LEFMIS: locally-oriented evaluation framework for medical image segmentation algorithms.

This article proposes a novel framework for the locally-oriented evaluation of segmentation algorithms (LEFMIS). The presented approach is robust and takes into account local inter/intra-observer variability and the anisotropy of medical images. What is more, the framework makes it possible to distinguish types of error locally. These features are crucial in the context of cancer image data. The proposed framework is based on use of the signed anisotropic Euclidean distance transform and the distance projection. It can be used easily in many different applications with or without additional expert outlines (both inter- and intra-observer variability). The performance of the proposed framework is depicted using both artificial and kidney cancer CT data with experts' manual outlines. In the article, in the case of artificial data, it is presented that the manual outlines dispersion is symmetric in relation to the truth border. The effectiveness of the selected segmentation algorithm was analysed in the context of kidney cancer using computed tomography data. For the calculated local inter-observer variability, 80.11% of the surface points generated by the kidney segmentation algorithm are within one expert outline standard deviation and 97.96% are within five. An error distribution shift in the direction of type I error equivalent was also observed. Finally, the significance of the local estimation of error type differences is presented. The article shows the greater usefulness and flexibility of the proposed framework in comparison to the state-of-the-art methods. The exemplary usage of the LEFMIS with or without inter-/intra-observer variability is also presented.

[The use of hemostatic agent Tachosil in surgical treatment of kidney cancer infiltrating liver--case report]. / Zastosowanie Tachosilu jako srodka hemostatycznego w leczeniu operacyjnym raka nerki naciekajacego watrobe--opis przypadku.

UNLABELLED: The right kidney cancer very rarely locally invades the liver as compared with blood metastasis which occur more frequent. In these cases, the only extensive surgical resection of part of the liver gives the opportunity to improve survival dependent on kidney cancer. In the intra-and postoperative bleeding and leakage of bile from the liver cut surface is a complication that it depends on the success of the treatment. A valuable complement to traditional ways of obtaining hemostasis is sealed section of liver collagen patches of horse, which are covered with tissue adhesive supplemented human fibrinogen and thrombin (Tachosil). The aim of this study is to present the case of 38-year-old woman with a tumor of the upper pole of the right kidney invasive by the continuity of the right lobe of liver, in which the classic methods of obtaining hemostasis supplemented using Tachosil postoperative course and a comparison with data from the literature. RESULTS: We demonstrated the usefulness of the application Tachosil sealing vascular suture in the vein cava inferior and obtain hemostasis and tissue sealing the right liver lobe cross-section area of about 250 cm2. After treatment, a patient had drainage from the site of the kidney comparable with data from the literature. Patient was discharged home on postoperative day 7 in good condition. CONCLUSIONS: Tachosil in major surgery because of locally advanced kidney cancer that invades the liver is a valuable complement to conventional surgical methods allowing for atraumatic stop bleeding and seal parenchymal liver tissue. Doing so helps to avoid early and late complications and reduce the cost of treating these complications.

Methodology and evaluation of the renal arterial system.

INTRODUCTION: The broad range of medical images and image processing technologies are applied in urology. The aim was to propose methodology to assess three-dimensional (3D) arrangement of renal arterial tree and to build a statistical model for analyzing the layout of arteries in the sections of the kidney. METHODS: The series of kidney CT slices are analyzed using image processing procedures and further the 3D model of arterial systems is converted to a graph tree which includes information about features of the renal arterial system. RESULTS: The selected endocast was transformed to the form of the 3D connected tubes, further to the tree data structure and next analyzed. The information about 3D coordinates of the nodes, also branch length and diameter were stored. Renal arterial system of the considered kidney possessed 181 branches with 14 bifurcation levels. The number of branches was highest at the 9th bifurcation level. The mean length of the arterial branch on each bifurcation level was constant (6 mm). The branch diameters rapidly decreased after each bifurcation. The number of terminal branches increases up to 9th level where there are 19 terminal branches. The mean length of terminal arteries was 7.17 mm while the mean radius 0.46 mm. A statistically significant correlation between parameters that described sub-trees was noticed. It was observed that the individual artery segments occupy a separate space in the kidney volume. CONCLUSIONS: The methodology has the potential to assist in presurgical planning based on branching patterns of the renal arterial system and corresponding pathology.

Prognostic factors of overall survival in renal cancer patients - single oncological center study.

