Дисертації з теми "Ultrasound findings"

Tennis elbow (TE) is a relatively common painful condition affecting the upper extremity. The aetiology is not known, but TE is most often seen in middle aged individuals using repetitive and forceful gripping at work or recreational activities, and is referred to overuse injuries. The pathogenesis is not known, but there are so-called degenerative changes in the wrist- and finger-extensor muscle origin (common extensor origin - CEO). The pain mechanisms involved have not been scientifically clarified. The studies in the present thesis aimed to 1) evaluate the structure and blood flow using ultrasound (US) and colour Doppler (CD) examinations of the CEO in patients with TE, and in pain-free elbows, 2) evaluate the clinical effects of US- and CD-guided intratendinous injection treatment with the sclerosing substance polidocanol, 3) evaluate the long term (2 years) effects of injection treatment on the tendon structure and blood flow, and 4) investigate if there is a local production of sympathetic and parasympathetic signal substances in non-neural cells in the CEO. Structural tendon changes and high blood flow was found in the CEO in patients with TE, but not in pain-free controls. Remaining structural changes and additional bone spur formation at the lateral epicondyle, but not high blood flow, were seen 2 years after successful injection treatment. In a randomised double-blind study, US- and CD-guided intratendinous injection treatment with sclerosing polidocanol or the local anaesthetic lidocaine combined with epinephrine, targeting the region with high blood flow, was found to reduce pain and increase grip strength in patients with TE. There were no differences in the outcome between the two treatment groups. A local production of catecholamines, but not acetylcholine, was found in fibroblasts in the CEO, in patients with TE. This thesis presents results showing US and CD examinations to be useful methods to diagnose TE, and to evaluate structure and blood flow in the CEO after treatment. US- and CD-guided injection treatment targeting high blood flow in the region with structural changes can reduce pain symptoms in patients with TE. The localised high blood flow, and local production of catecholamines in the tendon cells in the CEO, might be involved in the pain mechanisms.

Includes bibliographical references (leaves 105-115).<br>The aim of this prospective cohort study therefoew was to assess the morphological and blood flow changes in the Achille tendons of triathletes competing in the 2006 South African Ironman Triathlon.<br>abstract

The aim of this thesis was to examine a large cohort of women undergoing pregnancy assessment before 12 weeks gestation, collecting demographic, symptom and ultrasound data. I aimed to examine the role of prior risk factors and initial ultrasound findings in the prediction of first trimester viability of these pregnancies. Further, I aimed to develop and validate models to counsel women in future about the likely chance of viability for any individual pregnancy. The hypotheses were: (1) There are prior risk and ultrasound factors that can predict likely pregnancy viability, (2) These factors can be used to predict pregnancy loss or ongoing viability in any particular pregnancy and (3) In predicting outcome, both mathematical models } and 'simple rules' (for everyday clinical use) can perform well. ) The prospective study included 1881 women, with median age 32 years and median gestational age at presentation of 50 days. 46% presented with bleeding and 36% with pain. The final outcome was an ongoing pregnancy in 885 (61.7%) and early pregnancy loss in 550 (38.3%) women. Both 'prior risks' (maternal age and bleeding score) and ultrasound factors (gestation and yolk sac size and fetal heart beat) predicted viability. Mathematical models developed showed that these factors used separately and when combined together predicted viability with accuracy. The final scoring system using both demographic and ultrasound variables together was proven to be highly accurate in prediction of pregnancy viability, performing with a sensitivity of 0.92, specificity of 0.73, positive predictive value of 84.7% and negative predictive value of 85.4%. All 3 study hypotheses were proven. The conclusion of this study is that using routinely collected demographic and ultrasound data an accurate individualised likelihood of ongoing viability can be offered to women in early pregnancy with and without symptoms of pain or bleeding.

