scholarly journals Predicting the Amount of Intraperitoneal Fluid Accumulation by Computed Tomography and Its Clinical Use in Patients With Perforated Peptic Ulcer

2014 ◽  
Vol 99 (6) ◽  
pp. 824-829 ◽  
Author(s):  
Toru Ishiguro ◽  
Youichi Kumagai ◽  
Hiroyuki Baba ◽  
Yusuke Tajima ◽  
Hideko Imaizumi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peptic Ulcer ◽  
Postoperative Complications ◽  
Ct Scan ◽  
Peritoneal Fluid ◽  
Treatment Decision ◽  
Perforated Peptic Ulcer ◽  
Clinical Parameters ◽  
Treatment Decision Making ◽  
The Relationship

Abstract The correlation between the amount of peritoneal fluid and clinical parameters in patients with perforated peptic ulcer (PPU) has not been investigated. The authors' objective was to derive a reliable formula for determining the amount of peritoneal fluid in patients with PPU before surgery, and to evaluate the correlation between the estimated amount of peritoneal fluid and clinical parameters. We investigated 62 consecutive patients who underwent emergency surgery for PPU, and in whom prediction of the amount of accumulated intraperitoneal fluid was possible by computed tomography (CT) using the methods described by Oriuchi et al. We examined the relationship between the predicted amount of accumulated intraperitoneal fluid and that measured during surgery, and the relationship between the amount of fluid predicted preoperatively or measured during surgery and several clinical parameters. There was a significant positive correlation between the amount of fluid predicted by CT scan and that measured during surgery. When patients with gastric ulcer and duodenal ulcer were analyzed collectively, the predicted amount of intraperitoneal fluid and the amount measured during surgery were each associated with the period from onset until CT scan, perforation size, the Mannheim peritoneal index, and the severity of postoperative complications according to the Clavien–Dindo classification. Our present results suggest that the method of Oriuchi et al is useful for predicting the amount of accumulated intraperitoneal fluid in patients with PPU, and that this would be potentially helpful for treatment decision-making and estimating the severity of postoperative complications.

scholarly journals Computer knows best? The need for value-flexibility in medical AI

2018 ◽  
Vol 45 (3) ◽  
pp. 156-160 ◽  
Author(s):  
Rosalind J McDougall
Keyword(s):  
Decision Making ◽  
Medical Treatment ◽  
Shared Decision Making ◽  
Patient Autonomy ◽  
Ethical Issues ◽  
Treatment Decision ◽  
Shared Decision ◽  
Treatment Decision Making ◽  
Value Judgements ◽  
The Relationship

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making.

scholarly journals The deadly “bulging balloon” within the mediastinum: a case of a giant aortic root aneurysm in a young patient with Marfan syndrome

2020 ◽  
Author(s):  
JIAYU SHEN ◽  
Changping Gan ◽  
R.D.T. Rajaguru ◽  
Dou Yuan ◽  
ZHENGHUA XIAO
Keyword(s):  
Decision Making ◽  
Aortic Valve ◽  
Ct Scan ◽  
Young Patient ◽  
Marfan Syndrome ◽  
Aortic Root ◽  
Treatment Decision ◽  
Decision Making Process ◽  
Aortic Root Aneurysm ◽  
Treatment Decision Making

Abstract Introduction: Marfan syndrome (MFS) is a common heritable connective tissue disease involving multiple organs. Even though the clinical manifestations of MFS can be various, aortic root aneurysm is estimated as one of the most serious complications. We herein describe an individualized treatment decision-making process for a 23-year-old male with MFS, suffering from a giant but stable aortic root aneurysm which is extremely rare at his age. Case: The patient, a 23-year-old male with a family history of MFS, presented to our cardiovascular department because of progressive exertional chest distress, fatigue and occasional precordial pain. Physical examinations revealed six-foot-three inches of height, high myopia, and a diastolic murmur at the aortic valve area. Laboratory examinations for systemic vasculitis and infectious diseases were negative. The transthoracic echocardiography (TTE) and enhanced thoracic computed tomography (CT) scan revealed the existence of a giant aortic root aneurysm (125.1 mm in short-axis), severe aortic valve regurgitation, cardiac dilatation (LV; 99 mm in diastolic diameter) and a poor ejection fraction (EF; 18%). Considering the risk of rupture or dissection of the dilated aortic root, we successfully performed the Bentall procedure based on the intraoperative exploration results. Postoperative thoracic CT scan revealed a normal sized reconstructed aortic root, and the patient was discharged uneventfully 7 days later. Conclusion It is extremely rare to report such a giant aortic root aneurysm in a young patient. In the treatment decision-making process, the patient’s specific situation should be taken into consideration. The composite replacement of the aortic valve and ascending aorta should be performed if the patient is not suitable for valve-sparing operation.

