Displacement Of Organs Research Articles

The characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications

To explore the characteristics of pediatric primary retroperitoneal teratoma and the influencing factors of perioperative complications. The clinical data, imaging data, pathology results, perioperative complications, etc of patients with primary retroperitoneal teratoma admitted and treated at Shanxi Children's Hospital from March 2013 to September 2023 were retrospectively analyzed. The patients were divided into no complication group and complication group according to whether there were perioperative complications. The differences between the two groups were compared, and the influencing factors of complications were analyzed by multivariate logistic regression model. A total of 33 patients were included in this study, including 7 males and 26 females, with an age of [M (Q1, Q3), 9.0 (4.0, 24.0)] months. Nineteen cases had tumors located in the left upper abdomen and 14 cases in the right upper abdomen, among which 17 cases grew across the midline, with the maximum tumor diameter of (12.9±4.5) cm. All patients had anatomical displacement of retroperitoneal vessels and organs: the number of anatomical displaced arteries was 3 (3, 4), the number of anatomical displaced veins was 4 (3, 5), the number of anatomical displaced organs was 5 (4, 6). Pathologic examination revealed 28 mature teratomas (Grade 0 and Grade 1) and 5 immature teratomas (Grade 2 and Grade 3). There were 18 cases in no complication group and 15 cases in the complication group. The incidence of perioperative complications was 45.5% (15/33). The number of tumors crossing the midline (6/18 vs 11/15, P=0.037), the number of tumors adhering closely to the surrounding tissues (7/18 vs 12/15, P=0.033), the number of anatomical displaced veins [4 (3, 4) vs 5 (4, 5), P=0.001], and the number of anatomical displaced organs [4 (3, 5) vs 6 (5, 6), P=0.001] were significantly different between the two groups. Multivariate logistic regression model analysis showed that the number of anatomical displaced organs (OR=8.781, 95%CI: 2.155-35.784, P=0.002) was the influencing factor for perioperative complications of pediatric primary retroperitoneal teratoma.

Bilateral transobturator hysterosuspension using titanium tape-shaped mesh implants in women with apical prolapse of the internal genitalia

BACKGROUND: Pelvic organ prolapse is a common pathology with several relapses of the disease after surgical treatment using exclusively self-tissues, which necessitates the development of new surgical techniques using durable and biological inert materials. AIM: To evaluate the effectiveness and safety of an original surgical technique for apical prolapse correction in patients of reproductive and pre- and postmenopausal age. MATERIAL AND METHODS: Twenty-nine patients were examined and operated on using a developed original technique with the use of narrow tape-shaped titanium mesh implants. RESULTS: Follow-up was conducted at 1, 6, 12, and 24 months postoperatively. Comparison of patient survey indicators in the pre- and postoperative periods showed an improvement in the patients’ quality of life and an increase in their social and sexual activity. During the first month, 15 (51.7%) patients reported intermittent pulling pains in the perineal and/or inguinal–femoral folds, and 4 (13.8%) reported frequent urination. Clinical examination revealed complete preservation of the surgical correction of prolapse in all patients. Gynecological and rectal examinations and transperineal and transvaginal echography did not show displacement of pelvic organs or titanium implants. Mesh-associated complications were not noted during the observation period. CONCLUSION: The developed original technique for surgical correction of second-degree apical prolapse with the use of narrow ribbon-shaped titanium mesh implants is effective and safe. This is evidenced by the normalization of the uterus position in the pelvis, absence of displacement of pelvic organs in the near and distant postoperative periods, and absence of mesh-associated complications during the observation time.

Outcome of the novel description of arterial position changes after major liver resections: retrospective study.

