Predicting Waist Circumference From a Single Computed Tomography Image Using a Mobile App (Measure It): Development and Evaluation Study

Background

Despite the existing evidence that waist circumference (WC) provides independent and additive information to BMI when predicting morbidity and mortality, this measurement is not routinely obtained in clinical practice. Using computed tomography (CT) scan images, mobile health (mHealth) has the potential to make this abdominal obesity parameter easily available even in retrospective studies.

Objective

This study aimed to develop a mobile app as a tool for facilitating the measurement of WC based on a cross-sectional CT image.

Methods

The development process included three stages: determination of the principles of WC measurement from CT images, app prototype design, and validation. We performed a preliminary validity study in which we compared WC measurements obtained both by the conventional method using a tape measurement in a standing position and by the mobile app using the last abdominal CT slice not showing the iliac bone. Pearson correlation, student t tests, and Q-Q and Bland-Altman plots were used for statistical analysis. Moreover, to perform a diagnostic test evaluation, we also analyzed the accuracy of the app in detecting abdominal obesity.

Results

We developed a prototype of the app Measure It, which is capable of estimating WC from a single cross-sectional CT image. We used an estimation based on an ellipse formula adjusted to the gender of the patient. The validity study included 20 patients (10 men and 10 women). There was a good correlation between both measurements (Pearson R=0.906). The student t test showed no significant differences between the two measurements (P=.98). Both the Q-Q dispersion plot and Bland-Altman analysis graphs showed good overlap with some dispersion of extreme values. The diagnostic test evaluation showed an accuracy of 83% when using the mobile app to detect abdominal obesity.

Conclusions

This app is a simple and accessible mHealth tool to routinely measure WC as a valuable obesity indicator in clinical and research practice. A usability and validity evaluation among medical teams will be the next step before its use in clinical trials and multicentric studies.

Laparoscopic repair of the broad ligament hernia: A case report

INTRODUCTION AND IMPORTANCE

Broad ligament hernia is a rare type of internal hernia caused by the protrusion of viscera through an abnormal defect on the broad ligament. The diagnosis is difficult and challenging. Usually, it requires an urgent laparotomy to avoid intestinal necrosis or even the death of the patient.

CASE PRESENTATION

A 34-year-old woman, with no medical or surgical history, presented to our educational hospital with acute abdominal pain and recurrent vomiting for the last two days. After clinical and radiological investigations, the diagnosis of an internal hernia through the broad ligament was confirmed. An emergent laparoscopic repair was performed and the postoperative course was uneventful.

CLINICAL DISCUSSION

We report a rare case of an internal hernia through the broad ligament and we describe the challenges associated with the preoperative diagnosis and therapeutic approach. The defect in the broad ligament may be unilateral or bilateral and congenital or acquired. There are no specific clinical and radiologic findings. Surgery remains the cornerstone of the treatment.

CONCLUSION

Early diagnosis and rapid management of broad ligament hernia are necessary to prevent catastrophic sequelae. It is important to keep in mind that internal hernia like broad ligament hernia can occur in patients with no surgical history.

Primary aortoduodenal fistula presenting as a rare cause of upper gastrointestinal bleeding

Primary aortoduodenal fistula (ADF) is a serious life-threatening condition. Unlike secondary ADF which occurs in patients who had previous aortic prosthetic reconstruction, primary ADF is uncommon. Its diagnosis is often unsuspected until surgery or postmortem. We report a rare case of primary ADF presenting as massive gastrointestinal bleeding.

Emphysematous cystitis revealed by necrotizing fasciitis: An unusual presentation

Emphysematous cystitis (EC) is a severe infection of the bladder that usually affects older women with diabetes mellitus. In rare situations, EC can lead to serious complications such as necrotizing fasciitis. We report the case of a 77-year-old woman who developed emphysematous cystitis complicated with rapidly progressive, gas-producing, necrotizing inflammation located on the right lower abdominal wall. The patient had aggressive drainage and debridement in order to control the extensive necrosis. To our knowledge, this is the third case report that describes a possible association between EC and NF requiring aggressive surgical intervention for both diseases.

Giant gastrointestinal stromal tumour presenting with small bowel strangulation

Ileal Gastrointestinal tumor are usually asymptomatic and small bowel obstruction is a rare condition.

Acute post-traumatic dermoid peritonitis: A rare entity

Rupture of ovarian dermoid-cyst is rare case. We report the case of a woman admitted for acute post-traumatic abdominal pain due to ruptured ovarian cyst. The patient was operated and we found a very abundant peritoneal effusion with left ovarian cyst which was broken. we performed a left adnexectomy.

A massive colorectal lithobezoar in a 32‐year‐old woman

A 32‐year‐old female patient with a history of iron deficiency and mental retardation, presented with chronic constipation and painful defecation related to a massive colorectal lithobezoar. She was successfully treated with laxatives and daily rectal enema.

