Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.928
Filtrar
1.
Sci Rep ; 13(1): 244, 2023 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-36604562

RESUMO

Recent advances in deep learning realized accurate, robust detection of various types of objects including pedestrians on the road, defect regions in the manufacturing process, human organs in medical images, and dangerous materials passing through the airport checkpoint. Specifically, small object detection implemented as an embedded system is gaining increasing attention for autonomous vehicles, drone reconnaissance, and microscopic imagery. In this paper, we present a light-weight small object detection model using two plug-in modules: (1) high-resolution processing module (HRPM ) and (2) sigmoid fusion module (SFM). The HRPM efficiently learns multi-scale features of small objects using a significantly reduced computational cost, and the SFM alleviates mis-classification errors due to spatial noise by adjusting weights on the lost small object information. Combination of HRPM and SFM significantly improved the detection accuracy with a low amount of computation. Compared with the original YOLOX-s model, the proposed model takes a two-times higher-resolution input image for higher mean average precision (mAP) using 57% model parameters and 71% computation in Gflops. The proposed model was tested using real drone reconnaissance images, and provided significant improvement in detecting small vehicles.


Assuntos
Aeroportos , Veículos Autônomos , Humanos , Colo Sigmoide , Comércio , Excipientes
2.
Int J Colorectal Dis ; 38(1): 14, 2023 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-36645511

RESUMO

PURPOSE: Sigmoid resection for diverticular disease is a frequent surgical procedure in the Western world. However, long-term bowel function after sigmoid resection has been poorly described in the literature. This study aims to assess the long-term bowel function after tubular sigmoid resection with preservation of inferior mesenteric artery (IMA) for diverticular disease. METHODS: We retrospectively identified patients who underwent sigmoid resection for diverticular disease between 2002 and 2012 at a tertiary referral center in northern Germany. Using well-validated questionnaires, bowel function was assessed for fecal urgency, incontinence, and obstructed defecation. The presence of bowel dysfunction was compared to baseline characteristics and perioperative outcome. RESULTS: Two hundred and thirty-eight patients with a mean age of 59.2 ± 10 years responded to our survey. The follow-up was conducted 117 ± 32 months after surgery. At follow-up, 44 patients (18.5%) had minor LARS (LARS 21-29) and 35 (15.1%) major LARS (LARS ≥ 30-42), 35 patients had moderate-severe incontinence (CCIS ≥ 7), and 2 patients (1%) had overt obstipation (CCOS ≥ 15). The multivariate analysis showed that female gender was the only prognostic factor for long-term incontinence (CCIS ≥ 7), and ASA score was the only preoperative prognostic factor for the presence of major LARS at follow-up. CONCLUSION: Sigmoid resection for diverticular disease can be associated with long-term bowel dysfunction, even with tubular dissection and preservation of IMA. These findings suggest intercolonic mechanisms of developing symptoms of bowel dysfunction after disruption of the colorectal continuity that are so far summarized as "sigmoidectomy syndrome."


Assuntos
Doenças Diverticulares , Incontinência Fecal , Laparoscopia , Neoplasias Retais , Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Estudos Retrospectivos , Colo Sigmoide/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Incontinência Fecal/cirurgia , Doenças Diverticulares/cirurgia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/cirurgia
3.
Am J Case Rep ; 23: e938124, 2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36464886

RESUMO

BACKGROUND Colonic intussusception is a very rare disease in adults, and if present, is usually manifested by another pathology, such as malignancy. This report describes the diagnosis and treatment of the underlying cause of intussusception, which was spontaneously reduced. CASE REPORT A 39-year-old woman with no significant past medical history presented to St. Joseph's University Medical Center on July 2022 with gradually worsening abdominal pains for 1 year and hematochezia for 3 months. Physical examination was positive for left lower quadrant abdominal tenderness to palpation. A computed tomography scan of the abdomen and pelvis without contrast showed a long segment of intussusception involving the sigmoid colon and rectum, without any noticeable lesions. A repeat computed tomography scan with rectal contrast showed a 2.1×1.1-cm mesenteric mass in the sigmoid colon at the region of the intussusception. The patient was taken for a laparoscopic sigmoid resection with primary anastomosis, showing a 5-cm mass in the sigmoid colon, and surgical pathology confirming neoplastic etiology of intussusception. The patient recovered well after surgery, and was referred for oncological intervention soon afterward. CONCLUSIONS This report displays the importance of the type of imaging modalities with and without contrast to diagnosis and determine underlying causes of intussusception and further guide treatment options.