INTRODUCTION: The clinical course of renal cancer remains difficult to predict. Attempts to appoint new independent prognostic factors (IPFs) and comparisons of already identified ones among populations are inevitable to develop more effective prognostic instruments. The aim of this study was to evaluate IPFs of overall survival in a given population of patients with renal cancer. MATERIALS AND METHODS: Retrospective analysis of 148 patients with renal cancer treated at the Oncological Institute in Cracow from 2000 to 2007 was performed. Mean follow-up was 51 months. Using the log-rang test, a group of clinicopathological and biochemical features was analyzed in respect to their influence on overall survival. Results were presented as Kaplan-Meier curves. Final identification of IPFs was made by multivariate Cox regression analysis. RESULTS: Overall survival rate at 1, 2, and 5-year follow-up was 58.8%, 38.2%, and 21.4%, respectively. The set of identified IPFs consisted of performance status, smoking history, hemoglobin concentration, anatomical staging, tumor grade, and the presence of microvascular invasion. It was confirmed that only nephrectomy increases significantly overall survival. CONCLUSIONS: Apart from smoking history, the role of all other IPFs identified in our study is well documented in the literature. Smoking history seems to be a new IPF with strong negative impact on survival in patients with RCC.

[Selected markers of oxidative stress and carcinogenic trace elements concentrations in the renal cell carcinoma tissue]. / Wybrane markery stresu oksydacyjnego a stezenie rakotwórczych pierwiastków sladowych w tkance raka nerki.

UNLABELLED: In industrialized countries, increasing concentrations of harmful trace elements in the human environment increases their concentration in the organs, which in turn may be responsible for the growth of cancer including cancer of the kidney. Trace elements by increasing the concentration of active free radicals damage cell DNA, and in a consequence increase the risk of carcinogenesis. The aim of this study was to determine concentrations of biochemical markers providing an increase in the concentration of free radicals in the cell kidney cancer and renal cortical tissue, from which it originates and to attempt correlation of these markers with the concentration of carcinogenic trace elements identified in these same tissues using spectral analysis of PIXE (Proton induced X-Ray Emmision). MATERIALS AND METHODS: Of the 12 kidneys removed because of renal cell carcinoma clippings taken from the parenchyma of the kidney and kidney tumor, and then the concentration of markers of oxidative stress such as malonic dialdehyd (MDA), reduced form and oxidized glutathione and 1-ascorbic acid of the tissue. The concentration of elements was made by means of physical methods of analysis of multielemental PIXE (Proton Induced X-Ray Emission) in tumor tissue and kidney tissue of renal cortical tumor unchanged. RESULTS: Malonic dialdehyd concentrations (MDA), reduced and oxidized forms of glutathione and 1-ascorbic acid were successively 2.11, 1.23, 0.84 and 2.25 microg/g for tissue kidney tumor and subsequently one, 58, 0.99, 0.58 and 2.3 microg/g in the kidney cortex from which the tumor originates. Demonstrated significant differences in MDA concentrations (p < 0.01) and the oxidized form of glutathione (p < 0.05). In the analysis of correlation between the concentrations of markers of the concentrations of elements are carcinogenic by IARC (International Agency for Research on Cancer) showed significant increase in the concentration of 1-ascorbic acid with increasing concentrations of lead in kidney tumor tissue. In the renal cortex increased concentrations of MDA and oxidized forms of glutathione was significantly correlated with increased levels of selenium. CONCLUSIONS: By markers of oxidative stress has been shown indirectly to increased metabolism of oxygen free radicals in kidney tumor tissue compared to kidney cortex tissue from which it derives. At the same time was selected markers concentration dependence of the concentration of the elements considered by the IARC human carcinogens. Confirmation of these results on a larger group of patients may become a contribution to the study of substances that protect the kidney against carcinogens storage elements or substances that reduce oxidative stress in the kidney.

Bioequivalence study of 500 mg cefuroxime axetil film-coated tablets in healthy volunteers.

The aim of the study was to investigate the bioavailability of a generic product of 500 mg cefuroxime axetil film-coated tablets (test) as compared to that of a branded product (reference) at the same strength to determine bioequivalence and to apply for regulatory approval. The secondary objective of the study was to evaluate tolerability of both products. A double blinded, randomized, crossover, two-period, single-dose, comparative study was conducted in Caucasian healthy volunteers in fasting conditions. A single oral dose administration of the test or reference product was followed by 7-day wash-out period. The cefuroxime concentration was determined using a validated HPLC-UV method. The results of the single-dose study in healthy volunteers indicated that the film-coated tablets of Tarsime 500 mg manufactured by Tarchominskie Zaklady Farmaceutyczne Polfa S.A. (test product) are bioequivalent to those of Zinnat manufactured by GlaxoSmithKline Export Ltd. (reference product). Both products were well tolerated.

