Predictors and Treatment Outcomes of Pediatric Osteosarcoma in Diverse Socioeconomic Backgrounds in Southeast Asia: A Retrospective Multicenter Study.

BACKGROUND: Pediatric osteosarcoma outcomes among developed and developing countries have not been previously compared. Countries in Southeast Asia (SEA) have a wide variety of socioeconomic statuses. A multi-institutional retrospective study was conducted to determine the prognostic factors and outcomes for pediatric osteosarcoma in SEA. METHODS: Pediatric patients with osteosarcoma treated between 1998 and 2017 in 4 SEA pediatric oncology centers were studied. Countries were classified using the World Bank Atlas method. Kaplan-Meier method and Cox's Proportion Hazard Model were applied to estimate survival outcomes and identify prognostic factors. RESULTS: In all, 149 patients with osteosarcoma with a mean age of 12.48±3.66 years were enrolled. The localized to metastatic disease ratio was 1.5:1. The 5-year overall survival (OS) and event-free survival (EFS) were 53.8% and 42%, respectively. Prognostic factors associated with outcomes were country, stage of disease, MTX-containing regimens, and surgery type (p-value <0.05). In patients with localized disease, EFS was superior with limb-salvage surgery (62%) than amputation or rotationplasty (40%) (p-value 0.009). MTX-containing chemotherapies provided higher OS (45.3%) and EFS (37.9%) than non-MTX regimens (12.3% and 10.7%, respectively) among metastatic patients (p-value 0.004 and 0.005, respectively). Metastatic disease was an independent prognostic factor for death but not relapse outcome.  Conclusion: The disease outcomes in SEA were acceptable compared to developed countries. The stage of disease was the only independent prognostic factor. MTX-containing regimens and limb-salvage surgery should be considered where possible.

A Patient-Matched Entire First Metacarpal Prosthesis in Treatment of Giant Cell Tumor of Bone.

Giant cell tumor of the bones occurring in the first metacarpals frequently requires entire metacarpal resection due to the aggressive nature and high rate of recurrence. Bone reconstruction can be performed with autogenous bone grafts. Here we describe a new technique of reconstruction using a patient-matched three-dimensional printed titanium first metacarpal prosthesis. This prosthesis has a special design for ligament reconstruction in the proximal and distal portions. Good hand function and aesthetic appearance were maintained at a 24-month follow-up visit. This reconstructive technique can avoid donor-site complications and spare the autogenous bone grafts for revision options.

Risk factors of deep vein thrombosis (DVT) after total knee arthroplasty (TKA) at Phramongkutklao Hospital.

BACKGROUND: There have been sporadic reports on the Asian risk factor of DVT after total knee arthroplasty. OBJECTIVE: To determine the risk factors of DVT MATERIAL AND METHOD: Retrospective review of one hundred patients who had undergone TKA and postoperative Contrast Venography in bilateral legs between 2002 and 2005 were performed to identify risk factor of DVT The patients were divided into two groups, positive and negative venography which the patients who had positive venography were indicating the development to DVT RESULTS: One hundred patients were evaluated associated to DVT Eighteen of these patients were men, and eighty-two were women. The median age at the time of the procedure was seventy-five years old (range: 62 - 79 years old). Sixty-one patients showed positive venography for D VT Five critical risk factors were identified to develop DVT: 1. Underlying cardiovascular disease 2. Underlying hematological disease 3. Underlying rheumatoid arthritis 4. Patients who took oral herbal medicine about one year before the operation 5. Patients who received revision TKA. CONCLUSION: The risk factors of DVT in the presented patients at Phramongkotklo Hospital were similar to other countries. The research study could identify statistically significant risk factors and stimulate surgeons undertaking TKA to be aware of the probability of the patient to develop DVT.