Assuntos
Adenocarcinoma Mucinoso , Intussuscepção , Adulto , Feminino , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Colo , Colo Sigmoide , Reto , Dor Abdominal , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirurgia
4.
BMJ Case Rep ; 15(12)2022 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-36524262

RESUMO

A man in his 40s presented with a 7-day history of fever and abdominal pain after polypectomy of the sigmoid colon. On physical examination, he had mild tenderness on deep palpation of the left lower abdominal quadrants without guarding, rigidity or rebound tenderness. Contrast-enhanced CT revealed the thrombosis of the inferior mesenteric vein and the portal vein. Blood cultures were positive for Escherichia coli We diagnosed him with pylephlebitis after colonic polypectomy, as a rare complication. He was started on cefmetazole and heparin. Antibiotic and anticoagulation therapy were initiated. He had a complete recovery within 17 days. The patient had no evidence of underlying hypercoagulable condition, and no signs of recurrence at a 3-month follow-up. Pylephlebitis after colonic polypectomy is extremely rare. Although bacteraemia after colonoscopy was a rare complication, phlebitis should be considered in the differential diagnosis of patients who present with persisted fever and abdominal pain after polypectomy.


Assuntos
Colo Sigmoide , Flebite , Masculino , Humanos , Colo Sigmoide/cirurgia , Flebite/diagnóstico , Flebite/tratamento farmacológico , Flebite/etiologia , Veias Mesentéricas/diagnóstico por imagem , Veia Porta , Dor Abdominal/complicações
5.
J Med Case Rep ; 16(1): 487, 2022 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-36581904

RESUMO

BACKGROUND: Campylobacter-related infectious gastroenteritis is common and usually self-limited. Intestinal perforation is a rare complication of the infectious colitis caused by Campylobacter, and only handful of cases have been reported. This is the first published case report of pediatric Campylobacter intestinal perforation located in the sigmoid colon. CASE PRESENTATION: A 15-year-old previously Taiwanese healthy boy presented with 5 days of fever up to 39.8 °C, with right lower quadrant abdominal pain and watery diarrhea. Although he received antimotility agents and antipyretics at a local clinic to relieve symptoms, he came to the emergency department with signs of shock manifesting as hypothermia to 35.2 °C, tachycardia, and low blood pressure. Laboratory testing demonstrated leukocytosis with left shift and significant elevation of C-reactive protein. Stool and blood cultures were obtained, and he was admitted for fluid challenge and antibiotic treatment. On the second day of admission, he suffered from sudden onset of severe, diffuse abdominal pain. Physical examination revealed muscle guarding, rebounding tenderness, and silent bowel sound. Abdominal X-ray showed subdiaphragmatic free air at standing view. The patient underwent emergent exploratory laparotomy, which revealed sigmoid colon perforation about 0.5 cm. Enterolysis and repair of sigmoid colon were performed. Intraoperative stool specimen nucleic acid amplification testing had turned positive for Campylobacter spp. with negative results for other bacterial pathogens. His symptoms improved and he tolerated food well, and was discharged 15 days after admission. CONCLUSIONS: We present this case because of the rarity of Campylobacter-induced sigmoid colon perforation in the pediatric population. It is important to keep in mind that sigmoid colon perforation can be due to an infectious cause, and one of the culprits can be Campylobacter. Infectious colitis caused by Campylobacter spp. should be managed cautiously and the use of antimotility agents in such conditions should be considered judiciously.


Assuntos
Campylobacter , Colite , Doenças do Colo , Enterocolite , Perfuração Intestinal , Masculino , Humanos , Criança , Adolescente , Colo Sigmoide , Perfuração Intestinal/cirurgia , Doenças do Colo/diagnóstico , Dor Abdominal/etiologia , Enterocolite/complicações , Colite/complicações
6.
7.
BJS Open ; 6(6)2022 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-36515673

