scholarly journals THREE-DIMENSIONAL PREDICTORS OF FAI DISEASE PROGRESSION IN THE CONTRALATERAL HIP

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0013
Author(s):  
Lucas M. Fowler ◽  
John C. Clohisy ◽  
Wahid Abu-Amer ◽  
Cecilia Pascual Garrido ◽  
Jeffrey J. Nepple
Keyword(s):  
Surgical Treatment ◽  
Alpha Angle ◽  
Three Dimensional ◽  
Symptom Development ◽  
Acetabular Version ◽  
Femoral Version ◽  
Experienced Pain ◽  
Bony Morphology

Background: Bony morphologies contributing to femoroacetabular impingement (FAI) are relatively common in the general population, but drivers of symptom development are not well understood. Hypothesis/Purpose: The purpose of this study was to determine the role of three-dimensional bony morphology in symptom development in the contralateral hip in patients undergoing ipsilateral surgical treatment for FAI. Methods: The study included a prospective cohort of 161 consecutive patients (101 females, 60 males) who presented for ipsilateral FAI surgical treatment from 2013-2018. The average age was 29.1 years. Minimum follow-up was 1 year (mean, 2.3 years; range, 1-6 years). Low-dose CT scans were obtained prior to surgical treatment. Three-dimensional hip analysis of the contralateral hip was performed relative to normative data and allowed measurements of 15 key parameters. Prior to surgery and at routine follow-up, patients completed standardized questionnaires that included pain in the contralateral hip. Univariate and multivariate analyses were performed to identify independent predictors. Results: There were 133 patients (83%) with follow-up. Significant levels of pain in the contralateral hip were reported in 25 (18.8%) patients at presentation and 50 (35.3%) patients at follow-up. Twenty-six (19.5%) patients progressed to surgery at an average of 1.12 years. Significant predictors of symptom development were alpha angle >55° at 1:00 (p=0.037), femoral version <0° or > 20° (p=0.027), and decreased central acetabular version at 3:00 (p=0.048). Significant predictors of surgery were age <30 years (p=0.023) and alpha angle >55° at 1:00 (p=0.005). Conclusion: We found that roughly 1 in 5 patients undergoing surgical treatment for ipsilateral FAI experienced pain in the contralateral hip at presentation, over one third reported pain at follow-up, and 1 in 5 progressed to surgery. Higher alpha angle, abnormal femoral version, and decreased acetabular version were correlated with symptom development, while higher alpha angle and age under 30 were associated with progression to surgery.

A comparison between the CS-TOF and the CTA/DSA for WEB device management

2021 ◽  
pp. 159101992110147
Author(s):  
Oktay Algin ◽  
Gokhan Yuce ◽  
Ural Koc ◽  
Gıyas Ayberk
Keyword(s):  
Mr Angiography ◽  
Three Dimensional ◽  
Morphological Parameters ◽  
Perfect Agreement ◽  
Device Management ◽  
Web Device ◽  
Sensing Time ◽  
The Web

Purpose There is no study on the role of three-dimensional compressed sensing time of flight MR angiography (3D-CS-TOF) in the management of the WEB device. We evaluated the efficacy of 3-tesla 3D-CS-TOF for the management and follow-up of the WEB device implantations. Materials and methods Seventy-three aneurysms of 69 patients treated with the WEB device were retrospectively examined. Morphological parameters and embolization results of the aneurysms were assessed and compared on 3D-CS-TOF, CTA, and DSA images. Results Occluded, neck remnant, and recurrent aneurysms were observed in 61 (83.6%), 7 (9.6%), and 5 (6.8%) aneurysms, respectively. Inter- and intra-reader agreement values related to aneurysm size measurements were perfect. Aneurysms size, age, and proximal vessel tortuosity were negatively correlated with the visibility of the aneurysms and parent vessels on 3D-CS-TOF images (p = 0.043; p = 0.032; p < 0.001, respectively). Subarachnoid hemorrhage and age are associated with 3D-CS-TOF artifacts (p = 0.031; p = 0.005, respectively). 3D-CS-TOF findings are in perfect agreement with DSA or CT angiography (CTA) results (p < 0.001). Conclusion According to our results, 3D-CS-TOF can be an easy, fast, and reliable alternative for the management or follow-up of WEB assisted embolization.

