Femoral nerve block- or intravenous- guided patient control analgesiafor early physical rehabilitation after anterior cruciate ligament reconstruction in "fast-track" orthopedics: what is optimal?

Background and purpose: "Fast-track" orthopaedics characterizes early start of physical rehabilitation (PHR). Quality of mobilization depends on pain therapy success and preservation of motor function and muscle strength. Patient-control-analgesia (PCA), as an upgrade of continuous intravenous (IV) or regional analgesia (FB) makes the modern base in treatment of acute pain. The aim of the study was to determine more effective post-operative PCA-analgesia (IV-PCA vs. FB-PCA) for early PHR in "fast-track" orthopaedics. Materials and Methods: Prospective, observer-blinded study included 40 adults (bought gender, ASA I/II) scheduled for anterior cruciate ligament reconstruction (RACL). Spinal anaesthesia (12.5 mg, 0.5% levobupivacaine; G27-Pencil-Point) was performed in all patients. Patients were divided in two equal groups. In Group IV-PCA intravenous (fentanyl 0.5-1μg kg–1h–1), and in Group FB-PCA regional (femoral block: 0.125% levobupivacaine, 8 ml h–1) PCA-analgesia (Group IV-PCA: fentanil 10μg/8min/x6max; Group FB-PCA: 0.125% levobupivacaine, 8ml/30min/x3max) was established after surgery. Pain score (VAS) was assessed during 24-hours and accepted as satisfactory by 3. Diclofenac 75 i.v. was given in two doses, immediatelly and 12 hours after surgery. Paracetamol 1g was added intravenously if VAS was ³ 4. Start of early PHR was planned six hours after surgery. Result: FB- and IV-PCA provided equally effective analgesia during first 24-hours after RACL (VAS3). Early PHR was possible 6-hours after surgery in 85% of Group FB-PCA (Group IV-PCA=20%) (P=0,0001) due to significantly lower VAS 0,7+/–0,2 (Group IV-PCA=3,0+/–0,2)(P<0,0001). Residual motor block, presented in three patient (15%) with FB-PCA, disabled the onset of PHR.Additional analgesic dose wasmore need inGroup IV-PCA(40%) (Group FB-PCA=10%) (P<0,0001). Conclusion: FB-PCA allows more successful pain-free early PHR for orthopaedics "fast-track" ACL reconstruction compare to IV-PCA, excluding 15% of the FB-PCA patients in whom residual muscle weakness was present

Deep learning pipeline for quality filtering of MRSI spectra.

With the rise of novel 3D magnetic resonance spectroscopy imaging (MRSI) acquisition protocols in clinical practice, which are capable of capturing a large number of spectra from a subject's brain, there is a need for an automated preprocessing pipeline that filters out bad-quality spectra and identifies contaminated but salvageable spectra prior to the metabolite quantification step. This work introduces such a pipeline based on an ensemble of deep-learning classifiers. The dataset consists of 36,338 spectra from one healthy subject and five brain tumor patients, acquired with an EPSI variant, which implemented a novel type of spectral editing named SLOtboom-Weng (SLOW) editing on a 7T MR scanner. The spectra were labeled manually by an expert into four classes of spectral quality as follows: (i) noise, (ii) spectra greatly influenced by lipid-related artifacts (deemed not to contain clinical information), (iii) spectra containing metabolic information slightly contaminated by lipid signals, and (iv) good-quality spectra. The AI model consists of three pairs of networks, each comprising a convolutional autoencoder and a multilayer perceptron network. In the classification step, the encoding half of the autoencoder is kept as a dimensionality reduction tool, while the fully connected layers are added to its output. Each of the three pairs of networks is trained on different representations of spectra (real, imaginary, or both), aiming at robust decision-making. The final class is assigned via a majority voting scheme. The F1 scores obtained on the test dataset for the four previously defined classes are 0.96, 0.93, 0.82, and 0.90, respectively. The arguably lower value of 0.82 was reached for the least represented class of spectra mildly influenced by lipids. Not only does the proposed model minimise the required user interaction, but it also greatly reduces the computation time at the metabolite quantification step (by selecting a subset of spectra worth quantifying) and enforces the display of only clinically relevant information

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Application of Novel Lossless Compression of Medical Images Using Prediction and Contextual Error Modeling

