repeat Breeder. L’analyse a permis d’établir la dystocie comme étant la condition ayant le plus de conséquences sur la fertilité future. D’autres facteurs de risques à savoir le nombre de lactations influencent le pronostic reproducteur. La deuxième partie de ce mémoire consistait à explorer, à l’aide d’outils cliniques, la condition individuelle des vaches RB. Une étude cohorte fut menée sur des vaches Holstein en fin de période d’attente volontaire au jour 7 du cycle oestral. Les tests cliniques étudiés furent la vaginoscopie, l’examen transrectal, l’ultrasonographie du système reproducteur, la présence d’estérases leucocytaires, la bactériologie et la biochimie du liquide utérin, la cytologie endométriale et le profil de progestérone sérique. Les résultats de ces tests cliniques dévoilent que l’examen bactériologique du liquide utérin est révélateur du statut reproducteur futur.

Concentrações séricas hormonais em vacas azebuadas submetidas à baixa e alta ingestão alimentar

O objetivo deste trabalho foi avaliar a influência da ingestão alimentar nas concentrações séricas de hormônios reprodutivos e metabólicos em vacas azebuadas. Dezoito vacas foram divididas em dois grupos: 170% (alta ingestão = A) e 66% (baixa ingestão = B) da dieta de manutenção. Com 21 dias nas dietas experimentais, as vacas tiveram o estro sincronizado. Posteriormente, os ovários foram avaliados por ultra-sonografia transretal e sangue foi coletado diariamente até o dia 7 do ciclo (ovulação = dia 1). Na análise estatística, utilizou-se o teste t. As vacas ganharam 1,1 kg por dia no grupo A e perderam 1,5 kg por dia de PV no grupo B. Apesar de não ter havido diferença entre os grupos no diâmetro máximo do folículo ovulatório, o grupo A apresentou pico pré-ovulatório de estradiol sérico menor. Não foi observada diferença entre os grupos quanto ao volume luteal e concentração sérica de progesterona no dia 7 do ciclo e de FSH, IGF-I e insulina séricos no período peri-ovulatório. As dietas experimentais não alteraram a função ovariana e as concentrações séricas de hormônios reprodutivos e metabólicos, com exceção do estradiol, sugerindo que, no grupo de alta ingestão, ocorreu maior metabolismo desse hormônio.

Avaliação da dinâmica folicular em éguas superovuladas com extrato de pituitária eqüina e FSH eqüino purificado

Pós-graduação em Medicina Veterinária - FMVZ

Avaliação comparativa da suplementação de ácidos graxos saturados e insaturados sobre o desempenho produtivo, qualidade oocitária e embrionária, e metabolismo de vacas leiteiras no período de transição e início de lactação

