RESUMEN
BACKGROUND: The significant variation in the vascular anatomy of the abdominal wall makes preoperative imaging essential when raising a DIEP (deep inferior epigastric artery perforator) flap due to the potential for maximizing operative success, reducing intraoperative error and minimizing operative complications. Variability in perforator anatomy makes DIEP flap surgery a suitable candidate for computer and virtual reality bio models. In this context, a study was undertaken to determine the feasibility of CTA-guided by VirSSPA application. VirSSPA is a virtual reality tool developed in our Hospital for surgical planning and training. This application allows surgeons to generate the three-dimensional (3D) model of the patient. OBJECTIVE: In this paper, we present a study about VirSSPA tool for virtual reality navigation in DIEP flap surgery and compare findings with operative measurements. METHODS: We recruited 12 consecutive patients planned for an elective DIEP flap for breast reconstruction. Each patient underwent preoperative imaging of the anterior abdominal wall vasculature with both conventional CTA and VirSSPA 3D reconstruction. Imaging findings were compared to operative findings. RESULTS: 3D reconstruction of the abdominal wall with VirSSPA demonstrated a significant good correlation with perforator location compared to operative findings, showing an average error rate of 0.228 cm (95% CI, 0.17-0.30). The Pearson product-moment correlation coefficient was found to be 0.99 (p = 0.01), reflecting an almost linear relationship between the two distances, intraoperative and the one measured in the 3D reconstruction. CONCLUSION: VirSSPA provides additional and potentially more accurate data over conventional CTA with regard to the site of the best perforators and its course through the muscle for DIEP micro-vascular surgery.
Asunto(s)
Pared Abdominal/cirugía , Arterias Epigástricas/trasplante , Mamoplastia/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Tomografía Computarizada por Rayos X/métodos , Interfaz Usuario-Computador , Pared Abdominal/irrigación sanguínea , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Femenino , Humanos , Imagenología Tridimensional , Resultado del TratamientoAsunto(s)
Quemaduras por Electricidad/cirugía , Traumatismos del Antebrazo/cirugía , Ilustración Médica , Modelos Anatómicos , Procedimientos de Cirugía Plástica/métodos , Interfaz Usuario-Computador , Adulto , Simulación por Computador , Traumatismos del Antebrazo/etiología , Humanos , Imagenología Tridimensional/métodos , Masculino , Colgajos QuirúrgicosRESUMEN
This study aimed at investigating the changes occurring in the plasma lipid profile of patients with non-insulin-dependent diabetes mellitus (NIDDM) hospitalized for treatment of intercurrent diseases. Twenty-nine non-insulin requiring NIDDM patients (13 men, 16 women; mean age: 67 +/- 2 yrs) and 26 adequately matched patients (12 men, 14 women; mean age: 71 +/- 2 yrs) have been prospectively studied. They were all hospitalized for treatment of various diseases. Diabetic and non-diabetic patients received similar treatment except for intensive insulin therapy in the former group. On admission, diabetic subjects had significantly higher plasma levels of triglycerides and lower levels of HDL cholesterol; during hospitalization, LDL, HDL cholesterol and apo A1 levels increased significantly. In the non-diabetic group, hospitalization and treatment induced significant increases in triglycerides, LDL cholesterol and apo B levels. In conclusion, although insulin treatment during hospitalization of non-insulin requiring NIDDM patients does not fully reverse the abnormal lipid profile, it may help to prevent its further deterioration, particularly by increasing HDL cholesterol levels and hence by decreasing the LDL/HDL cholesterol ratio.
Asunto(s)
Diabetes Mellitus Tipo 2/sangre , Lípidos/sangre , Factores de Edad , Anciano , Estudios de Casos y Controles , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Femenino , Hospitalización , Humanos , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Masculino , Estudios ProspectivosRESUMEN
p24 antigen (p24 Ag) is usually not found in patients in the asymptomatic phase of HIV infection, mainly because it is bound to anti-p24 antibodies (p24 Ab), with which it forms immune complexes. Nine asymptomatic patients positive for HIV-1 antibodies (stage II CDC criteria) treated with r alpha-interferon were followed (7.5 +/- 0.5 months), and a basal and final sample were tested for p24 Ag immune complexes (p24 Ag-IC), free p24 Ag, p24 Ab, CD4 count, beta 2-microglobulin, properdin B factor, and C3 and C4 complement fractions. p24 Ag-IC was detected in 55.5% of the samples, whereas free p24 Ag was detected in 5.5%. The finding of no change or an increase in p24 Ag-IC serum levels may be considered a prognostic marker. We believe that p24 Ab cannot be used as a prognostic marker unless p24 Ag-IC detection is simultaneously evaluated.
Asunto(s)
Complejo Antígeno-Anticuerpo/sangre , Proteína p24 del Núcleo del VIH/sangre , Infecciones por VIH/inmunología , Biomarcadores , Linfocitos T CD4-Positivos , Humanos , Recuento de Leucocitos , PronósticoAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA , Infecciones por VIH/complicaciones , Leishmaniasis Visceral/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Animales , Humanos , Leishmaniasis Visceral/epidemiología , España/epidemiologíaRESUMEN
We studied the nutritional parameters in 82 patients with chronic airways obstruction (type chronic bronchitis). Midarm muscle circumference was the earliest parameter affected. Patients were admitted to the hospital when his serum albumin had a value under normal. On the other hand, the outpatients had a serum albumin within the normal limits. When the protein deficiency involved serum prealbumin and serum retinol binding protein the patients were admitted to intensive care unit (ICU). The body weight and triceps skinfold were within the normal limits even in icu's patients, so that, both parameters neither reflect the nutrition status nor the severity of the undernutrition.