Automatic segmentation of in-vivo intra-coronary optical coherence tomography images to assess stent strut apposition and coverage.

The implantation of intracoronary stents is currently the standard approach for the treatment of coronary atherosclerotic disease. The widespread adoption of this technology has boosted an intensive research activity in this domain, with continuous improvements in the design of these devices, aiming at reducing problems of restenosis (re-narrowing of the stented segment) and thrombosis (sudden occlusion due to thrombus formation). Recently, a new, light-based intracoronary imaging modality, optical coherence tomography (OCT), was developed and introduced into clinical practice. Due to its very high axial resolution (10-15 µm), it allows for in vivo evaluation of both stent strut apposition and neointima coverage (a marker of healing of the treated segment). As such, it provides valuable information on proper stent deployment, on the behaviour of different stent types in-vivo and on the effect of new types of stents (e.g. drug-eluting stents) on vessel wall healing. However, the major drawback of the current OCT methodology is that analysis of these images requires a tremendous amount of-currently manual-post-processing. In this manuscript, an algorithm is presented that allows for fully automated analysis of stent strut apposition and coverage in coronary arteries. The vessel lumen and stent struts are automatically detected and segmented through analysis of the intensity profiles of the A-lines. From these data, apposition and coverage can then be measured automatically. The algorithm was validated using manual assessments by two experienced operators as a reference. High Pearson's correlation coefficients were found (R = 0.96-0.97) between the automated and manual measurements while Bland-Altman analysis showed no significant bias with good limits of agreement. As such, it was shown that the presented algorithm provides a robust and fast tool to automatically estimate apposition and coverage of stent struts in in-vivo OCT pullbacks. This will be important for the integration of this technology in clinical routine and for the analysis of datasets of larger clinical trials.

Renal infarction: an uncommon mimic presenting with flank pain.

A 39-year-old woman arrived to the emergency department complaining of a constant, progressive, left flank pain, with no beneficial effect from spasmolytic and nonsteroidal antiinflammatory drugs. Two years before, she suffered another episode of right flank pain and stranguria, but instrumental examinations (ultrasonography, urography) remained negative. Besides a mild tenderness in the left flank, physical examination was normal. Blood chemistry panel showed leukocytosis (17.2 x 10(3) mL, neutrophils 82.8%) and a slight increase of serum lactate dehydrogenase (LDH) (543 U/L versus 230 to 460 U/L). Urinanalysis showed a slight hemoglobinuria (0.5 mg/dL), and sediment contained some red cells and leukocytes. Diagnostic examinations (ultrasonography, computed tomography) showed a left renal nonhomogeneous space-occupying lesion, orientative for renal malignancy. She was transferred to the urology department and operated. Both intraoperatory and histological diagnosis was ischemic infarction and, after exclusion of all possible underlying causes, final diagnosis was idiopathic renal infarction. Diagnostic procedures and literature reports are discussed.

Metastatic ulcerative penile Crohn's disease.

Metastatic Crohn's disease (MCD) is a cutaneous granulomatous reaction which affects patients with bowel disease in areas of the skin distant from the affected bowel. Penile involvement is a very uncommon observation. We report a case of penile ulcerative MCD in a 37-year-old man, which requested surgical management. The lesion developed during reactivation of the bowel disease.

[Staplers in bladder sutures]. / Gli staplers nelle suture vescicali.

Staplers are still little used for suturing a cystotomy. The basic reason for this reluctance is the inadvisability of using non-absorbable material in the lumen of the urinary tract, as this may be the nucleus for the formation of stones. It must be remembered, however, that a correct suture of a cystotomy should be carried out in two layers: one internal mucous layer, consisting of a continuous suture of absorbable material, and a more superficial suture of the margins of the vesical detrusor. The latter can be performed with a linear stapler, as it is completely outside the mucous layer. More recently, linear staplers with absorbable staples have appeared on the market, by which cystotomy sutures can be performed in a single layer.

[Diagnostic screening of varicocele: role of echography and Doppler examination in our experience with 216 cases of primary varicocele]. / Screening diagnostico del varicocele: ruolo dell'ecografia e dell'esame Doppler nella nostra esperienza di 216 casi di varicocele primitivo.

We compared two non-invasive methods to evaluate primary varicoceles: ultrasonography and Doppler examination. We submitted to ultrasonography and Doppler 216 patients, 147 of them were treated by sclerotherapy and 69 by surgery. All ultrasonographic studies were performed by means of a real-time equipment (7.5 Mhz transducer), while Doppler examination was performed with continuous wave equipment. Ultrasonographic findings are reliable for testicular morphology. Doppler examination is useful to evaluate reversed flow. In 4.1% of cases ultrasonography did not agree with the Doppler examination.

The gastrocnemius myocutaneous flap (GMF): an alternative method to repair severe lesions of the leg.

A short review of the various methods of closing skin defects associated with severe injuries of the leg raised the question for using a myocutaneous flaps and particularly a gastrocnemius flaps. The surgical technique is described and the versatility of the flap is demonstrated with several examples and discussed showing how both the medial and the lateral gastrocnemius flap, can be used as a pedicle as well as a free flap, ipsi- and contralaterally.

The use of free microvascular flaps in the leg. Their value in orthopaedic surgery.

After discussing the conventional techniques available for covering skin defects in the leg with associated complex orthopaedic problems the value of the free flap is empahsised. The technique is discussed briefly and six cases are presented. The advantages of this method are outlined and the improvement in healing afforded by the extra blood supply in cases where there is infection and exposure of bone or plate is stressed. Where large complicated skin defects can be predicted, early co-operation between orthopaedic and plastic surgeons is advised.