First degree relatives (FDRs) of subjects with early onset of coronary heart disease (CHD) have higher risk of developing cardiovascular disease. We verified early CHD by angiography in the index patients and extensively phenotyped their FDRs to investigate the relationship of traditional and non-traditional cardiovascular risk factors to carotid ultrasound and coronary calcium scoring findings. B-mode carotid ultrasound was used to assess the combined intima-media thickness and plaque burden in 111 FDRs. The biochemical and anthropometrical characteristics of the FDRs were compared with those of healthy controls matched for sex, age, ethnicity and BMI. Odds ratios indicate that FDRs are more likely to have positive carotid ultrasound findings compared to controls; 2.23 (95% CI 1.14 – 4.37) for intima-media thickness and 2.3 (95% CI 1.22 - 4.35) for average total thickness. In multivariate analysis positive carotid ultrasound findings were higher in FDRs independent of age, gender, total cholesterol over HDL-c ratio, systolic blood pressure and smoking but not homocysteine which had higher values in FDRs compared to controls. In conclusion FDRs of patients with angiographically confirmed CHD have higher burden of subclinical atherosclerosis even when considered in the context of traditional risk factors. Coronary artery calcium scoring (CAC), assessed by 64-slice multi-detector computed tomography (MDCT), was used to assess burden of subclinical atherosclerosis in 57 FDRs compared to controls. FDRs have a two-fold increase in risk of having CAC positive findings; odds ratios for the 75th percentile was 1.96 (95%CI 1.04 – 3.67, p<0.05) while for the 90th percentile odds ratio was 2.59 (95% 1.232 – 5.473, p<0.05). In summary, the risk of significant CAC findings, measured by 64-slice MDCT, is two-fold higher in FDRs than controls. These findings correlate highly with carotid ultrasound findings in the same cohort. Different thresholds for CAC may be appropriate when assessing male versus female FDRs. Together increased carotid ultrasound findings and CAC scoring results in FDRs of patients with validated early onset of CHD suggest these imaging techniques as potentially useful tools in cardiovascular risk assessment that will go above and beyond the current diagnostic algorithms.

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable<br>Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable.<br>Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint.<br>Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Includes abstract.<br>Includes bibliographical references.<br>To determine the most common indication for foetal MRI, and to correlate ante-natal MRI with ante-natal ultrasound, post-natal imaging and post mortem findings. This was a retrospective study of imaging between January 2006 and December 2011. Seventy foetal MRI cases with complete medical records (antenatal and postnatal) were included in the study. Antenatal ultrasound and antenatal MR imaging was compared and also compared with the postnatal imaging findings. Stata 12 was used to analyse the Data. Spearman’s test was used to test the agreement between the results. Intracranial pathology was the most common indication for foetal MRI, with ventriculomegaly being the commonest indication determined from prenatal ultrasound. There was 72% agreement between antenatal ultrasound and foetal MRI. Post-natal findings showed 28% agreement with antenatal ultrasound and 39% agreement with foetal MRI. Intracranial pathology was the major indication for foetal MRI. The study found good agreement between prenatal ultrasound and foetal MRI but poor agreement between antenatal and postnatal findings.

The goal of this study was to derive a clinical prediction rule for transient ischemic attack (TIA) and non-disabling stroke to predict a treatment change based on echocardiogram. Methods: We conducted a cohort sub-study for TIA and non-disabling stroke patients collected over five years from 8 Emergency Departments. We compiled a list of 27 potential predictors to look for treatment change based on echocardiogram findings. We used a univariate, logistic regression and recursive partitioning analysis to develop the final prediction model. Results: The frequency of treatment change was seen in 87 (3.1%) of 2804 cases. The final model contains six predictors: age less than 50 years old, coronary artery disease history, history of heart failure, any language deficit, posterior circulation infarct and middle cerebral artery infarct on neuroimaging. Conclusions: We have developed a highly sensitive clinic prediction rule to guide in the use of echocardiogram in TIA and non-disabling stroke.

