A Brain Parenchyma Model-Based Segmentation of Intraventricular and Intracerebral Haemorrhage in CT Scans.

Accurate quantification of haemorrhage volume in a computed tomography (CT) scan is critical in the management and treatment planning of intraventricular (IVH) and intracerebral haemorrhage (ICH). Manual and semi-automatic methods are laborious and time-consuming limiting their applicability to small data sets. In clinical trials measurements are done at different locations and on a large number of data; an accurate, consistent and automatic method is preferred. A fast and efficient method based on texture energy for identification and segmentation of hemorrhagic regions in the CT scans is proposed. The data set for the study was obtained from CLEAR-IVH clinical trial phase III (41 patients' 201 sequential CT scans from ten different hospitals, slice thickness 2.5-10 mm and from different scanners). The DICOM data were windowed, skull stripped, convolved with textural energy masks and segmented using a hybrid method (a combination of thresholding and fuzzy c-means). Artifacts were removed by statistical analysis and morphological processing. Segmentation results were compared with the ground truth. Descriptive statistics, Dice statistical index (DSI), Bland-Altman and mean difference analysis were carried out. The median sensitivity, specificity and DSI for slice identification and haemorrhage segmentation were 86.25%, 100%, 0.9254 and 84.90%, 99.94%, 0.8710, respectively. The algorithm takes about one minute to process a scan in MATLAB(®). A hybrid method-based volumetry of haemorrhage in CT is reliable, observer independent, efficient, reduces the time and labour. It also generates quantitative data that is important for precise therapeutic decision-making.

Dialysis arthropathy: a clinical, biochemical, radiological and histological study of 36 patients.

Out of a population of 97 haemodialysis patients, 36 patients with dialysis arthropathy were identified. Dialysis arthropathy is a chronic symmetrical polyarthritis which affected 97 per cent of the patients who had been undergoing cuprophane haemodialysis for more than 10 years. It commonly affected the shoulders, hips, hands, knees and wrists, worsening with time and extending to other joints. Fifty-eight per cent of the patients complained of morning stiffness and 47 per cent complained of exacerbation of shoulder pain during or after haemodialysis. Half of the patients also suffered from carpal tunnel syndrome, which recurred and was associated with a long-lasting disability. The most common radiological abnormality was periarticular bone cysts, followed by articular erosions and a destructive spondyloarthropathy, but clinical symptoms were more common than radiological signs. Patients with dialysis arthropathy had a higher C-reactive protein level than patients without arthropathy (18.6 mg/l versus 11.4 mg/l), indicative of an inflammatory process. Some of the clinical manifestations of the disease correlated with levels of C-reactive protein and ferritin. Serum ferritin levels correlated strongly with the units of blood transfused in the past five years (RS = 0.83), and the logarithm of ferritin level correlated weakly with C-reactive protein (r = 0.32). Haemarthroses were documented in 19 per cent of patients. Mean serum beta 2-microglobulin was elevated in the patients with (57.3 mg/l) and without arthropathy (50.7 mg/l), and there was no difference in the parathormone or aluminium levels between these groups. Articular tissue was obtained in 25 patients; beta 2-microglobulin amyloid was present in 24. Larger deposits were present in the capsular tissue, and these appeared to replace collagen bundles in eight cases. Amyloid deposits replaced the lining layer in six cases. It is likely therefore that amyloid disrupts normal joint function by replacing normal joint tissue. Mild chronic synovitis with haemosiderin deposition were found in approximately 60 per cent of cases. These findings suggest that amyloid derived from beta 2-microglobulin has a primary role in the pathogenesis of dialysis arthropathy, but there was also evidence of inflammatory processes. It is suggested that iron overload or haemarthroses might contribute to the inflammation, but other factors, such as dialysis-related bioincompatibility reactions, may also have a role.

Technetium-99-labelled methylene diphosphonate uptake scans in patients with dialysis arthropathy.

Patients on long-term haemodialysis suffer from dialysis arthropathy due to the deposition of dialysis amyloid. We investigated the use of 99Tc-labelled methylene diphosphonate bone scans in 17 patients as a possible in vivo diagnostic technique. In most clinically affected joints, with the exception of shoulders and hands, there was increased radioisotope uptake consistent with uptake by periarticular bone. In addition, we describe intense soft-tissue uptake around some clinically affected large joints. In contrast, control groups of patients on haemodialysis without arthropathy and patients without renal failure did not have increased uptake. A semi-quantitative scale of uptake was devised, and the following correlations were significant: pain perception and isotope uptake score in the ankles and feet, and the number of radiological lesions and isotope uptake scores in the wrists and knees. The following sites where the radioisotope might bind in the affected joints are proposed: amyloid deposits, areas of soft-tissue calcification, or areas of increased bone turnover. It is concluded that whereas the scanning technique cannot make a definite diagnosis of amyloid and, therefore, cannot be expected to supersede histological diagnosis, it is a useful adjuvant investigation, of particular importance in those patients unable or unwilling to undergo biopsy.

Prophylactic povidone iodine in minor wounds.

A total of 628 patients requiring sutures for minor wounds in an accident and emergency unit was included in a controlled trial using povidone iodine dry powder spray (Disadine DP) as prophylaxis against wound infection. In patients with injuries of the forearm and hand there was a statistically significant reduction in infection rate (P less than 0.02). Povidone iodine spray was found to be an effective, simple to use, not toxic, antiseptic prophylactic agent.

The modified lumbotomy versus the oblique loin incision for renal surgery.

The time to full mobility and total analgesic requirements have been assessed in 40 patients undergoing renal surgery by the oblique loin incision or the posterior lumbotomy approach. By these criteria the lumbotomy group fared better than patients who had oblique incisions. We consider lumbotomy to be a valuable incision which should be in the repertoire of every urologist.

Ureterosigmoidostomy in childhood: the quality of life.

Thirty-one patients in whom ureterosigmoidostomy had been performed between 1952 and 1974 for a variety of conditions are presented. Twelve patients, or 39%, were subsequently rediverted, mainly for upper tract deterioration. Nineteen patients retaining their ureterosigmoidostomy were evaluated after 3 to 22 yr. Growth was normal in all. Twelve patients required regular alkali and three intermittant antibiotics. In 14 patients, the I.V.U. remained perfect. Each patient was interviewed. Voiding was on average three hourly. Some urgency was common, but soiling was rare. Sleep was disturbed in nearly half the patients but this was usually around dawn. Lessons were rarely interrupted and nearly all took part in sports. The large majority felt no different from their peers. In spite of close initial supervision and significant rediversion rate, ureterosigmoidostomy can provide a very acceptable form of urinary diversion in children.

Necrotising ureteritis after cystoplasty for leukoplakia of the bladder--an unusual complication.

Ileocaecocystoplasty was performed after subtotal cystectomy in a man with extensive leukoplakia of the bladder as a prophylaxis against carcinoma. 2 years later the ureter (contralateral nephrectomy had previously been performed) became blocked by an unusual interstitial inflammation complicated by necrosis and calcification. This was excised, and the tail of the ileum anastomosed to the renal pelvis with a good result at 20 months.