Objetivou-se avaliar a suplementação dietética de ácidos graxos saturados e insaturados sobre o metabolismo, e desempenhos produtivo e reprodutivo no período de transição e início de lactação de vacas leiteiras. Foram utilizadas 36 vacas da raça holandesa distribuídas aleatoriamente para receber uma das três dietas experimentais. No período pré-parto as dietas foram: Controle (CON), sem adição de gordura e 2,8% de extrato etéreo baseado na matéria seca; Gordura Saturada (SAT), com inclusão de 2,4% de MAGNAPAC® (Tectron Ltda.) com 4,7% de EE baseado na MS; Gordura Insaturada (INS), com inclusão de 11% de grão de Soja, com 4,7% de EE baseado na MS. No período pós-parto, Controle (CON), sem adição de gordura e com 2,8% de EE baseado na MS; Gordura Saturada (SAT), com inclusão de 2,6% de MAGNAPAC® (Tectron Ltda.) com 5,0% de EE baseado na MS; Gordura Insaturada (INS), com inclusão de 13% de Grão de Soja, com 5% de EE baseado na MS. As dietas foram fornecidas 35 dias da data prevista do parto até 90 dias de lactação. No período pré-parto foi utilizada silagem de milho como volumoso, em uma relação volumoso:concentrado de 70:30, enquanto que no período pós-parto foram utilizados 5% de feno de tifton e 45% de silagem de milho como fontes de volumoso, com uma relação entre volumoso:concentrado de 50:50. A produção de leite foi mensurada diariamente durante todo o período experimental. As amostras utilizadas para análise da composição e o perfil de ácidos graxos do leite foram coletadas semanalmente, sendo provenientes das duas ordenhas diárias. As amostras de sangue para análise dos metabólitos sanguíneos foram coletadas semanalmente. Do dia 14 ao dia 90 pós-parto foi realizado avaliação da dinâmica folicular por ultrassonografia. Nos dias 30, 60 e 90 foram realizadas aspirações foliculares, com posterior fertilização in vitro dos oócitos. Todas as variáveis mensuradas foram avaliadas pelo procedimento PROC MIXED do SAS (2004) utilizando-se os seguintes contrastes ortogonais: Controle vs Fontes de Lipídeo (C1); Fonte de ácidos graxos saturados x Fonte de ácidos graxos insaturados (C2). Foi utilizado nível de 5% de significância. No período pós-parto, a suplementação de lipídeos aumentou as concentrações de AGNE quando comparada a dieta CON. O tratamento INS reduziu as concentrações de proteínas totais e de BHB quando comparado ao SAT. Houve interação entre tempo e dieta paras as variáveis colesterol total, LDL e BHB. Houve redução da produção de leite corrigida para 3,5% de gordura, na produção total de gordura e de proteína, e no teor de gordura do leite quando comparado o tratamento INS com o SAT. A suplementação de lipídeo reduziu as concentrações do somatório dos ácidos graxos saturados (Σ A.G. Saturados), dos ácidos graxos com menos de 16 carbonos (>C16), e da relação entre ácidos graxos saturados com insaturados (Σ SFA/(MUFA+PUFA)); e aumentou as concentrações de ácidos graxos acima de 16 carbonos (>C16), de ácidos graxos insaturados com 18 carbonos, da somatória dos ácidos graxos insaturados e dos ácidos graxos poli-insaturados (Σ A.G. Poli-insaturados). O tratamento INS aumentou a concentração de ácidos graxos poli-insaturados totais (Σ A.G. poli-insaturados), e reduziu o total de ácidos graxos de 16 carbonos (C16) em relação ao tratamento SAT. Houve redução no número de folículos classe 1, e folículos totais (NC1 e NTFol) com suplementação de lipídeo. O tratamento SAT aumentou o número de folículos classe 5 (NC5), em relação ao INS. Não houve alteração na qualidade oocitária e embrionária com a suplementação de lipídeo e entre as duas fontes de lipídeo. A suplementação de lipídeos insaturados através da suplementação via grão de soja cru e integral, quando comparada à suplementação de lipídeos saturados, para vacas no período de transição e início de lactação, não interferiu na dinâmica folicular e qualidade oocitária e embrionária; e reduziu o desempenho produtivo, devido às reduções na produção de gordura do leite a na produção de leite corrigida para 3,5% dos animais suplementados

Early toxicity from preoperative radiotherapy with continuous infusion 5-fluorouracil for resectable adenocarcinoma of the rectum: A phase II trial for the Trans-Tasman Radiation Oncology Group

Purpose: To assess the toxicity and the efficacy of preoperative radiotherapy with continuous infusion 5-fluorouracil (5-FU) for locally advanced adenocarcinoma of the rectum. Methods and Materials: Eligible patients had newly diagnosed localized adenocarcinoma of the rectum within 12 cm of the anal verge, Stage T3-4, and were suitable for curative resection. Eighty-two patients were treated with radiotherapy-50.4 Gy in 28 fractions in 5.6 weeks, given concurrently with continuous infusion 5-FU, using either 96-h/week infusion at 300 mg/m(2)/day or 7-days/week infusion at 225 mg/m(2)/day. Results: The median age was 59 years (range, 27-87), and 67% of patients were male. Pretreatment stages of the rectal cancer were T3, 89% and resectable T4, 11%, with endorectal ultrasound confirmation in 67% of patients. Grade 3 acute toxicity occurred in 5 of 82 patients (6%; 95% confidence interval [CI], 2-14%). Types of surgical resection were anterior resection, 61%; abdominoperineal resection, 35%; and other procedures, 4%. There was no operative mortality. Anastomotic leakage after low anterior resection occurred in 3 of 50 patients (6%; 95% CI, 1-17%). The pathologic complete response rate was 16% (95% CI, 9-26%). Pathologic Stages T2 or less occurred in 51%. Conclusion: Preoperative radiotherapy with continuous infusion 5-FU for locally advanced rectal cancer is a safe regimen, with a significant downstaging effect. It does not seem to lead to a significant increase in serious surgical complications. (C) 2001 Elsevier Science Inc.

Imaging for trans-catheter pulmonary stent-valve implantation without angiography: role of intravascular ultrasound.

