Traumatic pelvic injuries associated with high-energy pelvic fractures are life-threatening injuries. Extensive bleeding is relatively common with pelvic fractures. However, bleeding is especially prevalent with high-energy fractures. Hemorrhage remains the major cause of death that occur within the first 24 hours after a traumatic pelvic injury. Emergent-life saving treatment is required for high-energy pelvic fractures associated with hemorrhage. A thorough understanding of potential sources of bleeding within a short period is essential for diagnosis and treatment planning. Computed Tomography (CT) images have been widely in use in identifying the potential sources of bleeding. A pelvic CT scan contains a large number of images. Analyzing each slice in a scan via simple visual inspection is very time consuming. Time is a crucial factor in emergency medicine. Therefore, a computer-assisted pelvic trauma decision-making system is advantageous for assisting physicians in fast and accurate decision making and treatment planning. The proposed project presents an automated system to detect and segment hemorrhage and combines it with the other extracted features from pelvic images and demographic data to provide recommendations to trauma caregivers for diagnosis and treatment. The first part of the project is to develop automated methods to detect arteries by incorporating bone information. This part of the project merges bone edges and segments bone using a seed growing technique. Later the segmented bone information is utilized along with the best template matching to locate arteries and extract gray level information of the located arteries in the pelvic region. The second part of the project focuses on locating the source of hemorrhage and its segmentation. The hemorrhage is segmented using a novel rule based hemorrhage segmentation approach. This approach segments hemorrhage through hemorrhage matching, rule optimization, and region growing. Later the position of hemorrhage in the image and the volume of the hemorrhage are determined to analyze hemorrhage severity. The third part of the project is to automatically classify the outcome using features extracted from the medical images and patient medical records and demographics. A multi-stage feature selection algorithm is used to select the predominant features among all the features. Finally, boosted logistic model tree is used to classify the outcome. The methods are tested on CT images of traumatic pelvic injury patients. The hemorrhage segmentation and classification results seem promising and demonstrate that the proposed method is not only capable of automatically segmenting hemorrhage and classifying outcome, but also has the potential to be used for clinical applications. Finally, the project is extended to abdominal trauma and a novel knowledge based heuristic technique is used to detect and segment spleen from the abdominal CT images. This technique is tested on a limited number of subjects and the results are promising.

Women describe pelvic organ prolapse (POP) surgery as difficult to recover from. Expectancy is related to recovery in other surgeries but has not been examined in POP. There is no established measure of surgery expectancy or utility in women with POP. This research had four aims: 1) to establish the factor structure of a new measure of POP surgery expectancy; 2) to establish predictive validity of the expectancy measure by examining its ability to predict self-rated recovery over time; 3) to establish concurrent validity of the expectancy measure; and 4) to examine the ability of utility to predict additional variance in recovery. Exploratory factor analysis revealed a three-factor solution. Factors are conceptualized as: 1) Bladder/Bowel Function; 2) Sexual Function; and 3) Physical Function. Bladder/Bowel Function correlated with optimism and self-efficacy (<i>r</i> = .17, <i>p</i> = .03 and <i>r</i> = .27, <i>p</i> = .00, respectively). Physical Function was predictive of recovery at 42 days (standardized coefficient = .25; <i>p</i> < .05). However, these factors were generally poor and inconsistent predictors of recovery. Utility did not predict additional variance in recovery. Potential explanations for the poor predictive ability of the measure are discussed. The development of a measure that amends these limitations may still be beneficial. Further, exploring and establishing the relationship between surgery expectancy, utility, and recovery may guide physician-patient discussions and lead to improved surgical outcomes.

Le prolapsus des organes pelviens (vessie, rectum, utérus, vagin) est un problème de santé qui touche de plus en plus de femmes. Ce trouble, dont la fréquence augmente avec le vieillissement de la population, altère inévitablement la qualité de vie des malades. Pour autant, les causes de cette pathologie sont mal connues et les pratiques chirurgicales demeurent mal évaluées. La réalisation d’un simulateur du comportement dynamique des organes pelviens permettant au chirurgien d’estimer l’impact fonctionnel de son geste avant sa réalisation est donc un besoin identifié. Ce travail concerne ainsi le développement, par la méthode des éléments finis, d’un modèle numérique du mouvement des organes pelviens et de leurs interactions. Un modèle est construit à partir d’une segmentation de l’IRM des patiente, permettant de générer la géométrie des organes pelviens. Des lois hyperélastiques sont ensuite adoptées pour modéliser le comportement mécanique des organes. Des résultats qualitatifs sont obtenus, permettant de comprendre les causes de certaines formes de prolapsus et d’estimer l’effet virtuel des interactions entre les organes. / Pelvic organ prolapse is a health problem that occurs only in women and becomes more common. These disorders whose frequency increases with the aging of the population affect the patients’ quality of life. However, the causes of these diseases are poorly understood and the surgical practices remain poorly evaluated. The realization of a simulator will allow surgeon to estimate the functional impact of his actions before implementation, to perform the surgery in a more controlled and reliable way. This work concerns the development of a numerical model of pelvic organs’ movement and their interactions based on the finite element methods. A first model is constructed from patients MRI images, allowing the generation of the organ geometries. Hyperelastic modeling of the organs behaviors were considered. Qualitative results could help to understand the reasons for the prolapse and to estimate the potential effect of organs interactions.

