Many factors have been proposed to contribute to the risk of recurrent TSGCT (Tenosynovial Giant Cell Tumours); however, we remain unable to predict those at risk which formed the rationale for this multicentre retrospective case control study of 28 patients with recurrence. We age and sex matched cases of recurrence 1:1 with controls over 10 years. Using Cox regression, we present hazard ratios (HR) for recurrence with 95% confidence intervals (CI). Out of 285 cases, 28 individuals developed recurrence after a median 2.4 years. Recurrent TSGCT had a higher mitotic count/mm2 in the primary tumour (median increase of 3 [IQR 1, 7]). Mitotic count in the primary tumour was associated with the risk of recurrence (adjusted HR 1.1 [95% CI 1.1, 1.2], p=0.001) meaning that for every additional mitosis, the risk of recurrence increased by 10% per annum. Mitotic rate of the primary tumour is associated with the risk of recurrence although we recommend a prospective cohort study to validate our findings.
Facial nerve disorders present with varying levels of facial dysfunction. Facial nerve reinnervation techniques aim to correct this by attempting to reestablish the connection lost between the facial nerve nucleus and its distal branches, or by using donor nerves to provide an alternate neural input to the facial nerve. Many facial nerve disorders exist; however, tumors and trauma to the facial nerve are the 2 causes that most commonly result in the patient being considered for reanimation procedures, as they most often result in facial nerve discontinuity. Reinnervation techniques are the first line surgical intervention for facial paralysis when a direct connection between the facial nerve cannot be reestablished, with the XII-VII nerve transfer being the most reliable and having the most predictable outcome when compared with the alternative VII-VII procedure. However, when the reinnervation time window is missed, other techniques of reanimation must be used in an attempt to best restore the normal symmetry and function of the face. The modifications to the XII-VII nerve transfer technique have made it the most popular of all methods; however, there are still many other nerves that may be considered as donors, giving the surgeon other options in the event of the hypoglossal (XIIth) nerve being unsuitable.
The purpose of our study was to evaluate a new region-specific outcome measure in hand and upper limb surgery: the Patient Outcomes of Surgery (POS)-Hand/Arm questionnaire using the generic Short Form Health Survey (SF)-36 questionnaire as a 'gold standard' comparative measure. The POS-Hand/Arm preop questionnaire and the SF-36 questionnaire were completed by 214 patients on the day of their hand or upper limb surgery; and a postop POS-Hand/Arm and the SF-36 questionnaire were completed by patients 3 months after their initial surgery. The POS-Hand/Arm questionnaire responses were psychometrically evaluated and it was shown to have high internal consistency; high total-item correlations; signification scale correlations with the SF-36; and a low proportion of missing data. The POS-Hand/Arm questionnaire is a psychometrically sound instrument that can be used pre- and post-surgery to evaluate patient-based outcomes for a wide range of conditions in hand and upper limb surgery.
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