Impact Of Anatomical Location Research Articles

An extra-skeletal Ewing’s Sarcoma presenting with urinary retention- Impact of anatomical location on patient management; A case report

Background: Ewing’s sarcoma is one of the common malignant childhood tumours. The radiological features of pre-sacral Ewing’s sarcoma may mimic primary nerve sheath tumor or teratoma. Case Presentation: A 16-year-old girl presented with acute retention of urine found to have a midline mass in the pre-sacral region of the pelvis in clinical examination and radiological scans. A preoperative biopsy was not done. The complex location and the need to excise the biopsy tract, if histology turned out to be malignant, predicated this decision. The tumor was entirely excised. The histological diagnosis was that of an Ewing’s Sarcoma, with focal infiltration of the surgical margins. Conclusion: The anatomical site and size of an Ewing’s sarcoma should be considered before preoperative biopsy is considered. A biopsy result positive for malignancy would favor adjuvant chemotherapy and radiation, but requires the biopsy tract to be excised. Primary resection is the preferred choice when the location is complex.

Comparison of prognostic impact of anatomic location of the pancreas on postoperative pancreatic fistula in laparoscopic and open gastrectomy

BackgroundPostoperative pancreatic fistula (POPF) is a serious complication after gastric cancer surgery. The current study aimed to investigate the significance of the anatomic location of the pancreas as a predictor for POPF in both laparoscopic gastrectomy (LG) and open gastrectomy (OG).MethodsIn total, 233 patients with gastric cancer were assessed retrospectively. We measured the maximum vertical (P-L height; PLH) and horizontal length (P-L depth; PLD) between the upper border of pancreas and the root of left gastric artery on a preoperative CT in the sagittal direction. The maximum length of the vertical line between the surface of the pancreas and the aorta (P-A length), previously reported as prognostic factor of POPF, was also measured. We investigated the correlations between these parameters and the incidence of POPF in LG and OG groups.ResultsAmong the patients in this study, 118 underwent OG and 115 underwent LG. In LG, the median PLH and P-A length in patients with POPF were significantly longer compared with those without POPF (p = 0.026, 0.034, respectively), but not in OG. There was no significant difference in the median PLD between the patients with or without POPF in both LG and OG. The multivariate analysis demonstrated that PLH (odds ratio [OR] 4.19, 95% confidence interval [CI] 1.57–11.3, P = 0.004) and P-A length (OR 4.06, 95%CI 1.05–15.7, P = 0.042] were independent factors for predicting POPF in LG. However, intraoperative blood loss (OR 2.55, 95%CI 1.05–6.18, P = 0.038) was extracted as an independent factor in OG. The median amylase level in the drained fluid (D-Amy) were significantly higher in patients with high PLH(≥12.4 mm) or high P-A length (≥45 mm) compared with those with low PLH or low P-A length in LG. However, there were no differences in the D-Amy levels by PLH or P-A length in OG patients.ConclusionsThe anatomic location of the pancreas is a specific and independent predictor of POPF in LG but not in OG. PLH is a simple parameter that can evaluate the anatomic position of the pancreas, and it may be useful for preventing POPF after LG.

The impact of anatomical location and sun exposure on the dermoscopic recognition of atypical nevi and early melanomas: usefulness of an integrated clinical-dermoscopic method (iDScore).

The anatomical location of atypical melanocytic skin lesion (aMSL) was never combined into an algorithm for discriminating early melanomas (EM) from atypical nevi (AN). To investigate the impact of body location on the intuitive diagnosis performed in teledermoscopy by dermatologists of different skill levels. A further aim was to evaluate how the integration of the body location could improve an algorithm-aided diagnosis. We retrospectively collected 980 standardized dermoscopic images of aMSL cases (663 AN, 317 EM): data on the anatomical location were collected according to 15 body sites classified into 4 macro-areas of chronically/frequently/seldom/rarely exposure. Through a teledermatology web platform, 111 variously skilled dermoscopists performed either the intuitive diagnosis and 3 algorithm-assisted diagnostic tests (i.e. iDScore, 7-point checklist, ABCD rule) on each case, for a total of 3330 examinations. In the rarely photoexposed area (side, bottom, abdomen), AN were the most tricky (i.e. highest quote of false positives), due to a frequent recognition of dermoscopic features usually considered as suggestive for melanoma in these lesions; the EM at these sites received the highest quote of false negatives, being generally interpreted as 'featureless' according to these traditional parameters, that were more frequently displayed on the chronically photoexposed area. In rarely and seldom photoexposed area, intuitive diagnosis fails to achieve adequate accuracy for all aMSLs, as the ABCD rule and the 7-point checklist; by applying the iDScore algorithm the diagnostic performance was increased by 15% in young and 17% in experts. The body location of an aMSL can affect the quality of intuitive dermoscopic diagnosis, especially in sun-protected areas. Accuracy can be improved by using the iDScore algorithm that assigns a different partial score of each body site.

