Assessment of non-mydriatic fundus photography in detection of diabetic retinopathy.

Non-mydriatic retinal photography with later interpretation of the photographs was assessed as a screening method for the detection of diabetic retinopathy; when compared with an ophthalmologist''s clinical assessment in a random group of 62 diabetic patients it was accurate (false negative 6.8%, false positive 2%) and sensitive (sensitivity 96%, specificity 98%). The assessment of further management required based on analysis of the photographs was 96.5% in agreement with the further management suggested by the ophthalmologist after direct clinical assessment of the patient. If this technique were used to screen patients in a typical diabetic clinic the predicted positive accuracy rate would be 84% and the predicted negative accuracy rate 99.5%.     

The physical attractiveness of facially deformed patients before and after craniofacial surgery

The present experiment investigated whether the physical attractiveness of craniofacially deformed children and adolescents could be improved by surgical procedures. Twenty patients between the ages of 5 months and 17 years were randomly selected from patient files. Patient diagnoses included facial clefts, hypertelorism, Treacher Collins syndrome, and craniofacial dysostosis (Crouzon's and Apert's syndromes). Rigorously standardized photographs of patients taken before and after surgery were shown to 40 "naive" raters ranging in age from 17 to 52 years. Raters analyzed the photographs with regard to global physical attractiveness. These ratings indicated that the patients' physical attractiveness was reliably (62 percent) improved following surgery. The results are discussed in light of recent evidence that untreated craniofacial patients may be at risk for psychosocial disorders and in terms of the growing evidence of the importance of physical appearance for the development of cognitive and social-emotional competence. In addition, a standardized assessment system is described that can be used to facilitate the compilation of actuarial data predicting surgical outcomes. Finally, the importance of empirically evaluating the effectiveness of surgical procedures and practitioners on a continuing basis is emphasized.     

A new rig for standardized craniofacial photography put to the test

This article describes and tests a photography rig that has been built at the University of Melbourne, Australia, specifically for the purpose of taking rapid and highly standardized craniofacial photographs, in simultaneous views of front and profile. The rig uses a novel projected light range-finding system that has been designed for easy and accurate positioning of subjects, in the natural head position, at precise distances from the frontal camera. Results of experiments examining the intraobserver error of multiple photographs taken on the rig indicate that high-quality, repeatable photographs can be taken after a reasonably large amount of time has lapsed between photography sessions (e.g., 30 days). This study also indicates that some variability remains between photographs even when highly standardized protocols are followed. Consequently, it is expected that the variation between photographs with limited standardization is much larger and more likely to cause significant errors in any comparisons.     

Automatic system for 3D reconstruction of the chick eye based on digital photographs

The geometry of anatomical specimens is very complex and accurate 3D reconstruction is important for morphological studies, finite element analysis (FEA) and rapid prototyping. Although magnetic resonance imaging, computed tomography and laser scanners can be used for reconstructing biological structures, the cost of the equipment is fairly high and specialised technicians are required to operate the equipment, making such approaches limiting in terms of accessibility. In this paper, a novel automatic system for 3D surface reconstruction of the chick eye from digital photographs of a serially sectioned specimen is presented as a potential cost-effective and practical alternative. The system is designed to allow for automatic detection of the external surface of the chick eye. Automatic alignment of the photographs is performed using a combination of coloured markers and an algorithm based on complex phase order likelihood that is robust to noise and illumination variations. Automatic segmentation of the external boundaries of the eye from the aligned photographs is performed using a novel level-set segmentation approach based on a complex phase order energy functional. The extracted boundaries are sampled to construct a 3D point cloud, and a combination of Delaunay triangulation and subdivision surfaces is employed to construct the final triangular mesh. Experimental results using digital photographs of the chick eye show that the proposed system is capable of producing accurate 3D reconstructions of the external surface of the eye. The 3D model geometry is similar to a real chick eye and could be used for morphological studies and FEA.     