Conduction of tele-3D-computer assisted operations as well as other telemedicine procedures often requires highest possible quality of transmitted medical images and video. Unfortunately, those data types are always associated with high telecommunication and storage costs that sometimes prevent more frequent usage of such procedures. We present a novel algorithm for lossless compression of medical images that is extremely helpful in reducing the telecommunication and storage costs. The algorithm models the image properties around the current, unknown pixel and adjusts itself to the local image region. The main contribution of this work is the enhancement of the well known approach of predictor blends through highly adaptive determination of blending context on a pixel-by-pixel basis using classification technique. We show that this approach is well suited for medical image data compression. Results obtained with the proposed compression method on medical images are very encouraging, beating several well known lossless compression methods. The predictor proposed can also be used in other image processing applications such as segmentation and extraction of image regions

Primary Malignant Fibrous Histiocytoma of the Spleen: Recurrence Eight Years after Splenectomy – Report of a Case and Literature Review

Primary intraabdominal malignant mesenchymal tumors are very rare. There are just few cases of intraabdominal visceral malignant fibrous histiocytoma in the literature. We report a case of primary malignant fibrous histiocytoma of the spleen in a 57-year-old man, with a recurrence eight years after the splenectomy. After the initial surgery the patient was without complaints, and refused to receive chemotherapy or radiotherapy. Eight years after the surgery the patient reported due to general weakness and malaise when the diagnosis of disease relapse was established. Radical surgery was performed although the tumor involved large curvature of the stomach, left crus of the diaphragm, splenic flexure of the colon and tail of pancreas. Four months after the surgery patient died. To the best of our knowledge, to date, only 18 cases have been reported in the literature, describing malignant fibrous histiocytoma of the spleen

An open architecture control system for multi-axis wood CNC machining center

This paper presents an open architecture control system for multi‐axis wood computer numerical control (CNC) milling machining centre, based on LinuxCNC. The wood CNC machining system is supported by an equivalent virtual machine in a CAD/CAM environment, as well as in the control system. Simulation within virtual environment is essential for multi‐axis machining, and the developed virtual machines are used for program verification and monitoring of the machining process. The virtual machine in the programming system allows the verification of the program before it’s sent to the actual machine, while the virtual machine in the control system represents the final verification of the program, as well as the process monitoring system. Configuration of the control system and implementation of virtual machines will be shown, along with the conducted machining experiments that ensued after the successful simulation on developed virtual machines.For publisher: Full. Prof. Aleksandar Milašinović, Ph

An open architecture control system for multi-axis wood CNC machining center

This paper presents an open architecture control system for multi‐axis wood computer numerical control (CNC) milling machining centre, based on LinuxCNC. The wood CNC machining system is supported by an equivalent virtual machine in a CAD/CAM environment, as well as in the control system. Simulation within virtual environment is essential for multi‐axis machining, and the developed virtual machines are used for program verification and monitoring of the machining process. The virtual machine in the programming system allows the verification of the program before it’s sent to the actual machine, while the virtual machine in the control system represents the final verification of the program, as well as the process monitoring system. Configuration of the control system and implementation of virtual machines will be shown, along with the conducted machining experiments that ensued after the successful simulation on developed virtual machines.For publisher: Full. Prof. Aleksandar Milašinović, Ph

Prevencija sindroma abdominalnog kompartmenta pri teškim intraabdominalnim infekcijama

