Abdominal wall extraction using constrained deformable model and abdominal context.

This paper investigates, using prior shape models and the concept of ball\nscale (b-scale), ways of automatically recognizing objects in 3D images without\nperforming elaborate searches or optimization. That is, the goal is to place\nthe model in a single shot close to the right pose (position, orientation, and\nscale) in a given image so that the model boundaries fall in the close vicinity\nof object boundaries in the image. This is achieved via the following set of\nkey ideas: (a) A semi-automatic way of constructing a multi-object shape model\nassembly. (b) A novel strategy of encoding, via b-scale, the pose relationship\nbetween objects in the training images and their intensity patterns captured in\nb-scale images. (c) A hierarchical mechanism of positioning the model, in a\none-shot way, in a given image from a knowledge of the learnt pose relationship\nand the b-scale image of the given image to be segmented. The evaluation\nresults on a set of 20 routine clinical abdominal female and male CT data sets\nindicate the following: (1) Incorporating a large number of objects improves\nthe recognition accuracy dramatically. (2) The recognition algorithm can be\nthought as a hierarchical framework such that quick replacement of the model\nassembly is defined as coarse recognition and delineation itself is known as\nfinest recognition. (3) Scale yields useful information about the relationship\nbetween the model assembly and any given image such that the recognition\nresults in a placement of the model close to the actual pose without doing any\nelaborate searches or optimization. (4) Effective object recognition can make\ndelineation most accurate.\n

Isolated abdominal wall metastasis 42years after curative surgery for ovarian cancer: A case report.

Plain radiography (Fig. 9.1) has been superseded by cross-sectional imaging techniques and the peritoneal cavity is visualized only via contrast herniography (Fig. 9.2).

1. The melanocytes and melanin in the skin of the ear, anterior abdominal wall, areola and sole of foot have been studied in pure black and pure red immature, mature and pregnant female guinea-pigs. The melanocytes were identified by using the dopa reaction. The melanocytes and melanin present in the hair follicles have not been examined in this investigation. 2. In the ear, areola and sole of foot the melanocytes were found to be concentrated in the epidermal ridges. In the anterior abdominal wall the melanocytes were situated in the epidermis and were arranged in rows lying at right angles to the slope of the hairs. The melanocytes were found to lie between the cells of the basal layer of the epidermis and the dendritic processes were seen to extend out laterally and upwards between the deeper cells of the epidermis. The majority of the melanocytes present in each skin region presented certain characteristics which were constant for that region and were found in all the animals examined. The size of the melanocytes within each skin region showed considerable variation. 3. In the normal mature female guinea-pig the melanocyte counts showed that there were wide individual and regional variations. The cell counts were greatest in the skin of the ear and areola and least in the anterior abdominal wall. In the sole of the foot accurate counting was not possible but more melanocytes appeared to be present in this region than elsewhere. There was no statistically significant difference between the counts in the red and black guinea-pigs in any of the regions studied although there was a tendency for the counts to be higher in the ear and anterior abdominal wall of the black animals. 4. In the immature animals the melanocyte counts were higher in the ear and lower in the areola than in the mature animals but in the anterior abdominal wall the counts were similar. In the immature animals the melanocytes had a more general distribution than those found in the mature animals and less free melanin was present in all the regions. 5. A comparison of the results with those already reported on the male guinea-pig showed that the counts were significantly higher in the anterior abdominal wall and areola of the mature female and that the latter also possessed more free melanin and larger melanocytes which contained more melanin and were darker in colour. The appearances of the melanocytes and melanin in the immature animals of both sexes were practically identical. 6. In the pregnant guinea-pig in all the regions the melanocyte counts were significantly higher than before the onset of pregnancy and this was accompanied by an increase in the amount and depth of colour of the melanin both within and outside the melanocytes. 7. The relationship between these findings and the influences of sex hormones on melanogenesis is discussed.

We present a novel framework for learning a joint shape and appearance model from a large set of un-labelled training examples in arbitrary positions and orientations. The shape and intensity spaces are unified by implicitly representing shapes as “images” in the space of distance transforms. A stochastic chord-based matching algorithm is developed to align photo-realistic training examples under a common reference frame. Then dense local deformation fields, represented using the cubic B-spline based Free Form Deformations (FFD), are recovered to register the training examples in both shape and intensity spaces. Principal Component Analysis (PCA) is applied on the FFD control lattices to capture the variations in shape as well as on registered object interior textures. We show examples where we have built coupled shape and appearance prior models for the left ventricle and whole heart in short-axis cardiac tagged MR images, and used them to delineate the heart chambers in noisy, cluttered images. We also show quantitative validation on the automatic segmentation results by comparing to expert solutions.