The objective of this thesis was to determine the effect of yeast supplements on the performance and health of beef cattle during the receiving and finishing period. Furthermore, another aim of this study was to evaluate the applicability of rumenocentesis on beef cattle and the viability of transabdominal ultrasonography of the rumen mucosa as a suitable, non-invasive diagnostic tool to identify beef cattle affected by SARA. Three trails were conducted in order to do achieve that. Trail I and Trail II were conducted simultaneously using the same animals, while the third trail used a larger sample but always in the same herd. Trail I and II assessed the effect of dietary supplementation of yeast cell wall (YCW) and live cell yeast (LY) at different dosages on rumen’s metabolites. Sixty Charolaise steers were divided into two groups on the basis of their feeding phase: growing and finishing. Growing and finishing groups were each randomly divided into equal three subgroups (n = 10): no supplement (growing control), supplemented with YCW, and supplemented with LY + YCW, no supplement (finishing control), supplemented with LY and supplemented with LY + YCW. Ruminal fluid has been collected before, after 21 and 42 days of experimental period in order to evaluate the volatile fatty acids concentrations and pH values. Faeces samples were collected before (T0), after 21 (T1) and 42 (T2) days of the start of the study, which took place simultaneously and analysed for dry matter (DM), Ash, crude protein (CP), ethereal extract (EE), neutral detergent fibre (NDF), acid detergent fibre (ADF), acid detergent lignin (ADL) and Starch detection. Dietary supplementation of LY and YCW increased (P<0.05) DM, ADF and ADL faecal concentrations in the growing phase; DM, ADL and Starch faecal concentrations in the finishing phase. T2/FC Diet showed a significant effect (P<0.001) of different diets respect to T2/FB in the finishing stage. The obtained results suggest that yeast supplementation do not have beneficial effects with all type of diet condition. Statistical analysis of VFA's data showed a significant effect of time (P < .05) on all studied parameters except iso-valeric acid both in growing and finishing groups. Changes among growing subgroups (P < .05) on propionic acid, acetic acid, iso-butyric acid and n-butyric acid were found, whereas no statistical significances were found among finishing subgroups. Trail III was conducted on 478 beef cattle of Charolaise breed, they were monitored three times during the livestock cycle in order to evaluating the rumen fluid pH and to assess the measures of the rumen wall: T0: 5±3 d after the arrival in farm;T1: 60±10 d after arrival; T2: 1 month before slaughter. Period effect (P<0.001) were found between the three periods after 10 days from the housing, rumen pH values were lower than the threshold value of 5.71 in T0 than in T1 and T2. Pearson’s analysis showed interaction between pH and total ultrasound thickness of rumen wall (-0.700; P<0.0001) and rumen mucosa (-0.7921; P<0.0001). Both differentiation efficiency of mucosal and submucosal layer thickness and rumen wall thickness between healthy and ruminal acidosis affected animals, as a result of ROC curve analysis, was excellent. Using a cut-off value of 5.4 mm, sensitivity was 96.30% and specificity was 91.60% on mucosal and submucosal layer. Using a cut-off value of 8.2 mm, sensitivity was 91.36% and specificity was 91.60 % on rumen wall thickness. The study show that transabdominal ultrasonography of the rumen mucosa has the potential to be a suitable diagnostic tool to identify fattening bulls affected by SARA.<br>L'obiettivo di questa tesi era di determinare l'effetto degli integratori lievito sulle prestazioni e la salute dei bovini da carne durante il periodo di ricevimento e finissaggio. Inoltre, un altro obiettivo di questo studio era di valutare l'applicabilità di ruminocentesi sui bovini da carne e la possibilità di utilizzare l'ecografia transaddominale della mucosa ruminale come uno strumento diagnostico non invasivo per identificare i bovini affetti da SARA. Tre prove sono state condotte al fine di fare raggiungere questo obiettivo. Trail I e II sono stati condotti simultaneamente utilizzando gli stessi animali, mentre per la terza prova utilizzato un campione più grande, ma sempre nella stessa azienda zootecnica. Trail I e II ha valutato l'effetto della supplementazione alimentare di pareti di lieviti (JWC) e lievito cellule vive (LY) a diversi dosaggi di metaboliti nel rumine. Sessanta vitelloni di razza Charolaise sono stati divisi in due gruppi sulla base della loro fase di alimentazione: accrescimento e finissaggio. Il fluido ruminale è stato raccolto al tempo zero e dopo 21 e 42 giorni del periodo sperimentale al fine di valutare le concentrazioni degli acidi grassi volatili e del pH. I campioni di feci sono stati raccolti prima (T0), dopo il 21 (T1) e 42 (T2) giorni dall'inizio dello studio, e sono stati analizzati per sostanza secca (DM), ceneri, proteina grezza (CP), estratto etereo (EE), fibra neutra detergente (NDF), fibra detergente acido (ADF), acido detergente lignina (ADL) e amido.I risultati ottenuti suggeriscono che la supplementazione di lievito non hanno effetti benefici con tutti i tipi di condizione di dieta. L'analisi statistica dei dati di VFA ha mostrato un effetto significativo di tempo (P <.05) su tutti i parametri studiati, eccetto l'acido iso-Valerianico sia nei gruppi di crescita e di finissaggio. 408/5000 Sono stati riscontrati cambiamenti tra sottogruppi crescita (P <.05) su acido propionico, acido acetico, acido iso-butirrico e l'acido n-butirrico, mentre non è stata trovata significatività statistica tra sottogruppi del finissaggio. Trail III è stato condotto su 478 bovini da carne di razza Charolaise, sono stati monitorati per tre volte durante il ciclo di bestiame al fine di valutare il pH del fluido ruminale e per valutare le misure della parete ruminale.Effetto Periodo (P <0.001) è stato riscontrato tra i tre periodi dopo 10 giorni dall'arrivo. Valori di pH ruminale erano inferiori al valore di soglia di 5.71 in T0 rispetto al T1 e T2. L'analisi di Pearson ha mostrato interazione tra il pH e spessore ad ultrasuoni totale di parete ruminale (-0,700; p <0,0001) e del rumine mucosa (-0,7921; p <0,0001). Lo studio dimostrano che l'ecografia transaddominale della mucosa ruminale ha il potenziale per essere uno strumento diagnostico adatto per identificare i tori da ingrasso affetti da SARA.

