Mohd Zamrin Dimon

Chest Tube Injury to Left Ventricle: Complication or Negligence?

An injury to the left ventricle after a chest tube insertion is a rare but lethal phenomenon that is likely to occur if precautions are not seriously addressed. We present a 15-year-old girl who was diagnosed a left empyema thoracis. An attempt to place a chest drain in this young girl was almost fatal. A left ventricular repair together with thoracotomy and decortication were successful. This case emphasizes the rarity of this lethal complication and the importance of the correct technique for chest tube insertion.

Dermacyn® irrigation in reducing infection of a median sternotomy wound

BACKGROUNDnSternal wound infection is an infrequent yet potentially devastating complication following sternotomy. Among the standard practices used as preventive measures are the use of prophylactic antibiotics and povidone-iodine as an irrigation agent. A new antiseptic agent, Dermacyn super-oxidized water (Oculus Innovative Sciences), has recently been used as a wound-irrigation agent before the closure of sternotomy wounds.nnnMETHODSnThis prospective, randomized clinical trial was conducted to compare the effectiveness of Dermacyn and povidone-iodine in reducing sternotomy wound infection in patients undergoing coronary artery bypass graft surgery. Upon chest closure and after insertion of sternal wires, wounds were soaked for 15 minutes with either Dermacyn or povidone-iodine. Subcutaneous tissue and skin were then closed routinely. Patients were followed up, and any wound infection was analyzed.nnnRESULTSnOf the 178 patients, 88 patients were in the Dermacyn group, and 90 were in the povidone-iodine group. The mean (+/-SD) age of the patients was 61.1 +/- 7.6 years. The incidence of sternotomy wound infection was 19 cases (10.7%). Five (5.7%) of these cases were from the Dermacyn group, and 14 (15.6%) were from the povidone-iodine group (P = .033). No Dermacyn-related complication was identified.nnnCONCLUSIONnWe found Dermacyn to be safe and more effective as a wound-irrigation agent than povidone-iodine for preventing sternotomy wound infection.

A FAST AND ACCURATE METHOD FOR AUTOMATIC CORONARY ARTERIAL TREE EXTRACTION IN ANGIOGRAMS

Coronary arterial tree extraction in angiograms is an essential component of each cardiac image processing system. Once physicians decide to check up coronary arteries from x-ray angiograms, extraction must be done precisely, fast, automatically and including whole arterial tree to help diagnosis or treatment during the cardiac surgical operation. This application is very helpful for the surgeon on deciding the target vessels prior to coronary artery bypass graft surgery. Some techniques and algorithms are proposed for extracting coronary arteries in angiograms. However, most of them suffer from some disadvantages such as time complexity, low accuracy, extracting only parts of main arteries instead of the full coronary arterial tree, need manual segmentation, appearance of artifacts and so forth. This study presents a new method for extracting whole coronary arterial tree in angiography images using Starlet wavelet transform. To this end, firstly we remove noise from raw angiograms and then sharpen the coronary arteries. Then coronary arterial tree is extracted by applying a modified Starlet wavelet transform and afterwards the residual noises and artifacts are cleaned. For evaluation, we measure proposed method performance on our created data set from 4932 Left Coronary Artery (LCA) and Right Coronary Artery (RCA) angiograms and compared with some state-of-the-art approaches. The proposed method shows much higher accuracy 96% for LCA and 97% for RCA, higher sensitivity 86% for LCA and 89% for RCA, higher specificity 98% for LCA and 99% for RCA and also higher precision 87% for LCA and 93% for RCA angiograms.

Echocardiography Image Segmentation: A Survey

Segmentation is an important step in medical imaging to acquire qualitative measurements such as the location of the desired objects and also for quantitative measurements such as area, volume or the analysis of dynamic behaviour of anatomical structures over time. Among these images, ultrasound images play a crucial role, because they can be produced on video-rate and therefore allows a dynamic analysis of moving structures. In addition, the acquisition of these images is non-invasive, cheap, and does not require ionizing radiations compared to other medical imaging techniques. On the other hand, the automatic segmentation of anatomical structures in ultrasound imagery is a real challenge due to acoustic interferences (speckle noise) and artifacts which are inherent in these images. This paper surveys the literature often recent researches on echocardiography image segmentation methods, focusing on techniques developed for medical. First, we present a review of articles by clinical application to highlight the approaches that have been investigated and degree of validation that has been done in different clinical domains. Then, we present a classification of methodology in terms of use of prior information. We conclude by selecting ten recent papers which have presented original ideas that have demonstrated particular clinical usefulness or potential specific to the echocardiography segmentation problem. The contribution of the paper is in three ways: 1) to serve as a tutorial on the field for both clinicians and technologists, 2) to provide an extensive account of segmentation techniques in a comprehensive and systematic manner, and 3) to critically review recent approaches in terms of their performance and degree of clinical evaluation with respect to the final goal of cardiac functional analysis.