No description available.

Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (Ph. D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Computer Science. Title from resource description page. Includes bibliographical references. Unavailable until 5/12/2015.

Thesis (M. A.)--University of Canterbury, 2010. / Typescript (photocopy). Includes bibliographical references (leaves 122-161). Also available via the World Wide Web.

Background: Growing numbers of patients with cancer are surviving following treatment with pelvic radiotherapy. Eighty per cent will experience acute gastrointestinal (GI) toxicity during treatment and 50% will subsequently have a change in their bowel habit which will affect their quality of life. The main project in this thesis aims to determine whether delivery of a gastrointestinal bundle of care will decrease GI acute toxicity and late effects of pelvic chemoradiotherapy. Additional work in the thesis evaluated the newer technique of Volumetric Modulated Arc Therapy (VMAT) which delivers decreased dose to the organs at risk on planning scans. We aimed to determine outcomes of this technique in terms of patient-reported acute toxicity and late effects. There is no internationally accepted patient reported outcome measure to capture this toxicity data and this issue was addressed using Rasch analysis in a third project. Methods: A randomised controlled trial was performed. Patients who were scheduled to undergo potentially curative chemoradiotherapy for cervix and bladder cancers were recruited and randomised. The treatment group received dietetic input and if they developed lower GI symptoms they underwent investigations and treatment for bile acid malabsorption, small bowel bacterial overgrowth and lactose intolerance. The control group received standard care. Patients who were to undergo VMAT to treat gynaecological malignancy completed patient-reported outcomes at baseline, end of treatment and one year. The rates of patient-reported toxicity were compared with those of a historical cohort and were correlated with the volume of small bowel which was irradiated. Thirdly the technique of Rasch analysis was used to evaluate the Common Terminology Criteria for Adverse Events derived patient reported outcome to measure pelvic toxicity of gynaecological cancer treatments. Results: It was feasible and acceptable to deliver a GI care bundle to patients undergoing chemotherapy and pelvic radiotherapy. All patients' data were available for analysis for the primary outcome and 29 patients' data were available at the 1 year time point. GI toxicity at 6 weeks was predicted by the trial group, suggesting that the intervention benefited the patients in terms of GI toxicity at 6 weeks. It is not yet clear whether this benefit is maintained at the 1 year time point. The frequencies of acute and late GI toxicity reported by patients undergoing VMAT were similar to that of a historical cohort who received conformal therapy. There was not a strong association between the volume of small bowel which was irradiated and the toxicity which was reported suggesting that other factors are involved in the development of toxicity. Rasch analysis of the pelvic symptom questionnaire demonstrated the main issue to be response dependency. When this was accounted for by grouping items into sub-tests the questionnaire could be made to be unidimensional and showed high reliability in a symptomatic population. Conclusion: GI intervention holds promise as a measure to reduce the acute toxicity and late effects of pelvic radiotherapy. Although newer radiotherapy techniques appear to decrease the dose delivered to the small bowel this does not translate to a reduction in patient-reported toxicity. The measurement of toxicity is complex and patient-reported outcome measures should be developed with techniques such as Rasch analysis to ensure meaningful data is available to guide further developments to reduce GI toxicity secondary to pelvic radiotherapy.

