Hemorrhage from primitive rectal varices in patient with idiophatic thrombosis of portal vein: case report

Introduction. Rectal varices, primitive or secondary to hypertensive or thrombotic disorders of mesenteric-portal circle, represent an uncommon cause of lower digestive bleeding. The presence of rectal varices associated to idiopathic venous portal thrombosis represents a distinct nosologic entity, with important clinical and therapeutic problems related to it. Case report. Patient of young age, with positive anamnesis for primitive rectal varicies, admitted to our department for a serious rettorragy. The laboratory underlined moderate anaemia and the endoscopy documented the presence of multiple rectal varices, without evident signs of bleeding; the endoscopy documented the presence of two esophageal small varicose cords F1. The hepatobiliary sonography and the portography showed the massive thrombosis of the portal vein. The new serious episode of rectal bleeding induced us to subject the patient to a surgical operation of Hartmann recto-sigmoid resection. Conclusion. Because of the slight number of reported cases of primitive rectal varices and because of the scattering of many dates it’s difficult to draw an univocal diagnostic and therapeutic algorithm. Clinical framing and subsequent therapeutic approach rise often up from personal experience rather than well defined guidelines. The treatment is controversial, time by time many therapeutic options are reported either conservative or interventist. The failure of conservative therapy and the recurrent episodes of bleeding give indication to surgical treatment, that is represented by Hartmann colonic resection and/or the porto-systemic shunts in the cases of portal hypertension; in our case we made colonic resection sec. because of lapsed performing status of the patient

Right ventricular endocardial segmentation in CMR images using a novel inter-modality statistical shape modelling approach

Statistical shape modelling (SSM) approaches have been proposed as a powerful tool to segment the left ventricle in cardiac magnetic resonance (CMR) images. Our aim was to extend this method to segment the RV cavity in CMR images and validate it compared to the conventional gold-standard (GS) manual tracing. A SSM of the RV was built using a database of 4347 intrinsically 3D surfaces, extracted from transthoracic 3D echo cardiographic (3DE) images of 219 retrospective patients. The SSM was then scaled and deformed on the base of some features extracted, with different strategies, from each short-axis plane until a stable condition was reached. The proposed approach, tested on 14 patients, resulted in a high correlation (r2=0.97) and narrow limits of agreement (± 17% error) when comparing the semiautomatic volumes to the GS, confirming the accuracy of this approach in segmenting the RV endocardium

Pyoderma gangrenosum of the “sinus mammarum” in ulcerative colitis

The first part of this article deals with the report of a patient suffe - ring from pyoderma gangrenosum of the “sinus mammarum” associa - ted with asymptomatic ulcerative colitis. This is followed by a revision of the present epidemiological, etiological, pathogenetic and clinical knowledges about this systemic manifestation of chronic phlogosis of the colon. The Authors have analysed the treatment for this condition and emphasized the resistance of the cutaneous ulcer encountered to conven - tional medical therapy of the underlying colonic disease which proved to be efficacious only on the latter; this led to integrate traditional treatment with the use of perilesional injections of small doses of calcic heparin as an alternative to immunosuppressive drugs or surgery. Topical antithrombotic treatment, which can be justified by the histo - logical findings of phenomena of the vasculitis in the edge of pyoderma gangrenosum, demonstrated to be crucial and represents a peculiarity in the case here reported, which is unique in the literature as far as the Authors know, since it has not been experimented by anyone else

Evaluation of different statistical shape models for segmentation of the left ventricular endocardium from magnetic resonance images

International audienceStatistical shape models (SSMs) represent a powerful tool used in patient-specific modeling to segment medical images because they incorporate a-priori knowledge that guide the model during deformation. Our aim was to evaluate segmentation accuracy in terms of left ventricular (LV) volumes obtained using four different SSMs versus manual gold standard tracing on cardiac magnetic resonance (CMR) images. A database of 3D echocardiographic (3DE) LV surfaces obtained in 435 patients was used to generate four different SSMs, based on cardiac phase selection. Each model was scaled and deformed to detect LV endocardial contours in the enddiastolic (ED) and end-systolic (ES) frames of a CMR short-axis (SAX) stack for 15 patients with normal LV function. Linear correlation and Bland–Altman analyses versus gold-standard showed in all cases high correlation (r²>0.95), non-significant biases and narrow limits of agreement

3D right ventricular endocardium segmentation in cardiac magnetic resonance images by using a new inter-modality statistical shape modelling method

