BACKGROUND Soft tissue sarcomas of the hand and foot present unique management challenges. The purpose of the current study study was to determine oncologic outcome, particularly with respect to factors affecting local recurrence, distant recurrence, and disease‐specific survival. METHODS A retrospective study was performed on 115 patients with soft tissue sarcomas of the hand or foot who were evaluated, treated, and followed at the authors' institution between 1980 and 1998. The medical records and radiographs were reviewed. Kaplan–Meier analysis was used to assess patient survival. RESULTS Most patients (95%) were referred after previous surgery. The majority of tumors (75%) were T1 lesions (less than 5 cm), and most tumors (81%) were high grade. Patients who were treated by definitive, wide re‐excision (n = 43) had a 10 year local recurrence‐free survival of 88%, which was significantly better than the corresponding rate of 58% for patients who did not have re‐excision (n = 40, P = 0.05). Radiation improved local control in patients who did not undergo re‐excision (n = 17, P = 0.02). However, radiation did not improve local control in patients who had definitive re‐excision with negative margins (n = 13, P = 0.51). The disease‐specific survival at 5 and 10 years was 76% and 65%, respectively, for patients who presented with localized disease. Disease‐specific patient survival was significantly worse for patients who had regional or distant metastasis. Radical amputation as initial surgical treatment did not decrease the likelihood of regional metastasis and did not improve disease‐specific patient survival. The presence of distant metastasis at presentation was an independent predictor of local recurrence. CONCLUSION Limb sparing treatment is possible in many patients with soft tissue sarcomas of the hand and foot. Re‐excision to achieve microscopically negative surgical margins is an effective method of achieving a high rate of local control in appropriately selected patients who present after unplanned excision of the primary tumor. There does not appear to be a survival benefit to immediate radical amputation, which should be reserved for cases where surgical excision or re‐excision with adequate margins cannot be performed without sacrifice of functionally significant neurovascular or osseous structures. Cancer 2002;95:852–61. © 2002 American Cancer Society. DOI 10.1002/cncr.10750

BACKGROUND Giant cell tumors of the bone can behave as aggressive and sometimes lethal tumors. In the sacrum, the tumor can be extremely difficult to manage. Standard treatments, including surgery and radiation, are associated with significant complications and recurrence rates. The goal of this study is to evaluate the long‐term outcome of selective arterial embolization as an alternative treatment modality. METHODS From 1975 to 2001, 18 patients were treated with selective intraarterial embolization. The embolization method was a combination of Gelfoam particles and coils for peripheral and central occlusions, respectively. The number of embolizations was based on clinical symptoms, radiographic response, and the vascularity of the tumor. Nine patients received intraarterial cisplatin as part of their treatment. The median follow‐up was 105 months. RESULTS Of 18 patients, 14 responded favorably to embolization with improvement in pain and neurologic symptoms. Computed tomographic and magnetic resonance imaging scans showed reossification and stabilization of tumor size. Arteriograms showed diminished vascularity. With long‐term follow‐up, three patients developed late disease recurrences within the sacrum. Kaplan–Meier analysis showed that the risk of local recurrence is 31% at 10 years and 43% at 15 and 20 years. The long‐term outcome was not affected by intraarterial cisplatin. There was one death that occurred 1 day after embolization. CONCLUSIONS Most patients demonstrate an objective early radiographic response to embolization. Long‐term follow‐up shows that the response is durable in approximately one half of the patients. Given the potential morbidity of other treatments, embolization should be included in the armamentarium of treatment for this difficult disease. Embolization may be used alone or in conjunction with other therapy. Long‐term follow‐up is recommended for all patients because late disease recurrence or sarcomatous change can occur. Cancer 2002;95:1317–25. © 2002 American Cancer Society. DOI 10.1002/cncr.10803

The subvastus approach for total knee replacement was compared with the standard medial parapatellar approach in terms of postoperative knee scores and quadriceps strength. Two groups of patients with similar characteristics were formed: the first group consisted of 12 knees of 9 patients who were implanted via the medial parapatellar approach, and for the second group the subvastus approach was used in 10 knees of 10 patients. The groups' knee scores and quadriceps strength were compared preoperatively and postoperatively at week 6, months 3 and 6. The knee scores improved similarly in both groups, but the change was more pronounced in the subvastus group. Quadriceps strength was greater in the subvastus group at postoperative week 6, but there was no significant difference between the groups in months 3 and 6. It was concluded that although the subvastus approach offers greater quadriceps strength in the early postoperative period, it has no significant advantage in this aspect over the medial parapatellar approach.

A patient who suffered from severe deforming arthritis secondary to chronic tophaceous gout with multilobular, solid, tender, enlarged subcutaneous nodules and draining tophi in both hands was evaluated and treated by second ray amputation of the most deformed second finger to provide a more functional result.

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