After major liver resections, anatomical shifts due to liver parenchymal hypertrophy and organ displacement can happen. The aim of this study was to evaluate the impact of these anatomical changes on the main abdominal arteries (coeliac trunk and superior mesenteric artery) and on patient outcomes. All patients who underwent major liver resections (between January 2010 and July 2021) and who underwent preoperative and postoperative arterial-phase contrast-enhanced abdominal CT imaging were studied. Observed arterial position changes were classified into three groups: no position changes; class I position changes (vessel displacement with or without kinking with a vessel angle greater than 105°); and class II position changes (kinking less than or equal to 105°). The Mann-Whitney test and the Kruskal-Wallis test were used to compare continuous variables and the chi-squared test and Fisher's exact test were used to compare categorical variables. Univariable and multivariable logistic regression analyses were used to identify the risk factors for morbidity and mortality. A total of 265 patients (149 men and median age of 59 years) were enrolled. Arterial position changes were detected in a total of 145 patients (54.7%) (99 patients (37%) with class I position changes and 46 patients (18%) with class II position changes) and were observed more often after extended resection and right-sided resection (P < 0.001). Major complications were seen in 94 patients (35%) and the rate of mortality was 15% (40 patients died). Post-hepatectomy liver failure (P = 0.030), major complications (P < 0.001), and mortality (P = 0.004) occurred more frequently in patients with class II position changes. In multivariable analysis, arterial position change was an independent risk factor for post-hepatectomy liver failure (OR 2.86 (95% c.i. 1.06 to 7.72); P = 0.038), major complications (OR 2.10 (95% c.i. 1.12 to 3.93); P = 0.020), and mortality (OR 2.39 (95% c.i. 1.03 to 5.56); P = 0.042). Arterial position changes post-hepatectomy are observed in the majority of patients and are significantly related to postoperative morbidities and mortality.

Популяционные частоты врожденной диафрагмальной грыжи в регионах РФ по данным мониторинга врожденных пороков развития

Congenital diaphragmatic hernia (CDH) is a severe birth defect characterized by impaired development of the diaphragm that leads to displacement of the abdominal organs into the chest with incidence from 2 to 4 per 10,000 births and its interregional differences that determine the need for assessing the regional incidence. The purpose of this research was to determine the populational CDH incidence and its dynamics in Russia regions based on the data from nationwide epidemiological monitoring of birth defects (BDs). Materials and methods used: the analysis included 2011-2022 data from a cohort study based on BDs epidemiological monitoring from 25 regional registers. In total there were 1493 BD cases among live births, stillbirths and eliminated fetuses with malformations that were included in the study with the total birth count of 5,366,657. Results: the overall CDH incidence in the 25 selected Russia regions was 2.78 per 10,000 births (95% CI 2.71-2.85) without any significant change in its dynamics over the observed period. Interregional differences in CDH incidence were revealed as follows: the maximum incidence of 4.49 (95% CI 3.92-5.06) was registered in the Republic of Sakha (Yakutia); the minimum of 1.23 (95% CI 0.76-1.69) was registered in the Novgorod Oblast. The gender ratio of those affected was 1.2 males per 1 female. The majority of cases (53.81%) were represented by liveborn children, the proportion of stillborns was 5.99%, the proportion of fetuses with diaphragmatic hernia (DH) was 40.2%. 68% were represented by cases of isolated DH v. 32% of a combination of ВР with another BDs among all cases. Conclusion: this study has revealed the CDH incidence rates in 25 selected Russia regions, the incidence variety between the regions with the stability of it in dynamics. Conducting such epidemiological studies is important for understanding the nationwide spread of diseases and identifying risk factors that are important for the prevention and treatment of diseases.

3D Observation of Pelvic Organs with Dynamic MRI Segmentation: A Bridge Toward Patient-Specific Models.

Female pelvic organ prolapses are common, but their treatment is challenging. Notably, diagnosis and understanding of these troubles remain incomplete. Tridimensional observations of displacement and deformation of the pelvic organs during a strain could support a better understanding and help to develop comprehensive tools for preoperative planning. The present feasibility study evaluates tridimensional dynamic MRI in 12 healthy volunteers. Tridimensional acquisitions were approximated using five intersecting slices, each recorded twice per second. MRI was performed during rest and strain, with intrarectal and intravaginal contrast gel. Subject-specific dynamic 3D models were built for each volunteer through segmentation. For each volunteer, pelvic organs could be segmented in three dimensions with a rate of acquisition of two cycles per second on five slices, allowing for a fluid observation of displacements and deformations during strain. Manual segmentation of a full strain required 2 h and 33 min on average. The upper limit of the rectum and the pelvic floor were the most difficult structures to identify. This technique is limited by its time-consuming manual segmentation, which impedes its implantation for routine clinical use. This method must be tried in patients with pelvic organ prolapse. This multi-planar acquisition technique applied during a dynamic MRI allows for observation of displacement and deformations of pelvic organs during a strain.

