Search

Aim A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. Although the external forces and bony prominences differ depending on ulcer location, the way in which these anatomical differences affect pressure ulcer development is not well studied. Methods To clarify the location-dependent factors for pressure ulcer development, we focused on superficial injuries that develop over an undermining lesion, which we have termed them bilayer pressure ulcers. Because it is thought that a deep pressure ulcer is caused by ischemia at the deep lesion and a shallow pressure ulcer is caused by shear force to the superficial skin, a bilayer pressure ulcer can be considered a mixed phenotype, induced by both pressure and shear force. We retrospectively examined the frequency of bilayer pressure ulcers by location in a total of 568 pressure ulcers. Results The ratio of bilayer pressure ulcers to deep pressure ulcers staged III or more was significantly larger for pressure ulcers over the sacrum. Conclusion A new concept, the relative position between the external force and bony prominence, could explain the frequency and developmental mechanism of bilayer pressure ulcers. The external forces, shape of the bony prominence, and mobility of the soft tissue may be responsible for this concept.

Background: Significant heterogeneity exists in target volumes for postoperative stereotactic radiosurgery (SRS) for brain metastases. A set of contouring guidelines was recently published, and we investigated the impact of deviations. Methods: Patients (n = 41) undergoing single-fraction Gamma Knife SRS following surgical resection of brain metastases from 2011 to 2017 were retrospectively reviewed. SRS included the entire contrast-enhancing cavity with heterogeneity in inclusion of the surgical tract and no routine margin along the dura or clinical target volume margin. Follow-up MR imaging was fused with SRS plans to assess patterns of failure. Results: The median follow-up was 11.1 months with a median prescription of 18 Gy. There were 5 local failures: infield (n = 3, 60%), surgical tract (n = 1, 20%), and marginal > 5 mm from the resection cavity (n = 1, 20%). No marginal failures < 5 mm or dural margin failures were noted. For deep lesions (n = 13), 62% (n = 8) had the entire tract covered. The only tract recurrence was in a deep lesion without coverage of the surgical tract (n = 1/5). Conclusion: In this small preliminary experience, despite no routine inclusion of the dural tract or bone flap, no failures were noted in these locations. Omission of the surgical tract in deep lesions may increase failure rates.

Lesion detection from computed tomography (CT) scans is challenging compared to natural object detection because of two major reasons: small lesion size and small inter-class variation. Firstly, the lesions usually only occupy a small region in the CT image. The feature of such small region may not be able to provide sufficient information due to its limited spatial feature resolution. Secondly, in CT scans, the lesions are often indistinguishable from the background since the lesion and non-lesion areas may have very similar appearances. To tackle both problems, we need to enrich the feature representation and improve the feature discriminativeness. Therefore, we introduce a dual-attention mechanism to the 3D contextual lesion detection framework, including the cross-slice contextual attention to selectively aggregate the information from different slices through a soft re-sampling process. Moreover, we propose intra-slice spatial attention to focus the feature learning in the most prominent regions. Our method can be easily trained end-to-end without adding heavy overhead on the base detection network. We use DeepLesion dataset and train a universal lesion detector to detect all kinds of lesions such as liver tumors, lung nodules, and so on. The results show that our model can significantly boost the results of the baseline lesion detector (with 3D contextual information) but using much fewer slices.

Radiologists in their daily work routinely find and annotate significant abnormalities on a large number of radiology images. Such abnormalities, or lesions, have collected over years and stored in hospitals' picture archiving and communication systems. However, they are basically unsorted and lack semantic annotations like type and location. In this paper, we aim to organize and explore them by learning a deep feature representation for each lesion. A large-scale and comprehensive dataset, DeepLesion, is introduced for this task. DeepLesion contains bounding boxes and size measurements of over 32K lesions. To model their similarity relationship, we leverage multiple supervision information including types, self-supervised location coordinates and sizes. They require little manual annotation effort but describe useful attributes of the lesions. Then, a triplet network is utilized to learn lesion embeddings with a sequential sampling strategy to depict their hierarchical similarity structure. Experiments show promising qualitative and quantitative results on lesion retrieval, clustering, and classification. The learned embeddings can be further employed to build a lesion graph for various clinically useful applications. We propose algorithms for intra-patient lesion matching and missing annotation mining. Experimental results validate their effectiveness., Accepted by CVPR2018. DeepLesion url added

Volumetric lesion segmentation from computed tomography (CT) images is a powerful means to precisely assess multiple time-point lesion/tumor changes. However, because manual 3D segmentation is prohibitively time consuming, current practices rely on an imprecise surrogate called response evaluation criteria in solid tumors (RECIST). Despite their coarseness, RECIST markers are commonly found in current hospital picture and archiving systems (PACS), meaning they can provide a potentially powerful, yet extraordinarily challenging, source of weak supervision for full 3D segmentation. Toward this end, we introduce a convolutional neural network (CNN) based weakly supervised slice-propagated segmentation (WSSS) method to (1) generate the initial lesion segmentation on the axial RECIST-slice; (2) learn the data distribution on RECIST-slices; (3) extrapolate to segment the whole lesion slice by slice to finally obtain a volumetric segmentation. To validate the proposed method, we first test its performance on a fully annotated lymph node dataset, where WSSS performs comparably to its fully supervised counterparts. We then test on a comprehensive lesion dataset with 32,735 RECIST marks, where we report a mean Dice score of 92% on RECIST-marked slices and 76% on the entire 3D volumes.