Objective To evaluate the efficacy of ultrasound-guided transversus abdominis plane block for elderly herpetic neuralgia located in anterior abdominal wall. Methods A total of 112 elderly patients aged 65-75 years with less than 30 days of herpes zoster neuralgia located in anterior abdominal wall were enrolled for receiving a treatment of transversus abdominis plane block.Patients were randomly allocated into two groups: the control group(n=56)taking gabapentin and celebrex, and the observation group(n=56)receiving transversus abdominis plane block(three times per week for two weeks)as add on therapy to gabapentin and celebrex.Morphine 10 mg was ready for oral application in breakthrough pain.Pain was evaluated by McGill scores assessed by short-form of Mcgill pain questionnaire(SF-M PQ)and visual analogue scale(VAS)before(T0)and after 1(T1)and 2 weeks(T2)of transversus abdominis plane block, and 1(T3)and 8(T4)weeks after end of the treatment.Pain relief(PAR)was calculated by the formula: PAR=(VAS score before block--VAS score after block)/ VAS score before block × 100%.The morphine consumption and sleep quality were observed during the treatment and 1 week after treatment.Analgesic efficacy was graded 8 weeks after end of treatment.The effective rate and good response rate were calculated.Incidences of complications were recorded. Results There was no significant difference in the VAS score between the two groups before treatment(t=0.419, P>0.05), while VAS scores after treatment were lower in the observation group than in the control group(t=17.925, 19.662, 12.580 and 13.987, respectively, P 0.05). After treatment, the total scores of McGill were lower in the observation group than in the control group(t=18.612, 20.135, 13.213 and 12.356, respectively, P 0.05). While after treatment, the morphine consumptions were decreased in the observation group versus in the control group(t=22.341, 16.758, 17.827, 15.541 respectively, P<0.05). No punctures of abdominal cavity, chest cavity, internal organs or blood vessels by mistake occurred. Conclusions Ultrasound-guided transversus abdominis plane block is effective and has less adverse reactions in treating herpetic neuralgia located in anterior abdominal wall. Key words: Neuromuscular blockade; Ultrasonography; Herpes zoster; Neuralgia

Chapter 13 - Robust and Scalable Shape Prior Modeling via Sparse Representation and Dictionary Learning

Multidisciplinary treatment of abdominal wall endometriosis: A case report and literature review

Necrosis of the Anterior Abdominal Wall after Harvest of both Internal Thoracic Arteries and Inferior Epigastric Arteries

Introduction. Ventral hernias are quite common, but liver herniation is an extremely rare case. This type of abdominal protrusion of part of the liver usually occurs through incisional weak spots on the abdominal wall. Incisional herniation of the liver usually occurs 2 to 3 years after an abdominal operation consequently leading to focal weakness of the abdominal wall. Case report. We present an extremely rare case of incisional herniation of part of the left and smaller part of the right liver lobe in a woman aged 64 years, as a consequence of a previous open cholecystectomy, creating a focal abdominal wall weakness. Abdominal CT scan was performed. Analysis of the CT scans, as well as of the reconstruction made in the coronal and sagittal plane was performed. Herniation of the left and the smaller part of the right liver lobe through an incisive focal weakness of the right upper quadrant of the abdominal wall was detected. Discussion. Incisional hernias are delayed complications of abdominal surgery. They can occur anywhere on the abdominal wall and are more frequently encountered in a vertical than in a transverse incision. Typically, incisional hernias occur during the first months following surgery, but later occurrence has been reported as well. Herniation of the liver through the anterior abdominal wall is an extremely rare condition and usually related to previous surgery on the upper abdomen. Due to its rarity it is both a diagnostic and therapeutic challenge. Conclusion. We can conclude that there is a connection between liver herniation through the upper abdominal wall and a previously performed open abdominal surgery. CT is the method of choice for diagnosis of liver herniation through the anterior abdominal wall.

