Accurate segmentation of the left ventricle in computed tomography images for local wall thickness assessment.

In recent years, the fully automatic segmentation of the whole heart from three-dimensional (3D) CT or MR images has become feasible with mean surface accuracies in the order of 1mm. The assessment of local myocardial motion and wall thickness for different heart phases requires highly consistent delineation of the involved surfaces. Papillary muscles and misleading pericardial structures lead to challenges that are not easily resolved. This paper presents a framework to train boundary detection functions to explicitly avoid unwanted structures. A two-pass deformable adaptation process allows to reduce false boundary detections in the first pass while detecting most wanted boundaries in a second pass refinement. Cross-validation tests were performed for 67 cardiac datasets from 33 patients. Mean surface accuracies for the left ventricular endo- and epicardium are 0.76mm and 0.68mm, respectively. The percentage of local outliers with segmentation errors > 2mm is reduced by a factor of 3 as compared to a previously published approach. Wall thickness measurements in full 3D demonstrate that artifacts due to irregular endo- and epicardial contours are drastically reduced.

Mothers with congenital adrenal hyperplasia and their children: outcome of pregnancy, birth and childhood.

OBJECTIVES: Fertility rates in women with congenital adrenal hyperplasia (CAH) are reported to be poor, but few data are available. We assessed rates and course of pregnancy, mode of delivery and long-term outcome of offspring from women with CAH. DESIGN: A large cohort of women with CAH due to 21-hydroxylase deficiency had initially been diagnosed and followed at one centre. Those women who had given birth were contacted. Information was gathered from hospital records, direct patient contact, structured questionnaire and the Documentation of Pregnancy and Preventive Care Booklets. RESULTS: Between 1978 and 1998, 18 women with CAH (one salt wasting, 12 simple virilizing, five nonclassical) had given birth to 31 children (18 females, 13 males). Delivery was by Caesarean section in 16 out of the 31 children. None of the female newborns was masculinized. Twenty-nine children were born at term, five children were small for gestational age (SGA). Postnatal development was basically normal in all children; 18 are now older than 10 years, seven are between 5 and 10 years old, six are less than 5 years old. CONCLUSIONS: Fertility is reduced in females with CAH, especially those with the severe or salt wasting phenotype. In those women with CAH who do conceive, course and outcome of pregnancy is mostly uneventful, although the rate of SGA offspring may be increased. Psychomotor and somatic long-term development of the children was within normal limits.

[Problem infections of the external genital area in the female]. / Probleminfektionen des äusseren Genitalbereiches der Frau.

On account of difficult diagnostic procedures and often atypical clinical pictures, the following diseases must be regarded as problematic infections: infections with chlamydia, mycoplasma, urea-plasma, and herpes virus, as well as unspecific infections with aerobic and anaerobic bacteria. Since vulvitis and vaginitis are frequently associated with vaginal discharge, they may present a problem to dermatologists and gynecologists.

Ofloxacin versus doxycycline in gynecological infections.

40 patients were investigated with either ofloxacin (2 X 20 mg/7d) or doxycycline (2 X 100 mg/7d). E. coli (28 from 61 strains) was the predominant strain isolated. Microbiological efficacy: 51 from 61 strains were eliminated: 29 from 32 strains in the ofloxacin group and 22 from 29 strains in the doxycycline group. Two patients in the ofloxacin and four in the doxycycline group were not cured. There were two side effects (sickness) in the doxycycline and two in the ofloxacin group.

Pharmacokinetics of ceftriaxone in serum and in gynecological tissues.

The suitability of Ceftriaxone in gynecologic infections has been investigated in twenty-two patients. The long half life of Ceftriaxone seems to demonstrate its suitability for an effective preoperative prophylaxis in gynecology.

Ticarcillin/clavulanic acid treatment of gynecological infections.

Forty patients have been treated with a Ticarcillin/Clavulanic acid combination. This drug has proven to be effective in the treatment of gynecological soft tissues and wound infections.