The overall survival of osteosarcoma patients was influenced by the presence of pulmonary metastases and compliance to treatment. Histological subtype, different chemotherapy regimens and histological necrosis after chemotherapy did not significantly influence survival. The patients who did not complete treatment had significantly poorer survival.
When the first report of COVID-19 appeared in December 2019 from Wuhan, China, the world unknowingly perceived this as another flu-like illness. Many were surprised at the extreme steps that China had subsequently taken to seal Wuhan from the rest of the world. However, by February 2020, the SARS-CoV-2 virus, which causes COVID-19, had spread so quickly across the globe that the World Health Organization officially declared COVID-19 a pandemic. COVID-19 is not the first pandemic the world has seen, so what makes it so unique in Malaysia, is discussed to avoid a future coronacoma.
We evaluated functional outcomes for patients who
underwent surgery for resection and endoprosthesis
replacement for primary tumours around the knee. We used
the Musculoskeletal Tumour Society Scoring System
(MSTS) for functional evaluations to compare differences
between distal femur (DF) and proximal tibia (PT)
placements. The study sample included 34 cases of distal
femur and 20 cases of proximal tibia endoprosthesis
replacement. Primary tumours were classified as follows: 33
osteosarcoma, 20 stage III giant cell tumour (GCT) and one
case of mesenchymal chondrosarcoma. The mean MSTS
score for both DF and PT endoprosthesis together was 21.13
(70.43%), and The MSTS scores for DF was 21.94 (73.13%)
and PT was 19.75 (65.83%) Infection developed in 7 cases
and 5 of which were PT endoprosthesis cases. Three deep
infections required early, two-stage revision and resulted in
poor MSTS scores. We conclude that endoprosthesis
replacement for primary bone tumours had early good to
excellent functional outcome. There were no differences in
functional outcomes when comparing distal femur
endoprostheses with proximal tibia endoprostheses.Key Wordsfunctional outcome, bone tumour, knee, and endoprosthesis
A seven years retrospective study was performed in 45
consecutive vascular injuries in the extremities to investigate
the pattern of injuries, managements and outcomes.
Motor-vehicle accidents were the leading cause of injuries
(80%), followed by industrial injuries (11.1%) and iatrogenic
injuries (4.4%). Popliteal and brachial artery injuries were
commonly involved (20%). Fifteen (33.3%) patients had
fractures, dislocation or fracture dislocation around the knee
joint and 6 (13.3%) patients had soft tissue injuries without
fracture. Traumatic arterial transection accounted for 34
(75.6%) cases, followed by laceration in 7 (15.6%) and 9
(6.7%) contusions. Associated nerve injuries were seen in 8
(17.8 %) patients using intra-operative findings as the gold
standard, both conventional angiogram (CA) and
computerized tomography angiogram (CTA) had 100%
specificity and 100% sensitivity in determining the site of
arterial injuries.The mean ischemic time was 25.31 hours (4 - 278 hours).
Thirty-three (73.3 %) patients were treated more than 6
hours after injury and 6 patients underwent revascularization
after 24 hours; all had good collateral circulation without
distal pulses or evidence of ischemic neurological deficit.
The mean ischemic time in 39 patients who underwent
revascularization within 24 hours was 13.2 hours. Delayed
amputation was performed in 5 patients (11.1%). Of the 6
patients who underwent delayed revascularization, one
patient had early amputation, one -had delayed amputation
following infection and multiple flap procedures while the
rest of the patients’ limbs survived. Joint stiffness was noted
in 10 patients (22.2%) involving the knee joint, elbow and
shoulder in two patients each. Infection was also noted in 5
patients (11.1%) with two of them were due to infected
implants. Other complications encountered included nonunion
(2 patients, 4.4%), delayed union (1 patient, 2.2%),limb length discrepancy (1 patient, 2.2%), hematoma (1
patient, 2.2%) and leaking anastomosis in one patient
(2.2%). Volkmann’s ischemic contracture occurred in 3
(6.7%) patients. There was no complication noted in 8
(17.8%) patients Three patients (6.7%) died of whom two
were not due to vascular causes. We conclude that early
detection and revascularization of traumatic vascular injuries
is important but delayed revascularization also produced
acceptable results.
Background and Objectives. Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction.
Methods. A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications. Results. Thirteen patients were included with median age of 39 years (range 13–78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. Conclusions. Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity.
Introduction: Melioidosis involving bone, joints, and soft tissue is rare and reported usually following dissemination of disease from infection elsewhere in the body; to a lesser degree, it can also be reported as the primary manifestation of melioidosis. Methodology: The orthopedic registry at Hospital University Sains Malaysia from 2008 until 2014 was retrospectively reviewed and was followed by molecular typing of Burkholderia pseudomallei. Results: Out of 20 cases identified, 19 patients were confirmed to have osteoarticular and/or soft-tissue melioidosis. The majority of the patients were males (84%), and 16 patients had underlying diabetes mellitus with no significant estimated risk with the disease outcomes. Bacterial genotype was not associated with the disease as a risk. Death was a significant outcome in patients with bacteremic infections (p = 0.044). Conclusion: Patients with lung or skin melioidosis require careful treatment follow-up to minimize the chance for secondary osteoarticular infection. Human risk factors remain the leading predisposing factors for melioidosis. Early laboratory and clinical diagnosis and acute-phase treatment can decrease morbidity and mortality.
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