Advances in research on organ-at-risk protection in pelvic tumor external beam radiotherapy

The simultaneous objectives of destroying tumor cells while protecting normal pelvic organs present a dual clinical and technical challenge within the realm of pelvic tumor radiotherapy. This article reviews the latest literatures, focusing on technological innovations in key aspects of radiotherapy such as positioning, planning, and delivery. These include positioning fixation techniques, organ-at-risk avoidance irradiation, non-coplanar irradiation techniques, as well as organ displacement protection and image-guided adaptive techniques. It summarizes and discusses the research progress made in the protection of critical organs during pelvic tumor radiotherapy. The paper emphasizes technological advancements in the protection of critical organs throughout the processes of radiotherapy positioning, planning, and implementation, aiming to provide references for further research on the protection of critical organs in the external irradiation treatment of pelvic tumors.

MRI-compatible abdomen phantom to mimic respiratory-triggered organ movement while performing needle-based interventions.

In vivo studies are often required to prove the functionality and safety of medical devices. Clinical trials are costly and complex, adding to ethical scrutiny of animal testing. Anthropomorphic phantoms with versatile functionalities can overcome these issues with regard to medical education or an effective development of assistance systems during image-guided interventions (e.g., robotics, navigation/registration algorithms). In this work, an MRI-compatible and customizable motion phantom is presented to mimic respiratory-triggered organ movement as well as human anatomy. For this purpose, polyvinyl alcohol cryogel (PVA-C) was the foundation for muscles, liver, kidneys, tumors, and remaining abdominal tissue in different sizes of the abdominal phantom body (APB) with the ability to mimic human tissue in various properties. In addition, a semi-flexible rib cage was 3D-printed. The motion unit (MU) with an electromagnetically shielded stepper motor and mechanical extensions simulated a respiration pattern to move the APB. Each compartment of the APB complied the relaxation times, dielectricity, and elasticity of human tissue. It showed resistance against mold and provided a resealable behavior after needle punctures. During long-term storage, the APB had a weight loss of 2.3%, followed by changes to relaxation times of 9.3% and elasticity up to 79%. The MU was able to physiologically appropriately mimic the organ displacement without reducing the MRI quality. This work presents a novel modularizable and low-cost PVA-C based APB to mimic fundamental organ motion. Beside a further organ motion analysis, an optimization of APB's chemical composition is needed to ensure a realistic motion simulation and reproducible long-term use. This phantom enhances diverse and varied training environments for prospective physicians as well as effective R&D of medical devices with the possibility to reduce in vivo experiments.

Functional Morphology of Leg Mechanosensory Organs in Early Postembryonic Development in the Stick Insect (Sipyloidea chlorotica).

The subgenual organ complex of stick insects has a unique neuroanatomical organisation with two elaborate chordotonal organs, the subgenual organ and the distal organ. These organs are present in all leg pairs and are already developed in newly hatched stick insects. The present study analyses for the first time the morphology of sensory organs in the subgenual organ complex for a membrane connecting the two sensory organs in newly hatched insects (Sipyloidea chlorotica (Audinet-Serville 1838)). The stick insect legs were analysed following hatching by axonal tracing and light microscopy. The subgenual organ complex in first juvenile instars shows the sensory organs and a thin membrane connecting the sensory organs resembling the morphology of adult animals. Rarely was this membrane not detected, where it is assumed as not developed during embryogenesis. The connection appears to influence the shape of the subgenual organ, with one end extending towards the distal organ as under tension. These findings are discussed for the following functional implications: (1) the physiological responses of the subgenual organ complex to mechanical stimuli after hatching, (2) the influence of the membrane on the displacement of the sensory organs, and (3) the connection between the subgenual organ and distal organ as a possible functional coupling.

Is cryoablation a valid option for renal cell carcinomas in direct contact with critical organs?

This study aimed to assess the outcomes of percutaneous cryoablation (PCA) for renal cell carcinomas (RCCs) contacting critical organs without intervening fat tissue. Twenty-three patients with 24 RCCs (mean size, 28.8 mm) contacting critical organs on preprocedural images were included. The organ displacement techniques, technical success, efficacy, and adverse events per Clavien-Dindo classification were retrospectively reviewed. The organs contacting the RCCs included the colon (n = 16), pancreas (n = 3), duodenum (n = 3), small intestine (n = 1), and stomach (n = 1). In all procedures, hydrodissection was conducted, and probe traction was additionally utilized in one to displace organs. Two procedures were terminated with an insufficient ice-ball margin (<6 mm) due to recurring proximity of the colon or thermal sink effect by renal hilar vessels, yielding a technical success rate of 91.6% (22/24). No severe adverse events were noted. All patients were alive without any metastases during a median follow-up of 34.4 months. The primary and secondary technical efficacy rates were 91.6% (22/24) and 95.8% (23/24) of tumors, respectively. PCA can be a valid option for RCCs contacting critical organs with a good safety profile and sufficient technical efficacy.

