Leiomyosarcoma is an uncommon soft tissue sarcoma that composed of malignant mesenchymal cells with distinct features of the smooth muscle lineage. Typically affects the uterus and gastrointestinal tract, it can rarely be seen in large blood vessels, lymphatic and glandular duts, the mesentery, the omentum, retroperitoneum, and limbs. Occurrence is particularly rare in the limb region. Retrospective study based on patient records and postoperative pathological histological features. Four patients with limb leiomyosarcoma that were operated between 2016 and 2020 were included, three of them arising in the subcutis of the thigh region and one in cubitus. Extend resection with satisfactory outcomes is reported. Pathological examination showed that masses were composed of a fascicular arrangement of hyperchromatic spindle-shaped cells, characterized by the proliferation of epithelioid cells with eosinophilic cytoplasm for epithelioid leiomyosarcoma. Leiomyosarcomas that arise in the soft tissue, although rare, should be differentiated from other lesions, such as neurilemoma, neurofibroma, liomyoma,lipomyoma, synoviosarcoma, rhabdomyosarcoma, malignant fibrous histiotoma, and malignant neurinoma.
Background:Malnutrition is reported as one of the risk factors for surgical site infection (SSI). The prognostic nutritional index (PNI) is a simple method for nutritional evaluation. However, few studies have discussed the effectiveness of PNI as a nutritional assessment in predicting SSI after primary total knee arthroplasty (TKA). The aim of this study is to investigate the relationship between SSI and malnutrition as identified by the PNI scores following TKA. Methods: A retrospective analysis of 483 patients (SSI vs. non-SSI group: 19 vs. 464; follow-up period: at least 1 year) was performed to confirm the risk factors, including the PNI, associated with SSI after primary TKA using both univariate and multivariate analyses. Results: Postoperatively, nineteen patients (19/483, 3.9%) experienced SSI (deep vs. superficial SSI: 12 vs. 7), and periprosthetic joint infection was observed in all deep SSI cases. Univariate analysis showed that male sex, body weight, body mass index (BMI), diabetes mellitus, steroid usage, operative time and PNI differed between the SSI and non-SSI groups (P<0.05). Multivariate logistic regression analysis identified that the preoperative PNI (odds ratio [OR]: 0.859; 95% confidence interval [CI]: 0.762-0.969; cutoff [CV]: 49.27), operative time (OR: 1.005; 95% CI: 1.000-1.010; CV: 131.0 min), male sex (OR: 4.127; 95% CI: 1.165-14.615), diabetes mellitus (OR: 6.133; 95% CI: 2.067-18.193) and steroid usage (OR: 6.034; 95% CI: 1.521-23.935) were independently associated with SSI (P<0.05). Conclusions: A low preoperative PNI associated with malnutrition was demonstrated to be an independent risk factor for SSI following primary TKA. Patients with preoperative low PNI should be cautioned and provided with adequate nutritional intervention to reduce postoperative SSI.
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