Computer-aided interventions
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General physiology and biophysics. 1, ISSN 0231-5882 Supplement Vol. 47
57 s. : il. ; 24 cm
Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease worldwide. With no Food and Drug Administration approved drugs, current treatment options include dietary restrictions and lifestyle modification. NAFLD is closely associated with metabolic disorders such as obesity, type 2 diabetes, and dyslipidemia. Hence, clinically various pharmacological approaches using existing drugs such as antidiabetic, anti-obesity, antioxidants, and cytoprotective agents have been considered in the management of NAFLD and nonalcoholic steatohepatitis (NASH). However, several pharmacological therapies aiming to alleviate NAFLD-NASH are currently being examined at various phases of clinical trials. Emerging data from these studies with drugs targeting diverse molecular mechanisms show promising outcomes. This review summarizes the current understanding of the pathogenic mechanisms of NAFLD and provides an insight into the pharmacological targets and emerging therapeutics with specific interventional mechanisms. In addition, we also discuss the importance and utility of new approach methodologies and regulatory perspectives for NAFLD-NASH drug development.
- MeSH
- chirurgie s pomocí počítače MeSH
- intervenční ultrasonografie MeSH
- lidé MeSH
- otorinolaryngologické chirurgické výkony * metody MeSH
- ultrasonografie metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Rutinní testování prostatického specifického antigenu v některých částech světa vedlo k významné migraci stadia karcinomu prostaty v době diagnózy, což má často za následek zbytečnou diagnostiku (over-diagnosis) a zbytečnou léčbu (over-treatment) onemocnění. Při volbě radikálních definitivních možností léčby jako radikální prostatektomie a radioterapie jsou potom pacienti vystaveni nežádoucím účinkům souvisejícím s léčbou. Koncepce „aktivního sledování s indikací odložené intervence v případě potřeby“ získala popularitu jako možné řešení zbytečné léčby onemocnění, přestože tento přístup má svá omezení. Pro léčbu některých typů lokalizovaného karcinomu prostaty se tak nabízí jako vhodná alternativa fokální terapie. Pokrok v zobrazovacích technologiích a skutečnost, že jsme schopni bezpečně a účinně aplikovat energii potřebnou pro ablaci ložiska lokalizovaného karcinomu prostaty, umožnily rychlejší přijetí této formy léčby. Ačkoli v současné době nejsou k dispozici žádné údaje první úrovně, probíhá několik studií, které se pokoušejí definovat roli fokální terapie. Kryoterapie a fokusovaný ultrazvuk o vysoké intenzitě jsou zavedené modality užívané pro ablaci celé prostatické žlázy. V našem článku hodnotíme různé techniky fokální léčby lokalizovaného karcinomu prostaty a indikace pro tuto léčbu spolu s prvními publikovanými výsledky. Klíčová slova: karcinom prostaty fokální terapie kryoablace fokusovaný ultrazvuk o vysoké intenzitě intersticiální laserová terapie fotodynamická terapie ireverzibilní elektroporace a fokální brachyterapie
The ubiquity of prostate specific antigen testing in certain parts of the world has led to significant stage migration of prostate cancer at presentation, apparently resulting in over-diagnosis and over-treatment. With radical definitive therapies such as radical prostatectomy and radiotherapy, patients have to endure treatment-related adverse effects. “Active surveillance with delayed intervention if necessary”, has gained popularity as a possible solution for the over-treatment problem, although this approach also has inherent limitations. Focal therapy is emerging as a viable management option for certain localized prostate cancers. Advancement in imaging technology coupled with the ability to safely and effectively deliver energy to ablate foci of localized prostate cancer has accelerated acceptance of this form of management. Level one evidence is still lacking, although a number of trials are now underway to define the role of focal therapy. Cryotherapy and high intensity focused ultrasound have an established track record as energy sources for whole gland prostate ablation. In this article we review the indications and technique of focal treatment for localized prostate cancer, as well as early published results using these two technologies. Key Words: prostate cancer focal therapy cryoablation high intensity focused ultrasound interstitial laser photodynamic therapy irreversible electroporation and focal brachytherapy
- Klíčová slova
- fokální terapie, fokusovaný ultrazvuk o vysoké intenzitě, kryoablace, transperineal template-guided mapping biopsy, transperineální mapující biopsie s užitím šablony,
- MeSH
- chirurgie s pomocí počítače MeSH
- kryochirurgie * metody MeSH
- lidé MeSH
- magnetická rezonance intervenční MeSH
- nádory prostaty * diagnóza chirurgie terapie MeSH
- transrektální ultrazvuk o vysoké intenzitě * metody MeSH
- ultrazvukem navigovaná biopsie využití MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
Spinal navigation has substantially advanced during the past ten years. Surgeons have gained sufficient skills and confidence, and have introduced this technology to the anatomically challenging region of the upper cervical spine and craniocervical junction. The detailed evaluation of individual anatomy, rational pre-operative planning and final intraoperative control improve the safety and precision of classical surgical procedures. As methods technologically evolve, indication criteria change accordingly, but the basic principles of a relevatn choice remain; these are to reduce morbidity due to its three main causes, i.e., mechanical, neurological and vascular. We present an overview of current techniques and discuss their applicability in the region of the upper cervical spine and craniocervical junction. The systems allowing us to obtain live images intra-operatively, such as fluoroscopy or intra.operative CT, seem to be most versatile and accurate, especially when combined with traditional virtual navigation systems. Based on case histories, the authors suggest trends in the development of this field, with a focus on minimally invasive techniques. Key words: navigation, upper cervical spine, craniocervical junction.