RESUMO

BACKGROUND: D3 lymph node dissection is recommended for patients with advanced sigmoid and rectal cancer in Japan. This trial aimed to investigate the feasibility of indocyanine green (ICG) as a tracer to increase the nodal harvest during D3 lymph node dissection in patients with sigmoid and rectal cancer. METHODS: This prospective randomized clinical trial was performed between May 2021 and April 2022. The inclusion criteria were patients with stage I-III sigmoid or rectal cancer eligible for laparoscopic resection. Patients were 1: 1 randomized to either the ICG group (endoscopic ICG injection at the tumour site and intraoperative imaging to guide dissection) or the control group (routine laparoscopic white-light imaging). All patients were treated with D3 dissection, and the primary outcome was the number of harvested lymph nodes at the D3 level. RESULTS: Out of 210 patients screened, a total of 66 patients were enrolled and randomized. Patients in the two groups presented similar ages and clinical stages (ICG group versus control group, median age of 58.0 versus 58.5 years; stage III 36.4 per cent versus 36.4 per cent, whereas the rate of rectal cancer was 27.3 per cent versus 48.5 per cent respectively). ICG imaging was helpful for completely dissecting D3 lymph nodes and could identify a median of more than 2 (range 1-6) D3 lymph nodes neglected by routine laparoscopic white-light imaging during surgery. The median number of D3 lymph nodes harvested in the ICG group was significantly higher than that in the control group (7.0 versus 5.0, P = 0.003); however, there was no significant difference in the median numbers of positive D1, D2, and D3 lymph nodes between the two groups. CONCLUSION: ICG is safe and feasible to guide D3 lymph node dissection and can increase the number of harvested D3 lymph nodes in patients with sigmoid and rectal cancer. Registration number: NCT04848311 (http://www.clinicaltrials.gov).


Assuntos
Verde de Indocianina , Neoplasias Retais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Excisão de Linfonodo/métodos , Neoplasias Retais/cirurgia , Neoplasias Retais/patologia , Colo Sigmoide
10.
J Insur Med ; 49(3): 126-146, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36378889

RESUMO

This article reviews a 20-year retrospective population-based study using the statistical database of SEER*Stat 8.3.4 to compare the occurrence, long-term survival and mortality indices of 266,898 patients with cancer of the rectum and rectosigmoid junction (RSJ) juxtaposed by age, sex, race, stage, grade, disease duration, in two cohort entry time-periods, 1973-1994 & 1995-2014.


Assuntos
Colo Sigmoide , Neoplasias Retais , Humanos , Estudos Retrospectivos , Reto , Estudos de Coortes , Neoplasias Retais/epidemiologia
15.
Langenbecks Arch Surg ; 407(8): 3259-3274, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36214867

RESUMO

PURPOSE: The aim of this meta-analysis was to investigate the optimal time point of elective sigmoidectomy regarding the intraoperative and postoperative course in diverticular disease. METHODS: A comprehensive literature research was conducted for studies comparing the operative outcome of early elective (EE) versus delayed elective (DE) minimally invasive sigmoidectomy in patients with acute or recurrent diverticular disease. Subsequently, data from eligible studies were extracted, qualitatively assessed, and entered into a meta-analysis. By using random effect models, the pooled hazard ratio of outcomes of interest was calculated. RESULTS: Eleven observational studies with a total of 2096 patients were included (EE group n = 828, DE group n = 1268). Early elective sigmoidectomy was associated with a significantly higher conversion rate as the primary outcome in comparison to the delayed elective group (OR 2.48, 95% CI 1.5427-4.0019, p = 0.0002). Of the secondary outcomes analyzed only operative time (SMD 0.14, 95% CI 0.0020-0.2701, p = 0.0466) and time of first postoperative bowel movement (SMD 0.57, 95% CI 0.1202-1.0233, p = 0.0131) were significant in favor of the delayed elective approach. CONCLUSIONS: Delayed elective sigmoid resection demonstrates benefit in terms of reduced conversion rates and shortened operative time as opposed to an early approach. Conversely, operative morbidities seem to be unaffected by the timing of surgery. However, a final and robust conclusion based on the included observational cohort studies must be cautiously made. We therefore highly advocate larger randomized controlled trials with homogenous study protocols.


