Tubular structures segmentation of pediatric abdominal-visceral ceCT images with renal tumors: Assessment, comparison and improvement.

Renal tubular structures, such as ureters, arteries and veins, are very important for building a complete digital 3D anatomical model of a patient. However, they can be challenging to segment from ceCT images due to their elongated shape, diameter variation and intra- and inter-patient contrast heterogeneity. This task is even more difficult in pediatric and pathological subjects, due to high inter-subject anatomical variations, potential presence of tumors, small volume of these structures compared to the surrounding, and small available labeled datasets. Given the limited literature on methods dedicated to children, and in order to find inspirational approaches, a complete assessment of state-of-the-art methods for the segmentation of renal tubular structures on ceCT images on adults is presented. Then, these methods are tested and compared on a private pediatric and pathological dataset of 79 abdominal-visceral ceCT images with arteriovenous phase acquisitions. To the best of our knowledge, both assessment and comparison in this specific case are novel. Eventually, we also propose a new loss function which leverages for the first time the use of vesselness functions on the predicted segmentation. We show that the combination of this loss function with state-of-the-art methods improves the topological coherence of the segmented tubular structures.2.

Timing of laparoscopic elective surgery for acute left colonic diverticulitis. Retrospective analysis of 332 patients.

PURPOSE: The optimal time to perform elective surgery remains to be determined. We analyzed the impact of time interval to surgery on short-terme outcome parameters in patients undergoing elective laparoscopic left colonic resection for diverticulitis. MATERIALS AND METHODS: Retrospective analysis of two series of case-matched patients according to the timing of operation after the last episode of diverticulitis: group A (within 90 days) and group B (beyond 90 days). RESULTS: 332 patients had left colonic resection for diverticulitis. 117 patients were included in group A vs 114 patients in group B. Overall abdominal morbidity in Group A was 21% vs 5% in group B (p = 0.02). Mean hospital stay was 7.7 days in group A vs 5 days in group B (p = 0.08). Residual inflammation was significantly increased in group A (31%) as compared to group B (11%) (p = 0.01). CONCLUSIONS: Laparoscopic left colonic resection for acute diverticulitis is best performed beyond the third month after the last acute episode.

Routine surveillance endoscopy before and after sleeve gastrectomy?

There is no consensus when it comes to the necessity of an oeso-gastroduodenal fibroscopy (OGDF) before and after bariatric surgery. Many reports expressed the preoccupations about a gastroesophagal reflux disease (an acute risk of Barrett's esophagus) and its consequences after a sleeve gastrectomy (SG) and the risk of leaving a premalignant lesion in an excluded stomach after a Roux-en-Y gastric bypass. The International Federation for the Surgery of Obesity and Metabolic Disorders recommends a surveillance endoscopy, routinely after a SG. After review of the literature, we set out the arguments in favor of performing a systematic preoperative and post-operative OGDF.

Acute pyelonephritis revealing an intraprostatic obstructive megaureter in an adult: A rare finding.

INTRODUCTION: Duplicated renal collecting system is one of the most common congenital upper urinary tract abnormalities. Duplex system with ectopic obstructive megaureter in the prostatic urethra is rare and exceptionally revealed in adulthood. PRESENTATION OF CASE: We present a rare case of a 72-year-old man without any previous history of urinary symptoms, admitted through the emergency department for altered general condition associated with fever for several days. Investigations have identified left complete duplex system and intraprostatic obstructive megaureter manifesting as acute pyelonephritis. The evolution of acute pyelonephritis was favorable under urine drainage by percutaneous nephrostomy tube and antibiotherapy. Given the multiple comorbidities of the patient, radical surgical treatment by left upper pole nephrectomy was ruled out and we opted for an iterative change of percutaneous nephrostomy tube. DISCUSSION: We briefly review the pathophysiology, diagnosis and therapeutic aspects. CONCLUSION: Early diagnosis and treatment of complicated duplex system is important. Urologists should keep this anomaly in mind.

ZORRO: Z Omphaloplasty Repair for Omphalocele.

PURPOSE: To suggest a novel technique for omphalocele closure which uses the circular base of the umbilical cord, thus allowing for a more physiological healing process and natural-looking scar. METHODS: Among 16 neonates operated for omphalocele between 2011 and 2016, 12 were closed with a one-stage procedure using a Z omphaloplasty (ZORRO). Median gestational age was 36.5 weeks; median birth weight was 3210 g. The umbilical arteries were divided and ligated outside the peritoneal cavity above the parietal musculocutaneous plane. The upper part of the defect was closed vertically in the midline, while the lower part was closed in a circular fashion by imbricating 2 lateral cutaneous Z flaps thus forming a new cordonal base. RESULTS: The postoperative course was uneventful in all cases. The reconstructed cordonal bases healed as would a normal umbilical cord, with central umbilication surrounded by healthy skin. With a median follow-up period of 11 months, the umbilicus was in the normal position, with a 0.6 xyphoumbilical/xyphopubic ratio. CONCLUSIONS: This technique mimics the natural necrosis mechanism and physiological healing of the umbilicus thus allowing for an esthetic and "natural looking" umbilicus.