Photodynamic therapy for cutaneous squamous cell carcinoma in situ: Impact of anatomic location, tumor diameter, and incubation time on effectiveness

Photodynamic therapy (PDT) has been reported as a treatment for cutaneous squamous cell carcinoma in situ (SCCis), but only limited data are available on the effectiveness of PDT with aminolevulinic acid (ALA-PDT). To review the outcomes of SCCis treated with ALA-PDT and examine factors associated with response. A retrospective review identified 58 patients with 68 primary SCCis lesions treated with ALA-PDT and blue light illumination. Patient demographics, lesion features, treatment details, clinical response, and subsequent recurrence were extracted from medical record reviews. On completion of PDT the initial complete response rate was 77.9% and was not associated with the number of PDT treatments. On multivariate analysis factors associated with response were location on the face, tumor diameter <2cm, and longer ALA incubation time. Lesions treated with a maximum incubation time of <3hours had a 53.3% response compared with 84.9% for longer incubation. Subsequent recurrence of SCCis was noted in 7 of 53 cases (13.2%) at a median time of 11.7months. This was a retrospective study performed at a single institution without systematic follow-up. ALA-PDT may be an effective treatment for selected cases of SCCis. Effectiveness is impacted by anatomic location, tumor diameter, and ALA incubation time.

In vivo response to polypropylene following implantation in animal models: a review of biocompatibility

Introduction and hypothesisPolypropylene is a material that is commonly used to treat pelvic floor conditions such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Owing to the nature of complications experienced by some patients implanted with either incontinence or prolapse meshes, the biocompatibility of polypropylene has recently been questioned. This literature review considers the in vivo response to polypropylene following implantation in animal models. The specific areas explored in this review are material selection, impact of anatomical location, and the structure, weight and size of polypropylene mesh types.MethodsAll relevant abstracts from original articles investigating the host response of mesh in vivo were reviewed. Papers were obtained and categorised into various mesh material types: polypropylene, polypropylene composites, and other synthetic and biologically derived mesh.ResultsPolypropylene mesh fared well in comparison with other material types in terms of host response. It was found that a lightweight, large-pore mesh is the most appropriate structure.ConclusionThe evidence reviewed shows that polypropylene evokes a less inflammatory or similar host response when compared with other materials used in mesh devices.

Impact of anatomical location of positive lymph node on TNM classification in patients with node positive gastric cancer.

155 Background: In the 7th edition of TNM classification, node positive gastric cancer is subclassified into three categories (N1, 1-2 positive nodes; N2, 3-6 positive nodes; N3, 7 or more positive nodes) according to the number of positive lymph node (LN). However, anatomical location of positive LN is not taken into account in the TNM classification, although Japanese classification for gastric cancer had adopted anatomical location oriented nodal staging system and had shown relevance between location of positive LN and survival outcome. The aim of the present study is, therefore, to clarify the impact of anatomical location of positive LN on numerical number oriented, latest TNM nodal staging system. Methods: The present study included 1047 node positive gastric cancer patients who underwent curative gastrectomy at the Shizuoka Cancer Center between September 2002 and December 2014. Survival outcomes were compared between patients with positive extra-perigastric lymph node (PEPLN) and those with positive perigastric lymph node (PPLN) in each nodal stage according to the 7th edition of TNM classification. Results: The present study included 471 N1 patients, 309 N2 patients, and 267 N3 according to the 7th edition of TNM classification, and 5-year survival rates (5ysr) were 81.8%, 70.5%, and 51.9%, respectively. In the N1 group, 5ysr was 75.4% in patients with PEPLN, while it was 83.2% in those with PPLN, and the difference was not statistically significant (P = 0.105). It was also similar between patients with PEPLN (64.2%) and those with PPLN (73.8%, P = 0.343) in the N2 group. However, in the N3 group, survival outcome was significantly worse in patients with PEPLN (47.9%) than in those with PPLN (63.9%, P = 0.036). Conclusions: In the N1 and N2 group, involvement of extraperigastric LN did not have impact on survival outcome. On the contrary, in the N3 group, patients with PEPLN showed worse survival outcome than those with PPLN, and they could be potential candidates for intense postoperative adjuvant treatment.

Impact of Anatomic Location on Locally Recurrent Rectal Cancer: Superior Outcome for Intraluminal Tumour Recurrence

BackgroundLocal recurrence of rectal cancer after curative surgery predicts patients’ prognosis. The correlation between the exact anatomic location of tumour recurrence and patients’ survival is still under debate. Thus, this study aimed to investigate the impact of the exact location of recurrent rectal cancer on post-operative morbidity and survival. MethodsThis is a retrospective study including 90 patients with locally recurrent rectal cancer. The location of tumour recurrence was classified into intraluminal and extraluminal recurrence. Univariate and multivariable Cox regression analyses were used to determine the impact on post-operative morbidity and survival. ResultsPatients’ survival with intraluminal recurrence was significantly longer compared to patients with extraluminal recurrence (p = 0.027). Curative resection was associated with prolonged survival in univariate and multivariable analyses (p = 0.0001) and was more often achieved in patients with intraluminal recurrence (p = 0.024). Survival of curative resected patients with intraluminal recurrence was significantly longer compared to curatively resected patients with extraluminal recurrence (p = 0.0001). The rate of post-operative morbidity between intraluminal and extraluminal recurrence was not statistically different (p = 0.59). ConclusionBased on the present investigation, intraluminal recurrence is associated with superior outcome. Post-operative morbidity did not differ significantly between both groups.