The presence of large defects in the anterior abdominal wall in patients is an important problem for surgeons, due to the complexity of the hernioplasty implementation, the need to use large mesh, high frequency of postoperative complications. Nowadays, widely used laparoscopic hernioplasty include the use of mesh materials. In patients with large hernias, laparoscopic techniques are associated with a number of technical difficulties during operations and a high frequency of postoperative relapses (up to 30 %). The problem of choosing the treatment method for postoperative ventral hernias of large and gigantic still remains unsolved. Currently, the main trend is to restore the anterior abdominal wall anatomical integrity with the reduction of the anterior abdominal wall muscles to the white abdominal line and open component separation. Since the development of laparoscopic and endoscopic technologies, the technique of endoscopic separation of the anterior abdominal muscles has been improved to improve the quality of life of patients and to reduce the incidence of postoperative complications and recurrences. The use of endoscopic methods makes it possible to prevent a wide tissue dissection, reduce the risk of necrosis of the skin and aponeurotic flap through the preservation of perforant vessels in the anterior abdominal wall. The result comparison between the use of open and laparoscopic methods of component separation showed that the use of open separation methods leads to a significantly greater number of both intraoperative and postoperative complications associated with the development of 30 % of necrosis of the skin and aponeurotic flap, and relapses. The results of the studies indicate some advantages in reducing the frequency of postoperative wound complications with endoscopic component separation methods in patients with postoperative large size ventral hernias.

Automated model-based organ delineation for radiation therapy planning in the prostate region

Aim. To improve the results of laparoscopic cholecystectomies by studying the anatomic variants of hepatoduodenal zone structures, when introducing laparoscope at different angles against the anterior abdominal wall. Materials and methods. Clinical studies included 70 patients with acute and chronic calculous cholecystitis, Variant anatomy of hepatoduodenal zone structures, when laparoscope is introduced at different angles against the anterior abdominal wall, was studied. Results. Typical anatomy of hepatobiliary zone structures was detected in 63 (90 %) patients. Atypical anatomy was noted in 7 (10 %) cases. Awareness of anatomic variants of hepatobiliary zone structures is necessary for the prevention of complications and improvement of therapeutic results. No anatomic peculiarities of hepatoduodenal zone were revealed in the course of US investigation. Conclusions. To make visualization of the organs of the upper store of the abdominal cavity more convenient, it is necessary to introduce laparoscope at the angle of 33-47° against the anterior abdominal wall.

Background. In Ukraine surgical intervention because of hernia re-present 8-10% among other operations. Significant deficiency of any graft material is a manifestation of the local inflammatory process that occurs in response to the implantation of foreign material into the body. In this regard the development of synthetic materials which will cause a minor inflammatory response while maintaining a satisfactory strength characteristics and manufacturing cost. Objective. To experimentally approve the possibilities of processing the grafts with autogenous blood plasma and cattle cerebrospinal fluid for the reduction of tissue inflammatory reaction. Methods. 36 adult male rats were operated under ether narcosis with implantation of a polypropylene mesh endoprosthesis Alfa Vita 90 into anterior abdominal wall. Animals were divided into 2 groups: control, where grafts were processed with autogenic blood plasma, and experimental, with grafts processed with cattle cerebrospinal fluid. After 7, 14, 21 and 28 days after operation fragments of anterior abdominal wall were taken for histological analysis. Results. Intensity of local aseptic inflammatory reaction around the elements of the polypropylene mesh prosthesis in all terms was more intensive in the control group with continuous amplification till the 28 th day after surgical intervention. While in experimental animals on the 28 th day after graft implantation inflammatory signs were not visualized. Conclusion. Processing of polypropylene mesh implants with autologous blood plasma and cattle cerebrospinal fluid reduces the local inflammatory reaction after implantation in the anterior abdominal wall, decreasing the risk of local complications in the postoperative period.

Perforation of the inflamed diverticula is a common diverticulitis complication. It usually leads to the formation of a local abscess. In some rare cases, the inflammatory process may spread towards extra-abdominal sites like the anterior or posterior abdominal wall or the thigh and form an abscess in these sites. We present the case of a 73-year-old man with a history of pain at the lower left quadrant of the abdomen for 20 days and a visible mass in this site. Ultrasonography and computed tomography revealed this mass to be an abscess of the abdominal wall which had been formed by the spread of ruptured sigmoid diverticulitis by continuity of tissue through the lower left abdominal wall. Local drainage of the abscess was performed and the patient was discharged after alleviation of symptoms and an uneventful course. We also discuss causes of abdominal wall abscesses along with the possible pathways by which an intra-abdominal abscess could spread outside the abdominal cavity.