Laparoscopic diverticulectomy of perforated right‐sided colonic diverticulitis

The perforation of the right‐sided colonic diverticulitis (RSCD) is a rare surgical emergency with highly variable clinical presentations. The preoperative distinction between acute appendicitis and perforated diverticulitis represent a dilemma for surgeon. The laparoscopic repair is a feasible method instead of ileocecectomy in selected cases.

Evolution of anti-SARS-CoV-2 immune response in a cohort of French healthcare workers followed for 7 months

Objectives

We aimed to understand the immune response among healthcare workers (HCWs) following SARS-CoV-2 infection, and to determine the infection prevalence during the first wave of the pandemic among workers in our hospital.

Methods

Determination of the serological status against SARS-CoV-2 (nucleocapsid) was offered to all HCWs. All HCWs with positive SARS-CoV-2 serology were proposed to be included in a longitudinal medical and serological follow-up (anti-spike) for 7 months.

Results

We included 3062 HCWs; 256 (8.4%) were positive for anti-SARS-CoV-2 nucleocapsid IgG. Among them, early decrease in the anti-nucleocapsid antibody index was observed between the first (S1) and second (S2) serology samplings in 208 HCWs (84.2%). The initial anti-nucleocapsid IgG index seemed to be related to the HCWs’ age. Seventy-four HCWs were included in the 7-month cohort study. Among them, 69 (90.5%) had detectable anti-spike IgG after 7 months and 24 (32.4%) reported persistent symptoms consistent with post-acute COVID-19 syndrome diagnosis.

Conclusion

The prevalence of serological positivity among HCWs was 6.7%. Infection should be followed by vaccination because of antibody decrease.

Facteurs prédictifs de fistule anastomotique après colectomie pour cancer

Introduction

en chirurgie du cancer colique, la fistule anastomotique (FA) est la complication la plus redoutée. Le but de cette étude était de déterminer les facteurs prédictifs de fistule anastomotique après résection pour cancer colique ainsi de décrire l´impact de cette complication sur la mortalité et la durée du séjour postopératoire.

Méthodes

nous avons mené une étude retrospective, descriptive et analytique, allant du 1^er janvier 2013 au 31 d écembre 2020, dans le service de chirurgie générale de l´Hôpital Habib Bourguiba de Sfax, Tunisie.

Résultats

nous avons colligé 163 malades opérés pour cancer colique. L´âge moyen était de 62,7 ans avec un sexe ratio de 1,36. Les suites opératoires étaient simples dans 64,4% des cas et compliquées dans 35,6%. La morbidité chirurgicale était essentiellement représentée par les fistules anastomotiques, identifiées chez 22 malades. Au terme de notre travail, il ressort que les facteurs prédictifs de la survenue de cette complication sont: le diabète avec un p = 0,04, le tabagisme avec un p = 0,01, l´hypoalbuminémie avec un p = 0,01, l´hémoglobine préopératoire inférieure à 10g/dl avec un p < 0,01, la localisation au niveau de l´angle colique gauche avec un p = 0,02, la transfusion peropératoire avec un p <0,01 et une durée opératoire supérieure à 180 min avec un p = 0,04. Par ailleurs, la survenue de FA était accompagnée d´un taux de mortalité spécifique de 9% et avait prolongé de façon significative la durée de séjour postopératoire.

Conclusion

la prévention de la FA doit s´inscrire dans le cadre d´une prise en charge multimodale du patient avec essentiellement un apport nutritionnel et une correction d´une éventuelle anémie en préopératoire.

Primary leiomyosarcoma of the inferior vena cava: Is vascular reconstruction always necessary?

Both MRI and CT scan can determine tumor size and its extension. PLV have a poor prognosis if surgical resection cannot be achieved. We recommend no reconstruction for type II PLV if venous contact is less than 180° or where the implantation base does not exceed one third of the vena cava.

Unusual retrorectal ganglioneuroma: a case report of laparoscopic assisted approach

Ganglioneuromas are benign slow-growing lesions that arise from sympathetic ganglion cells. They are usually found incidentally. Ultrasound and magnetic resonance imaging (MRI), provides only an unspecified diagnosis and it has to be confirmed by pathologic studies. Complete surgical excision is believed to be the curative treatment for symptomatic lesions. In the literature, the pelvic location reported is exceptional. We report a case of laparoscopic assisted excision of a retrorectal presacral ganglioneuroma for 22-year-old female patient.

[Feasibility and diagnostic value of hysterosonography performed in bleeding time in the exploration of abnormal uterine bleeding]

OBJECTIVES

The aim of our study is to evaluate the feasibility, safety and diagnostic value of hysterosonography performed in an emergency setting among patients consulting for active abnormal uterine bleeding.

