Biomedical subjects

Berend Hillen

Publications and source records attributed to Berend Hillen.

4 recordsLinked to original sources

PubMed2004

Loco-regional conformal radiotherapy of the breast: delineation of the regional lymph node clinical target volumes in treatment position.

BACKGROUND AND PURPOSE: As the location of the regional lymph nodes (LNs) of the breast varies largely between patients and may be dependant on the position of the arm, adequate localization of these nodes is mandatory in order to fully take advantage of optimized conformal radiotherapy. For this purpose, the anatomical boundaries of the regional lymph node (LN) clinical target volumes (CTVs) for delineation on transverse CT-slices, made in treatment position, were established. PATIENTS AND METHODS: Anatomical and surgical descriptions of the regional LNs of the breast, as well as a shoulder dissection, were studied. Axial slices of a human cadaver with one arm in abduction and the other in adduction were investigated, to assess the displacement of LNs by abduction of the arm into treatment position. Based on these findings, we defined the anatomical boundaries of the regional LN CTVs visible on transverse CT-slices. RESULTS: Standard anatomical and surgical descriptions appeared to be inadequate for determination of the boundaries of the regional LN CTVs in treatment position. With abduction of the arm, a change in position of all regional LNs, except for the medial supraclavicular LNs and internal mammary LNs, was observed in the anatomical cross-sections. This was also taken into account in our delineation protocol proposal. CONCLUSIONS: Anatomically based guidelines for delineation of the regional LN CTVs for loco-regional irradiation of the breast on transverse CT-slices, made in treatment position, have been developed in this study. These could be used as a basis for conformal radiotherapy.

Arm↗

PubMed2004

Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study.

STUDY OBJECTIVE: Part 1: To describe cases of emphysema (subcutaneous and/or mediastinal) and pneumothorax after percutaneous dilational tracheostomy (PDT) in a series of 326 patients, and to review the existing literature describing the incidence and possible mechanisms. Part 2: To analyze the potential mechanisms for the development of emphysema and pneumothorax in human cadaver models. DESIGN: A retrospective analysis of PDTs, in combination with an anatomic study in human cadavers. MATERIALS AND METHODS: Part 1: All ICU patients who underwent PDT between 1997 and 2002 were enrolled in the study. We analyzed the cases of emphysema and pneumothorax. Similar cases were retrieved from the literature and underwent a systematic review. Part 2: The relevant anatomic structures were studied. We simulated the clinical situation after PDT in a human pathologic study in order to induce subcutaneous emphysema and pneumothorax. MEASUREMENTS AND RESULTS: Part 1: Five cases of subcutaneous emphysema (1.5%) and two cases of pneumothorax (0.6%) are described. In the literature search, we found 41 cases of emphysema (1.4%) and 25 cases of pneumothorax (0.8%) in a total of 3,012 patients. Part 2: Subcutaneous emphysema could easily be induced in a human cadaver model by inflating air in the pretracheal tissues and after posterior tracheal wall laceration. Air leakage was also possible through a fenestrated cannula via the space between the inner nonfenestrated cannula and outer cannula and then through the fenestration. CONCLUSIONS: We conclude that one mechanism for the development of emphysema is an imperfect positioning of the fenestrated cannula, whereby the fenestration is extraluminal. For this reason, fenestrated cannulas should not be used immediately after placement of a PDT. Posterior tracheal wall laceration is another mechanism responsible for emphysema after PDT. After perforation of the posterior tracheal wall, the pleural space can be reached easily. This may result in a pneumothorax.

Adult↗

PubMed2003

Anatomy and functionality of leptomeningeal anastomoses: a review.

BACKGROUND: This review seeks to provide a structured presentation of existing knowledge of leptomeningeal anastomoses from anatomic and functional points of view and to identify problems and possible research directions to foster a better understanding of the subject and of stroke mechanisms. SUMMARY OF REVIEW: Available data show that leptomeningeal anastomoses may be important in understanding stroke mechanisms and that leptomeningeal anastomoses play an important role in penumbra outcome. However, the literature shows no consensus between statements on the existence of leptomeningeal anastomoses and compensatory capacity. CONCLUSIONS: By analyzing the available literature and identifying the factors that contribute to this confusion, we found that variability and the functional consequences thereof are important but that quantitative data are lacking. Moreover, vascular remodeling is an issue to consider.

Animals↗

PubMed2003

Visible Human 2.0--the next generation.

The National Library of Medicine has initiated the development of new anatomical methods and techniques for the acquisition of higher resolution data sets, aiming to address the anatomical artifacts encountered in the development of the Visible Human Male and Female and to insure enhanced detection of structures, providing data in greater depth and breadth. Given this framework, we acquired a complete data set of the head and neck. CT and MR scans were also obtained with registration hardware inserted prior to imaging. The arterial and venous systems were injected with colorized araldite-F. After freezing, axial cryosectioning and digital photography at 147 microns/voxel resolution was performed. Two slabs of the specimen were acquired with a special tissue harvesting technique. The resulting tissue slices of the whole specimen were stained for different tissue types. The resulting histological material was then scanned at a 60x magnification using the Virtual Slice technology at 2 microns/pixel resolution (each slide approximately 75,000 x 100,000 pixels). In this data set, for the first time anatomy is presented as a continuum from a radiologic granularity of 1 mm/voxel, to a macroscopic resolution of .147 mm/voxel, to microscopic resolution of 2 microns/pixel. The hiatus between gross anatomy and histology has been assumed insurmountable, and until the present time this gap was bridged by extrapolating findings on minute samples. The availability of anatomical data with the fidelity presented will render it possible to perform a seamless study of whole organs at a cellular level and provide a testbed for the validation of histological estimation techniques. A future complete Visible Human created from data acquired at a cellular resolution, aside from its daunting size, will open new possibilities in multiple directions in medical research and simulation.

Computer Simulation↗