Lymphocyte-monocyte ratio as predictive factors for huvos scores in osteosarcoma extremities treated by neoadjuvan chemotherapy (cisplatin and doxorubicin)

Background: Chemotherapy is a vital treatment in osteosarcoma but it’s responses are difficult to predict, and there are still no biomarkers that can estimate the prognosis of chemotherapy. Lymphocytes and monocytes are key immune cells which are examined on complete blood count test before chemotherapy and often associated with prognosis of various malignancies. Low lymphocyte-monocyte ratio (LMR) are associated with poor prognostics in some cancers.Methods: This study is cross-sectional retrospective analytics that was conducted at Sanglah Hospital from June to August 2018. The research subject was medical records of intramedullary conventional osteosarcoma patients which fulfil inclusion and exclusion criteria. In this study, LMR as independent variable and Huvos score as dependent variable.Results: The result in this study showed positive correlation between LMR before neoadjuvan Chemotherapy and Huvos score (r=0.500) with p<0.05.Conclusions: A positive correlation was found between LMR and Huvos scores. Low LMR before neoadjuvan chemotheraphy (<2.81) were correlated with low huvos scores (grade I and II)

Unplanned surgery increases the morbidity of patients with solitary plasmacytoma of femoral bone: a case report

Solitary skeletal plasmacytoma is a malignant plasma cell tumour that accounts for 3-5% of all monoclonal gammopathies. Lytic bone disease is a hallmark, and a substantial percentage of patients develop pathologic fractures. For lesions involving the femur, internal fixation frequently fails; therefore, prosthetic reconstruction may be the optimal choice for treatment. A 52-year-old male patient with pathological fracture of right femoral bone. Patient was undergone surgery with internal fixation. The pain had been continuing for several months and giant masses has developed on affected side. Further test was done and showed solitary plasmacytoma of proximal femur. The patient was treated with cemented modular prosthesis following tumor excision. Treatment of pathological fracture often challenging. Unplanned surgery could be devastating for the patient. Compare to internal fixation, cemented modular prosthesis is designed as a modular system that can be used to replace diseased or deficient bone in the femur following wide excision. Treatment of pathological fractures in solitary plasmacytoma with modular prosthesis appears to be a feasible option. They were able to mobilize early with good pain relief and had a useful functional limb. Further diagnostic test should be done for fracture of proximal femoral bone that considered pathologic. Limb salvage surgery with modular prosthesis can be considered as a viable option for treating painful pathological fractures in solitary plasmacytoma. It provides pain relief, early mobilization, and good functional outcome with improved quality of life

Functional outcome following coracoclavicular ligament reconstruction using a gracilis tendon graft for acute type III acromioclavicular dislocation: a case report

The acromioclavicular joint is stabilized by two ligaments: the acromioclavicular ligaments and coracoclavicular ligaments. AC joint dislocations account for 9% to 10% of all shoulder injuries. Tossy and Allman classified acromioclavicular dislocations into three types (I, II and III). This classification was modified by Rockwood (types IV, V, and VI). Type I and II dislocations are treated conservatively. Surgery is indicated for certain Rockwood type III and for all type IV, V, and VI injuries. A 45 years old man yoga trainer presented to our emergency department with a chief complaint of pain over his left shoulder after had traffic accident 3 hours prior to admission. Physical examination revealed left lateral clavicular end prominent and tenderness over the left shoulder with limited range of motion due to pain. A Zanca view X-Ray of left shoulder was performed and revealed dislocation of acromioclavicular joint. The patient was diagnosed with suspect Left AC joint disruption grade III. We performed coracoclavicular ligament reconstruction using a gracilis tendon graft 2 days after the accident. Before the surgery, constant score of the patient left shoulder was 25 (Fair). The constant score measured was 63 after 10 month follow up. Coracoclavicular ligament reconstruction with an autogenous gracilis tendon graft was feasible and safe in physically active patients with acute type-III acromioclavicular joint dislocation