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Benefits of radial distortion correction in arthroscopic surgery: a first experimental study on a knee model
Get PDFBACKGROUND:
Lens probes used in arthroscopy typically have a small diameter and wide field-of-view. This introduces strong radial distortion (RD) into the image, ultimately affecting the surgeon's hand-eye coordination. This study evaluates potential benefits of using distortion-free images in arthroscopic surgery.
METHODS:
Distortion-free images were obtained using RDFixer™ software (Perceive3D, SA) to remove RD in the input video stream. Twelve orthopedic residents performed an arthroscopic task (loose body removal) in a dry-knee model using video with and without distortion. Residents were questioned about image quality, and surgical performance was rated using an adapted Global Rating Scale.
RESULTS:
A statistically significant improvement of all parameters was observed with distortion-free images. Residents perceived distortion-free images as providing a wider field-of-view and a better notion of relative depth and distance.
CONCLUSION:
RD correction improved the surgical performance of residents, potentially decreasing their learning curve. Future work will study whether the benefits are observable in experienced surgeons
Pheochromocytoma and Neurofibromatosis Type 1 - description of case
No full textIntroduction: Pheochromocytomas are rare neuroendocrine tumors that can occur sporadically or, in about 30% of cases, in the context of family syndromes. Ten percent are malignant. Type 1 neurofibromatosis is an autosomal dominant disease that is associated with the occurrence of these tumors. Pheochromocytomas appears in 0.1 to 5.7 % of patients with type 1 neurofibromatosis, and are usually solitary and benign lesions.
Clinical case: We present the case of a 50-years-old female, with a past history of type 1 neurofibromatosis, arterial hypertension, depressive syndrome, divergent strabismus and tabagism, medicated with irbesartan 300mg, sertraline and alprazolam. She was referenced to our service of Endocrinology due to a 6 cm nodular lesion in the right adrenal gland, detected in a renal CT. On physical examination, she presented high blood pressure, cafe-au-lait spots and cutaneous neurofibromas. Adrenal functional study revealed high levels of plasma metanephrines, and urinary fractionated catecholamines and metanephrines. The MRI showed a massive heterogeneous right adrenal gland mass with 48x48x63 mm, with hyperintense signal on T2-weighted images, internal cystic areas and hyperintensity on T1-weighted images that may correspond to hemorrhagic areas. This mass presents frank capture of contrast and marked restriction in diffusion weighting. These findings favour the diagnosis of pheochromocytoma. The I131-MIBG showed an image compatible with right adrenal pheochromocytoma. After appropriate preoperative therapy, laparoscopic right adrenalectomy was performed. Histological examination revealed a pheochromocytoma with capsule invasion, adjacent adipose tissue invasion, but without vascular invasion. After surgery, levels of plasma metanephrines, and urinary fractionated catecholamines and metanephrines became normal. Currently, she has her arterial blood pressure controlled without medication.
Conclusions: We consider important to present this case due to the rarity of the case, the possibility of malignancy, a hypothesis strengthened by tumor size, and the challenge of long-term follow up of these tumors
Dramatic recovery after IV thrombolysis in anterior circulation ischemic stroke: Predictive factors and prognosis
No full textBACKGROUND AND PURPOSE:
Dramatic recovery (DR) after thrombolysis is dependent of vessel recanalization and is predictive of favorable clinical outcome. Successful recanalization is not equivalent to DR. Our objective was to assess its frequency and evaluate clinical and biochemical predictors and their prognosis.
METHODS:
We analyzed prospectively registered data from January 2007 to September 2012. All patients with anterior circulation stroke and NIHSS≥10 were included. Improvement of ≥10 or a score ≤3 24h after thrombolysis was defined as DR.
RESULTS:
In the 230 patients included, DR frequency was 23% (53 patients). DR group had lower admission NIHSS (14 vs 17, p=0.024), less total anterior circulation infarcts (p=0.009), more partial anterior circulation infarcts (p=0.003) and lower blood glucose on admission (118 vs 128mg/dL, p=0.013). All patients with DR had an Alberta Stroke Program Early CT Score (ASPECTS) ≥7, vs 89.3% without DR (p=0.013). Arterial recanalization, defined as hyperdense middle cerebral artery sign disappearance on control CT, was more frequent in the DR group (68.4% vs 14.1%, p<0.001). Intracranial hemorrhage on 24h-control CT scan was less frequent in the DR group (p<0.001). Multinomial logistic regression analysis showed that ASPECTS score was an independent predictor of DR (OR=2.35, 95%CI=1.32-4.16, p=0.003) and CT evidence of recanalization was independently associated with DR (OR=11.60, 95%CI, 3.02-44.53, p<0.001).
CONCLUSION:
DR is a frequent occurrence. ASPECTS score is an independent predictor of DR, which is also independently associated with CT evidence of middle cerebral artery recanalization
Padrão terapêutico numa população de diabéticos tipo 2: relação com o tempo de doença e nível de cuidados de saúde
No full textIntrodução
A diabetes mellitus tipo 2 (DM2) exige alterações terapêuticas constantes e cuidados de saúde diferenciados ao longo da sua evolução.
Objetivo
caracterizar uma população de DM2 internados quanto ao tempo de evolução, seguimento médico, tratamento, HbA1c, motivo e tempo de internamento.
Materiais e métodos
Estudo transversal baseado nos processos clínicos dos doentes com DM2 internados no Serviço de Medicina Interna do Hospital de Braga, entre 3 de junho e 11 de novembro de 2011. Variáveis estudadas: idade, sexo, tempo e motivo de internamento, nível de cuidados de saúde, tempo de evolução, HbA1c, tratamento. Considerou‐se um nível de significância de 5%.
Resultados
Identificaram‐se 286 internamentos de doentes com DM2 (27,1%), obtendo‐se dados em 179 doentes. Idade mediana de 78,0 anos; 53,6% mulheres; tempo de internamento 9,0 dias; tempo de evolução da DM2: 21,8% ( 20 anos); 71,5% vigiados nos cuidados de saúde primários (CSP), 22,9% nos secundários (CSS); 66,5% medicados com ADO, 12,3% com ADO e insulina e 16,8% apenas com insulina; HbA1c mediana de 6,8%. Os doentes com maior tempo de evolução apresentaram pior controlo metabólico (p = 0,006) e maior taxa de insulinização (p = 0,001). Relativamente aos CSP, os doentes dos CSS tinham idade inferior (p = 0,001), maior tempo de evolução (p < 0,001), maior taxa de insulinização (p < 0,001) e pior controlo metabólico (p = 0,031).
Conclusão
A população estudada era envelhecida, seguida predominantemente nos CSP, com baixa percentagem de insulinização, mas com bom controlo metabólico. Encontraram‐se diferenças entre os doentes dos CSP e CSS, decorrentes da natural evolução da doença
