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1.
Front Bioeng Biotechnol ; 12: 1370837, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38524192

RESUMO

Introduction: The management of fractured bones is a key domain within orthopedic trauma surgery, with the prevention of delayed healing and non-unions forming a core challenge. This study evaluates the efficacy of the AO Fracture Monitor in conjunction with biomechanical simulations to better understand the local mechanics of fracture gaps, which is crucial for comprehending mechanotransduction, a key factor in bone healing. Through a series of experiments and corresponding simulations, the study tests four hypotheses to determine the relationship between physical measurements and the predictive power of biomechanical models. Methods: Employing the AO Fracture Monitor and Digital Image Correlation techniques, the study demonstrates a significant correlation between the surface strain of implants and interfragmentary movements. This provides a foundation for utilizing one-dimensional AO Fracture Monitor measurements to predict three-dimensional fracture behavior, thereby linking mechanical loading with fracture gap dynamics. Moreover, the research establishes that finite element simulations of bone-implant systems can be effectively validated using experimental data, underpinning the accuracy of simulations in replicating physical behaviors. Results and Discussion: The findings endorse the combined use of monitoring technologies and simulations to infer the local mechanical conditions at the fracture site, offering a potential leap in personalized therapy for bone healing. Clinically, this approach can enhance treatment outcomes by refining the assessment precision in trauma trials, fostering the early detection of healing disturbances, and guiding improvements in future implant design. Ultimately, this study paves the way for more sophisticated patient monitoring and tailored interventions, promising to elevate the standard of care in orthopedic trauma surgery.

2.
Eur Radiol Exp ; 7(1): 12, 2023 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-37009937

RESUMO

BACKGROUND: We investigated the feasibility of aneurysm sac embolization using a novel self-expanding porous shape memory polymer (SMP) device during endovascular aortic abdominal or thoracic aneurysm repair (EVAR). METHODS: Retrospective analysis of consecutive patients treated at 2 centers in Germany. Patients were treated from January 2019 to July 2021 with follow-up at 7 days and 3, 6, and 12 months. Aneurysm sacs were implanted with SMP devices immediately following endograft placement during the same procedure. Primary endpoint was technically successful SMP-device deployment into the aneurysm sac outside the endograft. Secondary endpoints were changes in aneurysm volume and associated complications (e.g., endoleaks). RESULTS: We included 18 patients (16 males), aged 72 ± 9 years, achieving 100% technical success. Mean preprocedure aortic aneurysm sac volume was 195 ± 117 mL with a perfused aneurysm volume of 97 ± 60 mL. A mean of 24 ± 12 SMP devices per patient were used (range 5-45, corresponding to 6.25-56.25 mL expanded embolic material volume). All evaluable patients exhibited sac regression except 2 patients yet to reach 3-month follow-up. At mean 11 ± 7 months (range 3-24), change in aneurysm volume from baseline was -30 ± 21 mL (p < 0.001). In 8 patients, aneurysm regression was observed despite type 2 endoleaks in 6 and type 1A endoleaks in 2, none of them requiring further intervention to date. No morbidity or mortality related to this treatment occurred. CONCLUSIONS: SMP devices for aortic aneurysm sac embolization during endovascular repair appear feasible and safe in this small case series. Prospective studies are needed. KEY POINTS: • Shape memory polymer is a novel, self-expanding, porous, and radiolucent embolic device material. • Aortic aneurysm sacs were treated with polymer devices immediately following endograft placement. • Aortic aneurysm sac regression was observed in all patients with over 3-month follow-up. • Aortic aneurysm sac regression was observed even in the presence of endoleaks.


