25 research outputs found
Identifying Visible Tissue in Intraoperative Ultrasound Images during Brain Surgery: A Method and Application
Intraoperative ultrasound scanning is a demanding visuotactile task. It
requires operators to simultaneously localise the ultrasound perspective and
manually perform slight adjustments to the pose of the probe, making sure not
to apply excessive force or breaking contact with the tissue, whilst also
characterising the visible tissue. In this paper, we propose a method for the
identification of the visible tissue, which enables the analysis of ultrasound
probe and tissue contact via the detection of acoustic shadow and construction
of confidence maps of the perceptual salience. Detailed validation with both in
vivo and phantom data is performed. First, we show that our technique is
capable of achieving state of the art acoustic shadow scan line classification
- with an average binary classification accuracy on unseen data of 0.87.
Second, we show that our framework for constructing confidence maps is able to
produce an ideal response to a probe's pose that is being oriented in and out
of optimality - achieving an average RMSE across five scans of 0.174. The
performance evaluation justifies the potential clinical value of the method
which can be used both to assist clinical training and optimise robot-assisted
ultrasound tissue scanning
An Efficient Strategy to Induce and Maintain In Vitro Human T Cells Specific for Autologous Non-Small Cell Lung Carcinoma
BACKGROUND: The efficient expansion in vitro of cytolytic CD8+ T cells (CTLs) specific for autologous tumors is crucial both for basic and translational aspects of tumor immunology. We investigated strategies to generate CTLs specific for autologous Non-Small Cell Lung Carcinoma (NSCLC), the most frequent tumor in mankind, using circulating lymphocytes. PRINCIPAL FINDINGS: Classic Mixed Lymphocyte Tumor Cultures with NSCLC cells consistently failed to induce tumor-specific CTLs. Cross-presentation in vitro of irradiated NSCLC cells by autologous dendritic cells, by contrast, induced specific CTL lines from which we obtained a high number of tumor-specific T cell clones (TCCs). The TCCs displayed a limited TCR diversity, suggesting an origin from few tumor-specific T cell precursors, while their TCR molecular fingerprints were detected in the patient's tumor infiltrating lymphocytes, implying a role in the spontaneous anti-tumor response. Grafting NSCLC-specific TCR into primary allogeneic T cells by lentiviral vectors expressing human V-mouse C chimeric TCRalpha/beta chains overcame the growth limits of these TCCs. The resulting, rapidly expanding CD4+ and CD8+ T cell lines stably expressed the grafted chimeric TCR and specifically recognized the original NSCLC. CONCLUSIONS: This study defines a strategy to efficiently induce and propagate in vitro T cells specific for NSCLC starting from autologous peripheral blood lymphocytes
Lumbar Endoscopic Microdiscectomy:Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence
Endoscopic disc surgery (EDS) for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. Rate of recurrence/residual, complications, and outcomes, in comparison with standard microdiscectomy (MD), is still debated and need further data. We performed an extensive review based on the last 6 years of surgical series, systematic reviews, and meta-analyses reported in international, English-written literature. Articles regarding patients treated through endoscopic transforaminal or interlaminar approaches for microdiscectomy (MD) were included in the present review. Papers focused on endoscopic surgery for other spinal diseases were not included. From July 2009 to July 2015, we identified 51 surgical series, 5 systematic reviews, and one meta-analysis reported. In lumbar EDS, rate of complications, length of hospital staying, return to daily activities, and overall patients’ satisfaction seem comparable to standard MD. Rate of recurrence/residual seems higher in EDS, although data are nonhomogeneous among different series. Surgical indication and experience of the performing surgeon are crucial factors affecting the outcome. There is growing but still weak evidence that lumbar EDS is a valid and safe alternative to standard open microdiscectomy. Statistically reliable data obtained from randomized controlled trials (better if multicentric) are desirable to further confirm these results
Dissecting aneurysm of the middle cerebral artery treated with heparin infusion in a 6-year-old child; neurological recovery with delayed spontaneous thrombosis: case illustration and literature review
Aneurysms in the pediatric population are a rare pathology with specific features which requires a deep knowledge of their pathogenesis for the best therapeutic choice; the authors report their experience with a patient presenting aneurysm of the middle cerebral artery (MCA) associated with proximal stenosis of the vessel. A six-year-old girl came to our observation after sudden onset of headache and left hemiparesis. Angio-MRI and angio-CT scan showed a right MCA dissecting aneurysms associated with proximal stenosis of the vessel. Patient started a therapy with low molecular weight heparin (LMWH), replaced, 15 days later, with acetyl-salicylic acid (ASA). Patient showed a rapid and almost complete neurological recovery, despite several radiological exams confirmed a complete occlusion of the right MCA. As many other authors noted, dissecting aneurysms in the pediatric population are probably due to a defect of the entire arterial wall. Combination of stenosis, turbulence and partial thrombosis of the aneurysm led to a complete occlusion of artery involved, leading to the formation of collateral circles. In our case, complete thrombosis was probably delayed with anticoagulant therapy and the progressive reinforcement of collateral circles lead to the patient's neurological recovery
Anterior cranial fossa traumas: clinical value, surgical indications and results – A retrospective study on a series of 223 patients
Objective Frontobasal fractures are relatively common traumas but surgical indications are still discussed. The authors report their results on patients showing anterior cranial fossa fractures; clinical data, surgical indications, and results are reported and critically analyzed.
Methods From 1991 to 2010, 223 patients were admitted in our institution with diagnosis of anterior cranial fossa fracture. Fractures were classified as type A-fracture of the anterior wall of the frontal sinus; type B-fracture of the posterior wall of the frontal sinus; and type C-frontobasal traumas without involvement of the frontal sinus. All patients entered a follow-up program consisting in periodic controls.
Results A total of 105 patients were conservatively treated, while 118 patients underwent surgical intervention. The presence of pneumocephalus (p < 0.0001) and rhinoliquorrhea (p = 0.001) were the factors influencing the surgical indication. In the fractures of group B with signs of pneumocephalus and or rhinoliquorrhea, full sinus cranialization represents the variable mainly influencing the outcome (p < 0.001).
Conclusion Patients with frontobasal traumas should be carefully evaluated to choose the best treatment option. Clinical and radiological data suggest that patients with frontobasal fractures with massive pneumocephalus and/or rhinoliquorrhea should be always surgically treated
Midline medulloblastoma versus astrocytoma: the position of the superior medullary velum as a sign for diagnosis.
PURPOSE:
We wish to describe the position of the superior medullary velum (SMV) in midline posterior fossa tumours as a sign in helping to distinguish between midline medulloblastoma and midline astrocytoma.
MATERIAL AND METHODS:
Sagittal T1-weighted MRI images of 21 consecutive patients with histologically documented posterior fossa midline astrocytomas (nine cases) and medulloblastomas (12 cases) were reviewed, with respect to the position of the velum medullare superius.
RESULTS:
In all medulloblastomas the SMV was superiorly dislocated; in eight astrocytomas it was anteriorly and/or inferiorly disclocated; only in one astrocytoma the SMV presented upward dislocation.
CONCLUSION:
In the differential diagnosis between medulloblastoma and astrocytoma the upward dislocation of the SMV is strongly suggestive of medulloblastoma