Blunt Abdominal Trauma in Pregnancy: Higher Rates of Severe Abdominal Injuries.

Previous studies suggest increased abdominal girth in obese individuals provides a "cushion effect," against severe abdominal trauma. In comparison, the unique anatomic/physiological condition of pregnancy, such as the upward displacement of organs by an expanding uterus, may decrease risk of abdominal injury. However, increased overall blood volume and vascularity of organs during pregnancy raise concerns for increased bleeding and potentially more severe injuries. Therefore, this study aimed to elucidate whether the "cushion effect" observed in obese patients extends to pregnant trauma patients (PTPs). We hypothesized a lower risk of blunt solid organ injury (BSOI) (liver, spleen, and kidney) in pregnant vs non-pregnant blunt trauma patients. The 2020-2021 Trauma Quality Improvement Program was queried for all female blunt trauma patients (age<50 years) involved in motor vehicle collisions (MVCs). We compared pregnant vs non-pregnant patients. The primary outcomes were incidence of BSOI, and severity of abdominal trauma defined by abbreviated injury scale (AIS). From 94,831 female patients, 2598 (2.7%) were pregnant. When compared to non-pregnant patients, PTPs had lower rates of liver (5.5% vs 7.6%, P < .001) and kidney (1.8% vs 2.6%, P = .013) injury. However, PTPs had higher rates of serious (13.4% vs 9.0%, P < .001) and severe abdominal injury (7.5% vs 4.3%, P < .001). BSOI occurred at a lower rate in PTPs compared to non-PTPs; however, contrary to the "cushion effect" observed in obese populations, pregnant women had a higher rate of severe abdominal injuries. These data support comprehensive evaluations for PTPs presenting after a MVC. IV (therapeutic).

Multimodal radiology diagnostics for recurrent congenital diaphragmatic hernia in a child with congenital heart disease: clinical case

Congenital diaphragmatic hernia (CDH) is a severe congenital malformation that occurs as a result of delayed closure of the pleuroperitoneal canal or the diaphragm failure, which leads to the displacement of abdominal organs into the thoracic cavity. Timely diagnosis of recurrent diaphragmatic hernia in the long-term period causes great difficulties. The article presents a clinical observation of a 1-year-and-8-months old female patient operated on for false congenital diaphragmatic hernia and congenital heart defect during the newborn period. Chest X-ray at the outpatient stage allowed diagnosing a relapse of CDH and determining the urgency of hospitalization. In the hospital, the diagnosis was confirmed by computed tomography, surgical treatment was performed.

Self-supervised context-aware correlation filter for robust landmark tracking in liver ultrasound sequences.

Respiratory motion-induced displacement of internal organs poses a significant challenge in image-guided radiation therapy, particularly affecting liver landmark tracking accuracy. Addressing this concern, we propose a self-supervised method for robust landmark tracking in long liver ultrasound sequences. Our approach leverages a Siamese-based context-aware correlation filter network, trained by using the consistency loss between forward tracking and back verification. By effectively utilizing both labeled and unlabeled liver ultrasound images, our model, Siam-CCF , mitigates the impact of speckle noise and artifacts on ultrasonic image tracking by a context-aware correlation filter. Additionally, a fusion strategy for template patch feature helps the tracker to obtain rich appearance information around the point-landmark. Siam-CCF achieves a mean tracking error of 0.79±0.83 mm at a frame rate of 118.6 fps, exhibiting a superior speed-accuracy trade-off on the public MICCAI 2015 Challenge on Liver Ultrasound Tracking (CLUST2015) 2D dataset. This performance won the 5th place on the CLUST2015 2D point-landmark tracking task. Extensive experiments validate the effectiveness of our proposed approach, establishing it as one of the top-performing techniques on the CLUST2015 online leaderboard at the time of this submission.

Treatment for benign skin lesion in zygomatic-infraorbital region by the expanded multi-lobe cervicofacial advancement rotation flap in pediatric patients

PurposeBenign skin lesions in zygomatic-infraorbital regions severely influence pediatric patients’ appearance as well as mental health. Treatments are difficult for the high requirements of patients’ guardians in both function and aesthetics. The present study aims to introduce a surgical method, Expanded Multi-Lobe Cervicofacial Flap, which combines the advantages of the classical cervicofacial advancement rotation flap and the tissue expansion technique.MethodsA total of 21 pediatric patients were enrolled. The treatment process included 2 stages: implantation of the skin tissue expander and flap transfer. The excessive skin created by tissue expansion extended the coverage area of the multi-lobe flap.ResultsIn this retrospective study, follow-up periods were all more than 12 months (20.8 ± 6.7). In the last follow-ups, the flaps were all in good condition, and No facial organ displacement was observed. The patients’ guardians were satisfied with the outcomes.ConclusionsUsing the expanded multi-lobe cervicofacial flap for the zygomatic-infraorbital benign skin lesion repair is effective, and this method is especially applicable to the pediatric population.

