Mahasen Al-Najar

Primary extensive pyomyositis in an immunocompetent patient: case report and literature review

Pyomyositis is a suppurative infection of the skeletal muscle; it mainly occurs in immunocompromised patients or, exceptionally, in immunocompetent patients in tropical or other areas. We present a 24-year-old immunocompetent lady with bilateral thigh myalgia and fever. Upon investigation, extensive multifocal bilateral fluid collections involving the extensor muscles of both thighs were demonstrated. Pus aspirate from the involved muscles proved the presence of Staphylococcus aureus. Incision and drainage of the involved muscles were performed with successful and complete recovery.

The usefulness of MR defecography in the evaluation of pelvic floor dysfunction: our experience using 3T MRI

PurposeTo assess the usefulness of MR defecography in evaluating pelvic floor dysfunction, and to correlate several pelvic organ abnormalities with each other and with patients’ symptoms and characteristics.MethodsMR defecographic examinations performed in 3T MRI machine of 95 patients (70 females, 25 males; mean age 48) were retrospectively reviewed. Pelvic organ abnormalities from all three compartments were recorded, including the anorectal junction descent, anterior rectocele, and cystocele. These were graded according to the known HMO system in relation to the pubococcygeal line. The correlation between these different abnormalities and their relation to patient symptoms and characteristics were evaluated.ResultsAnorectal junction descent and anterior rectocele were most commonly observed, predominantly manifesting in female patients. Both were associated with abnormalities from all compartments. The middle compartment was the least affected, and its abnormality of uterine/vaginal descent tended to occur in association with the anterior compartment abnormality (cystocele). Anismus was low in incidence, and was not associated with other compartments abnormalities. Both enterocele/peritoneocele and intussusception were uncommon.ConclusionMR defecography is the modality of choice in assessing pelvic floor dysfunction, because it can neatly show various pelvic organ abnormalities from all compartments in a dynamic fashion, which are frequently coexistent. It can even show clinically silent or unsuspected abnormalities which can impact the management of patients.

GPU accelerated implementation of kernel regression for freehand 3D ultrasound volume reconstruction

Freehand three-dimensional (3D) ultrasound has recently gained an increasing attention in the medical field as it enables low-cost, safe, and flexible 3D scanning of arbitrary-shaped anatomical structures. During freehand 3D ultrasound imaging, the clinician freely moves a conventional two-dimensional (2D) ultrasound probe to acquire different views of the organ. The acquired 2D ultrasound data, which is often irregularly and sparsely distributed in the 3D space, is processed using a reconstruction algorithm to synthesize a 3D ultrasound volume. One effective reconstruction method is the 3D Kernel Regression (KR) algorithm that enables the generation of high-quality ultrasound volumes. This algorithm performs nonparametric 3D interpolation of the voxel gray-level values. One limitation of the 3D KR algorithm is the high computational complexity that requires long execution times when run on serial computers. To overcome this limitation, this paper presents a parallel implementation of the 3D KR algorithm using graphics processing unit (GPU) technology. The parallel 3D KR algorithm enables the generation of high-quality ultrasound volumes in short execution times. The feasibility of the parallel 3D KR algorithm has been demonstrated by synthesizing an ultrasound volume of a breast tumor. The parallel execution time required to synthesize the ultrasound volume is more than ten times faster than the serial execution time.

A Fusion-Based Approach for Breast Ultrasound Image Classification Using Multiple-ROI Texture and Morphological Analyses

Ultrasound imaging is commonly used for breast cancer diagnosis, but accurate interpretation of breast ultrasound (BUS) images is often challenging and operator-dependent. Computer-aided diagnosis (CAD) systems can be employed to provide the radiologists with a second opinion to improve the diagnosis accuracy. In this study, a new CAD system is developed to enable accurate BUS image classification. In particular, an improved texture analysis is introduced, in which the tumor is divided into a set of nonoverlapping regions of interest (ROIs). Each ROI is analyzed using gray-level cooccurrence matrix features and a support vector machine classifier to estimate its tumor class indicator. The tumor class indicators of all ROIs are combined using a voting mechanism to estimate the tumor class. In addition, morphological analysis is employed to classify the tumor. A probabilistic approach is used to fuse the classification results of the multiple-ROI texture analysis and morphological analysis. The proposed approach is applied to classify 110 BUS images that include 64 benign and 46 malignant tumors. The accuracy, specificity, and sensitivity obtained using the proposed approach are 98.2%, 98.4%, and 97.8%, respectively. These results demonstrate that the proposed approach can effectively be used to differentiate benign and malignant tumors.

Freehand 3D ultrasound imaging system using electromagnetic tracking

Ultrasound imaging is a non-invasive, real-time, low-cost, effective imaging modality for diagnosing and managing a variety of diseases. Most ultrasound-based clinical procedures are performed using conventional two-dimensional (2D) ultrasound images. However, accurate visualization and analysis of the three-dimensional (3D) anatomy using a sequence of 2D ultrasound images is often challenging. To overcome this challenge, several approaches have been proposed for 3D ultrasound imaging. This study contributes to these ongoing efforts by describing a freehand 3D ultrasound imaging system based on a conventional 2D ultrasound machine and a 3D electromagnetic tracking system. The synthesized 3D ultrasound volumes are visualized using the Visualization Toolkit (VTK) open-source library and the ParaView open-source application. The feasibility of our freehand 3D ultrasound imaging system is demonstrated by imaging a double cross-wire phantom.

