A multimedia database for musculoskeletal tumour surgery

Pengurusan pesakit kanser otorangka menghasilkan banyak data. Disamping data asas pesakit yang begitu boleh disimpan dalam bentuk teks dan nombor, terdapat juga data multimedia yang terdiri dari gambar-gambar, imej-imej radiologi dan juga klip video. Ianya perlu disimpan dalam rekod pesakit bagi memperbaiki pengurusan pesakit. Satu cara yang berkesan untuk menyimpan data yang begitu banyak sangat diperlukan. Pangkalan data multimedia boleh digunakan untuk tujuan tersebut. Ianya akan memudahkan tugas-tugas pembelajaran. Management of patients with musculoskeletal tumour produced a lot of data. Besides the basic patients' data that can be stored as texts and numbers, there are also multimedia data which consists of photographic images, radiological images as well as video clips that need to be stored to improve patient care. An efficient method to manage the large amount of data is needed. A multimedia database system can be used to achieve this goal. It will facilitate clinical audit reporting, research and education

Functional outcomes after internal and external hemipelvectomy in HUSM

Background: Although great advancements have been made in survival rates over the last half century with adjuvant therapies and current surgical techniques, hemipelvectomy as the surgical treatment for pelvic tumours continue to have significant associations with morbidity and complications. Using the Enneking’s criteria as adopted by the Musculoskeletal Tumor Society (MSTS), we evaluated the functional outcomes of patients who have had an internal hemipelvectomy with and without reconstruction, and external hemipelvectomy. Method: We evaluated patients who underwent hemipelvectomy in our institution between 2001 and 2010. Patients who had had an internal or external hemipelvectomy surgery at any point in their clinical course were included in the study. Patients with follow up periods of less than four months were not included. MSTS scores were obtained at various times after the surgery. Results: A total of 50 patients who had undergone various types of resection and reconstruction techniques were included in this study. The average age is 40.1 years (range 12-79). Average duration of follow up is 10 months. The average MSTS percentage score was 44.32% (range: 6.67%-100%). Results show that external hemipelvectomy in our patients have a high morbidity and mortality rate. Various techniques of resection and reconstruction give different functional scores. Conclusion: Hemipelvectomies have a profound impact on patients’ lives as illustrated by their low MSTS scores. Proper patient selection is crucial to obtain the best outcome. This study is an effort to obtain a proper reference for preoperative discussion with patients and relatives regarding expected outcomes following such a procedure

Functional outcomes after internal and external hemipelvectomy in HUSM

Background: Although great advancements have been made in survival rates over the last half century with adjuvant therapies and current surgical techniques, hemipelvectomy as the surgical treatment for pelvic tumours continue to have significant associations with morbidity and complications. Using the Enneking’s criteria as adopted by the Musculoskeletal Tumor Society (MSTS), we evaluated the functional outcomes of patients who have had an internal hemipelvectomy with and without reconstruction, and external hemipelvectomy. Method: We evaluated patients who underwent hemipelvectomy in our institution between 2001 and 2010. Patients who had had an internal or external hemipelvectomy surgery at any point in their clinical course were included in the study. Patients with follow up periods of less than four months were not included. MSTS scores were obtained at various times after the surgery. Results: A total of 50 patients who had undergone various types of resection and reconstruction techniques were included in this study. The average age is 40.1 years (range 12-79). Average duration of follow up is 10 months. The average MSTS percentage score was 44.32% (range: 6.67%-100%). Results show that external hemipelvectomy in our patients have a high morbidity and mortality rate. Various techniques of resection and reconstruction give different functional scores. Conclusion: Hemipelvectomies have a profound impact on patients’ lives as illustrated by their low MSTS scores. Proper patient selection is crucial to obtain the best outcome. This study is an effort to obtain a proper reference for preoperative discussion with patients and relatives regarding expected outcomes following such a procedure

Evaluation of blood loss during internal (limb-salvage) hemipelvectomy for pelvic tumours : what have we learned so far?

Introduction: Pelvic tumour resections are complex and associated with extensive bleeding. Despite various blood management options in orthopaedic surgery, their used are limited particularly for pelvic tumour resections. Identifying predictive factors for a large amount of blood loss during surgery is essential. Objective: To evaluate the volume of blood loss in limb salvage pelvic resections and identify the risk factors for large amount of perioperative blood loss. Methodology: We retrospectively reviewed 25 patients underwent pelvic tumour resections performed between 2000 and 2010 in a single institution. Tumours originating from the sacrum were excluded. Total blood volume loss consisted of estimated intra-operative blood loss and the drainage volume on the first day after surgery. Loss of more than 3000ml of blood was classified as large amount of blood loss. Statistical analysis performed using Fisher’s exact test. Results: Six (24.0%) patients had total blood loss greater than 3000ml. Resections of primary bone sarcomas (osteosarcoma and chondrosarcoma) have the highest mean blood loss volume (6556.67ml and 1768.57ml, respectively). Most important factor associated with large amount of blood loss is the involvement of the acetabulum. Neo-adjuvant therapies and pre-operative embolization were not shown to be associated with extensive blood loss.. Conclusion: Resections of pelvic tumours involving the acetabular region are likely to have a large amount of blood loss perioperatively and should be anticipated. Radiation therapy prior to surgery was believed to increase the risk of bleeding intra-operatively, was not observed in this study

Penilaian perisian kursus adaptif multimedia (A-Maths) berasaskan stail pembelajaran