The surgical management of deep brain tumors is often challenging due to the limitations of stereotactic needle biopsies and the morbidity associated with transcortical approaches. We present a novel microscopic navigational technique utilizing the Viewsite Brain Access System (VBAS) (Vycor Medical, Boca Raton, FL, USA) for resection of a deep parietal periventricular high-grade glioma as well as another glioma and a cavernoma with no related morbidity. The approach utilized a navigational tracker mounted on a microscope, which was set to the desired trajectory and depth. It allowed gentle continuous insertion of the VBAS directly to a deep lesion under continuous microscopic visualization, increasing safety by obviating the need to look up from the microscope and thus avoiding loss of trajectory. This technique has broad value for the resection of a variety of deep brain lesions.

In this report, we describe a 1-stage zygomaticomandibular composite flap for improved access to the retromaxillary space and the base of the skull. The zygoma and the mandible were not detached from the facial musculature or from its overlying tissues, maintaining an optimum bone-soft tissue relationship. The advantage of this approach was the enhanced exposure of the deep lesion, which provided a shorter and wider view to the maxilla, the retromaxillary space, and the base of the skull. Restoration of the skeletal symmetry and the three-dimensional contour of the maxilla was greatly enhanced by using preadapted plates and a stereolithographic model. To the best of our knowledge, no references were found in the literature regarding the use of the same technique for treating defects of similar nature to those described in this article. The deep circumflex iliac artery flap was used to reconstruct the midfacial defect and the base of the skull. The use of the flap provided optimum results because the defect was closed with the muscle that became epithelialized with minimal bulk.

Atypical lipomatous tumors occur predominantly in middle-aged patients and often present as painless, slow-growing masses in the extremities. The clinical outcomes of surgically treated superficial or deep atypical lipomas of the extremities were reviewed. Thirty-one patients were included in this study. There were 16 men and 15 women, with an average age of 57 years (range, 32-87 years). The mean followup was 7 years (range, 1-28.8 years). Twenty-five tumors occurred in the lower extremity and six in the upper extremity. Sixteen patients (52%) had a recurrence at an average of 4.7 years after resection. Twelve (39%) patients required additional surgical procedures to treat their tumor. Occurrence of a deep lesion and positive margins at the time of the initial surgery correlated closely with the rate of recurrence and need for additional surgical treatment. Dedifferentiation to high-grade liposarcoma developed in four (13%) patients. Atypical lipomas have a high propensity for local recurrence and a potential for malignant dedifferentiation. Patients with atypical lipomas require careful evaluation, complete surgical excision when possible, and close clinical followup extending beyond 5 years.

Background: Neurofibromatosis may present with different skin lesions. Disfiguring lesions on the face might be challenging for the surgeon or clinician to correct and may have adverse effects on patients' social lives, especially in young women. Objective: To present the dermabrasion technique combined with serial excisions of a deeper accompanying lesion to treat superficial facial lesions in a young neurofibromatosis patient. Methods: Dermabrasion was applied to superficial lesions on the face, and staged excision was applied to the deeper lesion located on the forehead. Results: We obtained high patient satisfaction with the result. The deep lesion was excised totally, and superficial lesions were decreased with dermabrasion. Conclusion: Dermabrasion may become a good alternative in cases of neurofibromatosis with superficial facial lesions.

We introduced the procedure and the technique of percutaneous microwave coagulation therapy (PMCT) for small liver cancer. PMCT with a microwave electrode for deep lesion was done by an ultrasonic guide under local anesthesia. PMCT may be utilized simply and safely for the treatment of small liver cancer, and also be a useful treatment in combination with conventional palliative managements for recurrent tumors after hepatectomy.

In 2003, after the second Gulf War, the authors were medical doctors at the humanitarian Mission of the Red Cross Field Hospital in Baghdad, Iraq. Our experience in the fi eld indicated that civilians were at a high risk for injuries caused by stray bullets. Whilst we were attending an out-patient activity, we saw a 10-year old boy with a deep lesion of the skin in the left frontal-parietal area of his head caused by a stray bullet 2 months earlier. The bullet had entered the upper parietal portion of the skull (fi gures A, B). Clinical and neurological examination showed no defi cit of power, cognition, sense of touch, or speech. Blood test results were unremarkable. The scalp A stray bullet in the brain

To determine the clinical usefulness of gadolinium-DPTA-enhanced MRI in identifying recent small, deep infarcts we prospectively studied 91 patients with first-ever stroke and presenting with a lacunar syndrome. In 78 patients (85.7%), plain MRI revealed possibly appropriate infarcts, classified as deep (n = 69), internal borderzone (n = 1), and cortical (n = 8 patients). Enhancement was seen in 38 (80.9%) of 47 patients with only one possibly relevant deep lesion on plain MRI, and in 14 (63.6%) out of 22 patients with multiple lesions. MRI with gadolinium-DPTA facilitates identification of the relevant lesion in patients with presumed lacunar infarcts.