A Freehand 3D Ultrasound Imaging System using Open-Source Software Tools with Improved Edge-Preserving Interpolation

Ultrasound imaging is widely employed in various medical procedures. Most ultrasound procedures are performed with conventional 2D ultrasound systems, but visualizing the 3D anatomy using 2D ultrasound images is often challenging. This paper describes the use of open-source software tools to develop a freehand system for synthesizing high-quality 3D ultrasound volumes using electromagnetic tracking. In the proposed system, the spatial transformation between the 2D ultrasound images and the electromagnetic sensor attached to the ultrasound transducer was performed using an accurate spatial calibration method. A new interpolation method, called the edge-preserving distance-weighted EPDW, is employed to reconstruct the 3D ultrasound volumes. The performance of the system is evaluated by performing a set of phantom experiments. The results showed that the reconstructed 3D ultrasound volumes have sub-millimeter accuracy. Moreover, the ultrasound volumes synthesized using the EPDW method demonstrated improved edge preservation compared with a previous interpolation method.

Sporadic Lateral Ventricular Hemangioblastoma presenting with Intraventricular and Subarachnoid Haemorrhage

Intraventricular hemangioblastoma (HB) is very rare; few cases of intraventricular HB have been reported in the literature, either sporadically or in association with von Hippel-Lindau disease. Furthermore, the incidence of ventricular haemorrhage from HB seems to be uncommon. We report a unique case of sporadic HB of the right lateral ventricle presenting with intratumoural and intraventricular haemorrhage in addition to multifocal intracranial superficial siderosis, indicating the presence of a subarachnoid haemorrhage (SAH) as well. Such a combination has not been reported before. In the future, the detection of an intraventricular mass in association with ventricular haemorrhage, with or without SAH, should include HB as a differential diagnosis, particularly when the imaging appearances are not typical of the more common intraventricular tumours.

Adaptive kernel regression for freehand 3D ultrasound reconstruction

Freehand three-dimensional (3D) ultrasound imaging enables low-cost and flexible 3D scanning of arbitrary-shaped organs, where the operator can freely move a two-dimensional (2D) ultrasound probe to acquire a sequence of tracked cross-sectional images of the anatomy. Often, the acquired 2D ultrasound images are irregularly and sparsely distributed in the 3D space. Several 3D reconstruction algorithms have been proposed to synthesize 3D ultrasound volumes based on the acquired 2D images. A challenging task during the reconstruction process is to preserve the texture patterns in the synthesized volume and ensure that all gaps in the volume are correctly filled. This paper presents an adaptive kernel regression algorithm that can effectively reconstruct high-quality freehand 3D ultrasound volumes. The algorithm employs a kernel regression model that enables nonparametric interpolation of the voxel gray-level values. The kernel size of the regression model is adaptively adjusted based on the characteristics of the voxel that is being interpolated. In particular, when the algorithm is employed to interpolate a voxel located in a region with dense ultrasound data samples, the size of the kernel is reduced to preserve the texture patterns. On the other hand, the size of the kernel is increased in areas that include large gaps to enable effective gap filling. The performance of the proposed algorithm was compared with seven previous interpolation approaches by synthesizing freehand 3D ultrasound volumes of a benign breast tumor. The experimental results show that the proposed algorithm outperforms the other interpolation approaches.

Accurate and fully automatic segmentation of breast ultrasound images by combining image boundary and region information

Breast ultrasound image segmentation is challenging task due to the low quality of ultrasound images and the complex breast structure. An accurate and automatic algorithm is presented to segment breast ultrasound images by combining image boundary and region information. The algorithm decomposes the image into a set of superpixels using the Normalized Cuts method along with texture analysis. An SVM classifier is employed to estimate the tumor likelihood of each superpixel based on five texture features. A seed superpixel is identified based on the tumor likelihoods and spatial locations of the superpixels. The seed superpixel is extended to accurately highlight the tumor region using a region growing approach that combines both the superpixels tumor likelihoods and edge-based analysis. The proposed algorithm and two popular segmentation algorithms are used to segment 50 breast ultrasound images. The proposed algorithm achieved higher sensitivity and lower error rates compared to the two existing algorithms.

Postpartum Enterobacter Pyogenic Sacroiliitis

Postpartum pyogenic sacroiliitis is a rare condition. Accurate diagnosis is frequently delayed because of poor localization of initial symptoms and the rarity of this disorder. Pyogenic sacroiliitis has been related to trauma, intravenous drug abuse, and gynecological infections1-3, but it is rare without a predisposing factor. We report the case of a thirty-one-year-old woman with postpartum pyogenic sacroiliitis caused by the Enterobacter species, and we also provide a review of the pertinent literature. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A thirty-one-year-old woman (gravida 4, para 4) presented to our emergency department with symptoms of fever and pain in the right buttock for three days. The pain had begun two hours after a normal vaginal delivery. The past medical history noted sclerotherapy for varicose veins on both lower extremities two years earlier. The patient denied any recent history of intramuscular drug injection. Vital signs included a temperature of 38.8°C and a pulse rate of 99. On physical examination, there was limitation of right hip motion and a positive test for flexion, abduction, and external rotation (FABER). The right leg had normal muscle strength, with no swelling, warmth, or erythema. Laboratory studies, including complete blood-cell count as well as kidney and liver function tests, were normal except for leukocytosis (white blood-cell count: 14 × 109/L; lymphocytes: 9%; neutrophils: 84%), an elevated C-reactive protein level of 132 mg/L (normal, less than 5 mg/L), and an elevated erythrocyte sedimentation rate of 110 mm/h (normal, 0 to 15 mm/h). The urinalysis and the subsequent urine culture specimen were negative. The rose bengal test for Brucella was also negative. The patient was admitted to the hospital with a diagnosis of postpartum pyrexia and was administered ceftriaxone (1 gm …