Orientadores: Maria de Lourdes Setsuko Ayrizono, Raquel Franco Leal<br>Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-21T16:52:24Z (GMT). No. of bitstreams: 1 Morelli_Umberto_M.pdf: 2138633 bytes, checksum: 5f01d9ffff23b91ad957cfdd99ca4fea (MD5) Previous issue date: 2012<br>Resumo: Introdução: A incidência da doença de Crohn Perineal (DCP) varia entre 20% a 25% nos portadores de doença de Crohn . O padrão-ouro para a investigação da DCP é a avaliação clínica clássica seguida do exame sob anestesia, mas a ultrassonografia endoanal (USEA) e a ressonância nuclear magnética (RNM) da pelve podem ser úteis na pesquisa de abscessos, fistulas e lesões esfincterianas que podem levar à incontinência fecal e perda da qualidade de vida. Objetivo: Correlacionar a avaliação clínica clássica da função esfincteriana por meio do escore de Jorge-Wexner nos pacientes com DCP, comparando com os achados de USEA, através do escore de Starck. Casuística e Método: Vinte e quatro pacientes participaram do estudo, sendo 14 do sexo feminino e média de idade de 40,54 anos. Todos os doentes tinham diagnóstico confirmado de DCP, sendo que 7 (29,16%) também apresentavam acometimento do intestino delgado; 7 (29,16%) do cólon e reto, 2 (8,33%) do intestino delgado, do cólon e reto e 8 pacientes (33,33%) apresentavam DCP como manifestação única da doença. Resultados: Os dois escores apresentaram distribuição normal, com escore de Jorge-Wexner médio de 3,8333 (DP 4,52689) e escore de Starck médio de 9,7500 (DP 2,54097). A análise estatística mostrou não haver correlação entre os dois escores, com um intervalo de confiança de 95%. Conclusão: O escore de Jorge- Wexner apresentou utilidade limitada nessa categoria de pacientes, enquanto a USEA foi ferramenta útil para alcançar melhor correlação com deficiência muscular esfincteriana. No entanto, mais estudos com propostas similares são necessários para aumentar a validade desses achados e para estabelecer se a USEA pode predizer a função esfincteriana e a incontinência fecal antes de procedimento cirúrgico em pacientes com DCP<br>Abstract: Introduction: The incidence of perianal CD (PCD) is variable between 20% and 25% of patients with CD. The gold standard for assessment of PCD is still the classic clinical examination followed eventually by examination under anesthesia (EUA) but complementary examinations like endoanal ultrasound (EAUS) and magnetic resonance imaging of the pelvis (MRI) were introduced as useful to completely assess the anatomical lesions of the sphincteric muscles caused by fistulas and abscesses. Objective: Verify the adequacy of the classical clinical evaluation to which most of the patients are submitted, in particular regarding the adequacy of assessing the sphincteric function through the Jorge- Wexner score in patients with PCD, comparing it with the findings of EAUS trough a score published by Stark and colleagues. Patients and Methods: Twenty four patients participated to the study, being 16 females and the mean age is 40.54 years old. All patients have an established diagnosis of PCD, being 7 (29,16%) with a diagnosis of CD involving the small bowel, 7 (29,16%) CD involving the colon and rectum, 2 (8,33%) CD involving the small bowel and the colon-rectum, and 8 (33,33%) have a diagnosis of PCD as the only clinical manifestation of CD. Results: The two scores has a normal distribution, with a mean Wexner score of 3.8333 (SD 4,52689) and a mean Starck score of 9,7500 (SD 2,54097). The statistical analysis showed that there is no correlation between the two scores with a confidence interval of 95%. Conclusion: The Jorge-Wexner score had a limited usefulness in this category of patients, whereas EAUS was an useful tool for achieving better correlation with muscle deficiency. This study investigated CD, a very particular and still not fully understood disease, being the perianal disease important feature of CD. However, more studies with similar purpose are needed, in order to improve the validity of these findings, and establish if the EAUS can predict the sphincter function and fecal continence before perianal surgery for CD<br>Mestrado<br>Fisiopatologia Cirúrgica<br>Mestre em Ciências