Assuntos
Aneurisma da Aorta Abdominal , Aneurisma Aórtico , Implante de Prótese Vascular , Masculino , Humanos , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Endoleak/diagnóstico por imagem , Endoleak/terapia , Endoleak/etiologia , Implante de Prótese Vascular/efeitos adversos , Estudos Retrospectivos , Estudos de Viabilidade , Resultado do Tratamento , Aneurisma Aórtico/complicações
3.
Diagn Interv Radiol ; 28(4): 383-386, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35731712

RESUMO

This study aimed to report on complication management in a 58-year-old woman referred for transjugular biopsy for the evaluation of unknown liver disease. After an initial uneventful biopsy procedure, the patient complained of severe upper abdominal pain. Laboratory tests revealed increasing liver enzymes. Imaging studies depicted an iatrogenic pseudoaneurysm associated with an arterio-biliary fistula originating from the right peripheral hepatic artery. Angiography and percutaneous transarterial superselective embolotherapy was performed by means of a microcatheter and microvascular plug. Precise device positioning allowed for successful closure of the bleeding site without compromising the hepatic vasculature.


Assuntos
Falso Aneurisma , Fístula Biliar , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Fístula Biliar/complicações , Biópsia , Feminino , Artéria Hepática/diagnóstico por imagem , Humanos , Doença Iatrogênica , Fígado/diagnóstico por imagem , Pessoa de Meia-Idade
4.
Invest Radiol ; 57(4): 233-241, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-34743133

RESUMO

OBJECTIVES: The aim of this study was to compare the diagnostic accuracy of apparent diffusion coefficient (ADC) ratios as a monoparametric magnetic resonance imaging (MRI) protocol for the detection of prostate cancer (PCa) with the established multiparametric (mp) MRI at 3.0 T. MATERIALS AND METHODS: According to power analysis, 52 male patients were included in this monocenter study with prospective data collection and retrospective, blinded multireader image analysis. The study was approved by the local ethics committee. Patients were recruited from January to December 2020. Based on mpMRI findings, patients underwent in-bore MR biopsy or prostatectomy for histopathologic correlation of suspicious lesions. Three readers, blinded to the histopathologic results and images of mpMRI, independently evaluated ADC maps for the detection of PCa. The ADC ratio was defined as the lowest signal intensity (SI) of lesions divided by the SI of normal tissue in the zone of origin. Predictive accuracy of multiparametric and monoparametric MRI were compared using logistic regression analysis. Moreover, both protocols were compared applying goodness-of-fit analysis with the Hosmer-Lemeshow test for continuous ADC ratios and Pearson χ2 test for binary decision calls, correlation analysis with Spearman ρ and intraclass correlation coefficients, as well as noninferiority assessment with a TOST ("two one-sided test"). RESULTS: Eighty-one histopathologically proven, unique PCa lesions (Gleason score [GS] ≥ 3 + 3) in 52 patients could be unequivocally correlated, with 57 clinically significant (cs) PCa lesions (GS ≥ 3 + 4). Multiparametric MRI detected 95%, and monoparametric ADC detected ratios 91% to 93% of csPCa. Noninferiority of monoparametric MRI was confirmed by TOST (P < 0.05 for all comparisons). Logistic regression analysis revealed comparable predictive diagnostic accuracy of ADC ratios (73.7%-87.8%) versus mpMRI (72.2%-84.7%). Spearman rank correlation coefficient for PCa aggressiveness revealed satisfactory correlation of ADC ratios (P < 0.013 for all correlations). The Hosmer-Lemeshow test for the logistic regression analysis for continuous ADC ratios indicated adequate predictive accuracy (P = 0.55-0.87), and the Pearson χ2 test showed satisfactory goodness of fit (P = 0.35-0.69, χ2 = 0.16-0.87). CONCLUSIONS: Normalized ADC ratios based on advanced DWI are noninferior to mpMRI at 3.0 T for the detection of csPCa in a preselected patient cohort and proved a fast and accurate assessment tool, thus showing a potential prospect of easing the development of future screening methods for PCa.


