Structured zinc oxide dressing for secondary intention wounds.

OBJECTIVE: Inexpensive methods for more rapid healing of secondary intention wounds are sought. This pilot study measured the wound healing rate for a new zinc oxide structured dressing technique. METHOD: In this study, we included the three patients with the largest wounds with onset during a one month period. A 3-ply gauze was cut and placed in the centre of each wound, leaving a 3-5mm rim of the wound exposed to the zinc gauze. The central gauze was soaked with 0.9% saline solution and the entire wound area was covered with 3 layers of Unna zinc oxide dressing. The central gauze size was modified to fit as the wound healed and the size changed. The wound was photographed at each visit and wound areas were obtained using best-fit ellipses. RESULTS: The average wound closure rate is reported in the three wounds as 21.73mm2 per day. The scalp wound healed at a rate of 21.45mm2 per day.; the spider bite wound healed at a rate of 28.92mm2 per day; and the thigh wound healed at a rate of 14.81mm2 per day. CONCLUSION: Healing rates for the zinc gauze method exceed those previously reported for full-thickness wounds healing by secondary intention. Additional study of the new technique with more patients is needed before conclusions relevant to clinical practice can be made.

Adaptable texture-based segmentation by variance and intensity for automatic detection of semitranslucent and pink blush areas in basal cell carcinoma.

BACKGROUND: Pink blush is a common feature in basal cell carcinoma (BCC). A related feature, semitranslucency, appears as smooth pink or orange regions resembling skin color. We introduce an automatic method for detection of these features based on smoothness and brightness. We also introduce a neighborhood correction method for texture area correction. METHODS: Smoothness and brightness were analyzed over four bands: luminance, red, green, and blue, then merged using variance-based dynamic thresholding. Dermoscopic images of 100 biopsy-proven BCCs and 254 competitive benign mimics were used to train the algorithm. Sixteen color and texture features were extracted from the automatically detected areas. The confusion matrix for the algorithm showed 15 classification errors in the training set for the 354 images: three errors in the BCC set and 12 errors in the benign set. RESULTS: Logistic regression analysis on a separate 1024-image test set was able to achieve good separation of BCC from benign lesions with an area under the receiver operating characteristic curve (ROC) of 0.878 and 0.877 using manually-created and automatically-generated BCC border masks, respectively. CONCLUSION: This pilot study indicates that automatic detection of semitranslucent and pink blush areas in BCC is feasible using colors and first-order texture statistics.

Biologically inspired skin lesion segmentation using a geodesic active contour technique.

BACKGROUND/PURPOSE: Computer-aided diagnosis of skin cancer requires accurate lesion segmentation, which must overcome noise such as hair, skin color variations, and ambient light variability. METHODS: A biologically inspired geodesic active contour (GAC) technique is used for lesion segmentation. The algorithm presented here employs automatic contour initialization close to the actual lesion boundary, overcoming the 'sticking' at minimum local energy spots caused by noise artifacts such as hair. The border is significantly smoothed to mimic natural lesions. In addition, features that mimic biological parameters include spectral image subtraction and removal of peninsulas and inlets. Multiple boundary choices borders are created by parameter options used at different steps. These choices can allow future improvement over the basic default border. RESULTS: The basic GAC algorithm was tested on 100 images (30 melanomas and 70 benign lesions), yielding a median XOR border error of 6.7%, comparable to the median inter-dermatologist XOR border error (7.4%), and lower than the gradient vector flow snake median XOR error of 14.2% on the same image set. On a difficult low-contrast border set of 1238 images, which included 350 non-melanocytic lesions, a median XOR error of 23.9% is obtained. CONCLUSION: GAC techniques show promise in attaining the goal of automatic skin lesion segmentation.

Real-time supervised detection of pink areas in dermoscopic images of melanoma: importance of color shades, texture and location.

BACKGROUND/PURPOSE: Early detection of malignant melanoma is an important public health challenge. In the USA, dermatologists are seeing more melanomas at an early stage, before classic melanoma features have become apparent. Pink color is a feature of these early melanomas. If rapid and accurate automatic detection of pink color in these melanomas could be accomplished, there could be significant public health benefits. METHODS: Detection of three shades of pink (light pink, dark pink, and orange pink) was accomplished using color analysis techniques in five color planes (red, green, blue, hue, and saturation). Color shade analysis was performed using a logistic regression model trained with an image set of 60 dermoscopic images of melanoma that contained pink areas. Detected pink shade areas were further analyzed with regard to the location within the lesion, average color parameters over the detected areas, and histogram texture features. RESULTS: Logistic regression analysis of a separate set of 128 melanomas and 128 benign images resulted in up to 87.9% accuracy in discriminating melanoma from benign lesions measured using area under the receiver operating characteristic curve. The accuracy in this model decreased when parameters for individual shades, texture, or shade location within the lesion were omitted. CONCLUSION: Texture, color, and lesion location analysis applied to multiple shades of pink can assist in melanoma detection. When any of these three details: color location, shade analysis, or texture analysis were omitted from the model, accuracy in separating melanoma from benign lesions was lowered. Separation of colors into shades and further details that enhance the characterization of these color shades are needed for optimal discrimination of melanoma from benign lesions.

Outcome after developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status.

The efficacy of developmental intervention in the neonatal intensive care unit for mothers of preterm infants with low socioeconomic status was evaluated. Mothers were assigned to an experimental group in which they met at least weekly with an infant-development specialist or to a control group in which they did not. During the sessions, they participated in a structured developmental and behavioral assessment of their infants, with the goal of enhancing their ability to provide appropriate interactions and environmental stimulation for their infants. When the infants were 4 and 8 months of age, follow-up home visits by a nurse who was unaware of group assignment showed that the experimental-group infants performed more optimally on the Bayley Mental scale (Bayley Scales of Infant Development) at 4 and 8 months of age and on the Bayley Motor scale at 4 months. In addition, the home environment was more developmentally appropriate at 4 months of age, and the mothers rated their babies as temperamentally less difficult at 4 and 8 months. We conclude that a mother-focused, neonatal intensive care unit-based program that utilizes the assessment process in a therapeutic way is an effective strategy in the initiation of interventions for families of low socioeconomic status whose infants were born prematurely.

Infant stimulation reassessed. A new approach to providing care for the preterm infant.

Developmental intervention is a new method of improving the care of preterm infants. Use of the Assessment of Preterm Infant Behavior (APIB) to determine the current behavioral functioning of an infant and how that information can be used to develop and implement an individualized program of nursing care are described. Three examples of individualized programs developed as a result of assessment are presented. General environmental guidelines for special care nursery procedures, parent involvement, and nurse training are given.

Asymptomatic urinary tract infection in gynaecological outpatients.

In this study mid-stream specimens of urine were collected from all new patients attending a gynaecological outpatient department and tested for significant bacteriuria. Those having an asymptomatic infection were folloWed up, treated, and investigated adiologically.Of 1,506 women screened for bacteriuria 82 (5.4%) were found to have a persistent infection. The predominant organism was Escherichia coli, present in 83% of infections. Treatment with sulphonamides produced a good cure rate, which was improved by ampicillin given to failures. Some patients, however, had infections that persisted or recurred despite several antibiotics. The radiological investigations showed that a high proportion of women with asymptomatic urinary infection had severe renal disease which was quite symptomless. This was more pronounced in those with persistent or recurrent infections.