CILJ je usporediti rezultate dviju različitih metoda kirurškoga liječenja teške intraabdominalne infekcije. BOLESNICI I METODE: Provedena je prospektivna multicentrična studija od siječnja 2002. do prosinca 2003. U studiju je uključeno 36 bolesnika u Kliničkoj bolnici u Splitu, liječenih klasičnim “on-demand” kirurškim načinom liječenja i 32 bolesnika u Općoj bolnici u Sisku, liječenih individualno planiranim reintervencijama, primjenjujući poluotvoreni način liječenja laparostomom. Dva su bolesnika u prvoj skupini i jedan u drugoj skupini isključeni iz studije, jer su imali lokalizirani oblik peritonitisa. Bolesnici su uspoređivani prema dobi, spolu, uzroku infekcije, uzročniku infekcije, APACHE II skoru, duljini bolničkoga liječenja, postoperativnim komplikacijama i stopi smrtnosti. REZULTATI: Najčešći uzroci infekcija bili su nekrotizirajući pankreatitis i dehiscencija kolorektalne anastomoze, u obje skupine gotovo isto. APACHE II skor je u obje skupine bio visok, u prvoj skupini 22.15, a u drugoj skupini 22.09 bodova. MRSA je najčešći uzročnik infekcije, potom Pseudomonas, Enterokok i Escherichia colli. Postoperativne komplikacije bile su dehiscencija anastomoze, interintestinalni apscesi, ARDS i MOF. Smrtnost je u prvoj skupini bolesnika veća, 20/34 umrlih, uspoređujući je s drugom skupinom bolesnika, u kojoj je umrlo 9/31 bolesnika. Ta je razlika statistički značajna. Fisherov test je P=0.028. ZAKLJUČAK: Bolesnici s teškim oblikom intraabdominalne infekcije najbolje su karakterizirani visokim APACHE II skorom i zahtijevaju multimodalni pristup liječenju u jedinici intenzivnoga liječenja: gotovo trenutno kirurško liječenje, resuscitaciju, primjereno suportivno i ciljano antimikrobno liječenje. Naši rezultati pokazuju da inividualnim planiranjem reintervencija i kreiranjem posebno dizajnirane inovativne laparostome, prekrivene nešivanom plastičnom vrećicom, postižemo bolje rezultate liječenja. Imamo i manju smrtnost u usporedbi s klasičnim kirurškim liječenjem, gdje se reintervencije indiciraju nakon pogoršanja općega stanja bolesnika. Smatram da ponovljenim, unaprijed planiranim, operacijama postižemo bolju kontrolu izvorišta infekcije, a laparostoma sprječava porast tlaka u trbušnoj šupljini i razvitak abdominalnoga kompartmenta, koji je često uzrok lošega rezultata liječenja.AIM: Comparison of the results of two surgical approaches in patients with severe intra-abdominal infections. PATIENTS AND METHODS: Prospective multicentric study was performed from January 2002 to December 2003. There were 36 patient in Clinical Hospital Split treated with classical On-demand laparotomy, and 32 patients in General Hospital Sisak treated with semi-open laparostomy with individually planned reinterventions. Two patients from the first group and one patient from the second group were excluded, because of localized peritonitis. Patients were stratified by age, gender, source of infections, cause of peritonitis, APACHE II score, hospital stay, postoperative complications and mortality. RESULTS: The most frequent cause of infections were necrotizing pancreatitis and colon and rectum anastomosis dehiscence in both groups, APACHE II score were high in both groups with average 22.15 ± 19.41 in the first and 22.09 ± 6.86 in the second group, cause of intra-abdominal infections most frequently were MRSA, followed by Pseudomonas, Enterococcus and Escherichia colli. Postoperative complications were anastomosis dehiscence, intestinal abscesses, ARDS and MOF. The mortality rate were higher in the first group 20/34 comparing 9/31 in the second group, this differences are statistically significant, (Fisher exact test P=0.028). CONCLUSION: Patients with severe intra-abdominal infection, best documented with high APACHE II score, require multimodal treatment in the intensive care unit, consisting proper resuscitation and support followed by appropriate antimicrobial therapy and immediate surgical interventions. Our results suggest that individually planned reinterventions with specially designed semi-open laparostomy covered with innovative sutureless plastic sheet have a lower mortality rate comparing classical on-demand laparotomy, mostly because more aggressive approach has better source control and because semi-open laparotomy avoids abdominal compartment syndrome which may have undesirable result

Prevencija sindroma abdominalnog kompartmenta pri teškim intraabdominalnim infekcijama