Orientador: Marilza Vieira Cunha Rudge / Resumo: Foi realizado estudo de coorte prospectiva para analisar a evolução dos achados eletromiográficos dos músculos do assoalho pélvico de gestantes com diabete melito gestacional entre 24-30 e 36-40 semanas gestacionais. O estudo foi conduzido no Centro de Investigação Clínica e Experimental do Diabete na Gestação da Faculdade de Medicina de Botucatu /UNESP com 52 gestantes divididas em dois grupos: (DMG) 26 gestantes com diabete melito gestacional e (NG) 26 gestantes normoglicêmicas. Foi realizado eletromiografia dos músculos do assoalho pélvico de nulíparas ou primíparas com cesariana prévia diagnosticadas com diabete melito gestacional da American Diabetes Association. Os critérios de não elegibilidade foram diabete clínico, mais de duas gestações, prolapso genitais ou cirurgia uroginecológicas, doenças neurológicas, exercício físico e tabagismo. Previamente a eletromiografia foi realizado instrução sobre a anatomia e funcionalidade do assoalho pélvico. Partes do protocolo de Glazer foram aplicadas entre 24-30 semanas gestacionais e reaplicadas entre 36-40 semanas gestacionais para analisar a evolução no recrutamento em repouso, nas contrações fásicas e tônica. O recrutamento foi analisado pelo cálculo do root mean square normalizado pelo pico das contrações fásicas entre 24-30 semanas gestacionais que foi considerado como parâmetro inicial de contração dos músculos do assoalho pélvico. Os dados demográficos e obstétricos demonstraram-se homogêneos entre os grupos. Em relação ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Orientador: Marilza Vieira Cunha Rudge / Resumo: Objetivo - Determinar a influência da via de parto na força muscular do assoalho pélvico (AP) de primíparas, 4 a 6 meses pósparto. Sujeitos e Métodos - Estudo clínico, de corte transversal, para avaliar a função da musculatura do AP pelo teste da AFA e perineômetro pneumático e classificada em: zero - ausência de contração muscular, um - contração leve, dois - contração moderada não sustentada por 6 segundos e, três - contração normal sustentada por 6 segundos. As 94 mulheres, tinham entre 20 e 30 anos, foram divididas em 3 grupos de acordo com a via de parto: I com 32 primíparas pós-parto vaginal; II com 32 primíparas pós-parto cesárea e III com 30 nulíparas que serviram como grupo controle. A variável independente foi a via de parto e a dependente a força muscular do AP(1). Resultados e conclusões - A mediana e o 1º e 3º quartís da força muscular do AP foram menores (p=0.01) pós-parto vaginal (2.0;1-2) e intermediária pós-parto cesárea (2.0; 2-3) em relação as nulíparas (3.0;2-3) pelo AFA e perineômetro. Aumentou o risco relativo(RR) de exame alterado da força da musculatura do AP pós-parto vaginal (RR=2.579 IC 95%=1.32-5.04 p=0.002); (RR=2.31 IC 95%=1.24- 4.32 p=0.005) e pós-cesárea (RR=1.56 IC 95% = 0.94-2.57 p=0.12); (RR=1.38 IC 95%=0.85-2.23 p=0.29) pela AFA e perineômetro. O parto vaginal diminuiu a força muscular do AP de primíparas e comparando com a cesárea e as nulíparas. / Abstract: Objective - To evaluate the influence of the route of delivery on pelvic floor (PF) muscle strength, in primiparous patients at 4 to 6 months after delivery. Subjects and methods - A cross-sectional study was undertaken among primiparous women at 4 to 6 months postpartum to evaluate the PF muscle strength by AFA test and pneumatic perineometer, classified in: zero - lack of muscle contraction; one - weak contraction; two - moderate contraction not sustained for 6 seconds and three - normal contraction sustained for 6 seconds. 94 enrolled patients were divided in three groups based upon prior delivery route: I) 32 vaginal delivery with singleton cephalic presentation; II) 32 cesarean delivery; and III) 30 nuliparous patients served as a control group. The independent variable was the route of delivery and the dependent one was the muscle strength of the PF. Data were subjected to Student t test to estimate the relative risk and the Kappa test(1). Results and conclusions - The three subgroups were comparable with respect to maternal age, weight, gestational age and newborn weight. The 1st and the 3rd quartiles of the route of delivery on PF muscle strength were lower (p=0.01) for vaginal delivery (n=32) (2.0;1- 2) and intermediate for cesarean (n=32) (2.0; 2-3) comparing to the nuliparous (3.0; 2-3) by AFA test and pneumatic perineometer. The altered PF muscle strength in primiparous were significantly lower in the vaginal delivery group (RR=2.58, CI 95%=1.32-5.04, p=0.002); (RR=2.31, CI 95%=1.24-4.32, p=0.005); and postcesarean (RR=1.56, CI 95% = 0.94- 2.57, p= 0.12); (RR=1.38, CI 95%=0.85-2.23, p=0.29). Vaginal delivery decreases PF muscle strength when compared with caesarean delivery and control. / Mestre