- MeSH
- atlas (obratel) chirurgie MeSH
- axis chirurgie MeSH
- chirurgie s pomocí počítače MeSH
- fluoroskopie MeSH
- intervenční radiografie MeSH
- krční obratle chirurgie radiografie MeSH
- lidé MeSH
- magnetická rezonance intervenční MeSH
- počítačová rentgenová tomografie MeSH
- uživatelské rozhraní počítače MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
Intracardiac echocardiography (ICE) broadens the spectrum of echocardiographic techniques. Modern 10F sector echocardiographic catheters introduced into the right atrium allow high quality imaging of all cardiac structures, including pulse and continuous wave Doppler and/or color Doppler. The main indication for ICE appears to be monitoring of catheter ablation of complex arrhythmic substrates such atrial fibrillation, postincisional tachycardias and ventricular tachycardias. The other important role of ICE is the early diagnosis and prevention of complications during ablation procedures. These include those occurring during transseptal catheterization, damage to cardiac structures, left atrial thrombus formation, pulmonary venous stenosis, esophageal injury and pericardial effusion.
- MeSH
- chirurgie s pomocí počítače metody MeSH
- echokardiografie metody MeSH
- financování organizované MeSH
- intervenční ultrasonografie metody MeSH
- lidé MeSH
- mapování potenciálů tělesného povrchu metody MeSH
- převodní systém srdeční chirurgie ultrasonografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
A fast and accurate fusion of intra-operative images with a pre-operative data is a key component of computer-aided interventions which aim at improving the outcomes of the intervention while reducing the patient's discomfort. In this paper, we focus on the problematic of the intra-operative navigation during abdominal surgery, which requires an accurate registration of tissues undergoing large deformations. Such a scenario occurs in the case of partial hepatectomy: to facilitate the access to the pathology, e.g. a tumor located in the posterior part of the right lobe, the surgery is performed on a patient in lateral position. Due to the change in patient's position, the resection plan based on the pre-operative CT scan acquired in the supine position must be updated to account for the deformations. We suppose that an imaging modality, such as the cone-beam CT, provides the information about the intra-operative shape of an organ, however, due to the reduced radiation dose and contrast, the actual locations of the internal structures necessary to update the planning are not available. To this end, we propose a method allowing for fast registration of the pre-operative data represented by a detailed 3D model of the liver and its internal structure and the actual configuration given by the organ surface extracted from the intra-operative image. The algorithm behind the method combines the iterative closest point technique with a biomechanical model based on a co-rotational formulation of linear elasticity which accounts for large deformations of the tissue. The performance, robustness and accuracy of the method is quantitatively assessed on a control semi-synthetic dataset with known ground truth and a real dataset composed of nine pairs of abdominal CT scans acquired in supine and flank positions. It is shown that the proposed surface-matching method is capable of reducing the target registration error evaluated of the internal structures of the organ from more than 40 mm to less then 10 mm. Moreover, the control data is used to demonstrate the compatibility of the method with intra-operative clinical scenario, while the real datasets are utilized to study the impact of parametrization on the accuracy of the method. The method is also compared to a state-of-the art intensity-based registration technique in terms of accuracy and performance.
