As an important basis for lesion determination and diagnosis, medical image segmentation has become one of the most important and hot research fields in the biomedical field, among which medical image segmentation algorithms based on full convolutional neural network and U-Net neural network have attracted more and more attention by researchers. At present, there are few reports on the application of medical image segmentation algorithms in the diagnosis of rectal cancer, and the accuracy of the segmentation results of rectal cancer is not high. In this paper, a convolutional network model of encoding and decoding combined with image clipping and pre-processing is proposed. On the basis of U-Net, this model replaced the traditional convolution block with the residual block, which effectively avoided the problem of gradient disappearance. In addition, the image enlargement method is also used to improve the generalization ability of the model. The test results on the data set provided by the "Teddy Cup" Data Mining Challenge showed that the residual block-based improved U-Net model proposed in this paper, combined with image clipping and preprocessing, could greatly improve the segmentation accuracy of rectal cancer, and the Dice coefficient obtained reached 0.97 on the verification set.
Algorithms ; Delayed Emergence from Anesthesia ; Humans ; Image Processing, Computer-Assisted ; Rectal Neoplasms/diagnostic imaging* ; Tomography, X-Ray Computed

ObjectiveTo evaluate the analgesic effect of intrarectal local anesthesia (IRLA) versus that of periprostatic nerve block anesthesia (PPNB) in initial transrectal ultrasound-guided prostate biopsy (TRUS-PB) for patients with different prostate volumes (PV).

METHODSA total of 253 patients undergoing initial TRUS-PB in our hospital from January 2014 to November 2017 were divided into three PV groups (<50 ml, 50－100 ml, and >100 ml), each again randomized into three subgroups (control, IRLA, and PPNB) with the random number table method. The pain during the procedure was assessed based on the Visual Analogue Scale (VAS) scores and the blind method was used by the biopsy operator, VAS valuator and data analyst.

RESULTSAmong the patients with PV <50 ml, the VAS scores in the blank control, IRLA, and PPNB subgroups were 4.39±0.87, 3.51±0.84 and 3.43±1.07, respectively, remarkably higher in the control than in the IRLA and PPNB groups (P<0.05), but with no statistically significant differences between the latter two (P>0.05). Among those with PV of 50－100 ml, the VAS scores in the three subgroups were 4.50±1.05, 4.38±1.13 and 3.38±1.44, respectively, markedly higher in the control and IRLA than in the PPNB group (P<0.05), but with no statistically significant differences between the former two groups (P>0.05). Among those with PV >100 ml, the VAS scores in the three subgroups were 5.19±1.05, 5.00±1.25 and 4.19±0.91, respectively, remarkably higher in the former two groups than in the latter (P<0.05), but with no statistically significant differences between the former two groups (P>0.05).

CONCLUSIONSEither IRLA or PPNB can be recommended for initial TRUS-PB in patients with PV <50 ml, PPNB for those with PV of 50－100 ml, and PPNB with other painkillers for those with PV >100 ml.

Administration, Rectal ; Aged ; Anesthesia, Local ; methods ; Anesthetics, Local ; administration & dosage ; Biopsy ; Humans ; Male ; Nerve Block ; methods ; Pain Measurement ; Pain, Procedural ; etiology ; prevention & control ; Prospective Studies ; Prostate ; pathology

PURPOSE: Many centers rely on radiologists to detect prostate cancer by transrectal ultrasound guided prostate biopsy. In this study we evaluated transrectal ultrasound guided prostate biopsy by radiologist or urologist, and compared prostate cancer detection rate, pathologic results and pain scrore. MATERIAL AND METHODS: In all, 259 consecutive patients had transrectal ultrasound guided prostate biopsy by one radiologist (group 1) and one urologist (group 2). The indication for prostate biopsies were a raised or rising prostate specific antigen (PSA) level or abnormal digital rectal examination (DRE). All data were collected prospectively. RESULTS: Both group showed comparable demographic data in age, PSA, prostate volume. But pain score showed higher in urologist group (p<0.05). Prostate cancer was detected in 73 patients (28.1%). Radiologist detected prostate cancer in 38 patients (29.2%) and urologist detected prostate cancer in 35 patients (27.1%) (p=0.70). Both groups showed comparable cancer detection rates in PSA of <4, 4-10 and >10 ng/ml. Both groups had similar Gleason score (6.8+/-0.7 vs 6.7+/-0.8) and number of cancer cores (3.0+/-1.7 vs 3.9+/-2.3). Group 1 showed significantly low visual analogue pain scale compared with Group 2 (2.9+/-1.9 vs 4.0+/-2.1)(p<0.05). CONCLUSION: Transrectal ultrasound guided prostate biopsy showed equally reliable datas whether performed by radiologist or urologist. The urologist can effectively perform transrectal ultrasound guided prostate biopsy like radiologist in detecting prostate cancer. Also we recommend to perform anesthesia to relieve pain before prostate biopsy and furthermore future studies with more patients with more datas are needed.
Anesthesia ; Biopsy ; Digital Rectal Examination ; Humans ; Neoplasm Grading ; Pain Measurement ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Urology