Assuntos
Doenças Diverticulares , Doença Diverticular do Colo , Laparoscopia , Doenças do Colo Sigmoide , Humanos , Procedimentos Cirúrgicos Eletivos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Colo Sigmoide/cirurgia , Doenças Diverticulares/cirurgia , Período Pós-Operatório , Laparoscopia/métodos , Doença Diverticular do Colo/cirurgia , Colectomia/métodos , Doenças do Colo Sigmoide/cirurgia
16.
Pan Afr Med J ; 42: 175, 2022.
Artigo em Francês | MEDLINE | ID: mdl-36187042

RESUMO

Intrauterine device (IUD) is the mainstay of family planning methods in developing countries. However, it is associated with severe complications such as bleeding, perforation and migration to adjacent organs. Although perforation of the uterus is not rare, migration to the sigmoid colon is exceptional. We here report a case of IUD migration into sigmoid colon; this was removed via low endoscopy. The study involved a 45-year-old woman using an IUD who presented with pelvic pain associated with a feeling of pelvic heaviness 6 years later of insertion. Clinical examination was without abnormalities, and computed tomography (CT) scan showed the IUD embedded in the sigmoid colon wall. Diagnostic and therapeutic laparoscopy was performed, which objectified IUD-related intestinal perforation. IUD was partially embedded in the sigmoid colon wall and couldn't be removed. The device was removed during colonoscopy by diathermy loop excision (15 mm in diameter).


Assuntos
Migração de Dispositivo Intrauterino , Dispositivos Intrauterinos , Laparoscopia , Perfuração Uterina , Colo Sigmoide/cirurgia , Remoção de Dispositivo/métodos , Feminino , Humanos , Migração de Dispositivo Intrauterino/efeitos adversos , Dispositivos Intrauterinos/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Perfuração Uterina/etiologia , Perfuração Uterina/cirurgia
17.
Ethiop J Health Sci ; 32(5): 1043-1046, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36262699

RESUMO

Background: Mature colonic teratomas are rare tumors and no case, to the best of our knowledge, has been reported from the African continent. In addition, some pedunculated teratomas in the colon have been treated by endoscopic polypectomy and classified as primary teratoma of the colon. We report a case of a distinct intra sigmoid pedunculated teratoma originating from the retroperitoneum of a 4-year-old African girl and we highlight the potential for misclassification of primary origin of endoscopically removed polypoid teratomas in the colon. Case Presentation: A 4 year-old black African female child who presented with abdominal pain and hematochezia. On clinical assessment, she was found to be anaemic and to have a sigmoid colon mass. At surgery, there was a mobile mass within the lumen of sigmoid colon and the mass was fixed to the retroperitoneum by a stalk of tissue. Pathologist's review of the resected sigmoid segment showed a pedunculated intra-sigmoid mass with the stalk traversing the wall of the colon. The mass was histologically proven a mature solid teratoma. Conclusions: This, to the best of our knowledge, is the first report of intra sigmoid teratoma from the African continent. It highlights the potential for misclassification of endoscopically resected colonic teratomas.


Assuntos
Pólipos do Colo , Teratoma , Pré-Escolar , Feminino , Humanos , Abdome , Colo Sigmoide/cirurgia , Colo Sigmoide/patologia , Pólipos do Colo/complicações , Pólipos do Colo/diagnóstico , Pólipos do Colo/cirurgia , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Hemorragia Gastrointestinal/patologia , Teratoma/complicações , Teratoma/diagnóstico , Teratoma/cirurgia
18.
J Coll Physicians Surg Pak ; 32(9): 1222-1224, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36089727

RESUMO

Lipodystrophy (LD) is an acquired or congenital rare condition consisting of hyperlipidaemia, glucose intolerance/ insulin resistance, and almost complete absence and storage of adipose tissue. Colon perforations can be observed in type 4 congenital LD. Here, we aimed to present a case of sigmoid colon perforation which developed in a young woman with the diagnosis of LD. Extensive purulent peritonitis, significant wall thickening, and oedema in the sigmoid colon were detected during surgical exploration. Anterior resection with end colostomy procedure was then performed. Although bowel perforation has been theoretically reported to occur in LD, the presented case is the first adult patient in the literature. These individuals tend to develop colon perforation as a result of histological changes in their gastrointestinal tract. This situation should always be taken into consideration in order to avoid delay in diagnosis, especially in patients who present with abdominal pain and have a history of LD. Key Words: Intestinal perforation, Congenital lipodystrophy, Peritonitis, Sigmoid colon.