Computerized classification of Mediterranean vegetation using panchromatic aerial photographs

Abstract. Historical aerial photographs are an important source for data on medium- to long-term (10 - 50 yr) vegetation changes. Older photographs are panchromatic, and manual interpretation has traditionally been used to derive vegetation data from such photographs. We present a method for computerized analysis of panchromatic aerial photographs, which enables one to create high resolution, accurate vegetation maps. Our approach is exemplified using two aerial photographs (from 1964 and 1992) of a test area on Mt. Meron, Israel. Spatial resolution (pixel size) of the geo-rectified photos was 0.30 m and spatial accuracy (RMS error) ca. 1 m. An illumination adjustment prior to classification was found to be essential in reducing misclassification error rates. Two classification approaches were employed: a standard maximum-likelihood supervised classifier, and a modification of a supervised classification, which takes into account spectral properties of individual pixels as well as their neighbourhood characteristics. Accuracy of the maximum likelihood classification was 81 % in the 1992 image and 54 % in the 1964 image. The neighbour classifier increased accuracy to 89 % and 82 % respectively. The overall results suggest that computerized analysis of sequences of panchromatic aerial photographs may serve as a valuable tool for the quantification of medium-term vegetation changes.     

Intraoperative computer tomography control within the scope of maxillofacial traumatology using a mobile scanner]

Advances in intra-operative imaging and the development of new minimally invasive techniques are having an ever greater impact on modern surgery. Mobile CT scanners in the operating room is a new technique that permits image-guided surgery, and helps minimize postoperative complications. We report on our initial experience with intraoperative CT scanning during surgery on patients suffering lateral midface trauma. A mobile CT unit, the Tomoscan M (Philips, Utrecht, Netherlands) set up in the operating room, was evaluated in 6 patients with zygomatic bone fractures. The patients were placed on the CT scanner table, which is detachable from the gantry. The unit is powered by batteries charged from an ordinary ring mains supply via a conventional plug. The CT images obtained were of good quality in all cases. No technical problems were observed during surgery. Using repeat CT scans, the procedure also permits accurate intraoperative monitoring of the anatomical repositioning of the bone fragments, and accurate implantation. No intraoperative or early postoperative complications were observed. This new technical aid ensures highly accurate reduction of the bone fragments, and minimizes the need for reoperation. High-quality intraoperative imaging with surgical navigation increase surgical outcome, and expand the spectrum of minimally invasive surgery.     

The "third" dimension in craniofacial surgery

A new method for reconstruction of a three-dimensional surface from a sequence of high-resolution axial CT scans has been developed. This algorithm is realized as a set of computer programs that can operate on commercially available CT scanners or evaluation consoles. The program is both efficient and easy to implement. No operator intervention is required. The images produced simulate photographs of the skull. Frontal, lateral, oblique, bird's eye, worm's eye, and rear views are generated. As with photographs and conventional radiographs, each of these projections uniquely displays specific anatomic details. This method of osseous surface reconstruction is now routinely applied to all patients evaluated for major craniofacial reconstruction at our institution. The images are useful in defining aberrant anatomy, planning surgical procedures, and evaluating the results of such operations. This method replaces an inexact concept in the surgeon's imagination with a three-dimensional image of the craniofacial skeleton.     

Relationship between immediate post-operative appearance and 6-week operative outcome in trichiasis surgery

Background

Surgical technique, including suture placement and tension, is believed to contribute to the outcome of bilamellar tarsal rotation surgery for trachomatous trichiasis. However, the immediate post-operative appearance that minimizes the chance of recurrence and other adverse outcomes has not been investigated.

Methodology/Principal Findings

To explore whether the degree of correction immediately after surgery is predictive of surgical outcome at the 6-week post-operative visit, photographs taken immediately after surgery were used to predict surgical outcomes, including the severity of eyelid contour abnormality and trichiasis recurrence. Both eyelid contour abnormalities and recurrence were accurately predicted from the immediate post-operative photographs by an experienced oculoplastic surgeon 85% and 70% of the time, respectively. Participants with a “slight over-correction” that resulted in no eyelid contour abnormality and no recurrence were used to identify immediate post-operative contours that lead to a successful surgical outcome.

