Leiomyosarcoma in the extremities and trunk wall: systematic review and meta-analysis of the oncological outcomes.

BACKGROUND: Leiomyosarcomas are aggressive malignancies which can occur on the trunk and extremities whose pathogenesis is poorly understood. We aim to quantify the prognostic impact of various clinical and pathological markers on survival and recurrence of leiomyosarcomas. METHODS: We conducted a systematic review as per PRISMA protocol. Survival, local recurrence, and metastasis were the outcome measures. Data were extracted from the studies for the outcome variables; the resultant odds ratios (OR) and 95% confidence interval (CI) were used for the synthesis of a forest plot. RESULTS: Our search revealed thirteen studies comprising 1380 patients. Seven of these 13 publications were since 2012. Our analysis showed that tumor size larger than 5 cm adversely affected the outcome with an OR 3.39 (2.26-5.10, p < 0.01). Other factors which reduced the overall survival were positive margins of excision OR 2.12 (1.36-3.32, p < 0.01). A reduced risk of metastasis has strongly associated the use of radiotherapy with OR 10.84 (4.41-26.61, p < 0.01). Only a few studies analyzed the impact of factors on local recurrence. CONCLUSIONS: Size larger than 5 cm and positive margins of excision are associated with poor overall survival. In comparison, the use of adjuvant radiotherapy was associated with a lower metastatic rate. There is a need for methodically high-quality studies with more uniform study design and reporting to evaluate the impact of various risk factors on local recurrence and metastases. LEVEL OF EVIDENCE: Level 1 Prognostic.

The Effect of Sociodemographic Factors on Obtaining a Place in Core Surgical Training.

Competition for Core Surgical Training (CST) is rising, placing a strong emphasis on interview performance. Several interview courses offer to help candidates secure their chosen surgical job but at premium fees. A group of London-based CSTs started a free course offering high-quality mock interview experiences to over 90 applicants in 2022, with the aim of providing an accessible opportunity for financially disadvantaged candidates. Course candidates completed three sets of questionnaires, pre- and post-mock interview, and a final one upon job allocation. Candidates' educational background and schooling history were obtained as well as their self-assessment score, eventual rank after interview and the rank of the job they had accepted. The three sets of questionnaires were completed by 87, 73 and 45 candidates respectively. Overall, there was a statistically significant difference in self-reported confidence scores after the course (P < 0.001). There was no significant difference in the self-assessment score of the 44.2% of candidates who had attended private education in the UK, compared to publicly educated (P = 0.0525), nor was there a difference in their rank after interviews (P = 0.236). Candidates who spent £50 or more had higher self-assessment scores (P = 0.042) but they didn't rank higher in overall scores (P = 0.591). Interview preparation courses are helpful in increasing candidates' confidence, however spending more money does not translate into a better overall interview performance. Our study suggests that candidates from private education backgrounds do not have an advantage in the CST application process.

The use of MolecuLight i:X device in acute hand trauma.

Early diagnosis of wound infections are crucial as they have been shown to increase patient morbidity and mortality. We evaluated the use of Moleculight i:X to identify infections in acute open wounds in hand trauma. Data were collected from patients who attended the hand trauma unit over a 4 week period prior to having surgery. Wounds were inspected for clinical signs of infection and autofluorescence images were taken using the Moleculight i:X device. Wound swabs were taken and results interpreted according to report by microbiologist. Autofluorescence images were interpreted by a clinician blinded to the microbiology results. 31 patients were included and data collected from 35 wounds. 3 wounds (8.6%) showed positive clinical signs of infection, 3 (8.6%) were positive on autofluorescence imaging and 2 (5.7%) of wound swab samples were positive for significant infection. Autofluorescence imaging correlated with clinical signs and wound swab results for 34 wounds (97.1%). In one case, the clinical assessment and autofluorescence imaging showed positive signs of infection but the wound swabs were negative. Autofluorescence imaging in acute open wounds may be useful to provide real-time confirmation of bacterial infection and therefore guide management.

Transposition With Unobstructed Right Aortic Arch and Bicuspid Aortic Valve.

In patients with transposition, a right aortic arch has rarely been reported among the associated malformations. When present, the arch has been obstructed because of the presence of aortic coarctation and/or arch hypoplasia. A bicuspid aortic valve is also very rare in the presence of transposition. We report here the unusual association of transposition, an unobstructed right aortic arch, and a bicuspid aortic valve in a neonate who underwent a successful arterial switch operation.

The Impact of Temporal Artery Biopsy at a UK Tertiary Plastic Surgery Unit.

Guidelines recommend temporal artery biopsy (TAB) for patients suspected of having giant cell arteritis (GCA). We evaluated the impact of TAB on the diagnosis and management of patients with suspected GCA at a tertiary plastic surgery unit. METHODS: A retrospective review of all TAB procedures performed at our centre over 7 years was performed. One hundred and one patients were included in the study. Patients were classified into 3 diagnostic groups: confirmed (positive TAB), presumed (negative TAB with high clinical suspicion) and unlikely (negative TAB with low clinical suspicion). The clinical presentation and management for each group were compared. RESULTS: The average American College of Rheumatology (ACR) score was 3.07. The number of patients with an ACR score of ≥3 before TAB was 72 (71.3%) and remained the same after TAB. The number of patients who remained on steroid therapy was lower in the group with an unlikely diagnosis of GCA compared to the group with a confirmed diagnosis (p<0.05). Conversely, there was no significant difference in steroid therapy between those with a presumed and confirmed diagnosis (p>0.05). CONCLUSIONS: This study found a significant difference in steroid treatment between those with confirmed GCA and those where the diagnosis was unlikely showing that TAB may support decisions regarding steroid therapy. However, TAB was inappropriately requested for patients whose pre-TAB ACR score was ≥3 as this score is sufficient for the diagnosis of GCA. Therefore, the use of TAB should be limited to cases of diagnostic uncertainty.

Tetralogy of Fallot With Right Aortic Arch and Retro-Aortic Innominate Vein.

Right aortic arch (RAA) and retro-aortic innominate vein are rare vascular anomalies. Diagnosis of these anatomical variations can be achieved using fetal echocardiography, post-natal echocardiography, and computed tomography scan. RAA can form a vascular ring when associated with other vascular anomalies which may compress the trachea and/or esophagus. On the other hand, the existence of retro-aortic innominate vein can influence the clinical decision-making and surgical strategy. We report a rare occurrence of both RAA and retro-aortic innominate vein in a 3 months old girl with a prenatal diagnosis of tetralogy of Fallot and include details of her presentation and successful management.