Optimal surface finding (OSF), a graph-based optimization approach to image segmentation, represents a powerful framework for medical image segmentation and analysis. In many applications, a pre-segmentation is required to enable OSF graph construction. Also, the cost function design is critical for the success of OSF. In this thesis, two issues in the context of OSF segmentation are addressed. First, a robust model-based segmentation method suitable for OSF initialization is introduced. Second, an OSF-based segmentation refinement approach is presented. For segmenting complex anatomical structures (e.g., lungs), a rough initial segmentation is required to apply an OSF-based approach. For this purpose, a novel robust active shape model (RASM) is presented. The RASM matching in combination with OSF is investigated in the context of segmenting lungs with large lung cancer masses in 3D CT scans. The robustness and effectiveness of this approach is demonstrated on 30 lung scans containing 20 normal lungs and 40 diseased lungs where conventional segmentation methods frequently fail to deliver usable results. The developed RASM approach is generally applicable and suitable for large organs/structures. While providing high levels of performance in most cases, OSF-based approaches may fail in a local region in the presence of pathology or other local challenges. A new (generic) interactive refinement approach for correcting local segmentation errors based on the OSF segmentation framework is proposed. Following the automated segmentation, the user can inspect the result and correct local or regional segmentation inaccuracies by (iteratively) providing clues regarding the location of the correct surface. This expert information is utilized to modify the previously calculated cost function, locally re-optimizing the underlying modified graph without a need to start the new optimization from scratch. For refinement, a hybrid desktop/virtual reality user interface based on stereoscopic visualization technology and advanced interaction techniques is utilized for efficient interaction with the segmentations (surfaces). The proposed generic interactive refinement method is adapted to three applications. First, two refinement tools for 3D lung segmentation are proposed, and the performance is assessed on 30 test cases from 18 CT lung scans. Second, in a feasibility study, the approach is expanded to 4D OSF-based lung segmentation refinement and an assessment of performance is provided. Finally, a dual-surface OSF-based intravascular ultrasound (IVUS) image segmentation framework is introduced, application specific segmentation refinement methods are developed, and an evaluation on 41 test cases is presented. As demonstrated by experiments, OSF-based segmentation refinement is a promising approach to address challenges in medical image segmentation.

