Computer-aided clinical image analysis as a predictor of sentinel lymph node positivity in cutaneous melanoma

BACKGROUND Delays in sentinel lymph node(SLN)biopsy may affect the positivity of non-SLNs.For these reasons,effort is being directed at obtaining reliable information regarding SLN positivity prior to surgical excision.However,the existing tools,e.g.,dermoscopy,do not recognize statistically significant predictive criteria for SLN positivity in melanomas.AIM To investigate the possible association of computer-assisted objectively obtained color,color texture,sharpness and geometry variables with SLN positivity.METHODS We retrospectively reviewed and analyzed the computerized medical records of all patients diagnosed with cutaneous melanoma in a tertiary hospital in Germany during a 3-year period.The study included patients with histologically confirmed melanomas with Breslow>0.75 mm who underwent lesion excision and SLN biopsy during the study period and who had clinical images shot with a digital camera and a handheld ruler aligned beside the lesion.RESULTS Ninety-nine patients with an equal number of lesions met the inclusion criteria and were included in the analysis.Overall mean(±standard deviation)age was 66(15)years.The study group consisted of 20 patients with tumor-positive SLN(SLN+)biopsy,who were compared to 79 patients with tumor-negative SLN biopsy specimen(control group).The two groups differed significantly in terms of age(61 years vs 68 years)and histological subtype,with the SLN+patients being younger and presenting more often with nodular or secondary nodular tumors(P<0.05).The study group patients showed significantly higher eccentricity(i.e.distance between color and geometrical midpoint)as well as higher sharpness(i.e.these lesions were more discrete from the surrounding normal skin,P<0.05).Regarding color variables,SLN+patients demonstrated higher range in all four color intensities(gray,red,green,blue)and significantly higher skewness in three color intensities(gray,red,blue),P<0.05.Color texture variables,i.e.lacunarity,were comparable in both groups.CONCLUSION SLN+patients demonstrated significantly higher eccentricity,higher sharpness,higher range in all four color intensities(gray,red,green,blue)and significantly higher skewness in three color intensities(gray,red,blue).Further prospective studies are needed to better understand the effectiveness of clinical image processing in SLN+melanoma patients.

Urological Affections after Laparoscopic Hernia Repair in Long-Term Follow up

Objectives: Chronic pain is a severe complication of mesh-based inguinal hernia repair. Pain upon ejaculation, testicular touch sensitivity and dysuria are apparent. Regarding the large amount of patients undergoing laparoscopic hernia repair, the problem seems quite evident. In this prospective, clinical, randomized, double-blind study we intended to investigate the biocompatibility of three different meshes and their influence on urological affections after operative procedure. Methods: 180 male patients with primary inguinal hernia undergoing TAPP were randomized for using a heavyweight (108 g/m2), double-filament PP mesh (Prolene, 10 9 15 cm, group A, n = 60), a multifilament, heavyweight variant (116 g/m2) of PP mesh (Serapren, 10 9 15 cm, group B, n = 60), or a composite mesh (polyglactin and PP) (Vypro II, 10 9 15 cm, group C, n = 60). We compared in terms of complications (seromas, recurrence rate), urological affections and life quality (SF-36 Health Survey). The follow-up period was 60 months. Results: Convalescence in group A was slower than in groups B and C: mean-term values of the visual scales for pain development were significantly (p th week postoperatively. There were no significant differences between groups B and C. Beyond the 12th post-interventional week the differences diminished. Conclusions: Independent which kind of mesh was implanted still 5% of patients suffered from urological affections 60 month later.

Loop Ileostomy and Colostomy—A Comparison between Supporting Plastic Rods and Epicutaneous or Subcutaneous Silicon Drains

Purpose: Beside the conventional plastic rods, different techniques and materials have been proposed in the last years to prevent the loop from retraction into the abdominal cavity. The aim of this retrospective comparative study was to assess three different techniques of loop support. Methods: The study included 65 pa- tients who had loop ileostomy or colostomy formed. Depending on the decision of the operating surgeon, one of three techniques was chosen to fixate the stoma loop: an epicutaneous plastic rod (group 1, n = 14), an epicutaneous suture-fixated silicone drain (group 2, n = 27), or a subcutaneous silicone drain (group 3, n = 24). Results: The majority of patients (85%) received loop ileostomy. Pain intensity was significantly (p = 0.0014) different among the three groups. A total of 19 patients (30%) suffered a complication. There was a tendency towards less complications if the stoma was secured by a silicone drain with epicutaneous fixation. Comfort with stoma care was significantly different, with group 3 experiencing the best results. Conclusions: Using a subcutaneously tunnelled silicon drain as a stoma bridge results in less complications, less pain and higher satisfaction as compared to the conventional plastic rod. Conventional plastic rods should be avoided.