[Evaluation of 99mTc-DTPA scyntygraphy of the relative degree of renal dysfunction after surgical removal of kidney tumor]. / Ocena scyntygraficzna 99mTc-DTPA stopnia uposledzenia funkcji nerki po zabiegach usuniecia guza nerki.

UNLABELLED: In nephron sparing surgery (NSS) procedures the most important is oncological outcome and also the preservation of maximum renal function. Renal scyntygraphy using 99mTc-DTPA allows for assessment of renal function and its changes after surgery because of tumor. THE AIM OF THIS STUDY: To assess the loss of kidney function operated using 99mTc-DTPA scyntygraphy, depending on the location of the tumor, type of growth, and time of warm ischemia of the operated kidney. MATERIALS AND METHODS: Renal scyntygraphy was performed in 30 patients who underwent NSS procedures for renal cortical tumors of its diameter of about 3.2 cm (range: 2.5-4.1 cm) before surgery and after surgery at an average of 3.8 months (range: 2.3-5.4 months). All patients were stratified according to time of warm ischemia (up to and above 10 mines), type of tumor growth (endo- and egzophytic) and tumor location (upper, middle and lower pole). RESULTS: The relative loss of kidney function operated depending on the type of kidney tumor growth when egzophytic and endophytic was amounted to 16% (range: 12-22%) and 29% (range: 24-46%) respectively (p < 0.01), in contrast depending on the location in the upper, middle and lower pole of the kidney 24% (range: 12-36%), 31% (range: 26-46%) and 25% (range: 15-38%), respectively (p < 0.05) Depending on the time of warm ischemia for up to and above 10 mines a relative loss of kidney function of surgery was set at 21% (range: 12-24%) and 31% (range: 29-46%), respectively (p < 0.1). CONCLUSIONS: The results of this study suggest that the loss of kidney function after NSS procedures for renal cortical tumor is the largest in the middle field of tumor endophytic growth where, during the operation the time of warm ischemia is the longest. Tumors of this type should be operating in the centers performing these procedures on a routine basis.

[Urological surgical technique using image guided therapy]. / Operacje urologiczne kierowane za pomoca technik obrazowania.

In open urological operations planning and appropriate course of treatment based on the experience of operator and information collected directly by the sense of vision and touch during operation. With the development of minimally invasive urology surgical techniques, as well as laparoscopic techniques, the operator is facing an increasing problem associated with the increasingly limited access to the operating area, or just watching them directly on the monitor. Currently looking for new techniques for better imaging, planning, carrying out surgery, and improving access to the surgical site. These techniques should allow dynamic linking of intraoperative image (anatomy of the operating field) with a two-dimensional pre-operative imaging studies of 2-D, as well as intraoperative imaging, three-dimensional 3-D. A promising treatment is surgery technique-driven image (IGT--image guided therapy), whose essence is to carry out the surgery with indirect insight into the operative field. Intraoperative three-dimensional imaging allows for real-time three-dimensional visualization of the operative field available to the operator, as well as the invisible. The paper reviews the current imaging techniques used during the surgical treatment of urolithiasis, renal cancer and prostate cancer.

[Augmented reality for image guided therapy (ARIGT) of kidney tumor during nephron sparing surgery (NSS): animal model and clinical approach]. / Obrazowanie guza nerki w trakcie zabiegow nerkooszczednych: model zwierzecy i zastosowanie kliniczne.

