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J Hand Surg Am ; 45(3): 175-181, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31959378


PURPOSE: Osteoporosis and osteopenia are extremely common and can lead to fragility fractures. The purpose of this study was to determine whether a computer learning system could classify whether a hand radiograph demonstrated osteoporosis based on the second metacarpal cortical percentage. METHODS: We used the second metacarpal cortical percentage as the osteoporosis predictor. A total of 4,000 posteroanterior (PA) radiographs of the hand were standardized through laterality correction, vertical alignment correction, segmentation, proxy osteoporosis predictor, and full pipeline. Laterality was classified using a LeNet convolutional neural network (CNN). Vertical alignment classification used 2,000 PA x-rays to determine vertical alignment of the second metacarpal. We employed segmentation to determine which pixels belong to the second metacarpal from 1,000 PA x-rays using the FSN-8 CNN. The full pipeline was tested on 265 previously unseen PA x-rays. RESULTS: Laterality classification accuracy was 99.62%, with a specificity of 100% and sensitivity of 99.3%. Rotation of the hand within 10° of vertical was accurate in 93.2% of films. Segmentation was 94.8% accurate. Proxy osteoporosis predictor was 88.4% accurate. Full pipeline accuracy was 93.9%. In the testing data set, the CNN had a sensitivity of 82.4% and specificity of 95.7%. In the balanced data set, 6 of 39 osteoporotic films were classified as nonosteoporotic; sensitivity was 82.4% and specificity, 94.3%. CONCLUSIONS: We have created a series of CNN that can accurately identify osteoporosis from non-osteoporosis. Furthermore, our CNN is able to make adjustments to images based on laterality and vertical alignment. CLINICAL RELEVANCE: Convolutional neural network and computer learning can be used as an adjunct to dual-energy x-ray absorptiometry scans or to screen and make appropriate referrals for further workup in patients with suspected osteoporosis.

J Arthroplasty ; 33(8): 2613-2615, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29636248


BACKGROUND: Early wound healing complications and persistent drainage are associated with an increased risk of infection following knee arthroplasty. However, the scenario in which a patient sustains an acute, traumatic wound dehiscence has not been investigated. The purpose of this study is to determine the outcomes of an acute traumatic wound dehiscence following arthroplasty treated with an urgent irrigation and debridement and primary wound closure. METHODS: Using a single institution's arthroplasty registry, patients sustaining an acute, traumatic wound dehiscence within 30 days of undergoing a primary knee arthroplasty were identified. Patients experiencing chronic wound drainage without injury or a history of prior infection were excluded. Patients were followed for the occurrence of complications and clinical outcomes using the Knee Society Score. RESULTS: From 2006 to 2016, 14 of 25,819 eligible patients (0.05%) were identified as having a traumatic wound dehiscence. The mean time from arthroplasty to wound dehiscence was 9.3 days. All but one patient was treated operatively within 24 hours of dehiscence. Postoperative antibiotics were administered for a mean of 21 days. At a mean of 6.5 years, 6 patients were considered failures (43%) including 2 deep infections, 3 revisions for instability, and 1 patient with a Knee Society Score <60 points. CONCLUSION: Despite emergent incision and drainage and wound closure, patients experiencing an acute traumatic wound dehiscence following knee arthroplasty subsequently exhibit high rates of reoperation for instability, periprosthetic infection, and clinical failure. Further work is required to better understand the optimal modes of treatment for this complication.

Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Período Pós-Operatório , Sistema de Registros , Índice de Gravidade de Doença , Ferida Cirúrgica , Cicatrização
Cureus ; 9(8): e1600, 2017 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-29067224


We report a case of combined central retinal vein occlusion and branch retinal artery occlusion. A previously healthy 47-year-old male presented with decreased vision in the right eye after completing a half marathon. A fundus exam and retinal imaging revealed a combined central retinal vein and branch retinal artery occlusion. In the present report, we review the literature and discuss the possible mechanisms behind combined retinal vessel occlusions. To our knowledge, this is the first reported case of combined central retinal vein occlusion and branch retinal artery occlusion following intense exercise.

J Endourol Case Rep ; 2(1): 235-237, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28078326


Background: Upper tract urothelial carcinoma (UTUC) is an uncommon disease that is diagnosed clinically by the selective use of urine cytology, urine biomarkers, and imaging of the upper tract. We present a case of a patient with Lynch syndrome and high-grade UTUC that was diagnosed by an abnormal Cxbladder assay, prompting further endoscopic examination. Case Presentation: A 59-year-old Caucasian female with a history of endometrial cancer and bladder cancer with Lynch syndrome presented for evaluation of recurrent urothelial carcinoma. Her previous bladder tumors have been T1 high grade and Ta high grade and have been treated with resection and multiple cycles of intravesical Bacillus Calmette-Guerin (BCG) therapy. She had also undergone a robotic left distal ureterectomy and psoas hitch for a high-grade distal ureteral tumor. Surveillance cystoscopy 7 months after revealed a biopsy-confirmed bladder tumor, which was resected, and she was started on maintenance BCG therapy. At presentation, follow-up urine cytology and UroVysion studies were negative. Cxbladder test was also initially negative. However, during close clinical monitoring, the Cxbladder test became positive. Cystoscopy was once more performed, which was unremarkable. Bilateral ureteroscopy was performed, revealing high-grade upper tract renal papillary carcinoma (UTUC) in the left renal pelvis. The patient declined a nephroureterectomy. She was treated with two sessions of holmium laser ablation of the left renal pelvis tumor and underwent 6 weekly courses of BCG + interferon instilled into her left renal pelvis using a 5F open-ended catheter. Repeat urine cytology, UroVysion, and Cxbladder tests were negative after completion of upper tract BCG therapy. Conclusion: Cxbladder test may be useful and an adjunct to urine cytology and the UroVysion FISH assay to evaluate patients at high risk for recurrent UTUC.