PURPOSE: Surgical removal for a mass in the pre-sacral space or mid rectum through a posterior approach is not frequent. We would like to present the technique of trans-sacral local resection as a posterior approach. We analyzed the follow up of patients who underwent surgery using the proposed technique. METHODS: A total of 21 patients who had undergone a trans-sacral local resection with lower sacrectomy between January 1997 and December 2006 were enrolled in this study. The diagnoses were large epidermal cyst, gastrointestinal stromal tumor, high grade adenoma, and early cancers in the mid rectum. We analyzed the surgical complications and disease recurrences. The mean follow up for tumors of the rectum was 53+/-35 mo. RESULTS: Epidural anesthesia was appropriate for all whole procedures. Among the 21 cases, there was one case of a rectocutaneous fistula as a postoperative complication (4.9%). In one case among the submucosal cancers, there was a systemic metastasis at 24 mo without local recurrence. CONCLUSION: In our experience, a trans-sacral resection with a lower sacrectomy is a good option and provides a wide and direct surgical exposure for the removal of a pre-sacral or a mid-rectal mass. Good bowel preparation is mandatory.
Adenoma ; Anesthesia, Epidural ; Epidermal Cyst ; Fistula ; Follow-Up Studies ; Gastrointestinal Stromal Tumors ; Humans ; Neoplasm Metastasis ; Postoperative Complications ; Rectal Neoplasms ; Rectum ; Recurrence

A male, 67 years old, visited the emergency room because of a foreign body impacted in his rectum. While he was being treated for grade-II hemorrhoids conservatively, he heard that massage of the peri-anal area could be helpful for preventing hemorrhoids. Thus, while using an electronic massager after placing the head of the machine into a short round bar, the head became separated from the machine, and this was inserted into the anus and impacted. The patient had anal discomfort without abdominal pain. His vital signs were stable, and no abnormal physical findings were found for the abdomen. On digital rectal examination, the rim of the foreign body was palpated about 8 cm from the anal verge. Anal bleeding, abnormal discharge, or foul odor was not found. On a simple abdominal X-ray, a radio-opaque foreign body was observed in the pelvic cavity, and mild leukocytosis was noted on the laboratory test. To avoid injury to the anal sphincter, we tried to remove the foreign body under the spinal anesthesia. After anesthesia had been administered, the foreign body was palpated more distally at 5-6 cm from the anal verge by digital examination, and the foreign body was found to have a hole in its center. This was held using a Kelly clamp, and with digital guiding, was removed through the anus. After removal, an anoscopic examination was performed to determine if mucosal injury had occurred in the rectum or anal canal. The patient was discharged without complication after 24 hours of close observation.
Abdomen ; Abdominal Pain ; Anal Canal ; Anesthesia ; Anesthesia, Spinal ; Digital Rectal Examination ; Electronics ; Electrons ; Emergencies ; Foreign Bodies ; Head ; Hemorrhage ; Hemorrhoids ; Humans ; Leukocytosis ; Male ; Massage ; Odors ; Rectum ; Vital Signs

A 59-year-old woman underwent explorative laparotomy under general anesthesia for mechanical ileus. The patient had rectal cancer with multiple metastasis, and was receiving 1.5-2 mg of intravenous morphine per hour due to severe abdominal pain. After about 3 hours of general anesthesia, the patient was extubated and transferred to postanesthesia care unit. The patient was supplied with 6 L/min of oxygen by facial mask. In 30 minutes, the patient showed no response to verbal order and pain stimulus with sluggish eye reflex, although pulse-oximeter showed 98-99%. After emergent intubation, arterial blood gas was sampled, and the result showed severe acidosis with hypercapnia. The patient was transferred to intensive care unit, and after 1 hour of mechanical ventilation the patient became conscious then fully recovered without further complication.
Abdominal Pain ; Acidosis ; Anesthesia, General ; Carbon Dioxide ; Coma ; Eye ; Female ; Humans ; Hypercapnia ; Ileus ; Intensive Care Units ; Intubation ; Laparotomy ; Masks ; Middle Aged ; Morphine ; Neoplasm Metastasis ; Oxygen ; Rectal Neoplasms ; Reflex ; Respiration, Artificial

OBJECTIVETo investigate the more reliable and effective operations for high anal fistula.

METHODSFrom Jan. 2002 to Oct. 2004, 117 cases suffering from high anal fistula were divided into two groups, and received tying therapy on main fistula with external anal fistulae excision (62 cases) or tying therapy on main fistula with external anal fistulae laid aside (55 cases). The curing time and recurrence were compared between the two groups.