Objective Statistical shape modelling (SSM) has established as a powerful method for segmenting the left ventricle in cardiac magnetic resonance (CMR) images However, applying them to segment the right ventricle (RV) is not straightforward because of the complex structure of this chamber. Our aim was to develop a new inter-modality SSM-based approach to detect the RV endocardium in CMR data. Methods Real-time transthoracic 3D echocardiographic (3DE) images of 219 retrospective patients were used to populate a large database containing 4347 3D RV surfaces and train a model. The initial position, orientation and scale of the model in the CMR stack were semi-automatically derived. The detection process consisted in iteratively deforming the model to match endocardial borders in each CMR plane until convergence was reached. Clinical values obtained with the presented SSM method were compared with gold-standard (GS) corresponding parameters. Results CMR images of 50 patients with different pathologies were used to test the proposed segmentation method. Average processing time was 2 min (including manual initialization) per patient. High correlations (r2 > 0.76) and not significant bias (Bland-Altman analysis) were observed when evaluating clinical parameters. Quantitative analysis showed high values of Dice coefficient (0.87 ± 0.03), acceptable Hausdorff distance (9.35 ± 1.51 mm) and small point-to-surface distance (1.91 ± 0.26 mm). Conclusion A novel SSM-based approach to segment the RV endocardium in CMR scans by using a model trained on 3DE-derived RV endocardial surfaces, was proposed. This inter-modality technique proved to be rapid when segmenting the RV endocardium with an accurate anatomical delineation, in particular in apical and basal regions

L’impiego di un’originale pinza nella chirurgia per via anteriore dell’ernia inguinale primitiva

Gli Autori propongono l’impiego di un’originale pinza a punta smussa da dissezione e passafettuccia negli interventi di ernioplastica inguinale protesica tension-free con ‘mini-inguinotomia’. In acciaio inossidabile e della lunghezza di 16 cm, lo strumento è costituito da due branche con impugnatura a occhiello, chiusura a cremagliera e articolazione pressoché identiche a quelle dei comuni ferri chirurgici; è lievemente curvo nella sua parte distale, laddove presenta un’ampia punta smussa e un altrettanto largo morso da presa del tutto originali. Il singolare ferro chirurgico dà all’operatore la possibilità di effettuare in modo agevole e delicato l’isolamento, per via smussa e in prossimità del tubercolo pubico, del funicolo spermatico dalla parete posteriore del canale inguinale, andando a sostituirsi al dito indice ripiegato a uncino che, utilizzato con gesti ‘sgraziati’, ‘grossolani’ e causa di trazioni nelle ampie incisioni, non può essere adoperato nelle ‘mini-incisioni’ per il limitato spazio disponibile nel focolaio operatorio. In successione di tempo la nuova pinza consente di provvedere in modo più semplice e rapido del tradizionale impiego di un grosso passafili alla sospensione su fettuccia di gomma degli elementi funicolari inguainati dalla fascia cremasterica. Nel complesso la pinza a punta smussa da dissezione e passafettuccia, il cui prototipo è dagli Autori routinariamente utilizzato negli interventi di ernioplastica inguinale protesica con accesso mini-inguinotomico, consente l’esecuzione di gesti chirurgici facili, prudenti, eleganti, precisi, efficaci e soprattutto sicuri

Il trattamento chirurgico degli sventramenti spontanei: tecnica originale di protesizzazione della parete addominale

Gli Autori si soffermano sulla correzione chirurgica degli sventramenti spontanei e ne puntualizzano le indicazioni e gli obiettivi. Precisate le possibilità e definiti i limiti delle metodiche chirurgiche tradizionali dell’affezione, discutono sul razionale di un’innovativa e originale tecnica di protesizzazione della parete anteriore dell’addome, messa a punto per la cura degli importanti divari fra i due retti e frutto di una sorta di eclettismo e di integrazione di alcune fasi operatorie del procedimento di autoplastica di Quénu e della tecnica di Welti-Eudel e Chevrel. Descrivono, quindi, la sequenza dei tempi operatori della metodica ideata e presentano la preliminare esperienza clinica maturata con la stessa, i cui risultati definiscono lusinghieri e incoraggianti riguardo all’efficacia curativa (in senso cosmetico e funzionale) immediata e duratura, alla sicurezza e alla compliance del paziente. Gli Autori ritengono di potere sostenere, alla luce dei risultati ottenuti, l’indubbia affidabilità della protesizzazione della parete addominale nel trattamento dei grandi sventramenti spontanei e si prefiggono di esprimere sulla metodica un definitivo giudizio dopo ulteriori esperienze cliniche su casistiche più ampi