Conclusions/Significance

The immediate post-operative eyelid contour is an important indicator of post-operative success of BLTR surgery. Based upon our findings, we developed a Surgery Photocard. This card illustrates some examples of immediate post-surgical appearances, which led to a successful outcome, as well as sub-optimal appearances, which led to poor surgical outcomes. The card also provides suggestions for improving the appearance by adjusting the suture placement or tension based upon standard oculoplastic principles.     

微等离子体射频技术治疗成熟瘢痕50例临床观察

目的:研究新型微等离子体射频技术治疗瘢痕的效果。方法:50例成熟瘢痕患者,包括31例痤疮疤痕,19例外伤或手术疤痕。均采用微等离子体射频技术进行功率为70～90Watt的滑动式或定点式治疗,每4周治疗一次,共治疗2～5次,通过治疗前及治疗后3个月统一衡量标准对比来进行疗效评估。结果:成熟瘢痕表现为身体各部位分布形状不规则形状皮肤组织凹陷或轻度增生。通过临床指标评分,50例患者总有效率为82%。疗效显著18例(36%),有效22例(44%),轻微改善11例(22%),无效9例(18%)。结论:微等离子体射频技术能显著改善成熟瘢痕的色泽、质地和凸凹程度,不良反应少,是治疗成熟瘢痕的有效方法。     

Morphologic evaluation of spermatogenetic activity in cryptorchidism

The AA. have done an accurate study on 41 patients affected by retained testicles and they arrive to the conclusion that to obtain an exact evaluation of the surgical treatment to perform it is necessary a bioptic examination of both the testes.     

Portrait of the Patient as a Young Man: An Exploration of the Use of Photographs in Hospital

The display of personal photographs in hospital is a common practice that has yet to be rigorously examined. The photographs displayed are subject to interpretation by the viewer and may lead to misunderstandings or miscommunication if clarification of meaning is not sought. This paper explores a range of possible meanings that the display of photographs in hospital may hold, based on a case study of a 15 year old boy hospitalised with a life threatening illness. Further research is needed into the actual meanings attributed to the display of photographs in hospital by patients and family members.     

Brow suspension,a minimally invasive technique in facial rejuvenation

People tend to prefer noninvasive or minimally invasive methods of facial rejuvenation, especially when it involves their face, which is the hallmark of a person's identity and impossible to hide. It is widely known that brow ptosis gives the face a "tired look" and also accentuates deformities of the upper eyelid. Most people who are interested in facial rejuvenation may not accept even a minor surgery, such as an endoscopic surgery. The senior author has developed a minimally invasive method of suspending the brow at a higher position. In this technique, there is neither surgical dissection nor a surgical incision except for four stab incisions and suture insertion, which is why we refer to it as a nonsurgical brow suspension. It is done under local anesthesia, and the brows are fixed in the position that they assume when the patient is supine. In the past 6 years, we performed 387 brow suspensions on 324 female and 63 male patients. The youngest patient was 19 years old, and the oldest was 74 years old. A retrospective chart review was done. These 387 cases were reviewed by comparison of preoperative and postoperative photographs. This approach was not only used for patients who were not interested in surgical rejuvenation but was also combined with lipofilling, laser resurfacing, and/or upper blepharoplasty. This technique is useful for correcting postsurgical brow asymmetry. We present this technique as an adjunct to the established techniques of facial rejuvenation. Despite the high patient acceptance and technical ease, it is not a replacement for the established techniques of facial rejuvenation.     

Transconjunctival lateral canthopexy in Down's syndrome patients: a nonstigmatizing approach

In Down's syndrome patients, surgical correction of the palpebral fissure obliquity through an external approach may produce a red, slightly hypertrophic scar. A transconjunctival approach for this repair was used for 15 Down's syndrome patients aged 3 to 17 years (mean 8.7 years), and the results were compared with those in two boys aged 6 and 17 years who underwent correction by the external approach. Palpebral fissure inclinations were recorded using anthropometric measurements preoperatively and 6 months postoperatively. Inclinations were reduced significantly by either technique; however, often the precise degree of the improvement was clear only from the measurements rather than from photographs. Complications of the transconjunctival approach were few, and there were no problems with wound healing and no ocular injury. Transconjunctival lateral canthopexy is a safe, effective method that avoids a potentially stigmatizing external scar.     