Kertas kerja ini membentangkan kajian tentang pembangunan dan penilaian perisian kursus matematik multimedia adaptif (A-MathS). Reka bentuk antara muka dan persembahan kandungan adalah berasaskan ciri-ciri stail pembelajaran global dan analitikal, kecenderungan modaliti visual dan verbal, serta teori pengajaran dan pembelajaran kognitivisme dan konstruktivisme. Metodologi yang digunakan adalah diubahsuai daripada model reka bentuk berarahan Robyler untuk perisian kursus berasaskan komputer. Penilaian keberkesanan dan kepenggunaan prototaip A-MathS dilaksanakan melalui kajian kes yang melibatkan 35 orang sampel, menggunakan teknik eksperimen separa ujian pra-ujian pasca dan soal selidik. Data hasil penilaian dianalisis menggunakan statistik tak-berparameter. Hasil kajian mendapati bahawa sampel yang menggunakan modul A-MathS yang sepadan dengan stail pembelajaran mereka menunjukkan peningkatan markah ujian pasca yang signifikan (p = 0.000). Kumpulan eksperimen memperoleh markah pencapaian min 10.5 berbanding 1.8 bagi kumpulan kawalan. Ini bermakna, perisian kursus yang direka bentuk berasaskan stail pembelajaran adalah berkesan dalam membantu meningkatkan pencapaian pelajar

Global prevalence and risk of local recurrence following cryosurgery of giant cell tumour of bone:a meta-analysis

SIMPLE SUMMARY: Giant cell tumours are benign but locally aggressive and can potentially metastasise to the lungs. Reducing the risk of local recurrence while maintaining limb function and minimising adverse consequences is the best therapeutic strategy in treating giant cell tumours. Based on our observation through this meta-analysis, cryosurgery is one of the viable treatment options that can provide good oncologic and functional outcomes with minimal complication rates. ABSTRACT: The challenge in the surgical treatment of giant cell tumours of bone is the relatively high recurrence rate after curettage alone. The use of a local adjuvant following curettage, on the other hand, has lowered the rate of recurrence. This systematic review and meta-analysis aimed to investigate the prevalence and risk of local recurrence of giant cell tumours of the bone after cryosurgery and the subsequent complications. Web of Science, Scopus, ScienceDirect, PubMed, and Google Scholar were searched to identify articles published until 13 October 2021. A random-effects model was used to examine the pooled prevalence and risk ratio (RR) of local recurrence in patients with giant cell tumours after cryosurgery with 95% confidence intervals (CIs). This study was registered with PROSPERO (CRD42020211620). A total of 1376 articles were identified, of which 38 studies (n = 1373, 46.2% male) were included in the meta-analysis. Following cryosurgery, the pooled prevalence of local recurrence in giant cell tumours was estimated as 13.5% [95% CI: 9.3–17.8, I(2) = 63%], where European subjects exhibited the highest prevalence (24.2%). Compared to other local adjuvants. The RR of local recurrence following cryosurgery was 0.85 (95% CI: 0.63–1.17, I(2) = 15%), which was not statistically significant compared to other local adjuvants. We found 3.9% fracture, 4.0% infection, 2.1% nerve injury, and 1.5% skin necrosis as the common complications. Based on the sensitivity analyses, this study is robust and reliable. This meta-analysis estimated a low prevalence of local recurrence of giant cell tumours with low complications following cryosurgery. Thus, it can be one of the adjuvant options for treating giant cell tumours

Resection of thumb metacarpal Ewings Sarcoma and primary reconstruction with a non-vascularized, autologous, osteoarticular metatarsal graft

Introduction: Ewings sarcoma is a rare, malignant neoplasm; rarely originates in the bones of the hand. Historically, treatment involves a combination of chemotherapy and radiotherapy. The role of surgical intervention remains limited, depending on the anatomic location. Resection and reconstruction will usually result in reduced or loss of function. Methodology: We reviewed a case of an 11-year girl with Ewings sarcoma of the first metacarpal bone of her dominant right hand with a solitary lung metastasis. Results: Treatment consisted of neo- and adjuvant chemotherapy, and wide resection of the first metacarpal followed by reconstruction of her thumb with a non-vascularised, intercalated, autologous second metatarsal graft. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. Her donor site was reconstructed with an autologous tricortical iliac bone graft. Two years following surgery, she achieved near normal functioning of her dominant hand, with no donor site morbidity and local recurrence. The surgical techniques are described together with the excellent functional outcomes in the patient. Conclusion: The use of non-vascularised, autologous metatarsal bone graft to reconstruct the thumb following tumour resection is an excellent option available. It is relatively simple and can be performed as a single resection and reconstruction procedure

Outcomes following total femur resection and modular endoprosthetic replacement for primary bone tumours

Introduction: Total femur endoprosthesis is an alternative reconstruction option following resection for massive malignant bone tumour with intramedullary extension or skip lesions. Methodology: We reviewed cases with primary bone tumours underwent total femur resection and replacement with megaprosthesis at our centre for the past 15 years. Results: Nine patients were included in our review. Mean age of patients was 21.3 years (range 12 to 35 years old). Seven had osteosarcoma of the femur and two were results of salvage procedure for implant loosening following distal femoral replacement. Another patient underwent surgery for revision of total femur allograft. Free oncologic margins were achieved in all patients. Four patients required vascularised latissimus dorsi free flaps cover for reconstruction of soft tissue defects. The average follow-up was 137 months, ranging from 24 to 180 months. Seven patients were still alive on their last follow up. Six of them being disease free and one survived with presence of pulmonary and contralateral femur metastases. Two patients were complicated with infections, two had stiff knee joint, and one case of peroneal nerve palsy. Excellent or good functional outcomes obtained in all patients on their last follow up in accordance to Musculoskeletal Tumor Society (MSTS) Scoring System. Conclusion: Modular endoprosthetic replacement is a good reconstruction option in selected cases. It provides early stability and good functional outcomes. However, it is a technically demanding procedure