Clinical application of a fixed reference line in the ultrasound quantitative diagnosis of female pelvic organ prolapse

ObjectiveThis study explored using an improved ultrasound (US) for quantitative evaluation of the degree of pelvic organ prolapse(POP).DesignA transluminal probe was used to standardize ultrasound imaging of pelvic floor organ displacements. A US reference line was fixed between the lower edge of the pubic symphysis and the central axis of the pubic symphysis at a 30°counterclockwise angle.MethodPoints Aa, Ba, C and Bp on pelvic organ prolapse quantification (POP-Q) were then compared with the points on pelvic floor ultrasound (PFUS).ResultsOne hundred thirteen patients were included in the analysis of the standard US plane. Correlations were good in the anterior and middle compartments (PBN:Aa, ICC = 0.922; PBB:Ba, ICC = 0.923; and PC:C, ICC = 0.925), and Bland-Altman statistical maps corresponding to the average difference around the 30°horizontal line were close to 0. Correlations were poor in the posterior compartment (PRA:Bp, ICC = 0.444). However, eight (7.1%) cases of intestinal hernia and 21 (18.6%) cases of rectocele were diagnosed.ConclusionsIntroital PFUS using an intracavitary probe, which is gently placed at the introitus of the urethra and the vagina, may be accurately used to evaluate organ displacement. The application of a 30°horizontal line may improve the repeatability of the US diagnosis of POP.

Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose

To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction. The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

Bowel in Chest Following Hiatal Hernia: A Rare Presentation

Organ displacement severity across the esophageal hiatus determines how severe a hiatal hernia is. Rare Type IV paraesophageal hernias entail the protrusion of additional abdominal organs in addition to the stomach. We discuss the case of a 13-year-old boy who experienced intestinal obstruction and had a recurring hiatal hernia. A paraesophageal hiatal hernia with colonic and small bowel herniation was identified through clinical examination and imaging. Surgery was used to strengthen the anti-reflux system, reduce the hernia contents, and fix the hernia defect. The patient’s postoperative course was successful. This instance emphasizes the significance of quick paraesophageal hernia diagnosis and care to avoid consequences. An early surgical intervention can enhance results and reduce possibly fatal consequences.

THE BENEFITS OF PHYSIOTHERAPY IN THE TREATMENT OF POSTPARTUM DIASTASIS

The diastasis of the rectus abdominis muscle (ARMD) is a physiological change that occurs in the female body due to pregnancy, hormonal changes, mechanical stress on the abdominal wall by fetal growth and displacement of abdominal organs. Physiotherapy plays a very important role, promoting a stimulation mainly of the abdominal and pelvic muscles to improve muscle tone.

A decision aid for the port placement problem in robot-assisted hysterectomy

ObjectiveIn robot-assisted minimally invasive surgery, proper port positioning ensures that surgical tools have adequate access to the surgical site and avoids mid-surgery collisions of robotic arms. To date, several guidelines have been proposed for more accurate port placement. However, challenges remain due to variations in patient morphology, anatomy, and, in particular, organ displacement due to insufflation in certain laparoscopic procedures. The objective of this study was to design and develop a decision aid for optimal port placement in robot-assisted hysterectomy that accounts for patient variability and organ displacement due to insufflation. MethodsThree components were constructed: a robot model, a patient-specific model, and an optimization algorithm. The three components were integrated, and the system was verified using four different patients who underwent robotic hysterectomy. Once verified, two expert surgeons were asked to evaluate the decision aid for face and construct validity. A usability test was conducted using a torso phantom with target organs located in three different locations. Two expert surgeons performed a simulated hysterectomy task with and without the decision aid to evaluate performance and satisfaction. ResultsThe optimization algorithm was sensitive to individual differences in anatomy in the four patients. Expert surgeons successfully established face and construct validity. Usability test results showed a 28%–40% reduction in time to task completion with the optimized ports compared to expert-determined port locations without using the decision aid. ConclusionsThe decision aid, based on an individualized patient-specific model, robot model, and optimization algorithm, was shown to be effective at addressing the challenges of displaced organs due to insufflation in robot-assisted hysterectomy. The face and construct validity of the decision aid was established by expert surgeons, while efficiency gains in task performance were demonstrated experimentally.

