Abstract Aim To review extremity soft tissue sarcoma (ESTS) in MSK sarcoma unit in Glasgow Royal Infirmary. To assess reliability of PERSARC nomogram in estimating outcomes of FNCLCC Grade II and III ESTS. Method A retrospective study of 72 patients with primary ESTS, treated surgically at GRI from 2010-2015 was performed. Patients were followed up as per local sarcoma protocol up to 10 years. Overall survival (OS), Local recurrence (LR) and Distant metastasis (DM) at 3 years and 5 years post-op were calculated and PERSARC nomogram was used to estimate predicted OS, LR and DM at 3 years and 5 years post-op. The reliability of PERSARC to estimate ESTS outcomes was assessed using discrimination and calibration. Concordance index was used to assess discrimination. Calibration plot was used to assess calibration. Results Observed 5-year OS, LR and DM were 77.78%, 12.5% and 27.77% respectively. Concordance indices for 3-year OS, LR and DM were 0.82, 0.68 and 0.70 respectively. Concordance indices for 5-year OS, LR and DM were 0.77, 0.69 and 0.66 respectively. Calibration plot showed PERSARC underestimated 3-year and 5-year OS. Calibration plot showed good calibration for 3-year and 5-year LR and DM. Conclusions PERSARC nomogram showed good discriminative ability for 3-year OS, 3-year DM, and 5-year OS as the concordance indices were >0.7 and good calibration for 3-year and 5-year LR and DM. PERSARC could be beneficial to guide shared decision making between patients and healthcare professionals, leading to focused and personalised care for patients with ESTS.
Melioidosis is an infection caused by Burkholderia pseudomallei, a fastidious, facultative, intracellular gram-negative microorganism.It spreads by a myriad of routes (direct contact with contaminated water or soil, inhalation, ingestion, and cutaneous inoculation), 1) resulting in a multi-tude of clinical manifestations.First described in 1912 by Whitmore and Krishnaswami, 2) melioidosis is considered endemic in Thailand, Australia, and parts of Southeast Asia, which account for majority of published data. 3,4)In India the earliest report was in the year 1990. 5)Subsequent reports have stressed that although India is not a region of high endemicity, melioidosis is prevalent and under reported probably due to low index of suspicion and lack of sufficient diagnostic facilities. 6)The musculoskeletal system is often affected in conjunction with a disseminated illness with rates of involvement being 4% to 12%.
Aims: Reconstruction following resection of tumours involving the peri-acetabular area is challenging. Achieving acceptable long-term functional status remains difficult and complications are common. The aim of this study was to describe our experience of using the Stanmore ice-cream cone implant after major pelvic tumour resection and present 2 unique cases of implant fatigue failure. Methods: Ten patients with primary pelvic tumours involving the peri-acetabular region were treated with resection (type 2/2+3) and reconstruction using the Stanmore ice-cream coned pelvic implant between 2010 and 2019 at our centre. Retrospective analysis of our database and patient records was carried out to identify outcomes and complications. Results: Seven male and three female patients with a mean age of 46 years (range- 17-74 years) were treated with reconstruction using the Stanmore ice-cream cone implant. Chondrosarcoma (n=7) was the most common diagnosis. At a mean follow up of 67 months, 7 patients were alive without disease, 1 patient developed metastatic disease and 2 patients died of recurrent/metastatic disease. Dislocation occurred in 2 patients and 1 patient developed deep infection requiring re-operation for local control. Two patients developed fatigue failure of the implant, which has not been described in the literature. No revision was performed at the time of study. Conclusion: Reconstruction after peri-acetabular tumour resection remains challenging with high rates of complications. Surgical techniques and implant options are evolving but the ideal implant is yet to be established. Patients should be advised about potential complications including the need for further treatment related to implant failure.
Introduction: Non compressive myelopathy is defined as "spinal cord dysfunction in the absence of clinico-radiological evidence of spinal cord compression."It can result from demyelinating, infectious, autoimmune, vascular, degenerative and metabolic disorders in the absence of demonstrable compression by imaging techniques.We aimed in analyzing the etiological profile of non-compressive myelopathies in a tertiary care hospital of Central Tamil nadu.Material and Methods: In the Neurology department, we conducted an observational study at Thanjavur Medical College, Thanjavur, from September 2017 to September 2018.Patients of non-compressive myelopathies who underwent magnetic resonance imaging (MRI) of the spine were segregated into two categories: Degenerative and non-Degenerative, as well as into acute, subacute and chronic myelopathies. Results:The study had 75 patients with a median age of 34.5 years and male: female ratio of 1.35:1.Presentation was acute in 10 patients (13%), subacute in 5 (6.5%), chronic in 54 (72.5%) and history of relapse and remission in 6(8%) patients.Degenerative etiology was found for 42 (56%) others were non degenerative (demyelinating, autoimmune, vascular, nutritional, or physical agent).MRI study carried out in all cases showed signal changes in 51 cases (68%) which included myelomalacia, demyelination, atrophy of cord, infarction of cord.Etiological diagnosis could be established in 74 (97.3%) cases. Conclusion:Underlying etiology (degenerative, demyelinating, autoimmune, infectious, vascular, metabolic disorder, or physical agent) was found in 91.3% patients of noncompressive myelopathy.Clinical features combined with MRI findings are helpful in defining the cause of non-compressive myelopathies.A follow-up of long term may reveal some of the diagnosis especially degenerative myelopathies in early stage.
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