- MeSH
- algoritmy MeSH
- analýza metodou konečných prvků MeSH
- biomechanika MeSH
- břicho diagnostické zobrazování chirurgie MeSH
- chirurgie s pomocí počítače metody MeSH
- elastografie * MeSH
- lidé MeSH
- nemoci jater diagnostické zobrazování chirurgie MeSH
- peroperační doba MeSH
- počítačová rentgenová tomografie * MeSH
- počítačová simulace MeSH
- počítačová tomografie s kuželovým svazkem * MeSH
- polohování pacienta MeSH
- rentgenový obraz - interpretace počítačová metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- validační studie MeSH
Autoři prezentují své zkušenosti s využitím silikonových epitéz u pacientů po mutilujících operačních výkonech v oblasti hlavy. Diskutují výhody a nevýhody silikonových náhrad, indikace, perioperační management. Prezentují případy pacientů, u kterých byly využity epitézy ke krytí defektu a k rekonstrukci po radikálních onkologických operacích.
The authors present their experience of the application of silicon epitheses in patients after mutilating surgical interventions in the head region. Advantages and disadvantages of silicon substitutions, indications and perioperative management are discussed. Cases of patients, where epitheses were used to cover defects and reconstruction after radical oncological surgeries are described.
- Klíčová slova
- mutilující výkony, epitéza,
- MeSH
- design s pomocí počítače MeSH
- estetika MeSH
- lidé středního věku MeSH
- lidé MeSH
- maxilofaciální protézy * MeSH
- nádory lebky chirurgie MeSH
- nádory očního víčka chirurgie MeSH
- nádory ucha chirurgie MeSH
- oční víčka chirurgie MeSH
- orbita chirurgie MeSH
- protézy - design * MeSH
- protézy a implantáty MeSH
- senioři MeSH
- silikony MeSH
- ušní boltec chirurgie MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
In image-guided percutaneous interventions, a precise planning of the needle path is a key factor to a successful intervention. In this paper we propose a novel method for computing a patient-specific optimal path for such interventions, accounting for both the deformation of the needle and soft tissues due to the insertion of the needle in the body. To achieve this objective, we propose an optimization method for estimating preoperatively a curved trajectory allowing to reach a target even in the case of tissue motion and needle bending. Needle insertions are simulated and regarded as evaluations of the objective function by the iterative planning process. In order to test the planning algorithm, it is coupled with a fast needle insertion simulation involving a flexible needle model and soft tissue finite element modeling, and experimented on the use-case of thermal ablation of liver tumors. Our algorithm has been successfully tested on twelve datasets of patient-specific geometries. Fast convergence to the actual optimal solution has been shown. This method is designed to be adapted to a wide range of percutaneous interventions.
- MeSH
- ablace MeSH
- algoritmy * MeSH
- anatomické modely * MeSH
- chirurgie s pomocí počítače metody MeSH
- játra patofyziologie chirurgie MeSH
- lidé MeSH
- nádory jater chirurgie MeSH
- počítačová simulace * MeSH
- předoperační období * MeSH
- uživatelské rozhraní počítače MeSH
- zobrazování trojrozměrné MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
OBJECTIVE: Visualization by Draf I-III endoscopic access to the frontal sinus via drainage pathways is sometimes inadequate. We compare lateral frontal sinus exposures by Draf approaches versus our modification of removing the medial-superior wall of the orbit while preserving the periorbita. METHODS: Twenty cadaveric heads dissected using Draf IIB, III, and modified Draf III with medial and superior orbital decompression (MSOD) underwent thin-cut computed tomography (CT) scanning. Under image guidance, measurements extended from the midline crista gali to the most lateral point of the frontal sinus. A case report shows the modified Draf III improved frontal sinus access. RESULTS: Comparing Draf IIB and III with Draf III with MSOD, respectively, distances between midline and most lateral point averaged 19.1 mm, 23.7 mm, and 30.4 mm (left) and 18.7 mm, 25.1 mm, and 32.2 mm (right). Differences between Draf III with/without MSOD were 6.65 mm (left) and 7.09 mm (right); 12 heads were excluded because of under-pneumatization of the sinuses. CONCLUSIONS: Draf III with MSOD extended surgical access to lateral regions of the frontal sinus. This extension achieved better visualization and instrumentation with minimal removal of the frontal bone's orbital segment anterior and superior to the anterior ethmoidal artery while preserving the periorbita.
- MeSH
- baze lební radiografie chirurgie MeSH
- chirurgie s pomocí počítače MeSH
- endoskopie metody MeSH
- intervenční radiografie MeSH
- lidé MeSH
- mrtvola MeSH
- orbita radiografie chirurgie MeSH
- počítačová rentgenová tomografie metody MeSH
- sinus frontalis radiografie chirurgie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