RESULTSThere were no significant differences in basic clinical data between the two groups. There were 37 cases of high simple fistula, and 25 cases of complicated fistulae in resection group, while 39 cases of simple fistula and 16 cases of complicated fistulae in laying aside group. The curing time was 15-20 (17+/-2) days and no recurrence occurred after follow-up for half a year in resection group. The curing time was 25-55 (35+/-8) days and recurrence occurred in 6 cases (10.9%) in laying aside group including one case of high simple anal fistula and five cases of high complicated anal fistulae. There was statistical significance in treatment efficacy for high complicated anal fistulae (chi2=6.23, P=0.013), and the overall efficacy (chi2=5.06, P=0.024) between the two groups.

CONCLUSIONTying therapy on main fistula with external anal fistulae excision is a more effective treatment for high complicated anal fistulae.

Adolescent ; Adult ; Aged ; Anesthesia ; methods ; Digestive System Surgical Procedures ; methods ; Female ; Humans ; Male ; Middle Aged ; Rectal Fistula ; surgery ; Young Adult

OBJECTIVETo observe analgesic effect of acupuncture anesthesia.

METHODSSixty-nine cases undergoing rectal cancer surgery were randomly divided into 3 groups, group I, II and III, 23 cases in each group. Both Zusanli (ST 36) and Sanyinjiao (SP 6) were selected for acupuncture anesthesia. Group I received general anesthesia after acupuncture induction, group II received acupuncture after general anesthesia, and group II received only general anesthesia. Minimum alveolar concentration (MAC) before and after operation was recorded.

RESULTSMAC was (1.35 +/- 0.19) vol% in the group I, (1.49 +/- 0.22) vol% in the group II and (1.64 +/- 0.27) vol% in the group III. Acupuncture before and after general anesthesia could decrease respectively by about 0.29% and 0.15% of MAC in rectal cancer surgery undergoing general anesthesia, with a very significant difference (P < 0.01) or a significant difference (P < 0.05) among the 3 groups.

CONCLUSIONAcupuncture anesthesia has a certain adjuvant action for anesthesia and analgesia, and acupuncture before general anesthesia has a better action.

Acupuncture Analgesia ; Acupuncture Therapy ; Anesthesia, General ; Humans ; Pain Management ; Rectal Neoplasms

The present study was performed to determine the accuracy and reproducibility of calculating the mitral regurgitant orifice area with the proximal isovelocity surface area (PISA) method in dogs with experimental mitral regurgitation and in canine patients with chronic mitral insufficiency and to evaluate the effect of general anesthesia on mitral regurgitation. Eight adult, Beagle dogs for experimental mitral regurgitation and 11 small breed dogs with spontaneous mitral regurgitation were used. In 8 Beagle dogs, mild mitral regurgitation was created by disrupting mitral chordae or leaflets. Effective regurgitant orifice (ERO) area was measured by the PISA method and compared with the measurements simultaneously obtained by quantitative Doppler echocardiography 4 weeks after creation of mitral regurgitation. The same procedure was performed in 11 patients with isolated mitral regurgitation and in 8 Beagle dogs under two different protocols of general anesthesia. ERO and regurgitant stroke volume (RSV) by the PISA method correlated well with values by the quantitative Doppler technique with a small error in experimental dogs (r = 0.914 and r = 0.839) and 11 patients (r = 0.990 and r = 0.996). The isoflurane anesthetic echocardiography demonstrated a significant decrease of RSV, and there was no significant change in fractional shortening (FS), ERO area, LV end-diastolic and LV end-systolic volume. ERO area showed increasing tendency after ketamine-xylazine administration, but not statistically significant. RSV, LV end-systolic and LV end-diastolic volume increased significantly (p < 0.01), whereas FS significantly decreased (p < 0.01). The PISA method is accurate and reproducible in experimental mitral regurgitation model and in a clinical setting. ERO area is considered and preferred as a hemodynamic-nondependent factor than other traditional measurements.
Anesthesia, Rectal ; Animals ; Body Surface Potential Mapping/*veterinary ; Chordae Tendineae/physiopathology/surgery ; Dog Diseases/diagnosis/*physiopathology ; Dogs ; Echocardiography, Doppler/veterinary ; Electrocardiography/veterinary ; Mitral Valve/*physiopathology ; Mitral Valve Insufficiency/diagnosis/physiopathology/*veterinary

PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.
Analgesia ; Anesthesia ; Biopsy* ; Digital Rectal Examination ; Humans ; Lidocaine ; Male ; Nerve Block* ; Pain, Postoperative ; Prostate* ; Prostate-Specific Antigen ; Ultrasonography*