Coronary Artery Segmentation in Angiograms with Pattern Recognition Techniques -- A Survey

Medical image processing is nowadays one of the best tools to make an informative model from a raw image of each part of the body, and segmentation is the most important step in which used to extract significant features. Coronary artery segmentation algorithm in angiograms is a fundamental component of each cardiac image processing system. There are lots of techniques and algorithms proposed for extracting coronary arteries in angiograms. But based on our knowledge, there is not any review paper to categorize and compare them together. In this paper, we have divided these algorithms into five major classes and propose a survey for the main class, pattern recognition, which is a famous technique in this manner. We studied all the papers in the pattern recognition class and defined six categories for them: (1) Multi scale approaches (2) Region growing approaches (3) Matching filters approaches (4) Mathematical morphology approaches (5) Skeleton based approaches and (6) Ridge based approaches. Finally, we made a table to compare all the algorithms in each category against criteria such as: user interaction, angiography types, dimensionality, enhancement method, full coronary artery output, whole tree output, and 3D reconstruction ability.

Renal outcome following on- and off-pump coronary artery bypass graft surgery.

A prospective study was carried out to compare the outcomes of patients with preexisting non-dialysis-dependent renal dysfunction who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Elective off-pump coronary artery bypass was performed in 29 patients with renal dysfunction. Their results were compared with those of a similar group of 35 patients who underwent the conventional on-pump coronary artery grafting. There was a significant deterioration in creatinine clearance in the on-pump group on days 1, 2, and 4 after surgery, while creatinine clearance in the off-pump group remained close to the baseline level. Both groups had improved to the preoperative creatinine clearance values on follow-up at 4 weeks. It was concluded that off-pump surgery provided better renal protection than the conventional on-pump technique in patients with preexisting non-dialysis-dependent renal dysfunction.

Pedunculated Parietal Pleural Lesion: A Rare Presentation of Bronchogenic Cyst

We present a 35-year-old man with a preoperative diagnosis of a right lower lobe cystic mass. Misled by a radiological suggestion of an intraparenchymal lesion, he had a thoracotomy and right lower lobectomy. An intraoperative finding of a pedunculated cyst arising from the parietal pleural with subsequent histopathology confirmation of a benign bronchogenic cyst, however, would have made a less invasive surgical excision more appropriate.

Comminuted sternal fracture -- a sternotomy wire fixation: report of 2 cases.

Various techniques of sternal stabilization via either metal plates or wires have been described. We describe an alternative technique of simple median sternotomy followed by reduction and wire fixation of the sternal fracture. The 2 patients described in this report had traumatic comminuted and displaced sternal fractures. Even though wire repair was deemed to be tedious and achieved poor approximation of the bone, we performed median sternotomy and achieved simple wire fixation with an excellent result.

AUTOMATIC DETECTION OF THE END-DIASTOLIC AND END-SYSTOLIC FROM 4D ECHOCARDIOGRAPHIC IMAGES

Accurate detection of the End-Diastolic (ED) and End-Systolic (ES) frames of a cardiac cycle are significant factors that may affect the accuracy of abnormality assessment of a ventricle. This process is a routine step of the ventricle assessment procedure as most of the time in clinical reports many parameters are measured in these two frames to help in diagnosing and dissection making. According to the previous works the process of detecting the ED and ES remains a challenge in that the ED and ES frames for the cavity are usually determined manually by review of individual image phases of the cavity and/or tracking the tricuspid valve. The proposed algorithm aims to automatically determine the ED and ES frames from the four Dimensional Echocardiographic images (4DE) of the Right Ventricle (RV) from one cardiac cycle. By computing the area of three slices along one cardiac cycle and selecting the maximum area as the ED frame and the minimum area as the ES frame. This method gives an accurate determination for the ED and ES frames, hence avoid the need for time consuming, expert contributions during the process of computing the cavity stroke volume.

Quantitative Detection of Left Ventricular Wall Motion Abnormality by Two-Dimensional Echocardiography

Echocardiography is a widely used imaging technique to examine various cardiac functions, especially to detect the left ventricular wall motion abnormality. Unfortunately the quality of echocardiograph images and complexities of underlying motion captured, makes it difficult for an in-experienced physicians/ radiologist to describe the motion abnormalities in a crisp way, leading to possible errors in diagnosis. In this study, we present a method to analyze left ventricular wall motion, by using optical flow to estimate velocities of the left ventricular wall segments and find relation between these segments motion. The proposed method will be able to present real clinical help to verify the left ventricular wall motion diagnosis.