Digital Photography Improves Consistency and Accuracy of Bat Counts in Hibernacula

ABSTRACT The size and distribution of measurement errors associated with major techniques for estimating numbers of hibernating bats are unstudied, although this is the principle method of enumerating several endangered bat species. However, decisions concerning the listing status of a species under the Endangered Species Act require consistent and accurate estimation of population size and trends. Recent advances in digital photography have improved the ability to produce a quantitative record of the numbers of bats in hibernacula. We surveyed clusters of Indiana bats in a hibernaculum and compared results from counts of digital photographs of clusters to results from 4 variations of visual estimation. We counted bats in photographs using Geographic Information System digitization over the photograph. Total counts from 2 sets of photographs varied by <1.5%. Nonphotographic estimation techniques varied from 76% to 142% of counts from photographs for clusters for which estimation (rather than counting) was used. Where feasible, photography can improve status and trend information for species of concern, permitting more timely and specific management actions.     

Reciprocal translocation and the Philadelphia chromosome

Summary We examined metaphases from three patients with chronic myeloid leukaemia and a typical Philadelphia chromosome with one chromosome 9 as the recipient to determine whether the 9q+ 22q- translocation is reciprocal. Good quality G-banded photographs of the chromosomes concerned were subjected to light absorption density analysis. This provided enlarged tracings corresponding to the relevant chromosome regions and so facilitated accurate measurement. This technique has unambiguously shown that the typical Philadelphia chromosome results from a reciprocal translocation and that probably no material is gained or lost in the exchange. Furthermore, in a total of six patients for whom sequential G and C banding was performed, the chromosome 9 with the largest block of centromeric heterochromatin received the translocated material. We offer tentative explanations for this curious observation.     

Adding retinal photography to screening for diabetic retinopathy: a prospective study in primary care.

OBJECTIVE--To evaluate whether adding retinal photography improved community screening for diabetic retinopathy. SETTING--Mobile screening unit at rural and urban general practices in south west England. SUBJECTS--1010 diabetic patients from primary care. DESIGN--Prospective study; patients were examined by ophthalmoscopy by general practitioners or opticians without fundal photographs and again with photographs, and assessments were compared to those of an ophthalmologist. MAIN OUTCOME MEASURES--Whether fundal photography improved the sensitivity of detection of retinopathy and referrable diabetic retinopathy, and whether this sensitivity could be improved by including a review of the films by the specialist. RESULTS--Diabetic retinopathy was detected by the ophthalmologist in 205 patients (20.5%) and referrable retinopathy in 49 (4.9%). The sensitivity of the general practitioners and opticians for referrable retinopathy with ophthalmoscopy was 65%, and improved to 84% with retinal photographs. General practitioners'' sensitivity in detecting background retinopathy improved with photographs from 22% to 65%; opticians'' sensitivity in detecting background retinopathy improved from 43% to 71%. The sensitivity of detecting referrable retinopathy by general practitioners improved from 56% to 80% with photographs; for opticians it improved from 75% to 88%. CONCLUSIONS--Combining modalities of screening by providing photography with specialist review of all films in addition to direct ophthalmoscopy through dilated pupils improves assessment and referral for diabetic retinopathy by general practitioners and opticians. With further training and experience, primary care screeners should be able to achieve a sensitivity that will achieve an effective, acceptable, and economical community based screening programme for this condition.     

Photographic assessment of head shape following sagittal synostosis surgery.