scholarly journals BORDERLINE ACETABULAR DYSPLASIA: THREE-DIMENSIONAL DEFORMITY PREDICTORS OF THE DIAGNOSIS OF SYMPTOMATIC INSTABILITY TREATED WITH PERIACETABULAR OSTEOTOMY

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0016
Author(s):  
Elizabeth Graesser ◽  
Maria Schwabe ◽  
Cecilia Pascual Garrido ◽  
John C. Clohisy ◽  
Jeffrey J. Nepple
Keyword(s):  
Low Dose ◽  
Acetabular Dysplasia ◽  
Periacetabular Osteotomy ◽  
Alpha Angle ◽  
Three Dimensional ◽  
Acetabular Coverage ◽  
Low Dose Ct ◽  
Femoral Version ◽  
Center Edge ◽  
Hip Morphology

Introduction: Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia. Methods: Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups. Results: Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92. Conclusion: We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia. Summary: This study attempts to define 3D CT characteristics to help distinguish between patients with impingement-based vs instability-based symptoms of borderline acetabular dysplasia.

Quasi-Periodic Orbits in the Five-Dimensional Nondissipative Lorenz Model: The Role of the Extended Nonlinear Feedback Loop

2018 ◽  
Vol 28 (06) ◽  
pp. 1850072 ◽  
Author(s):  
Sara Faghih-Naini ◽  
Bo-Wen Shen
Keyword(s):  
Periodic Solution ◽  
Feedback Loop ◽  
Three Dimensional ◽  
Nonlinear Feedback ◽  
Lorenz Model ◽  
Restoring Force ◽  
Oscillatory Solutions ◽  
Nonlinear Temperature

A recent study suggested that the nonlinear feedback loop (NFL) of the three-dimensional nondissipative Lorenz model (3D-NLM) serves as a nonlinear restoring force by producing nonlinear oscillatory solutions as well as linear periodic solutions near a nontrivial critical point. This study discusses the role of the extension of the NFL in producing quasi-periodic trajectories using a five-dimensional nondissipative Lorenz model (5D-NLM). An analytical solution to the locally linear 5D-NLM is first obtained to illustrate the association of the extended NFL and two incommensurate frequencies whose ratio is irrational, yielding a quasi-periodic solution. The quasi-periodic solution trajectory moves endlessly on a torus but never intersects itself. While the NFL of the 3D-NLM consists of a pair of downscaling and upscaling processes, the extended NFL within the 5D-NLM additionally introduces two new pairs of downscaling and upscaling processes that are enabled by two high wavenumber modes. One pair of downscaling and upscaling processes provides a two-way interaction between the original (primary) Fourier modes of the 3D-NLM and the newly-added (secondary) Fourier modes of the 5D-NLM. The other pair of downscaling and upscaling processes involves interactions amongst the secondary modes. By comparing the numerical simulations using one- and two-way interactions, we illustrate that the two-way interaction is crucial for producing the quasi-periodic solution. A follow-up study using a 7D nondissipative LM shows that a further extension of NFL, which may appear throughout the spatial mode-mode interactions rooted in the nonlinear temperature advection, is capable of producing one more incommensurate frequency.

Echocardiographic considerations during deployment of the Helex Septal Occluder for closure of atrial septal defects

2003 ◽  
Vol 13 (3) ◽  
pp. 290-298 ◽  
Author(s):  
Leo Lopez ◽  
Roque Ventura ◽  
Elizabeth M. Welch ◽  
David G. Nykanen ◽  
Evan M. Zahn
Keyword(s):  
Three Dimensional ◽  
Intracardiac Echocardiography ◽  
New Device ◽  
Septal Defects ◽  
Acoustic Interference ◽  
Atrial Septal Defects ◽  
Helex Septal Occluder ◽  
Interventional Catheterization

The Helex Septal Occluder is a new device used to close atrial septal defects via interventional catheterization. In order to study the role of echocardiography during its use, and to describe the morphologic variants of defects suitable for closure with this occluder, we evaluated all patients undergoing intended closure of an atrial septal defect with the Helex occluder. A combination of transthoracic, transesophageal, three-dimensional, and intracardiac echocardiography were used before, during, and after the procedure to characterize anatomy, assess candidacy for closure, guide the device during its deployment, and evaluate results. Among the 60 candidates included in the study, 11 were excluded because of transesophageal echocardiographic and/or catheterization data obtained in the laboratory. Attempts at closure were successful in 46 patients, and unsuccessful in 3. We successfully treated four types of defects. These were defects positioned centrally within the oval fossa with appreciable rims along the entire circumference of the defect, defects with deficient or absent segments of the rim, defects with aneurysm of the primary atrial septum, and defects with multiple fenestrations. Follow-up transthoracic echocardiograms taken at a median of 7 months demonstrated no residual defects in 21, trivial residual defects in 17, and small residual defects in 8 patients. In 20 patients, three-dimensional reconstructions were used to characterize the morphology of the defect and the position of the device. Because transesophageal echocardiography was often limited by acoustic interference from the device, intracardiac echocardiography was utilized in 3 cases to overcome this limitation.

