Computer aided detection of deep inferior epigastric perforators in computed tomography angiography scans.

The deep inferior epigastric artery perforator (DIEAP) flap is the most common free flap used for breast reconstruction after a mastectomy. It makes use of the skin and fat of the lower abdomen to build a new breast mound either at the same time of the mastectomy or in a second surgery. This operation requires preoperative imaging studies to evaluate the branches - the perforators - that irrigate the tissue that will be used to reconstruct the breast mound. These branches will support tissue viability after the microsurgical ligation of the inferior epigastric vessels to the receptor vessels in the thorax. Usually through a computed tomography angiography (CTA), each perforator is manually identified and characterized by the imaging team, who will subsequently draw a map for the identification of the best vascular support for the reconstruction. In the current work we propose a semi-automatic methodology that aims at reducing the time and subjectivity inherent to the manual annotation. In 21 CTAs from patients proposed for breast reconstruction with DIEAP flaps, the subcutaneous region of each perforator was extracted, by means of a tracking procedure, whereas the intramuscular portion was detected through a minimum cost approach. Both were subsequently compared with the radiologist manual annotation. Results showed that the semi-automatic procedure was able to correctly detect the course of the DIEAPs with a minimum error (average error of 0.64 and 0.50 mm regarding the extraction of subcutaneous and intramuscular paths, respectively), taking little time to do so. The objective methodology is a promising tool in the automatic detection of perforators in CTA and can contribute to spare human resources and reduce subjectivity in the aforementioned task.

Paracentese associada a dextran-70 no tratamento da ascite de hepatopatas crônicos / Paracentesis associated to dextra-70 in the treatment of ascites in patients with chronic liver disease: a randomized therapeutic study

O tratamento da ascite de grande volume em hepatopatas foi avaliado através do presente estudo, onde comparamos diuréticos com paracentese e infusäo de Dextran-70. Eficácia terapêutica, complicaçöes e permanência hospitalar foram as variáveis estudadas. De 38 pacientes, 20 foram randomizados e avaliados através de critérios clínicos, laboratoriais e/ou histológicos: 10 pacientes no grupo paracentese com Dextran-70 e 10 no grupo diurético. Os grupos foram semelhantes quanto a idade, diagnóstico, classificaçäao de Child-Pugh; entretanto o sexo masculino predominou sobre o feminino no grupo paracentese com Dextran-70. Em cada paracentese retirou-se em média 9,41 litros de líquido ascítico (4,5 a 14 L). O período médio de hospitalizaçäao no grupo paracentese com Dextran-70 foi de 10,5 dias (8-14), significativamente menor quando comparado ao grupo diurético: 24,4 dias (14-48). No grupo diurético observou-se em um paciente complicaçöes como hiperpotassemia, elevaçäo de uréia e creatinina e no grupo paracentese com Dextran-70, um paciente apresentou temperatura acima de 38§C durante o tratamento. Os resultados sugerem que a paracentese associada ao Dextran-70 pode representar uma alternativa terapêutica para hepatopatas com ascite na nossa populaçäo. Este tratamento foi eficaz, näo apresentou efeitos colaterais importantes, diminuiu a permanência hospitalar e, conseqüentemente, deve diminuir o custo e o risco de complicaçöoes de pacientes com hospitalizaçäo prolongada