SARS-CoV-2 in the abdomen or pelvis: SAFE SURGERY study.
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ABSTRACT:
SUBMITTER: Vimalachandran D
PROVIDER: S-EPMC9620655 | biostudies-literature | 2023 Feb
REPOSITORIES: biostudies-literature
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SARS-CoV-2 in the abdomen or pelvis: SAFE SURGERY study.
Vimalachandran Dale D Jones Robert P RP Dickson Ed E Seehra Jaspreet J Acheson Austin A Griffiths Ewen A EA Kamarajah Sivesh S Leung Elaine E Torrance Andrew A Ottensmeier Christian C Beggs Andrew D AD Whiteside Ellen E Sanna Helen H Bury Danielle D Youd Esther E Leopold Gareth G Pugh Matthew M Sundar Sudha S Taylor Graham S GS
The British journal of surgery 20230201 3
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Project description:PurposeOrgan autosegmentation efforts to date have largely been focused on adult populations, due to limited availability of pediatric training data. Pediatric patients may present additional challenges for organ segmentation. This paper describes a dataset of 359 pediatric chest-abdomen-pelvis and abdomen-pelvis Computed Tomography (CT) images with expert contours of up to 29 anatomical organ structures to aid in the evaluation and development of autosegmentation algorithms for pediatric CT imaging.Acquisition and validation methodsThe dataset collection consists of axial CT images in Digital Imaging and Communications in Medicine (DICOM) format of 180 male and 179 female pediatric chest-abdomen-pelvis or abdomen-pelvis exams acquired from one of three CT scanners at Children's Wisconsin. The datasets represent random pediatric cases based upon routine clinical indications. Subjects ranged in age from 5 days to 16 years, with a mean age of 7 years. The CT acquisition, contrast, and reconstruction protocols varied across the scanner models and patients, with specifications available in the DICOM headers. Expert contours were manually labeled for up to 29 organ structures per subject. Not all contours are available for all subjects, due to limited field of view or unreliable contouring due to high noise.Data format and usage notesThe data are available on The Cancer Imaging Archive (TCIA_ (https://www.cancerimagingarchive.net/) under the collection Pediatric-CT-SEG. The axial CT image slices for each subject are available in DICOM format. The expert contours are stored in a single DICOM RTSTRUCT file for each subject. The contour names are listed in Table 2.Potential applicationsThis dataset will enable the evaluation and development of organ autosegmentation algorithms for pediatric populations, which exhibit variations in organ shape and size across age. Automated organ segmentation from CT images has numerous applications including radiation therapy, diagnostic tasks, surgical planning, and patient-specific organ dose estimation.
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Project description:BackgroundPreoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling.MethodsThe primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty.ResultsNNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year.ConclusionAs global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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Project description: Not available
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Project description:ImportanceThe association of radiation and chemotherapy with the development of secondary sarcoma is known, but the contemporary risk has not been well characterized for patients with cancers of the abdomen and pelvis.ObjectiveTo compare the risk of secondary sarcoma among patients treated with combinations of surgery, radiation, or chemotherapy with patients treated with surgery alone and the general population.Design, setting, and participantsThis population-based cohort study included 173 580 patients in Ontario, Canada, with nonmetastatic cancer of the prostate, bladder, colon, rectum or anus, cervix, uterus, or testis. Patients were enrolled from January 1, 2002, to January 31, 2017. Data analysis was conducted from March 1, 2019, to January 31, 2020.ExposuresTreatment combinations of radiation, chemotherapy, and surgery.Main outcome and measuresDiagnosis of sarcoma based on histologic codes from the Ontario Cancer Registry. Time to sarcoma was compared using a cause-specific proportional hazard model.ResultsOf 173 580 patients, most were men (125 080 [72.1%]), and the largest group was aged between 60 and 69 years (58 346 [33.6%]). Most patients had genitourinary cancer (86 235 [51.4%]) or colorectal cancer (69 241 [39.9%]). Overall, 64 301 (37.1%) received surgery alone, 51 220 (29.5%) received radiation alone, 15 624 (9.0%) were treated with radiation and chemotherapy, 15 252 (8.8%) received radiation with surgery, and 11 822 (6.8%) received all 3 treatments. A total of 332 patients (0.2%) had sarcomas develop during a median (interquartile range) follow-up of 5.7 (2.2-8.9) years. The incidence of sarcoma was 0.3% among those who underwent radiation alone (138 of 51 220) and radiation with chemotherapy (40 of 15 624), 0.2% among those who received radiation and surgery (36 of 15 252) and all 3 modalities (25 of 11 822), and 0.1% among those who received surgery with chemotherapy (13 of 14 861) and surgery alone (80 of 64 801). Compared with a reference group of patients who had surgery alone, the greatest risk of sarcoma was found among patients who underwent a combination of radiation and chemotherapy (cause-specific relative hazard [csRH], 4.07; 95% CI, 2.75-6.01; P < .001), followed by patients who had radiation alone (csRH, 2.35; 95% CI, 1.77-3.12; P < .001), radiation with surgery (csRH, 2.33; 95% CI, 1.57-3.46; P < .001), and all 3 modalities (csRH, 2.27; 95% CI, 1.44-3.58; P < .001). In the general population, 7987 events occurred during 46 554 803 person-years (17.2 events per 100 000 person-years). The standardized incidence ratio for sarcoma among patients treated with radiation compared with the general population was 2.41 (95% CI, 1.57-3.69; 41.3 events per 100 000 person-years). The annual number of cases of sarcoma increased from 2009 (15 per 100 000 persons) to 2016 (32 per 100 000 persons), but the annual rate did not change during the study period.Conclusions and relevanceIn this cohort study, patients treated with radiation or chemotherapy for abdominopelvic cancers had an increased rate of sarcoma. Although the absolute rate is low, patients and physicians should be aware of this increased risk of developing sarcoma.