INTRODUCTION: The main problem in nephron sparing surgery (NSS) is to preserve renal tumors oncological purity during the removal of the tumor with a margin of macroscopically unchanged kidney tissue while keeping the largest possible amount of normal parenchyma of the operated kidney. The development of imaging techniques, in particular IGT (Image Guided Therapy) allows precise imaging of the surgical field and, therefore, is essential in improving the effectiveness of NSS (increase of nephron sparing with the optimal radicality). AIM: The aim of this study was to develop a method of the three-dimensional (3D) imaging of the kidney tumor and its lodge in the operated kidney using 3D laser scanner during NSS procedure. Additionally, the animal model of visualization was developed. MATERIAL AND METHODS: The porcine kidney model was used to test the set built up with HD cameras and linear laser scanner connected to a laptop with graphic software (David Laser Scanner, Germany) showing the surface of the kidney and the lodge after removal the chunk of renal parenchyma. Additionally, the visualization and reconstruction was performed on animal porcine model. Moreover, 5 patients (3 women, 2 men) aged from 37 to 68 years (mean 56), diagnosed with kidney tumors in CT scans with a diameter of 3.7-6.9 cm (mean 4.9) were operated in our Department this year, scanning the surface during the treatment with the kidney tumor and kidney tumor after it is removed with a margin of renal tissue. In one case, the lodge of removed tumor was scanned. Dimensions in 3D reconstruction images of laser scans in the study of animal model and the images obtained intraoperatively were compared with the dimensions evaluated during preoperative CT scans, intraoperative measurements. RESULTS: Three-dimensional imaging laser scanner operating field loge resected tumor and the tumor on the kidney of animal models and during NSS treatments for patients with kidney tumors is possible in real time with an accuracy of -2 mm do +9 mm (+/- 3 mm). The duration of data acquisition by laser scanner and obtain three-dimensional image of the operating field takes an average of 13 seconds +/- 2 seconds. Movements associated with breathing and heart rate did not affect on the quality of the reconstruction. The imposition of the scanned surface texture occurs in real time, allowing you to identify renal parenchymal structures such as renal cortex, pyramids, pyelo-calices complex. CONCLUSIONS: Imaging control of NSS procedures is possible in animal models and in real time intraoperatively. The comparison of tumor size and the tumor lodge obtained in preoperative CT scans with the measurements during NSS procedure provide the surgeon to assess the extent of macroscopic estimation of the resection. This procedure helps the surgeon in obtaining oncological radicality with saving as much normal tissue kidney as possible. Performance of the imaging methods should be evaluated on a larger group of patients with kidney tumors eligible for NSS treatment.

Aspergillosis in children after liver transplantation: Single center experience.

Aspergillus infection in immunocompromised patients is associated with high morbidity and mortality. We retrospectively reviewed cases of Aspergillosis (A), in a series of 277 children who received LTx between 1990 and 2006. All children were given antifungal prophylaxis after transplantation. Aspergillosis was identified in 10 cases (3.6%) and diagnosis was confirmed when clinical symptoms were associated with identification of Aspergillus sp. or detection of galactomannan antigen. Incidence of Aspergillosis considerably decreased from 6.9% to 0.6% when liposomal amphotericin B was introduced as prophylaxis in high-risk patients. Mean time since LTx to Aspergillosis was 14.5 days. Histologically, Aspergillosis was diagnosed in two cases. Galactomannan antigen was present in two recipients. Aspergillus infection occurs usually within first 30 days after transplantation as a result of a combination of several risk factors. Following risk factors were observed: multiple antibiotic therapy, prolonged intensive care unit stay, poor graft function, retransplantation, relaparotomies, co-infection. Amphotericin B was administered in all cases. Two patients (20%) died because of Aspergillosis Liposomal Amphotericin B prophylaxis in high-risk children decreases the incidence of Aspergillus infection. High index of suspicion and early diagnosis followed by intensive treatment with amphotericin B facilitates achieving mortality rate lower than presented in other reports.

Single pretransplant bolus of recombinant activated factor VII ameliorates influence of risk factors for blood loss during orthotopic liver transplantation.

Large blood loss and transfusions during liver transplantation (LTx) may lead to serious complications and have a negative impact on post-transplant mortality and morbidity. In the retrospective study we compared two groups of recipients of primary cadaveric liver transplantation: group I (study group), consisted of 28 patients with preoperative risk of high intraoperative blood loss, including severe uncorrected coagulopathy. This group was given a bolus of recombinant activated factor VII (rFVIIa) just before LTx. Group II (control group) included 61 patients without a particular risk for increased intraoperative blood loss. These patients were not given rFVIIa. We analyzed both groups for: coagulation parameters before, during and after surgery (INR, APTT, factor VII activity), blood and FFP transfusions, operative time, postoperative complications (vascular thrombosis, reoperation for bleeding), postoperative ICU stay, post-transplant hospitalization time and mortality. Patients from the study group (I) had significantly worse coagulation parameters than patients in the control group (II) at the start of the surgical procedure; however, after administration of a bolus of rFVIIa there was immediate correction of coagulation in all recipients. No significant differences in intraoperative blood transfusions were observed between study and control groups (1980 +/- 311.4 mL vs. 1527 +/- 154.2 mL, respectively), operating time (8.7 h vs. 8.9 h) or ICU and hospital stay (7.03 days vs. 6.15 days and 40.89 days vs. 41.1 days). Re-exploration because of bleeding was performed in three patients from group I (10.7%) and in seven patients (11.5%) from group II. No single case of vascular thrombosis was observed in the study group, while in the control group there were three hepatic artery thromboses, two portal vein thromboses and one hepatic vein thrombosis. We conclude that rFVIIa given preoperatively to liver transplant recipients with several risk factors for high intraoperative bleeding adjusts these patients to a normal risk group, without an increased risk for thrombotic complications.