CILJ je usporediti rezultate dviju različitih metoda kirurškoga liječenja teške intraabdominalne infekcije. BOLESNICI I METODE: Provedena je prospektivna multicentrična studija od siječnja 2002. do prosinca 2003. U studiju je uključeno 36 bolesnika u Kliničkoj bolnici u Splitu, liječenih klasičnim “on-demand” kirurškim načinom liječenja i 32 bolesnika u Općoj bolnici u Sisku, liječenih individualno planiranim reintervencijama, primjenjujući poluotvoreni način liječenja laparostomom. Dva su bolesnika u prvoj skupini i jedan u drugoj skupini isključeni iz studije, jer su imali lokalizirani oblik peritonitisa. Bolesnici su uspoređivani prema dobi, spolu, uzroku infekcije, uzročniku infekcije, APACHE II skoru, duljini bolničkoga liječenja, postoperativnim komplikacijama i stopi smrtnosti. REZULTATI: Najčešći uzroci infekcija bili su nekrotizirajući pankreatitis i dehiscencija kolorektalne anastomoze, u obje skupine gotovo isto. APACHE II skor je u obje skupine bio visok, u prvoj skupini 22.15, a u drugoj skupini 22.09 bodova. MRSA je najčešći uzročnik infekcije, potom Pseudomonas, Enterokok i Escherichia colli. Postoperativne komplikacije bile su dehiscencija anastomoze, interintestinalni apscesi, ARDS i MOF. Smrtnost je u prvoj skupini bolesnika veća, 20/34 umrlih, uspoređujući je s drugom skupinom bolesnika, u kojoj je umrlo 9/31 bolesnika. Ta je razlika statistički značajna. Fisherov test je P=0.028. ZAKLJUČAK: Bolesnici s teškim oblikom intraabdominalne infekcije najbolje su karakterizirani visokim APACHE II skorom i zahtijevaju multimodalni pristup liječenju u jedinici intenzivnoga liječenja: gotovo trenutno kirurško liječenje, resuscitaciju, primjereno suportivno i ciljano antimikrobno liječenje. Naši rezultati pokazuju da inividualnim planiranjem reintervencija i kreiranjem posebno dizajnirane inovativne laparostome, prekrivene nešivanom plastičnom vrećicom, postižemo bolje rezultate liječenja. Imamo i manju smrtnost u usporedbi s klasičnim kirurškim liječenjem, gdje se reintervencije indiciraju nakon pogoršanja općega stanja bolesnika. Smatram da ponovljenim, unaprijed planiranim, operacijama postižemo bolju kontrolu izvorišta infekcije, a laparostoma sprječava porast tlaka u trbušnoj šupljini i razvitak abdominalnoga kompartmenta, koji je često uzrok lošega rezultata liječenja.AIM: Comparison of the results of two surgical approaches in patients with severe intra-abdominal infections. PATIENTS AND METHODS: Prospective multicentric study was performed from January 2002 to December 2003. There were 36 patient in Clinical Hospital Split treated with classical On-demand laparotomy, and 32 patients in General Hospital Sisak treated with semi-open laparostomy with individually planned reinterventions. Two patients from the first group and one patient from the second group were excluded, because of localized peritonitis. Patients were stratified by age, gender, source of infections, cause of peritonitis, APACHE II score, hospital stay, postoperative complications and mortality. RESULTS: The most frequent cause of infections were necrotizing pancreatitis and colon and rectum anastomosis dehiscence in both groups, APACHE II score were high in both groups with average 22.15 ± 19.41 in the first and 22.09 ± 6.86 in the second group, cause of intra-abdominal infections most frequently were MRSA, followed by Pseudomonas, Enterococcus and Escherichia colli. Postoperative complications were anastomosis dehiscence, intestinal abscesses, ARDS and MOF. The mortality rate were higher in the first group 20/34 comparing 9/31 in the second group, this differences are statistically significant, (Fisher exact test P=0.028). CONCLUSION: Patients with severe intra-abdominal infection, best documented with high APACHE II score, require multimodal treatment in the intensive care unit, consisting proper resuscitation and support followed by appropriate antimicrobial therapy and immediate surgical interventions. Our results suggest that individually planned reinterventions with specially designed semi-open laparostomy covered with innovative sutureless plastic sheet have a lower mortality rate comparing classical on-demand laparotomy, mostly because more aggressive approach has better source control and because semi-open laparotomy avoids abdominal compartment syndrome which may have undesirable result

Prevencija sindroma abdominalnog kompartmenta pri teškim intraabdominalnim infekcijama