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Project description:Introduction: Telerobotic ultrasound has emerged as a promising technology in medicine, especially in settings with limited medical access or a lack of specialized personnel. However, there are very few studies evaluating its usefulness in real-world clinical practice. Objective: This study evaluates the usefulness of abdominopelvic telerobotic ultrasound in a real-world practice setting. Methods: A prospective study was performed in a cohort of adult patients who underwent abdominal ultrasound in a remote secondary hospital for suspected abdominal or pelvic pathology. Examinations were performed by an on-site technician and a remote abdominal radiologist. Satisfaction of patients and explorers, scan times, quality of visualization of anatomical structures, and ultrasound findings were measured and compared with standard ultrasound examinations performed by an on-site radiologist blinded to telerobotic ultrasound findings. Multivariate analyses were performed to predict variables related to the visualization quality of abdominopelvic organs. Results: The sample included 40 patients (60% women; mean age, 51.2 ± 16.1 years; 35% overweight and 17.5% obese). Significant differences in ultrasound duration were observed between telerobotic ultrasound and standard ultrasound (27.4 ± 8.3 and 12.7 ± 3.1 min, respectively; p < 0.001). The mean satisfaction of radiologists, technicians, and patients with telerobotic ultrasound was high (7.35 ± 1.14 for radiologists, 7.93 ± 0.83 for technicians, and 8.43 ± 1.38 for patients). Visualization of anatomical structures was acceptable for most organs on telerobotic ultrasound but significantly worse than conventional ultrasound when "excellent visualization" was the reference standard. In addition, telerobotic ultrasound did not identify potentially relevant findings in a significant (70%) proportion of patients. Conclusions: Telerobotic ultrasound offers acceptable results in the assessment of abdominopelvic organs and can help provide adequate healthcare to patients in locations with limited access to radiology specialists. However, there are significant limitations compared to standard ultrasound for their optimal evaluation.
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Project description:ObjectiveThe purpose of this article is to review abdominopelvic applications of diffusion-weighted imaging (DWI), discuss advantages and limitations of DWI, and illustrate these with examples.ConclusionHigh-quality abdominopelvic DWI can be performed routinely on current MRI systems and may offer added value in image interpretation. Particularly in unenhanced MRI examinations, DWI may provide an alternative source of image contrast and improved conspicuity to identify and potentially characterize pathology. DWI is a powerful technique that warrants implementation in routine abdominal and pelvic imaging protocols.
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Project description:This article aims to present the case of a man affected by SARS CoV-2 and to discuss the association between this manifestation, viral infection and Open Abodmen. A 52 years old Caucasian man, affected by SARS CoV-2 infection, was admitted to the Emergency department of Arcispedale Sant'Anna of Ferrara for epigastralgia followed by syncopal episode, vomiting and diarrhea with bloody stools. The next day the patient underwent colonoscopy, which detected an ulceration proximally to the ileocecal valve without active bleeding. Subsequently an initial non-operative management and two pharyngeal swabs negative, for another rectorrhagia and hypotensive episode, underwent emerging surgery and an Open Abdomen was performed. The patient was discharged in 12th post-surgery day without complications. The IHC analysis with anti-SARS-CoV-2 nucleocapsid-protein revealed the presence of viral protein expression in epithelial cell of ulcerated intestinal mucosa. In this case report, we showed the presence of viral inclusion in small intestinal wall after two negative pharyngeal swabs for SARS-CoV-2 RNA. We can also say that the largest amount of viral inclusions was in the tissue of ulceration of the last ileal loop. This case report showed that SARS-CoV-2 can be unseen also after clinical healing. It's probably can be expelled with stools and rectal swabs search for SARS-Cov-2 RNA after pharyngeal swabs could be mandatory for declare heled a patient. Moreover, damage control surgery and Open Abdomen as a surgical technique can be a valid alternative in case of uncertainty of the bleeding source and when a second surgical look is necessary.
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