scholarly journals Standard Radiographic Assessment of Femoral Cam Morphology is Influenced by Neck-Shaft Angle and Femoral Version

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0039
Author(s):  
Layla Haidar ◽  
Ryan Warth ◽  
Erinn Pemberton Annie Waite ◽  
Alfred Mansour
Keyword(s):  
Femoral Head ◽  
Alpha Angle ◽  
Three Dimensional ◽  
Neck Shaft Angle ◽  
Incremental Change ◽  
Observer Reliability ◽  
Angle Measurements ◽  
Femoral Version ◽  
Shaft Angle ◽  
Head Neck

Objectives: Cam-type femoroacetabular impingement (FAI) is a three-dimensional (3D) deformity that is still difficult to assess using traditional two-dimensional (2D) radiographic views. While measurements of alpha angle and head-neck offset are used to estimate the likelihood of actual impingement, these 2D measurements do not account for z-axis variations in femoral version (FV) and neck-shaft angle (NSA). The purpose of this qualitative proof-of-concept study was to evaluate the potential variation in alpha angle and neck-shaft offset measurements with incremental changes in NSA and FV by simulating traditional radiographic views with software-generated Digitally-Reconstructed Radiographs (DRRs). We hypothesize that incremental changes in hip morphology will produce qualitative changes in alpha angle and neck-shaft offset. Methods: 3D-CT reconstruction images were obtained from one subject with symptomatic cam-type FAI. The 3D reconstruction was cleaned to include only the femoral head, neck and subtrochanteric region along with the ipsilateral hemipelvis. Using 3D medical image processing software (Mimics; Materialise, Inc.; Belgium), the pre-processed 3D model was manipulated in a standardized manner to simulate 5-degree incremental variations in FV and NSA (-15 degrees to +15 degrees for FV; -15 degrees to +10 degrees for NSA). Negative FV reflected external rotation of the femoral head-neck unit, whereas negative NSA reflected abduction of the femoral head-neck unit. Each modified 3D model was then used to generate DRRs corresponding to traditional 2D radiographic views used for assessment of cam-FAI (Anteroposterior [AP], False Profile [FP]), Cross Table Lateral [CTL], Frog Leg Lateral [FLL], 45- and 90-degree Dunn [45D and 90D, respectively]. Alpha angle and head-neck offset were measured on each radiographic view corresponding to each incremental change in FV and NSA. All measurements utilized the perfect circle technique and were made by two independent observers for assessment of inter-observer reliability. Two-way random effects ANOVA was used for statistical assessment of inter-observer reliability and reported as intra-class correlation coefficients (κ). Comparisons between groups were performed using two-tailed paired t-tests assuming unequal variance. P-values less than 0.05 were considered statistically significant. Results: Inter-observer reliability (κ) for head-neck offset and alpha angles were 0.46 (fair) and 0.88 (excellent), respectively. Variations in head-neck offset and alpha angle with incremental variations in FV and NSA are summarized in Figure 1. There were statistically significant changes in mean alpha angles when the NSA was adjusted from Neutral to -5 degrees (p=0.01) and from -5 degrees to -10 degrees (p<0.001). There were no statistically significant differences in alpha angles or head-neck offsets between each incremental change in FV (p<0.05). Alpha angle measurements were significantly more variable than head-neck offset measurements for all variations in FV (p<0.001) and NSA (p=0.02) (Figure 2). Conclusion: Two-dimensional evaluation of three-dimensional Cam morphology (alpha angle and head-neck offset) was found to be significantly affected by alterations in femoral version and head-neck offset. Head-neck offset measurements were significantly less variable than alpha angle measurements across all FVs and NSAs within each radiographic view. Future work should be done to develop standardized procedures for routine 3D radiographic assessment of cam-type FAI. [Figure: see text][Figure: see text]

scholarly journals Propranolol as an effective therapy for infantile haemangioma of the urinary bladder