CILJ je usporediti rezultate dviju različitih metoda kirurškoga liječenja teške intraabdominalne infekcije. BOLESNICI I METODE: Provedena je prospektivna multicentrična studija od siječnja 2002. do prosinca 2003. U studiju je uključeno 36 bolesnika u Kliničkoj bolnici u Splitu, liječenih klasičnim “on-demand” kirurškim načinom liječenja i 32 bolesnika u Općoj bolnici u Sisku, liječenih individualno planiranim reintervencijama, primjenjujući poluotvoreni način liječenja laparostomom. Dva su bolesnika u prvoj skupini i jedan u drugoj skupini isključeni iz studije, jer su imali lokalizirani oblik peritonitisa. Bolesnici su uspoređivani prema dobi, spolu, uzroku infekcije, uzročniku infekcije, APACHE II skoru, duljini bolničkoga liječenja, postoperativnim komplikacijama i stopi smrtnosti. REZULTATI: Najčešći uzroci infekcija bili su nekrotizirajući pankreatitis i dehiscencija kolorektalne anastomoze, u obje skupine gotovo isto. APACHE II skor je u obje skupine bio visok, u prvoj skupini 22.15, a u drugoj skupini 22.09 bodova. MRSA je najčešći uzročnik infekcije, potom Pseudomonas, Enterokok i Escherichia colli. Postoperativne komplikacije bile su dehiscencija anastomoze, interintestinalni apscesi, ARDS i MOF. Smrtnost je u prvoj skupini bolesnika veća, 20/34 umrlih, uspoređujući je s drugom skupinom bolesnika, u kojoj je umrlo 9/31 bolesnika. Ta je razlika statistički značajna. Fisherov test je P=0.028. ZAKLJUČAK: Bolesnici s teškim oblikom intraabdominalne infekcije najbolje su karakterizirani visokim APACHE II skorom i zahtijevaju multimodalni pristup liječenju u jedinici intenzivnoga liječenja: gotovo trenutno kirurško liječenje, resuscitaciju, primjereno suportivno i ciljano antimikrobno liječenje. Naši rezultati pokazuju da inividualnim planiranjem reintervencija i kreiranjem posebno dizajnirane inovativne laparostome, prekrivene nešivanom plastičnom vrećicom, postižemo bolje rezultate liječenja. Imamo i manju smrtnost u usporedbi s klasičnim kirurškim liječenjem, gdje se reintervencije indiciraju nakon pogoršanja općega stanja bolesnika. Smatram da ponovljenim, unaprijed planiranim, operacijama postižemo bolju kontrolu izvorišta infekcije, a laparostoma sprječava porast tlaka u trbušnoj šupljini i razvitak abdominalnoga kompartmenta, koji je često uzrok lošega rezultata liječenja.AIM: Comparison of the results of two surgical approaches in patients with severe intra-abdominal infections. PATIENTS AND METHODS: Prospective multicentric study was performed from January 2002 to December 2003. There were 36 patient in Clinical Hospital Split treated with classical On-demand laparotomy, and 32 patients in General Hospital Sisak treated with semi-open laparostomy with individually planned reinterventions. Two patients from the first group and one patient from the second group were excluded, because of localized peritonitis. Patients were stratified by age, gender, source of infections, cause of peritonitis, APACHE II score, hospital stay, postoperative complications and mortality. RESULTS: The most frequent cause of infections were necrotizing pancreatitis and colon and rectum anastomosis dehiscence in both groups, APACHE II score were high in both groups with average 22.15 ± 19.41 in the first and 22.09 ± 6.86 in the second group, cause of intra-abdominal infections most frequently were MRSA, followed by Pseudomonas, Enterococcus and Escherichia colli. Postoperative complications were anastomosis dehiscence, intestinal abscesses, ARDS and MOF. The mortality rate were higher in the first group 20/34 comparing 9/31 in the second group, this differences are statistically significant, (Fisher exact test P=0.028). CONCLUSION: Patients with severe intra-abdominal infection, best documented with high APACHE II score, require multimodal treatment in the intensive care unit, consisting proper resuscitation and support followed by appropriate antimicrobial therapy and immediate surgical interventions. Our results suggest that individually planned reinterventions with specially designed semi-open laparostomy covered with innovative sutureless plastic sheet have a lower mortality rate comparing classical on-demand laparotomy, mostly because more aggressive approach has better source control and because semi-open laparotomy avoids abdominal compartment syndrome which may have undesirable result