MATERIALS AND METHODS

In this prospective study, we included 216 patients visiting our emergency department for abnormal uterine bleeding. All patients had a transvaginal ultrasound with doppler study and an hysterosonography. Secondly, the patients, in whom we diagnosed a suspected organic lesion, were addressed to an endoscopic or surgical procedure with pathological examination. Initially, we evaluated the feasibility and the safety of hysterosonography and secondly, we compared the two techniques (EEV and hysterosonography), sensitivity, specificity, LHR+and LHR-.

RESULTS

The hysterosonography was performed in 98.1 % of patients and its realization has resulted in an additional period of 1.2minutes on average (extreme: 6-12) compared to ultrasound. The tolerance of the hysterosonographic examination was very good in 73.5 % of patients and good in 23.1 % of them. For the 167 patients who had been diagnosed with presumed organic lesions, pathological examination found an endometrial hyperplasia in 34.7 % of cases, polyps in 40.1 % of cases, sub-mucosal fibroids in 11.3 % of cases, endometrial cancer in 0.7 % of cases and other lesions in 13.2 % of cases. The diagnostic value of hysterosonography was superior to ultrasound in the detection of polyps (AUC: 0.894 vs 0.778, P=0.003) and fibromas (AUC: 1.000 vs 0.716, P=0.001) while the two methods showed no significant difference in the detection of hyperplasia.

CONCLUSION

The purpose of our study was to focus on a particular context of use of the hysterosonography consisting on hemorrhagic period and on its realization in the emergency room. We were able to demonstrate that hysterosonography is compatible with the emergency situation as to its feasibility and its diagnostic value and that its realization would contribute to the sorting of patients to guide them immediately to a surgical or endoscopic procedure if necessary.

An experimental model of gastroschisis using fetoendoscopy: preliminary results and technical considerations

BACKGROUND

The aim of this study was to show the feasibility of an experimental model of gastroschisis using fetoendoscopic surgery on sheep fetuses, and also to perform amnioinfusion until delivery using an in-dwelling intraamniotic catheter.

METHODS

We analyzed the data from 18 pregnant ewes having 26 fetuses, which underwent surgery at 80 days of gestation (full term, 145 days). The fetendo technique was used to create a gastroschisis in 15 fetuses. The fetal abdominal wall was opened on the left side of the cord using scissors. The omentum and the intestinal loops were eviscerated using atraumatic forceps. Eleven fetuses were used as a control group. Twenty-one fetuses underwent amnioinfusion; a simple exteriorized catheter was used in seven cases and an intraamniotic catheter with an implantable port was used in the other 14. All ewes and fetuses were killed at the end of the experiment by an intravenous injection of pentotal; thereafter, the fetuses underwent necropsy.

RESULTS

Twelve fetuses died and 14 survived (53.8%); seven of the 15 that underwent gastroschisis survived (46.7%). An amniotic infection occurred in nine fetuses (34.6%); of these, six died and three that were administered antibiotics survived.

CONCLUSIONS

Our experience shows that this experimental model of gastroschisis is feasible and reproducible, and that a repeated amnioinfusion can be performed with an in-dwelling catheter in pregnant ewes. The use of an implantable port is safer than a simple exteriorized catheter.

Scattering analysis of slanted fiber gratings

The diffraction efficiency of a tilted in-core fiber grating is analyzed with the scattering formalism and the first Born approximation. Without any prior physical assumptions about the shape or direction of the scattered wave, it is shown that diffraction occurs when the so-called Bragg conditions are nearly satisfied and the interaction process can be described by a pair of coupled first-order differential equations that are exactly the same as those obtained through the coupled-mode analysis.

Measurement of the extensional and flexural rigidities of a subcellular structure: marginal bands isolated from erythrocytes of the newt

The elastic properties of marginal band, a microtubular structure isolated from the newt (notophthalmus viridescens) have been measured. Bands were isolated using Triton X-100 and pepsin at pH 6.8 according to the method of Cohen (1978). Isolated bands were manipulated with a glass microhook in a buffer-filled chamber under the microscope. Single bands were stretched between the hook and a thin glass fiber. The fiber was calibrated so that the force on the band could be calculated from the displacement of the fiber. The data pairs of force versus band deflection were analyzed according to the theoretical work of Libai and Simmonds (1983) to obtain the flexural and extensional rigidities of the band. Band dimensions calculated from the data were consistent with microscopically determined values. The average flexural rigidity of the bands (EI) was 5.3 X 10(-13) dyn X cm2 and the average extensional rigidity (EA) was 0.017 dyn. Compared to the cell membrane, the marginal band is nearly inextensible and has a much greater resistance to bending, indicating that the band makes an important contribution to the deformability of the circulating cell.