2019 ◽  
Vol 12 (2) ◽  
pp. e226929
Author(s):  
Taha Anwar ◽  
Elizabeth Malm-Buatsi
Keyword(s):  
Surgical Treatment ◽  
Urinary Bladder ◽  
Medical Therapy ◽  
Potential Role ◽  
Marked Decrease ◽  
Surgical Techniques ◽  
Cutaneous Lesions ◽  
Infantile Haemangiomas

Infantile haemangiomas are one of the most common tumours in infancy, but typically present as cutaneous lesions; haemangiomas of the urinary bladder are incredibly rare. Although benign, these can sometimes ulcerate and bleed, causing haematuria in the case of bladder lesions. Propranolol is a well-documented medical therapy for cutaneous lesions, but surgical treatment dominates the literature on bladder haemangiomas. We present the case of a child with infantile haemangiomas of the urinary bladder, as well as internal and cutaneous lesions, treated with propranolol. At 6-week follow-up cystoscopy and MRI, there was a significant improvement in both bladder and internal lesions, respectively. Follow-up with dermatology 9 months after initiation of propranolol demonstrated excellent regression of the cutaneous lesions with a marked decrease in both size and prominence. This case demonstrates the potential role of propranolol in the treatment of bladder haemangiomas in lieu of more invasive surgical techniques.

Different Therapeutic Approaches and Outcome in the Treatment of Pterygium

1998 ◽  
Vol 8 (3) ◽  
pp. 148-152 ◽  
Author(s):  
C. H. Karabatsas ◽  
G. W. Marsh ◽  
A. M. Cook ◽  
S. D. Cook
Keyword(s):  
Surgical Treatment ◽  
Surgical Techniques ◽  
Surgical Excision ◽  
Lamellar Keratoplasty ◽  
Therapeutic Approaches ◽  
Therapeutic Modalities ◽  
Results Of Treatment ◽  
One Year

Purpose This study was initiated to investigate the role of different therapeutic modalities in the outcome of the surgical treatment of pterygium. Methods The results of treatment of pterygia with a variety of surgical techniques were studied in 56 eyes (49 patients) operated on at Bristol Eye Hospital during a period of five years. The surgical techniques included simple excision; bare sclera; conjunctival autograft; sliding conjunctival flap; lamellar keratoplasty and penetrating keratoplasty. Twelve eyes received additional beta irradiation in a fractionated total dose of 40 Gys. Results The incidence of recurrence was 23.2% for the 43 treated primary pterygia, and 23% for the 13 recurrent pterygia. All recurrences occurred between 2.5 and 11 months postoperatively. None of the 11 cases where additional beta irradiation was used showed any recurrence or other complication within the study period. In the recurrent pterygia group, the cases treated with a combination of surgical excision and beta irradiation, showed significantly lower recurrence rate (p<0.001) compared to those cases treated with surgical excision alone. Conclusions Beta irradiation as a complement to surgical treatment of pterygium, is successful in treating high risk cases such as reoperations, whereas for the majority of primary pterygia surgical excision alone is adequate. Additionally, follow up of one year will reveal any recurrences.

scholarly journals Bleeding Pseudocyst of the Pancreatic Head. The role of Omentoplasty and Local Hemostasis

HPB Surgery ◽  
1994 ◽  
Vol 8 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Francesco Stipa ◽  
Adolfo Gavelli ◽  
Claude Huguet
Keyword(s):  
Surgical Treatment ◽  
Mortality Rate ◽  
Pancreatic Resection ◽  
Pancreatic Head ◽  
Postoperative Mortality ◽  
Arterial Embolization ◽  
Arterial Ligation ◽  
Post Traumatic

Treatment of bleeding psedoaneurysms and pseudocysts of the pancreas is controversial. Surgical treatment with pancreatic resection or trancystic arterial ligation is not always satisfactory since postoperative mortality rate is high, especially for lesions located in the pancreatic head and rebleeding is not unusual. Two patients with bleeding pseudoaneurysms (one post traumatic, one spontaneous) and one with a hemorrhagic pseudocyst of the pancreatic head were treated surgically with arterial suture and omentoplasty. Bleeding was controlled in all, without any postoperative mortality or morbidity. No rebleeding occurred with a follow up of 33, 26 and 12 months. Trancystic ligation of bleeding vessels with omentoplasty may be a useful approach, which should be compared to arterial embolization in the future.

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