Patients with stenosed biologic pulmonary conduits require redo cardiac surgery to prevent severe right ventricular dysfunction. Following the latest trends, the trans-catheter pulmonary stent-valve implantation represents a new fascinating alternative carrying a lower operative risk, compared with the standard open-heart re-intervention. Traditionally, the pulmonary stent valve is positioned off pump, under fluoroscopic control, and requires angiographies. However, alternative tools not requiring contrast injections for the intra-operative cardiac imaging have to be also considered strongly. The usefulness of intravascular ultrasound for the positioning of aortic endoprosthesis has already been proven in previous reports and, following the same principle, we have started to routinely implant balloon-expandable stent valves (Edwards Sapien? THV) in stenosed pulmonary valve conduits using intravascular ultrasound for the stent-valve positioning without angiography. We describe the intra-operative intravascular imaging technique with technical details.

L'ultrasonographie endorectale dans les cancers du rectum [Endorectal ultrasound of rectal cancers].

Endorectal ultrasonography has become the preferred exam to assess the local extent of rectal cancers. From 1990 to 1992, we have examined 28 patients with a rectal cancer. The tumours were classified according to the TNM. The objective of this exam is to identify patients whose tumours have invaded the perirectal fat. These patients are first treated in our clinic by an accelerated hyperfractionated radiotherapy and then operated. The preoperative staging made with the endorectal ultrasound was then compared with the anatomopathologic staging. The depth of the invasion was assessed precisely in 78.5% of cases. The exam's sensitivity to detect the invasion of the perirectal fat was 96% and its specificity 75%. Lymph node involvement was accurately identified in 67.8% of cases with a sensitivity of 81% and a specificity of 50%. This short retrospective study confirms that endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma prior to operation and hence to select the patients that can benefit from preoperative irradiation.

Abstract Title: Ultrasound Guided Trans-sartorial Continuous Saphenous Nerve Blockade - A technique for Relief of Postoperative Medial Incisional Foot and Ankle Pain

The saphenous nerve (SaN) innervates the region from the upper medial thigh to the medial aspect of the foot and ankle. A femoral nerve block (FNB) is effective for blockade of the SaN but this causes quadriceps weekness and reduced patient mobility that is unsuitable in an ambulatory surgical setting.

Multigradient field-active contour model for multilayer boundary detection of ultrasound rectal wall image

Extraction and reconstruction of rectal wall structures from an ultrasound image is helpful for surgeons in rectal clinical diagnosis and 3-D reconstruction of rectal structures from ultrasound images. The primary task is to extract the boundary of the muscular layers on the rectal wall. However, due to the low SNR from ultrasound imaging and the thin muscular layer structure of the rectum, this boundary detection task remains a challenge. An active contour model is an effective high-level model, which has been used successfully to aid the tasks of object representation and recognition in many image-processing applications. We present a novel multigradient field active contour algorithm with an extended ability for multiple-object detection, which overcomes some limitations of ordinary active contour models—"snakes." The core part in the algorithm is the proposal of multigradient vector fields, which are used to replace image forces in kinetic function for alternative constraints on the deformation of active contour, thereby partially solving the initialization limitation of active contour for rectal wall boundary detection. An adaptive expanding force is also added to the model to help the active contour go through the homogenous region in the image. The efficacy of the model is explained and tested on the boundary detection of a ring-shaped image, a synthetic image, and an ultrasound image. The experimental results show that the proposed multigradient field-active contour is feasible for multilayer boundary detection of rectal wall

Factors affecting management decisions in rectal cancer in clinical practice: results from a national survey

Management of rectal cancer has become increasingly complex and a multidisciplinary approach is considered of key importance for improving outcomes. A national survey among specialists involved in this multidisciplinary setting was performed. A web-based survey containing 11 questions regarding rectal cancer management was sent to surgeons and medical oncologists registered by their corresponding societies as members. Statistical analysis was performed using the chi-square and Fisher`s exact tests for all categorical variables according to response to individual questions. Multivariate analysis was performed using Cox`s logistic regression. Overall, 418 email recipients responded the survey. Local staging was performed without either magnetic resonance imaging or endorectal ultrasound by 64% of responders. Seventy-two percent considered that final management decision should be made after neoadjuvant chemoradiation therapy. Additionally, 46% considered that an alternative procedure (local excision or observation) was appropriate in a patient with a complete clinical response. Colorectal surgeons were more frequently in favor of longer intervals after completion of chemoradiation therapy (P = 0.001) and of alternative management procedures after a complete clinical response (P = 0.02). After multivariate analysis, the choice of a watch and wait approach after a complete clinical response following neoadjuvant chemoradiation therapy was significantly more frequent among surgeons (OR 3.5, 95% CI 1.8-7.1). Surgeons seem to be more in favor of tailoring management of rectal cancer according to tumor response after neoadjuvant chemoradiation therapy, with longer intervals after chemoradiation therapy, decisions about treatment strategy being made after chemoradiation therapy instead of before, and the use of alternative surgical procedures after a complete clinical response following neoadjuvant therapy.

