Background To date, there are no consensus guidelines for management of lymphatic leak in groin vascular reconstruction patients. The goal of this study is to review the relevant literature to determine alternatives for treatment and to design an evidence-based algorithm to minimize cost and morbidity and maximize efficacy.Methods A systematic review of the literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Two independent reviewers applied agreed-upon inclusion and exclusion criteria to eligible records. Studies that included patients who underwent groin dissection for oncologic diagnoses and level 5 data were excluded. Interventions were then categorized by efficacy using predetermined criteria.Results Our search yielded 333 records, of which eight studies were included. In four studies, the success of lymphatic ligation ranged from 75% to 100%, with average days to resolution ranging from 0 to 9. Conservative management in the form of elevation, compression, and bedrest may prolong time to resolution of lymphatic leak (14–24 days) and therefore cost.Conclusions The majority of patients should be offered early operative intervention in the form of lymphatic ligation with or without a primary muscle flap. If the patient is not an operative candidate, a trial of conservative management should be attempted before other nonsurgical interventions.
Carpometacarpal (CMC) joint instability may be caused by either joint trauma or systemic ligamentous laxity in a setting of connective tissue disorders. Bilateral CMC joint dislocation is extremely rare and has only been described in 2 cases, both resulting from high-energy mechanisms in adults. Here, we present a case of recurrent, bilateral CMC joint subluxation and dislocation resulting from low-energy mechanisms in a pediatric patient with no diagnosable connective tissue disorder. Over a course of 4 years, the patient underwent 10 procedures, including bilateral closed reduction and immobilization, bilateral closed reduction and percutaneous pinning, bilateral tightrope placement, and eventual bilateral tightrope revision with anterior oblique ligament reconstruction. To date, the optimal treatment options for bilateral, low-energy CMC dislocations have not been well described, and these depend on the time from injury to closed reduction as well as postreduction joint stability. Tightrope placement and ligamentous reconstruction may be required in a setting of long-term instability.
a 3D convolutional neural network can auto-segment the lens, optic nerves and chiasm on planning CT scans alone for Gamma Knife SRS with similar accuracy to manual contours. Materials/Methods: A dataset of 101 patients treated with Gamma Knife SRS at a single institution for pituitary tumors or skull base meningiomas were collected. High resolution CT and MRI images were fused and the optic nerves and chiasm were contoured by a neuroanatomic expert. These contours were then transferred to the CT image. The dataset was split into training, validation, and test sets and the data was trained using an attention-gated 3D Residual Network (AG-3DResNet) with a generalized dice loss function. The predicted structures were then compared to manual contours using the Dice Similarity Coefficient (DSC), 95% Hausdorff Distance (HD), Precision, Recall, and Relative Average Volume Difference (RAVD). Results: We compared the predicted contours from the model to the manually constructed contours for all 101 patients. Conclusion: Our AG-3DResNet deep convolutional network can provide accurate segmentation of the lens, optic nerves and chiasm on planning CT scans alone for Gamma Knife SRS. The Dice and 95% HD for our model outperformed the current published best performing model, AnatomyNet, for the Chiasm and Optic Nerves by nearly 10%.
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