Assuntos
Doenças do Colo , Perfuração Intestinal , Lipodistrofia Generalizada Congênita , Lipodistrofia , Peritonite , Adulto , Colo Sigmoide/cirurgia , Doenças do Colo/cirurgia , Feminino , Humanos , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Lipodistrofia/complicações , Lipodistrofia/patologia , Lipodistrofia Generalizada Congênita/patologia , Peritonite/complicações , Peritonite/diagnóstico , Peritonite/cirurgia
19.
World J Surg Oncol ; 20(1): 313, 2022 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-36163068

RESUMO

BACKGROUND: Anastomotic blood supply is vital to anastomotic healing. The aim of this study was to demonstrate the effect of the left colic artery (LCA) on blood supply in the anastomotic area, explore the relationship between individual differences in the LCA and blood supply in the anastomotic area, and elucidate the relevant indications for LCA retention during radical resection for sigmoid or rectal cancer. METHOD: Radical sigmoid or rectal cancer resection with LCA retention was performed in 40 patients with colorectal cancer who participated in this study. Systemic pressure, LCA diameter, and the distance from the root of the LCA to the root of the inferior mesenteric artery were measured and recorded. The marginal artery stump pressure in the anastomotic colon before and after the LCA clamping was measured, respectively. RESULTS: There is a significant difference between the marginal artery stump pressure before LCA ligation and after ligation (53.1 ± 12.38 vs 42.76 ± 12.71, p < 0.001). The anastomotic blood supply positively and linearly correlated with body mass index and systemic pressure. Receiver-operating curve analysis revealed that LCA diameter (area under the curve 0.971, cutoff 1.95 mm) was an effective predictor of LCA improving anastomosis blood supply. No relationship was found between the LCA root location and anastomotic blood supply. CONCLUSION: Preserving the LCA is effective in improving blood supply in the anastomotic area, and larger LCA diameters result in a better blood supply to the anastomotic area.


Assuntos
Laparoscopia , Neoplasias Retais , Neoplasias do Colo Sigmoide , Anastomose Cirúrgica , Colo Sigmoide/cirurgia , Humanos , Artéria Mesentérica Inferior/cirurgia , Projetos Piloto , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgia
20.
J Med Case Rep ; 16(1): 349, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36180925

RESUMO

BACKGROUND: Persistent descending mesocolon, an anomaly of fixation of the mesentery of the descending colon, can sometimes cause complications such as intestinal obstruction and intussusception. We present the first reported case of sigmoid volvulus with persistent descending mesocolon. CASE PRESENTATION: An 82-year-old Japanese man had intermittent lower abdominal pain. Abdominal computed tomography showed dilation and a shift to the right side of the sigmoid colon, but no findings of volvulus. The next day, he presented continuous lower abdominal pain with bloody stool. A second abdominal computed tomography showed strangulation and dilation of the sigmoid colon, with shift from the right side of the abdominal cavity to the pelvic space. This suggested the descending colon was running to the medial side with sigmoid volvulus. Emergency surgery was performed for volvulus with persistent descending mesocolon. Operative findings revealed dilation of the sigmoid colon with a partial poorly colored region and strangulation that caused volvulus. After releasing the strangulation of the sigmoid colon, the descending colon was revealed to be running more to the medial side, with adherence to small intestinal mesentery. There was no Toldt's fusion fascia at the descending colon. Persistent descending mesocolon was therefore diagnosed due to abnormality of fixation of the descending colon. The sigmoid colon, including the poorly colored region, was resected and reconstructed, while the inferior mesenteric and left colonic arteries were preserved because of the complexity of the vascular system running around the descending and sigmoid colon due to the shortened mesentery. These findings were pathologically compatible with circulatory compromise and intestinal degeneration due to sigmoid volvulus. The patient had no complications after discharge, including in relation to defecation. CONCLUSION: Persistent descending mesocolon can occasionally cause acute abdominal symptoms requiring immediate treatment. A computed tomography finding of the descending colon running more to the medial side than ordinary cases can aid diagnosis of persistent descending mesocolon.


Assuntos
Abdome Agudo , Volvo Intestinal , Laparoscopia , Mesocolo , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Idoso de 80 Anos ou mais , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/cirurgia , Humanos , Volvo Intestinal/diagnóstico , Volvo Intestinal/diagnóstico por imagem , Laparoscopia/métodos , Masculino , Mesocolo/anormalidades , Mesocolo/diagnóstico por imagem , Mesocolo/cirurgia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...