scholarly journals Perforated peptic ulcer imaged directly by computed tomography

1997 ◽  
Vol 2 (2) ◽  
pp. 31-32
Author(s):  
W. K. Loftus ◽  
L. T.C Chow ◽  
C. Metreweli
Keyword(s):  
Computed Tomography ◽  
Peptic Ulcer ◽  
Perforated Peptic Ulcer ◽  
Oral Contrast ◽  
Perforated Ulcer ◽  
Free Gas

Perforation occurs in 10% of patients with peptic ulcer. Computed tomography (CT) may show free intraperitoneal gas and/or extravasation of oral contrast. While the location of the free gas or contrast may suggest the site of perforation, the perforation itself is difficult to demonstrate. We present a case of perforated ulcer in which the perforation was imaged directly by CT.

scholarly journals Quantitative Perfusion and Permeability Biomarkers in Brain Cancer from Tomographic CT and MR Images

2016 ◽  
Vol 8s2 ◽  
pp. BIC.S31801 ◽  
Author(s):  
Armin Eilaghi ◽  
Timothy Yeung ◽  
Christopher d'Esterre ◽  
Glenn Bauman ◽  
Slav Yartsev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Magnetic Resonance ◽  
Planning Process ◽  
Treatment Decision ◽  
Vascular Supply ◽  
Brain Parenchyma ◽  
Treatment Decision Making ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced ◽  
Area Product

Dynamic contrast-enhanced perfusion and permeability imaging, using computed tomography and magnetic resonance systems, are important techniques for assessing the vascular supply and hemodynamics of healthy brain parenchyma and tumors. These techniques can measure blood flow, blood volume, and blood-brain barrier permeability surface area product and, thus, may provide information complementary to clinical and pathological assessments. These have been used as biomarkers to enhance the treatment planning process, to optimize treatment decision-making, and to enable monitoring of the treatment noninvasively. In this review, the principles of magnetic resonance and computed tomography dynamic contrast-enhanced perfusion and permeability imaging are described (with an emphasis on their commonalities), and the potential values of these techniques for differentiating high-grade gliomas from other brain lesions, distinguishing true progression from posttreatment effects, and predicting survival after radiotherapy, chemotherapy, and antiangiogenic treatments are presented.

Radiological Correlation between Pneumatization of Frontal Sinus and Height of Fovea Ethmoidalis

2007 ◽  
Vol 21 (5) ◽  
pp. 626-628 ◽  
Author(s):  
Cesur Gumus ◽  
Altan Yildirim
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Skull Base ◽  
Frontal Sinus ◽  
Ct Scans ◽  
The Relationship

Background We need more data about the variations of skull base to minimize the complications of ethmoidectomy. The aim of this study was to analyze the relationship between the pneumatization of the frontal sinus and height of the fovea ethmoidalis. Methods Paranasal coronal computed tomography (CT) scans of 487 sides of 300 patients were evaluated. The presence of the frontal cell and pneumatization of the frontal sinus were studied with respect to the height of the fovea ethmoidalis. Results We found a statistically significant correlation between the frontal cell and frontal sinus hyperpneumatization (p = 0.000). We determined that there was a deeper fovea ethmoidalis in the sides that have a frontal cell (p ≤ 0.001) and in the sides that have hyperpneumatization of the frontal sinus (p = 0.000). We also observed flatter fovea ethmoidalis in the sides that have hypopneumatization of the frontal sinus (p ≤ 0.001). Conclusion The presence of a frontal cell or hyperpneumatization of the frontal sinus on CT scan should alert the clinician that there may be a deep fovea ethmoidalis.

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