Acute symptoms, not rectally administered sucralfate, predict for late radiation proctitis: Longer term follow-up of a phase III trial - trans-Tasman radiation oncology group

Image : To assess the potential for sucralfate administered rectally to reduce the risk of late rectal morbidity in patients undergoing nonconformal radiotherapy (RT) for carcinoma of the prostate and to study the variables potentially contributing to late rectal morbidity and particularly to explore the relationship between acute and late toxicity. Image : Eighty-six patients with localized prostate carcinoma were randomized in a double-blind, placebo-controlled study to a daily enema of 3 g of sucralfate in a 15-mL suspension or the same suspension without sucralfate. The enema began the first day of RT and was continued for 2 weeks after treatment completion. The primary end point of the study was acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) toxicity; however, the patients were followed for an additional 5 years on a 6-month basis. The evaluation included late RTOG/EORTC toxicity and a patient self-assessment questionnaire. Image : With a median follow-up of 5 years, the Kaplan-Meier probability of late Grade 2 RTOG/EORTC toxicity was 12% (95% confidence interval [CI] 2–22%) for placebo and 5% (95% CI 0–12%) for sucralfate (p = 0.26). The probability of late rectal bleeding was 59% (95% CI 45–73%) for placebo and 54% (95% CI 40–68%) for sucralfate. No statistically significant difference was found between the treatment arms for the peak incidence of any of the other patient self-assessment variables. Cox proportional hazards modeling indicated acute RTOG/EORTC toxicity of Grade 2 or greater was associated with a hazard ratio of 2.74 (95% CI 1.31–5.73) for the development of late toxicity of Grade 1 or greater. Substituting the patient self-assessment variables for acute RTOG/EORTC toxicity revealed that rectal pain of a moderate or severe grade during RT was the best predictor of the subsequent development of late toxicity, with a hazard ratio of 3.44 (95% CI 1.68–7). Image : The results of this study do not support the use of sucralfate administered rectally as a method for reducing the late toxicity of nonconformal RT for prostate cancer. There appears to be an association between the development of acute and subsequent late toxicity, although the nature of this association remains to be determined

Pelvic lymphoscintigraphy: contribution to the preoperative staging of rectal cancer

PURPOSE: Preservation of the anal sphincter in surgery for cancer of the distal rectum in an attempt to avoid colostomy has been a main concern of colorectal surgeons. Various proposed procedures contradict oncological principles, especially with respect to pelvic lymphadenectomy. Therefore, prior knowledge of pelvic lymph node involvement is an important factor in choosing the operative technique, i.e., radical or conservative resection. Introduction of ultrasound, computerized tomography, and magnetic resonance have made preoperative study of the area possible. Nevertheless, these resources offer information of an anatomical nature only. Lymphoscintigraphy enables the morphological and functional evaluation of the pelvic area and contributes toward complementing the data obtained with the other imaging techniques. The objective of this prospective study is twofold: to standardize the lymphoscintigraphy technique and to use it to differentiate patients with rectal cancer from those with other coloproctologic diseases. CASUISTIC AND METHODS: Sixty patients with various coloproctologic diseases were studied prospectively. Ages ranged from 21 to 96 years (average, 51 and median, 55 years). Twenty-six patients were male and 34 were female. Thirty patients had carcinoma of the distal rectum as diagnosed by proctologic and anatomic-pathologic examinations, 20 patients had hemorrhoids, 5 had chagasic megacolon, 2 had diverticular disease, 2 had neoplasm of the right colon, and 1 had ulcerative colitis as diagnosed by proctologic exam and/or enema. The lymphoscintigraphy method consisted of injecting 0.25 mL of a dextran solution marked with radioactive technetium-99m into the right and left sides of the perianal region and obtaining images with a gamma camera. The results were analyzed statistically with a confidence level of 95% (P < .05) using the following statistical techniques: arithmetic and medium average, Fisher exact test, chi-square test corrected for continuity according to Yates, and distribution tables for the number of patients. RESULTS: In rectal cancer, the tracer progresses unilaterally or is absent; in other patients, the progress of the tracer is bilateral and symmetrical, although its progress may be slow. Statistical tests showed with high significance that the agreement index between the clinical diagnosis and the result of the lymphoscintigraphic exam was 93%. CONCLUSIONS: Lymphoscintigraphy is a standardized, painless, and harmless test that can be performed in all cases; it differentiates patients with rectal cancer from those with other coloproctological diseases.