A molecular epidemiologic study provided the opportunity to characterize the biology of the biofilm-gingival interface (BGI) in 6,768 community-dwelling subjects.Disease classifications and multivariable models were developed using clinical, microbial, inflammatory, and host-response data. The purpose was to identify new clinical categories that represented distinct biologic phenotypes based upon DNA checkerboard analyses of eight plaque bacteria, serum immunoglobulin G (IgG) titers to 17 bacteria, and the gingival crevicular fluid (GCF) levels of 16 inflammatory mediators. Five BGI clinical conditions were defined using probing depths (PDs) and bleeding on probing (BOP) scores. Subjects with all PDsor = 3 mm were grouped as BGI-healthy (14.3% of sample) or BGI-gingivitis (BGI-G, 15.1%). Subjects with one or more PDsor = 4 mm [deep lesion (DL)] were divided into low BOP (18.0%), moderate BOP (BGI-DL/MB, 39.7%), and severe BOP (BGI-DL/SB, 12.9%).Subjects with BGI-G had increased levels of Campylobacter rectus-specific serum IgG levels (P = 0.01), and those with BGI-DL/SB had increased IgG levels to Porphyromonas gingivalis (P0.0003) and C. rectus (P0.01). BGI-DL/SB subjects had an excessive GCF interleukin (IL)-1beta and prostaglandin E2 response and an enhanced chronic inflammatory response with significant increases in GCF IL-6 and monocyte chemotactic peptide-1. Within BGI-DL/SB subjects, more severe pocketing and BOP were associated with higher levels of GCF IL-1beta, not higher microbial counts or plaque scores.New BGI classifications create categories with distinct biologic phenotypes. The increased titers of C. rectus IgG among 68.5% of the BGI-G subjects and elevated P. gingivalis titers among BGI-DL/MB and BGI-DL/SB subjects (63.8% and 75.7%, respectively) are strongly supportive of the microbial specificity of pathogenesis for BGI categories.

Analytical studies have shown that both blunt and shear stress are manifest at the tidemark that separates the calcified and uncalcified cartilage in the articular surface.1 This “essential lesion” of articular cartilage damage has subsequently been substantiated by cadaver and animal studies.2,3 The development of focal lesions of the articular surface is attributed to the progression of this essential deep lesion. Thus, the rationale behind osteochondral transfer is to replace the damaged cartilage bone unit with a healthy one.

Figure 1. Acute, severe odynophagia developed in a 52-year-old man known to be positive for the human immunodeficiency virus (HIV). A double-contrast esophagogram (Panel A) shows two giant, ovoid ulcers (arrows) measuring 3 cm and 6 cm in length in the middle and distal thirds of the esophagus, respectively. An endoscopic photograph of the mid-portion of the esophagus (Panel B) shows the proximal ulcer to be a deep lesion with well-demarcated margins (arrows). The distal ulcer had a similar appearance, and the mucosa between the lesions was grossly normal, without exudates or plaques. Endoscopic brushings, biopsy specimens, and cultures obtained . . .

Two hundred and twenty three right-handed patients consecutively admitted to the wards in a 21-month period for a left-sided cerebrovascular disease were examined 15 to 30 days after the stroke for the presence of aphasia. Twenty-seven of them could not be assessed. Of the remaining 196, 108 (55.1%) were aphasic. The incidence of global aphasia (43%) in the latter group was higher than in previous studies. Based on CT-scan data it was associated in 32% of patients with a deep lesion and only in 53% with an antero-posterior cortical-subcortical lesion, contrary to what is traditionally assumed. There was no sex difference in the incidence and distribution of aphasia.

The contralateral corneal reflex may be absent in patients with a deep lesion of the parietal lobe. Frontal and temporal lobe lesions apparently do not interfere with this reflex.

Hemorragie de la tete du noyau caude gauche et de la partie contigue du bras de la capsule interne

A neuropsychological analysis of a deep echinococcus cyst of the left temporal lobe where the hippocampus system suffers and the cortical structures of the Wernicke zone is preserved gives important data on the comparative role of both structures in memory processes. A syndrome of specific disturbance of acoustic-verbal memory and no defects in phonematic analysis is described and the neurodynamic disturbances underlying the defect are analysed. A comparative analysis of differential symptoms of memory deficit in cases of a deep lesion of the left temporal lobe is presented.