Accuracy of abdominal organ motion estimation in radiotherapy using the right hemidiaphragm top as a surrogate during prolonged breath-holds quantified with MRI.

Respiratory motion presents a challenge in radiotherapy of thoracic and upper abdominal tumors. Techniques to account for respiratory motion include tracking. Using magnetic resonance imaging (MRI) guided radiotherapy systems, tumors can be tracked continuously. Using conventional linear accelerators, tracking of lung tumors is possible by determining tumor motion on kilo voltage (kV) imaging. But tracking of abdominal tumors with kV imaging is hampered by limited contrast. Therefore, surrogates for the tumor are used. One of the possible surrogates is the diaphragm. However, there is no universal method for establishing the error when using a surrogate and there are particular challenges in establishing such errors during free breathing (FB). Prolonged breath-holding might address these challenges. The aim of this study was to quantify the error when using the right hemidiaphragm top (RHT) as surrogate for abdominal organ motion during prolonged breath-holds (PBH) for possible application in radiation treatments. Fifteen healthy volunteers were trained to perform PBHs in two subsequent magnetic resonance imaging (MRI) sessions (PBH-MRI1 and PBH-MRI2). From each MRI acquisition, we selected seven images (dynamics) to determine organ displacement during PBH by using deformable image registration (DIR). On the first dynamic, the RHT, right and left hemidiaphragm, liver, spleen and right and left kidney were segmented. We used the deformation vector fields (DVF), generated by DIR, to determine the displacement of each organ between two dynamics in inferior-superior (IS), anterior-posterior (AP), left-right (LR) direction and we calculated the 3D vector magnitude (|d|). The displacements of the RHT, both hemidiaphragms and the abdominal organs were compared using a linear fit to determine the correlation (R2 of the fit) and the displacement ratio (DR, slope of the fit) between displacements of the RHT and each organ. We quantified the median difference between the DRs of PBH-MRI1 and PBH-MRI2 for each organ. Additionally, we estimated organ displacement in the second PBH by applying the DR from the first PBH to the displacement of the RHT measured during the second PBH. We compared the estimated organ displacement to the measured organ displacement during the second PBH. The difference between the two values was defined as the estimation error of using the RHT as a surrogate and assuming a constant DR over MRI sessions. The linear relationships were confirmed by the high R2 values of the linear fit between the displacements of the RHT and the abdominal organs (R2 > 0.96) in the IS and AP direction and |d|, and high to moderate correlations in the LR direction (0.93 > R2 > 0.64). The median DR difference between PBH-MRI1 and PBH-MRI2 varied between 0.13 to 0.31 for all organs. The median estimation error of the RHT as a surrogate varied between 0.4 and 0.8 mm/min for all organs. The RHT could serve as an accurate surrogate for abdominal organ motion during radiation treatments, e.g. in tracking, provided the error of the RHT as motion surrogate is taken into account in the margins. The study was registered in the Netherlands Trial Register (NL7603). This article is protected by copyright. All rights reserved.

Successful surgical treatment of mediastinal lung hernia with a mesh implant. Consequent results

An observation from practice is given – surgical treatment of mediastinal pulmonary hernia in a patient after pneumonectomy using the method of anterior mediastinal plastic surgery with a mesh implant with demonstration of long-term results.The patient I. 31 years old was ill with pulmonary tuberculosis for 3 years, treatment was carried out, against which the stenosis of the left main bronchus progressed. The patient underwent endoscopic operations: argonoplasmic destruction of the left main bronchus, balloon dilation of the left main bronchus, with a temporary effect. Due to recurrent stenosis of the left main bronchus, a pneumonectomy was performed on the left. After 7 months, she complained of severe shortness of breath at rest. Computed tomography revealed a displacement of the mediastinal organs to the left, an upper-anterior pulmonary mediastinal hernia of the right lung to the left midclavicular line at the level of the anterior I-IV intercostals on the left. The patient underwent plastic surgery of the anterior mediastinum on the right using a polymer mesh implant. As a result of treatment, after 3 years, radiologically stable restoration of the position of the only right lung in its hemithorax. The patient is functionally compensated, shortness of breath is not observed. The patient has completely returned to her usual lifestyle.