Successful treatment of a child with fulminant liver failure and coma caused by Amanita phalloides intoxication with albumin dialysis without liver transplantation.

FLF is a life-threatening disease. Hepatic coma exerts dramatic impact on patient survival. At present, LTx is the treatment modality of choice that provides significant improvement in outcome of most patients with FLF. Multiple attempts have been made to reduce mortality and improve the patient's condition. One of the new options is AD - MARS. We present the case of a 11-yr-old boy with FLF and hepatic coma who avoided the scheduled LTx because of rapid neurological and biochemical improvement immediately after three MARS sessions.

Preliminary study on the distribution of selected elements in cancerous and non-cancerous kidney tissues.

In this study special interest was given to trace elements recognized as to be carcinogenic to humans. The kidney tissue sections were analyzed in order to determine the concentrations of elements present in the sample. The Synchrotron Radiation Induced X-ray Emission (SRIXE) technique was applied using a white photon microbeam. The results from cancerous parts of the kidney tissues were compared to non-cancerous parts and to the control group. In addition the iron concentration level was determined in the serum of those patients. Two-dimensional scans are presented to illustrate the differences between perfused and not-perfused tissues. According to this study there is no significant difference in the Mn concentration between cancerous and non-cancerous parts of the kidney, but the concentrations of Cd, Cr, Ti, V, Cu, Se, and Zn are at a lower concentration level in the cancerous parts than in the non-cancerous parts. A converse observation has been made for Fe. This may be associated with different metabolism and dynamics of the cancer process and both higher vascularization and need of higher blood supply in the cancerous tissue. The two-dimensional scanning of thin kidney sections showed differences in the trace element distributions depending on the analyzed samples: perfused and non-perfused. Perfusion removed blood mostly from the peritubular capillaries while in the glomerulus some capillaries had a relatively high Fe content. A low Fe concentration was observed in nephron tubules while a converse observation has been made for Cd. This may indicate that Cd is localized in the cells but not in the blood.

Trace elements distribution in renal cell carcinoma depending on stage of disease.

OBJECTIVES: The aim of this study was to identify those trace elements which can be used to distinguish between normal and malignant tissue in renal cell cancer (RCC) kidney and to assess changes in trace elements concentration in tissue with progressing malignant disease. METHODS: In case control study, 36 cases of RCC were analyzed by Synchrotron Radiation Induced X-ray Emission (SRIXE) in order to establish the concentration of 19 elements. Patients with RCC were examined to obtain staging of disease after radical nephrectomy, which was performed in each case. Results were compared with 15 control kidney cortex tissue obtained during autopsy in which cause of death was trauma. RESULTS: The most relevant decrease was detected in Cd content: from 81 +/- 39.2 ppm in normal control samples to 16.6 +/- 22.2 ppm concentration in RCC. We found that the concentrations of Ti, Pb and Rb were also lower in RCC tissue. On the other hand, the RCC tissue was rich in iron and zirconium. With the progress of malignant disease, assessed by TNM (UICC 1997) scale, lower concentration of S and higher concentration of Ca in both RCC and neoplastic kidney cortex can be seen. The same tendency is observed in Zn and Se concentrations. Cadmium shows raising concentration with progress of RCC only in cortex of neoplastic kidney. In all cases it was shown that the relatively high tissue concentration of iron in both investigated tissues is decreasing with the progress of disease. The zirconium has shown raising tissue concentration in advanced disease. CONCLUSION: Trace elements concentration is different in malignant tissue and surrounding macroscopically unchanged kidney cortex. Progress of the disease is connected with changes in trace elements concentration. This may reflect different biology of compared tissue with potential practical implication.