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关键词： Pulmonary infarction   Pulmonary thromboembolism   Post-mortem computed tomography   Post-mortem magnetic resonance imaging  

摘要： Pulmonary thromboembolism may be accompanied by pulmonary infarction. Even though pulmonary thromboembolism (PTE) is a frequently found cause of death at autopsy, pulmonary infarction accompanying PTE is a less common finding and may therefore easily be misinterpreted as infectious or cancerous lung disease. Appearance of pulmonary infarction in post-mortem imaging and acquisition parameters helping to identify pulmonary infarctions are not described yet. Based on a case of a 50-year-old man who died due to PTE and presented pulmonary infarction, we suggest using a pulmonary algorithm in post-mortem computed tomography combined with post-mortem magnetic resonance imaging of the lungs using conventional T1- and T2-weighted sequences.

关键词： Professionalism   Smartphone   Digital devices   Patient care   Patient-physician communication  

摘要： Background: Use of digital devices have become ubiquitous in healthcare and can create professionalism issues. This study presents opinions of faculty, residents, and medical students to inform policy on the appropriate use of digital devices in the patient care setting. Materials and methods: A survey was administered from September 2018 to October 2018 to faculty and residents within the general surgery department at a large academic medical center and all fourth-year medical students at an affiliated university. The survey included direct statements and case-based scenarios on similar themes to triangulate responses. Results: There were 114 participants in the survey-50 faculty, 26 residents, and 38 medical students. Digital device utilization was equivalent among all groups, and all participants use a smartphone. Digital devices were most frequently used during rounds and clinical conferences. Overall, digital device use was found more appropriate when seen in the case-based format rather than as a direct statement. Furthermore, use of these devices was seen as most appropriate when the provider explained its use or left the room to use the device. Conclusions: Digital devices are used by faculty and trainees at similar rates for parallel purposes, and the benefits for patient-related care are evident. However, the use of digital devices in the presence of patients should be minimized and always preceded by an explanation. These findings can inform institutional policy when creating guidelines on the professional use of these devices in the patient care setting. (C) 2020 Elsevier Inc. All rights reserved.

关键词： Iliosacral screw fixation   Percutaneous   CT-guided navigation   Pelvic fracture   Pelvic ring  

摘要： Percutaneous iliosacral screw fixation is an essential osteosynthesis technique for pelvic fractures and requires precise imaging tools to assist correct screw placement. 3D imaging coupled to navigation has significantly improved this technique. Several possibilities exist, depending on the instrument set used, with varying degrees of difficulty and very variable risk of error. The techniques traditionally described use a guide to navigate a drill bit, where a one-degree difference in trajectory can alter screw tip placement by several millimeters. The present article proposes a standardization of the procedure by using navigated pedicular screw instruments that have the advantage of navigating the instrument itself and not a projection. In a series of 90 screws implanted in 62 patients using this technique, only one path had to be repeated in the light of intraoperative control. No improperly positioned screws were found on postoperative control. (C) 2020 Elsevier Masson SAS. All rights reserved.

关键词： translaminar   full endoscopic lumbar diskectomy   migrated disk herniation   lumbar spine  

摘要： Background and Study Aims Technically and anatomically, accessing a high-grade migrated lumbar disk herniation (LDH) using traditional full endoscopic lumbar diskectomy (FELD) approaches (either transforaminal or interlaminar) is challenging. The objective of this study was to present an effective and safe surgical approach for high-grade up-migrated LDH by translaminar FELD. Patients and Methods Thirteen patients with soft high-grade up-migrated LDH treated with a translaminar FELD between May 2015 and July 2018 were reviewed in this study. Five of these patients had very high-grade up-migration. Clinical outcomes were assessed including preoperative and postoperative visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and MacNab criteria. Results Overall, 7 of the 13 patients had disk-fragment migration at L4-L5: three at L5-S1, two at L3-L4, and the remaining one at L2-L3. In all cases, the highly up-migrated LDH was removed successfully through the translaminar approach, as confirmed by postoperative magnetic resonance imaging. The improvements of VAS for back and leg pain were 4.5 +/- 0.9 to 1.3 +/- 1.3 and 7.1 +/- 1.0 to 1.6 +/- 0.7, respectively (bothp < 0.05). The ODI decreased from preoperative 41.9 +/- 6.0 to postoperative 13.0 +/- 4.1 (p < 0.05). According to the MacNab criteria, the satisfaction rate was 92.3% (excellent or good outcomes). None of the patients experienced any perioperative complications or recurrence during the follow-up period. Conclusion Although full endoscopic technique via the translaminar keyhole route may not be used as a routine surgical approach, it could serve as a feasible alternative method for patients with highly up-migrated disk herniation.

关键词： image processing   pharmacokinetics   radionuclide dosimetry  

摘要： Background Dosimetry in nuclear medicine often relies on estimating pharmacokinetics based on sparse temporal data. As analysis methods move toward image-based three-dimensional computation, it becomes important to interpolate and extrapolate these data without requiring manual intervention;that is, in a manner that is highly efficient and reproducible. Iterative least-squares solvers are poorly suited to this task because of the computational overhead and potential to optimize to local minima without applying tight constraints at the outset. Methodology This work describes a fully analytical method for solving three-phase exponential time-activity curves based on three measured time points in a manner that may be readily employed by image-based dosimetry tools. The methodology uses a series of conditional statements and a piecewise approach for solving exponential slope directly through measured values in most instances. The proposed algorithm is tested against a purpose-designed iterative fitting technique and linear piecewise method followed by single exponential in a cohort of ten patients receiving(177)Lu-DOTA-Octreotate therapy. Results Tri-exponential time-integrated values are shown to be comparable to previously published methods with an average difference between organs when computed at the voxel level of 9.8 +/- 14.2% and -3.6 +/- 10.4% compared to iterative and interpolated methods, respectively. Of the three methods, the proposed tri-exponential algorithm was most consistent when regional time-integrated activity was evaluated at both voxel- and whole-organ levels. For whole-body SPECT imaging, it is possible to compute 3D time-integrated activity maps in <5 min processing time. Furthermore, the technique is able to predictably and reproducibly handle artefactual measurements due to noise or spatial misalignment over multiple image times. Conclusions An efficient, analytical algorithm for solving multiphase exponential pharmacokinetics is reported. The