Lower rates of lipofilling sessions in latissimus dorsi flap breast reconstruction with initial higher volume transfer by preservation of subfascial fat: A 3D camera-assisted volumetric case series.
- 作者列表："Stivala A","Bertrand B","Ouar N","Revol M","Atlan M","Cristofari S
:Breast reconstruction with latissimus dorsi flap (LDF) is a well-known technique, but the crucial goal is to achieve a satisfying final volume restoration. Our hypothesis is that LDF reconstruction with the preservation of subfascial fat can achieve a higher volume in a one-time procedure than that achieved in a classic LDF harvest. The aim of the study was to quantify the volume resorption in LDF reconstructions with the preservation of subfascial fat. Fifteen breasts were reconstructed with a simple LDF and the remaining 15 with an LDF with the preservation of the subfascial fat between January 2016 and May 2017. Secondly, every patient underwent a lipofilling procedure. A supplemental lipofilling procedure was performed in unsatisfying cases. A Structure-Sensor camera manufactured by OccipitalⓇ was used. Each patient received a 3D measurement during immediate postoperative care and then after 3 and 6 months of follow-up. This study shows no difference in volume retention at follow-up between the 2 techniques. The gain of an immediate and stable fatty layer in LDF + subfascial fat technique leads to breast volume improvement in one surgical step. Breast reconstruction with LDF and subfascial fat can be defined as a reliable solution, which provides an optimal result with a reduced number of surgical interventions when compared with a simple LDF.
: 背阔肌皮瓣 (LDF) 乳房重建是一项众所周知的技术，但关键目标是实现满意的最终体积恢复。我们的假设是，与经典的LDF收获相比，保留筋膜下脂肪的LDF重建可以在一次性手术中获得更高的体积。该研究的目的是量化保留筋膜下脂肪的LDF重建中的体积吸收。2016年1月至2017年5月期间，15个乳房用简单的LDF重建，其余15个乳房用保留筋膜下脂肪的LDF重建。其次，每例患者均接受了脂肪填充术。在不满意的情况下进行补充脂肪填充程序。使用由ccipitale制造的结构传感器相机。每个患者在术后即刻护理期间接受3D测量，然后在3个月和6个月的随访后接受3D测量。该研究显示在2种技术之间的随访中体积保留没有差异。在ldf + 筋膜下脂肪技术中获得即时稳定的脂肪层，在一个手术步骤中导致乳房体积改善。使用LDF和筋膜下脂肪的乳房重建可以被定义为可靠的解决方案，与简单的LDF相比，它提供了减少手术干预次数的最佳结果。
METHODS:OBJECTIVES:The aim was to evaluate the image quality and sensitivity to artifacts of compressed sensing (CS) acceleration technique, applied to 3D or breath-hold sequences in different clinical applications from brain to knee. METHODS:CS with an acceleration from 30 to 60% and conventional MRI sequences were performed in 10 different applications in 107 patients, leading to 120 comparisons. Readers were blinded to the technique for quantitative (contrast-to-noise ratio or functional measurements for cardiac cine) and qualitative (image quality, artifacts, diagnostic findings, and preference) image analyses. RESULTS:No statistically significant difference in image quality or artifacts was found for each sequence except for the cardiac cine CS for one of both readers and for the wrist 3D proton density (PD)-weighted CS sequence which showed less motion artifacts due to the reduced acquisition time. The contrast-to-noise ratio was lower for the elbow CS sequence but not statistically different in all other applications. Diagnostic findings were similar between conventional and CS sequence for all the comparisons except for four cases where motion artifacts corrupted either the conventional or the CS sequence. CONCLUSIONS:The evaluated CS sequences are ready to be used in clinical daily practice except for the elbow application which requires a lower acceleration. The CS factor should be tuned for each organ and sequence to obtain good image quality. It leads to 30% to 60% acceleration in the applications evaluated in this study which has a significant impact on clinical workflow. KEY POINTS:• Clinical implementation of compressed sensing (CS) reduced scan times of at least 30% with only minor penalty in image quality and no change in diagnostic findings. • The CS acceleration factor has to be tuned separately for each organ and sequence to guarantee similar image quality than conventional acquisition. • At least 30% and up to 60% acceleration is feasible in specific sequences in clinical routine.
METHODS:BACKGROUND:The main surgical techniques for spontaneous basal ganglia hemorrhage include stereotactic aspiration, endoscopic aspiration, and craniotomy. However, credible evidence is still needed to validate the effect of these techniques. OBJECTIVE:To explore the long-term outcomes of the three surgical techniques in the treatment of spontaneous basal ganglia hemorrhage. METHODS:Five hundred and sixteen patients with spontaneous basal ganglia hemorrhage who received stereotactic aspiration, endoscopic aspiration, or craniotomy were reviewed retrospectively. Six-month mortality and the modified Rankin Scale score were the primary and secondary outcomes, respectively. A multivariate logistic regression model was used to assess the effects of different surgical techniques on patient outcomes. RESULTS:For the entire cohort, the 6-month mortality in the endoscopic aspiration group was significantly lower than that in the stereotactic aspiration group (odds ratio (OR) 4.280, 95% CI 2.186 to 8.380); the 6-month mortality in the endoscopic aspiration group was lower than that in the craniotomy group, but the difference was not significant (OR=1.930, 95% CI 0.835 to 4.465). A further subgroup analysis was stratified by hematoma volume. The mortality in the endoscopic aspiration group was significantly lower than in the stereotactic aspiration group in the medium (≥40-<80 mL) (OR=2.438, 95% CI 1.101 to 5.402) and large hematoma subgroup (≥80 mL) (OR=66.532, 95% CI 6.345 to 697.675). Compared with the endoscopic aspiration group, a trend towards increased mortality was observed in the large hematoma subgroup of the craniotomy group (OR=8.721, 95% CI 0.933 to 81.551). CONCLUSION:Endoscopic aspiration can decrease the 6-month mortality of spontaneous basal ganglia hemorrhage, especially in patients with a hematoma volume ≥40 mL.
METHODS:OBJECTIVE:The primary purpose of this study was to evaluate the effectiveness of a three-dimensional (3D) software tool (smart planes) for displaying fetal brain planes, and the secondary purpose was to evaluate its accuracy in performing automatic measurements. MATERIAL AND METHODS:This prospective study included singleton fetuses with a gestational age (GA) greater than 18 weeks. Transabdominal two-dimensional ultrasound (2DUS) and 3D smart planes images were respectively used to obtain the basic planes of the fetal brain, with five parameters measured. The images, by either two-dimensional (2D) manual or 3D automatic operation, were reviewed by two experienced sonographers. The agreements between two measurements were analyzed. RESULTS:A total of 226 cases were included. The rates of successful detection by automatic display were as high as 80%. There was substantial agreement between the measurements of the biparietal diameter, head circumference and transcerebellar diameter, but poor agreement between the measurements of cisterna magna and lateral ventricle width. CONCLUSIONS:Smart Planes might be valuable for the rapid evaluation of fetal brain, because it simplifies the evaluation process. However, the technology requires improvement. In addition, this technology cannot replace the conventional manual US scans; it can only be used as an additional approach.