Impact of Anatomical Location on Value of CT–PET Co-Registration for Delineation of Lung Tumors

To derive guidelines for the need to use positron emission tomography (PET) for delineation of the primary tumor (PT) according to its anatomical location in the lung. In 22 patients with non-small-cell lung cancer, thoracic X-ray computed tomography (CT) and PET were performed. Eleven radiation oncologists delineated the PT on the CT and on the CT-PET registered scans. The PTs were classified into two groups. In Group I patients, the PT was surrounded by lung or visceral pleura, without venous invasion, without extension to chest wall or the mediastinum over more than one quarter of its surface. In Group II patients, the PT invaded the hilar region, heart, great vessels, pericardium, mediastinum over more than one quarter of its surface and/or associated with atelectasis. A comparison of interobserver variability for each group was performed and expressed as a local standard deviation. The comparison of delineations showed a good reproducibility for Group I, with an average SD of 0.4 cm on CT and an average SD of 0.3 cm on CT-PET (p = 0.1628). There was also a significant improvement with CT-PET for Group II, with an average SD of 1.3 cm on CT and SD of 0.4 cm on CT-PET (p = 0.0003). The improvement was mainly located at the atelectasis/tumor interface. At the tumor/lung and tumor/hilum interfaces, the observer variation was similar with both modalities. Using PET for PT delineation is mandatory to decrease interobserver variability in the hilar region, heart, great vessels, pericardium, mediastinum, and/or the region associated with atelectasis; however it is not essential for delineation of PT surrounded by lung or visceral pleura, without venous invasion or extension to the chest wall.

P-363 Impact of anatomical location of primary tumor in lung on valueof CT-PET co-registration for delineation

P-363 Impact of anatomical location of primary tumor in lung on valueof CT-PET co-registration for delineation

The effect of body region on the canine hair cycle as defined by unit area trichogram.

The impact of anatomic location on trichogram analysis of the hair cycle phases was evaluated in 15 clinically normal dogs. The purposes of this study were to determine if the number of hairs in anagen and telogen vary among anatomic sites within a dog and to see whether there is an optimal region to sample hairs for canine trichogram evaluation of the hair cycle phases. In each dog eight sites were sampled. Four (26.7%) of the 15 dogs had no significant differences in the number of hairs in anagen and telogen among the eight body sites examined. Nine (81.8%) of the remaining 11 dogs had only one site that revealed significant differences in the number of hairs in anagen or telogen. In seven (77.8%) of these dogs only the anagen differed significantly, and in two (22.2%) dogs both phases differed significantly. Two (18.2%) dogs revealed two sites with significant differences in the number of hairs in anagen. The number of hairs in anagen and telogen in the shoulder area did not vary significantly in any of the dogs. This observation, coupled with the ease of sampling at this site, indicates that the shoulder is the site of choice when studying variations in ratios of hair cycle phases using unit area trichogram. Our results also suggest that numbers of telogen and anagen hairs from body regions with different hair shaft lengths do not vary significantly, and the occasional inconsistent results noted at some body sites might be due to sample collection technique.

Impact of anatomical location on barrier recovery, surface pH and stratum corneum hydration after acute barrier disruption.

It is not known whether distinct anatomical locations will respond with different recovery rates following acute barrier challenges. To investigate whether barrier parameters differ at five body sites during recovery from acute disruption. Acute barrier disruption was achieved by tape stripping and by acetone extraction of stratum corneum lipids. Transepidermal water loss (to assess barrier function), capacitance (for stratum corneum hydration) and skin surface pH were measured at each of five different body sites in 14 human volunteers. Individual measurements were obtained every 24 h for 96 h. Lipid-rich skin areas (e.g. the forehead) were the most vulnerable to barrier disruption by either method. While acetone treatment affected barrier function and decreased stratum corneum hydration, tape stripping similarly altered barrier function but increased capacitance values. Although the effect of barrier disruption on surface pH appeared to vary with location, no significant pattern of variation emerged. Independent of the method used for barrier disruption, the pH normalized within 96 h. Skin at different body sites shows distinct patterns of barrier recovery that are likely to be related to structural and physiological differences. Therefore, 'anatomically specific' regimens appear possible and relevant for the treatment of cutaneous disorders. In addition, adequate statistical analyses are essential to detect real differences in barrier recovery parameters.