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.
The modified Glasgow Prognostic Score (mGPS) is a validated prognostic indicator in various carcinomas as demonstrated by several meta-analyses. The mGPS includes pre-operative CRP and albumin valu...
The role of perioperative antibiotic prophylaxis in sarcoma surgery is well established. There are no guidelines for their use in this context but there is pressure from microbiologists to comply with agreed prophylaxis for joint arthroplasty despite major differences between patient groups and risks of infection in sarcoma surgery. Two simple surveys were conducted online, the first for bone sarcoma surgery, the second for soft tissue sarcomas. An email was sent to the major centres worldwide conducting such surgery with links to the online surveys to assess current practice regarding antibiotic prophylaxis and surgical drains. The survey was limited to 8 questions, the emphasis being a simple survey, but included questions on indications, choice, duration of therapy as well as use, size and duration of surgical drains. We received 38 responses from 15 countries to the bone sarcoma survey and 33 responses from 12 countries to the soft tissue sarcoma survey. Current antibiotic prophylaxis regimens varied widely among surgeons, emphasising the controversy that exists regarding what constitutes best clinical practice. Opinions regarding use of perioperative antibiotic prophylaxis in sarcoma surgery vary widely among orthopaedic surgeons worldwide, illustrating the controversy as to what constitutes best clinical practice. This survey suggests the need for a randomised clinical trial to aid in the development of guidelines in this area.
We report our experience of using a computer navigation system to aid resection of malignant musculoskeletal tumours of the pelvis and limbs and, where appropriate, their subsequent reconstruction. We also highlight circumstances in which navigation should be used with caution. We resected a musculoskeletal tumour from 18 patients (15 male, three female, mean age of 30 years (13 to 75) using commercially available computer navigation software (Orthomap 3D) and assessed its impact on the accuracy of our surgery. Of nine pelvic tumours, three had a biological reconstruction with extracorporeal irradiation, four underwent endoprosthetic replacement (EPR) and two required no bony reconstruction. There were eight tumours of the bones of the limbs. Four diaphyseal tumours underwent biological reconstruction. Two patients with a sarcoma of the proximal femur and two with a sarcoma of the proximal humerus underwent extra-articular resection and, where appropriate, EPR. One soft-tissue sarcoma of the adductor compartment which involved the femur was resected and reconstructed using an EPR. Computer navigation was used to aid reconstruction in eight patients. Histological examination of the resected specimens revealed tumour-free margins in all patients. Post-operative radiographs and CT showed that the resection and reconstruction had been carried out as planned in all patients where navigation was used. In two patients, computer navigation had to be abandoned and the operation was completed under CT and radiological control. The use of computer navigation in musculoskeletal oncology allows accurate identification of the local anatomy and can define the extent of the tumour and proposed resection margins. Furthermore, it helps in reconstruction of limb length, rotation and overall alignment after resection of an appendicular tumour.
Background: Congenital heart disease (CHD) is a significant risk factor for maternal morbidity and mortality during pregnancy. The physiological changes of pregnancy exacerbate underlying cardiac conditions, posing challenges for maternal and fetal health. Despite advances in medical care, maternal mortality due to CHD remains a critical concern, particularly in low-resource settings. Objective: This review aims to synthesize evidence on the impact of CHD on maternal mortality, emphasizing risk factors, clinical outcomes, management strategies, and research gaps. Method: A systematic review of 30 studies from PubMed, Scopus, and Web of Science was conducted. Studies published in the last two decades focusing on maternal outcomes associated with CHD were included. Data were categorized into prevalence, outcomes, management strategies, and research gaps. Results: CHD contributes significantly to maternal mortality, particularly in women with cyanotic defects, Eisenmenger syndrome, and Fontan circulation. Advanced care in high-resource settings has reduced mortality rates; however, disparities persist. Multidisciplinary management, pre-pregnancy counseling, and tailored interventions improve outcomes. Emerging approaches, such as telemedicine and improved training, show promise but require further validation. Conclusion: CHD is a major cause of maternal mortality, requiring comprehensive and multidisciplinary care. Addressing global disparities and developing standardized guidelines are crucial for improving outcomes. Further research is needed to address existing knowledge gaps and support evidence-based clinical practice.
Introduction Bony tumours of the foot account for approximately 3% of all osseous tumours. However, literature regarding os calcis and talar tumours comprises individual case reports, short case series or literature reviews with no recent large series. Methods We retrospectively reviewed the medical notes and imaging for all patients with calcaneal or talar tumours recorded in the Scottish Bone Tumour Registry since the 19409s. Demographics, presentation, investigation, histology, management and outcome were reviewed. Results 34 calcaneal tumours and 23 talar tumours were identified. Calcaneal tumours 2:1 male prevalence, mean age at presentation 30, average length of symptoms 9 months. 4 cases presented with pathological fracture. 21 benign tumours including 6 unicameral bone cysts, 3 chondroblastoma, and a wide variety of individual lesions. 13 malignant tumours comprising 6 osteosarcoma, 5 chondrosarcoma and 2 Ewings sarcoma. Talar Tumours male to female ratio 3:1, mean age at presentation 28, average length of symptoms 5 months. 20 benign cases including 7 osteoid osteoma, 4 chondroblastoma, and several individual lesions. 3 malignant lesions comprising 2 chondrosarcoma, 1 osteosarcoma. Discussion Tumours of the hindfoot frequently are delayed in diagnosis due to their rarity and lack of clinician familiarity. They are more common in men, especially talar tumours, which are most commonly benign osteoid osteoma or chondroblastoma. Calcaneal tumours have 1 in 3 risk of malignancy and cover a wider variety of lesions. Osteosarcoma of the foot tends to present later than other anatomical regions. Outcome is dependant on early diagnosis, timely surgery and most importantly neo-adjuvant chemotherapy. Diagnosis is often made on plain radiograph but MRI is the gold standard. Despite their rarity clinicians should maintain a high index of suspicion as accurate and timely diagnosis is important to management and outcome.
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