A photographic assessment of the head shape of infants who had undergone surgical correction of sagittal synostosis was performed to determine (a) whether this subset could be delineated from an age-matched normal subpopulation and (b) whether two operative procedures differed in achieving normalization of head shape. This retrospective study included 8 patients who underwent extended strip craniectomy, 12 patients who underwent subtotal calvarectomy and cranial vault remodeling, and 12 age-matched subjects with no calvarial abnormality, for a total of 32 subjects. Criteria for inclusion in this study included surgery for sagittal synostosis within the first year of life and postoperative photographs at ages 4 to 8 years (mean, 4.5 years). Each set of images (frontal and lateral profile) were ranked from most to least normal by five lay observers and four professional observers. The rankings were analyzed with statistics designed for ordinal data. Differences in ranking between treatment groups were examined with Kruskal-Wallis rank sums tests. Mean ranks were calculated for lay and professional observers in an attempt to produce simpler and more generalizable results; these means were also analyzed using statistics designed for ordinal data. There was no statistical difference in the ranks of infants who had undergone a surgical correction and the normal subpopulation. In the mean rankings of the lay observers, the normal groups had the highest score mean (15.6), the group with extended strip craniectomy was second (16.0), and the subtotal calvarectomy with calvarial remodeling group was last (17.8) (p = 0.84). In the mean rankings of the professional observers, the normal groups again had the highest score mean (15.8), the subtotal calvarectomy group was second (15.9), and the extended craniectomy group was last (18.6) (p = 0.77). These results suggest that children who have undergone correction of sagittal synostosis in infancy are indistinguishable from their peers, on the basis of fully haired head shape on frontal and lateral photographs, when they begin primary school, irrespective of the type of calvarial surgery.     

Angiogenesis in non-small cell lung cancer: microvessel area in needle biopsy in vascular tumor density

OBJECTIVE: To evaluate angiogenesis in non-small cell lung cancer (NSCLC) through immunohistochemistry with CD34 and computerized image analysis comparing the microvessel area in needle biopsies and surgical specimens. STUDY DESIGN: Core biopsies and surgical specimens from 28 patients with NSCLC were reviewed. Microvessels were highlighted by immunohistochemistry with anti-CD34. Tumor microvessel area was measured in digital photographs from hot spots of all samples. RESULTS: Average microvessel area among core samples was 5,093.6 microm2 (range, 233.4-17,916.8) and among surgical specimens was 3,599.3 microm2 (range, 376.9-9,514.0). There was strong correlation between overall microvascular area in biopsies and surgical specimens (r = 0.7; p = 0.0001). Mean area of core specimens was used to divide cases into groups of low and high vascular areas. A slightly stronger correlation was observed between biopsies and surgical specimens with low vascular areas (r = 0.84; p = 0.0001). CONCLUSION: There is strong correlation of microvessel area in core biopsies and respective surgical specimens in NSCLC. These data indicate that core specimens could be used to assess the extent of angiogenesis in NSCLC in the pretreatment phase.     

Hispanic rhinoplasty in the United States,with emphasis on the Mexican American nose

Because an increasing number of Hispanic patients are seeking nasal surgical treatment, a critical analysis of 25 consecutive Hispanic rhinoplasties was performed. After a review of the patient data and preoperative photographs, a new classification was developed, based on the type of deformity rather than geographical origins (as previously used). A treatment paradigm is offered for each type of deformity. Type I involves a high radix, a high dorsum, and a nearly normal tip and is often referred to as a Castilian nose. Treatment consists of a closed functional reduction rhinoplasty, with dorsal reduction and minor tip changes. Type II involves a low radix, a normal dorsum, and a dependent tip and is a new designation. Treatment consists of a finesse rhinoplasty with a radix graft, minimal dorsal changes, use of a columellar strut for support, and open tip suturing. Type III involves a broad base, thick skin, and a wide tip deformity, with its worst expression in the mestizo nose. Treatment consists of a balanced rhinoplasty with minimal dorsal alteration but maximal lobular reduction and an open-structure tip graft. The following conclusions with respect to Hispanic rhinoplasty in the United States are important: (1) an enormous anatomical diversity of deformities is present, in contrast to Asian and black noses; (2) three distinct types of deformities have been identified, each of which requires a different surgical approach; (3) a wide variety of surgical techniques are necessary, in contrast to other ethnic noses; (4) conservative dorsal reduction is essential for type II and III noses; and (5) limitations imposed by the skin envelope are far less than presupposed, and the results are better than generally recognized. As the Hispanic population grows and becomes more prosperous, plastic surgeons in the United States can expect to encounter an increasing number of Hispanic patients requesting rhinoplasty.