Kanser tulang dan sakoma anggota : rawatan pembedahan menyelamatkan anggota

Di Malaysia, penyakit kanser merupakan masaalah kesihatan yang penting, dan antara penyebab kematian utama. Rawatan kanser tulang dan tisu anggota sudah di jalankan negara kita semenjak dua dekad lampau. Umumnya rawatan untuk menghalang rebakan kanser ini melibatkan pembedahan amputasi anggota yang akan mengakibatkan kecacatan kekal. Secara tidak langsung ini menghalang pesakit untuk mendapatkan rawatan yang menyeluruh dan berakhir dengan kematian. Pendekatan terbaru dalam rawatan kanser tulang yang melibatkan pembedahan menyelamatkan anggota telah berjaya menjamin pesakit menerima dan mendapatkan rawatan yang optimun

Trauma kecederaan anggota dan rawatannya

Kemalangan yang menimpa seseorang dan kecacatan yang berlaku akibat kecederaan kemalangan bukan bermakna mangsa akan menjadi cacat selamanya, yang bakal menggelapkan masa depan. Keadaan ini harus dianggap sebagai suatu cabaran hidup yang perlu dihadapi dan titik permulaan untuk menghadapi liku-liku kehidupan yang mendatang dengan lebih tabah. Dengan itu, hari esok akan menjadi lebih bernilai dan bererti. Pengetahuan tentang kecederaan, pertolongan awal dan rawatan bukan sahaja berguna untuk menolong mangsa kemalangan. Malahan, mangsa yang tercedera akan lebih bersedia untuk menjalani proses rawatan. Dengan pengetahuan yang ada, mangsa akan berasa kurang takut dan lebih yakin semasa menjalani rawatan. Pengalaman menjalani rawatan dapat dipertingkat dengan cadangan yang dapat dilakukan oleh pesakit semasa rawatan

Resection of thumb metacarpal Ewing Sarcoma and primary reconstruction with non-Vascularized osteoarticular metatarsal autograft

Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will usually result in reduced or loss of thumb function. We describe a case of successful transplantation of non- vascularized osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique. Detailed surgical procedures and excellence function after 2 years following surgery are described

Association of degree of expression of ki 67 proliferative cell marker with aggressive giant cell tumor of the bone

Stag11 Ill Campanacci giant cell tumour of· the bone always exhibits high biological aggressiveness and has tendency for local recurrenc11s and pulmonary metastases. We analyzed Ki-67 immuno-histochemistry of 31 cases of stage Ill giant cell tumour of the bone to determine the clinico-pathological correlation. The mean value of Ki-67 index obtained as a percentage of 1000 background cells was 8. 15 with range from 1. 00 to 20. 00. There was no difference of indices in cases with r11currence and pulmonary metastasis. In conclusion, Ki-67 index is not useful as a prognostic marker for aggressive typ.e of giant cell tumour of the bone

Soft Tissue Reconstruction following Hemipelvectomy: Eight-Year Experience and Literature Review

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

A critical appraisal of Covid-19 in Malaysia and beyond

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

Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee

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

Outcome of Surgical Treatment of Pelvic Osteosarcoma: Hospital Universiti Sains Malaysia Experience

We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment

Long-term Outcome of Total Femur Replacement

Introduction: Total femur replacement is an option instead of amputation for extensive bone tumour or after revision surgery with a massive bone loss. Over a long period of time the patients may need revision surgery, and this might affect the functional outcome. We reviewed all consecutive total femur replacements done for primary and revision surgery of primary bone tumours in our centre to evaluate the long-term functional outcome and survival. Materials and methods: All patients who had total femur resection and reconstruction with modular endoprosthesis replacement in our centre from June 1997 to May 2022 were reviewed. The respondents were surveyed through WhatsApp using google form which was translated into Bahasa Malaysia based on the Musculoskeletal Tumour Society Scoring System (MSTS). The data were presented as descriptive data on the final survival of the limb and prosthesis. Results: Ten patients underwent total femur replacement. There were eight osteosarcoma, one giant cell tumour and one chondromyxoid fibroma. Three patients with osteosarcoma succumbed to pulmonary metastases; all had good early post-operative functional outcomes without local recurrence. Seven patients were available for long term evaluation of function with a mean follow-up of 17.6 years (ranged 10-25 years). Four patients with total femur replacement had good functional outcomes (60-80%) without revision with 10-25 years follow-up. Three patients experienced acetabulum erosion and chronic pain that required early hip replacements. Two of them were complicated with superior erosions and bone loss and subsequently were managed with massive reconstruction using cemented acetabulum cage reconstruction. The other has diabetes mellitus with chronic infection following revision of distal femur endoprosthesis to total femur replacement and subsequently underwent limited hemipelvectomy after 14 years. Conclusion: Total femur replacement offers a good long term functional outcome and prosthesis survival and is a favourable option for limb salvage surgery