Abstract: Purpose: Assessment of anastomotic perfusion in Hirschsprung disease using Indocyanine Green (ICG)-near-infrared (NIR) fluorescence angiography. Introduction: Anastomotic stricture and leak are well-known complications of Hirschsprung pull-through procedures. Complications are due to tension, infection, and/or poor perfusion. While a surgeon can visually determine and control the amount of tension and contamination, assessment of perfusion is subject to surgeon determination. Intraoperative use of ICG-NIR enhances this decision-making process by illustrating perfusion intensity and adequacy in the pulled-through bowel segment. This technique, proven to reduce anastomotic stricture and leak in adults, has not been studied in children to our knowledge. ICG, an FDA approved, nontoxic, non-immunogenic, intravascular (IV) dye, has been used in adults and children for over 60 years, with few side effects. ICG-NIR was used in this report to demonstrate the adequacy of perfusion during transanal pullthrough for Hirschsprung’s disease. Method: 8 patients with Hirschsprung disease were evaluated with ICG-NIR technology. Levels of affected area ranged from sigmoid to total colonic Hirschsprung disease. After leveling, but prior to anastomosis, ICG was administered at 1.25 mg (< 2 mg/kg) and perfusion visualized using an NIR camera, before and during anastomosis. Video and photo imaging was performed and perfusion of the bowel was compared to surrounding tissues. This showed the degree of perfusion and demarcation of perfused and non-perfused bowel. The anastomosis was completed uneventfully and the patients all did well. Results: There were no complications of stricture or leak. 5 of 8 patients (62.5%) had modification of the plan based on ICG-NIR imaging. Conclusion: Technologies that enhance surgeons’ ability to visualize bowel perfusion prior to anastomosis in Hirschsprung’s patients may help reduce post-operative complications. Further studies are needed to assess the potential benefits.
Abstract: Prior research evidenced that unimodal biometric
systems have several tradeoffs like noisy data, intra-class variations,
restricted degrees of freedom, non-universality, spoof attacks, and
unacceptable error rates. In order for the biometric system to be more
secure and to provide high performance accuracy, more than one
form of biometrics are required. Hence, the need arise for multimodal
biometrics using combinations of different biometric modalities. This
paper introduces a multimodal biometric system (MMBS) based on
fusion of whole dorsal hand geometry and fingerprints that acquires
right and left (Rt/Lt) near-infra-red (NIR) dorsal hand geometry (HG)
shape and (Rt/Lt) index and ring fingerprints (FP). Database of 100
volunteers were acquired using the designed prototype. The acquired
images were found to have good quality for all features and patterns
extraction to all modalities. HG features based on the hand shape
anatomical landmarks were extracted. Robust and fast algorithms for
FP minutia points feature extraction and matching were used. Feature
vectors that belong to similar biometric traits were fused using
feature fusion methodologies. Scores obtained from different
biometric trait matchers were fused using the Min-Max
transformation-based score fusion technique. Final normalized scores
were merged using the sum of scores method to obtain a single
decision about the personal identity based on multiple independent
sources. High individuality of the fused traits and user acceptability
of the designed system along with its experimental high performance
biometric measures showed that this MMBS can be considered for
med-high security levels biometric identification purposes.