L'artrite reumatoide è una patologia autoimmune che può coinvolgere non solamente il danno articolare, ma anche organi come il cuore e i polmoni. Il rischio cardiovascolare associato all'artrite reumatoide è sovrapponibile a quello del diabete e lo studio del dismentabolismo lipidico e la valutazione dell'ecocardiografia sono indispensabili per una valutazione del rischio global. In una coorte selezionata di pazienti (studio EPIDAURO) è stato seguito uno studio Tissue Doppler per indagare eventuali alterazioni della funzione sistolica del ventricolo sinistro e l'associazione con l'artrite reumatoide<br>rheumatoid arthritis is an autoimmune disease that affects both joints (with the related articular damage) and organs like lungs and heart. The cardiovascular risk in patients with RA is the same of the diabetic ones. The evaluation of lipid dismetabolism and heart ultrasonography are essential in order to achieve a global risk evaluation. in a selected cohort of patients (EPIDAURO study) a Tissue Doppler evaluation was done in order to clear which are the alterations of sistolic function of left ventricule and their association with rheumatoid arthritis

Thesis (M.Tech.: Chiropractic) -Dept. of Chiropractic, Durban Institute of Technology, 2002<br>The purpose of this randomized controlled clinical trial was to investigate the relative effectiveness of proprioceptive neuromuscular facilitation (PNF) versus ultrasound therapy for the treatment of Temporomandibular joint (TMJ) dysfunction caused by masticatory myofascial trigger points, in terms of subjective and objective clinical findings.

碩士<br>高雄醫學大學<br>臨床醫學研究所<br>105<br>Objective: To evaluate the change of ultrasound and cartilage biomarker COMP and CPII among rheumatoid arthritis who were in DAS28 remission. Method: From June 2016 to February 2017, total fourteen patients were diagnosed to have rheumatoid arthritis by fulfill 1987 American College of Rheumatology revised criteria and have disease duration over than three years in one single center. These patients received biologic and non-biologic disease mod anti-rheumatic drug and all of them achieved DS28 remission for more than one year. Scheduled ultrasound examination of 28 pairs of joints and blood test including C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR), Oligomertic matrix protein (COMP) and C-propeptide of type II collagen (CPII) at month 0, 3 and 6. Results: 14 patients received totally 42 times of ultrasound examination. The average Power Doppler scale (PD) score: 1.28, Grey scale (GS) score: 1.9. The most common abnormal finding in ultrasound in these 28 pair joints was wrist joint, 52%. The ultrasound PD score have significant association with COMP (P=0.0277), no significant association with CPII, CRP and ESR.

碩士<br>國立清華大學<br>電機工程學系<br>104<br>Breast cancer is the most common type of cancer in women worldwide, which inspires researchers worldwide to develop computer-aided-diagnosis with ultrasound images. In this thesis, we propose the research of combining texture features with tumor segmentation based on level set evolution in breast ultrasound image. Furthermore we try to find if the texture features coming from ultrasound images have correlation with histological features or some specific types of breast cancer. First a segmentation method, which combines the texture features and one rubout weak-edge segmentation algorithm, called combined distance regularized level set evolution (cDRLSE), is developed for capturing the contour of tumors. The proposed cDRLASE consists of the following steps. First, apply the texture features for support vector machine (SVM) to decide the initialization area. Second, re-initialize by improved DRLSE, where the edge indicator of external energy was improved so that the contour can easily and precisely reach to the weak boundary. Third, Gaussian filtering is used to smooth noise, and apply DRLSE for roughly capturing the tumor area. Last, with the post-processing to find a proper tumor area. Meanwhile, manual segmentation on BUS images under the supervision of Dr. Chou, an experienced doctor, are performed to define the contour separating the tumor and non-tumor region and used as ground truth contour for evaluation. Comparing the cDRLSE method with two other segmentation methods in Appendix, cDRLSE outperforms the other two in the average. Then, BUS tumor image texture features are extracted by gray scale intensity analysis and texture analysis. The image features includes mean, variance, skewness, kurtosis, entropy, fractal dimension and gray-level co-occurrence matrix. During the procedure of computing gray level co-occurrence matrix, various distance parameters are included, which lead us to build a large number of texture features. Finally, we investigate if there are any correlations between texture features extracted from breast ultrasound images, pathological features and the histological type by SPSS. According to the analysis, most of the features have no relation among histological type, except only histological grade and category show relations. Also, few histological features were found correlate with texture features; size, lymph nodes and tumor necrosis are the ones associate with some texture features.