Assuntos
Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata , Coleta de Dados , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Imageamento por Ressonância Magnética , Masculino , Gradação de Tumores , Neoplasias da Próstata/patologia , Estudos Retrospectivos
5.
Rofo ; 194(1): 49-61, 2022 01.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-34352916

RESUMO

PURPOSE: To analyze the quality of endovascular aortic aneurysm repair using the data of the DeGIR quality management system. Comparison of data between 2011 and 2019. MATERIALS AND METHODS: A retrospective analysis of all data registered in the DeGIR quality management system of the year 2019 was performed regarding the treatment quality for endovascular aortic aneurysm repair. Registration of data was voluntary. As quality parameters indication, treatment process data and quality of results were examined. The latter was judged by treatment success, complication rates and radiation exposure. RESULTS: Out of 189 590 data sets overall 1639 cases of EVAR were registered; compared to 2011 this was an increase of 472 cases. 5.9 % of these cases encompassed emergency treatments. The most frequent indication was an abdominal aneurysm with 72 % of cases. In 54 % of cases, the aortic diameter ranged 50-70 mm. The rates for technical success, over all complications and major complications were 92.8 %, 6.7 % and 6.0 % respectively for all EVAR including emergency indications. In general, EVAR yielded a mortality rate of 1.2 % while emergency procedures had a mortality rate of 7.3 %. Median dose area product and fluoroscopy time were 10 503 cGy × cm2 and 20 minutes respectively at a mean procedure time of 114 minutes. CONCLUSION: Data analysis of the DeGIR quality management system persistently showed a very high technical success rate for endovascular aortic aneurysm repair performed by interventional radiologists accompanied by a low complication rate. KEY POINTS: · The voluntary DeGIR quality assurance-system has reached high acceptance among interventional radiologists.. · The database has nearly 200 000 submissions on record for 2019.. · EVAR by interventional radiologists has shown very high technical success as well as a low complication rate.. CITATION FORMAT: · Frenzel F, Bücker A, Paprottka P et al. DeGIR Quality Report 2019: Report on the treatment quality of minimally invasive methods - Interventional therapy (EVAR) of abdominal aortic aneurysms. Fortschr Röntgenstr 2022; 194: 49 - 61.


Assuntos
Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Fluoroscopia , Humanos , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
6.
Arch Gynecol Obstet ; 302(5): 1075-1080, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32767070

RESUMO

BACKGROUND: Internal herniation of small intestine in the lesser pelvis alongside iliac vasculature is a rare occurrence. Skeletonization of iliac vessels during pelvic lymph node dissection (LND), as part of surgical staging or treatment of patients with uterine, ovarian or urogenital cancer, is a strict prerequisite for orifice formation. CASE PRESENTATION: A 68-year-old woman presented at the emergency department with complaints of constipation for the last 3 days and acute-onset abdominal pain, nausea and vomiting since few hours. She had a history of laparoscopic hysterectomy, bilateral salpingo-oophorectomy and para-aortic and pelvic LND 7 years ago. A distended abdomen with diffuse tenderness on palpation was noted. A CT scan demonstrated bowel obstruction secondary to an incarcerated hernia underneath an elongated right external iliac artery. During an emergency exploratory laparotomy, the incarcerated bowel was reduced and the hernial orifice closed with a running suture. The patient had an uneventful postoperative period and was discharged on the fifth postoperative day. DISCUSSION: This rare internal hernia can manifest with non-specific symptoms of small bowel obstruction at any given point after index surgery, sometimes even after several years free of complaints. Contrast-enhanced computed tomography is the method of choice for fast and reliable diagnosis and helps in planning the necessary emergency laparotomy. CONCLUSION: This life-threatening complication adds to the current controversy of pelvic and para-aortic lymphadenectomy in patients with endometrial cancer. Primary closure of peritoneal defects should be considered to potentially prevent internal hernias, especially when elongated iliac vessels are present.


Assuntos
Dor Abdominal/diagnóstico por imagem , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Hérnia Interna/complicações , Obstrução Intestinal/diagnóstico por imagem , Laparoscopia/efeitos adversos , Laparotomia/métodos , Dor Abdominal/etiologia , Idoso , Feminino , Humanos , Histerectomia/efeitos adversos , Obstrução Intestinal/etiologia , Laparoscopia/métodos , Laparotomia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Náusea/etiologia , Salpingo-Ooforectomia/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
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