Assessment of local complications with preoperative versus postoperative radiotherapy in patients with soft tissue sarcoma in extremities: A randomized comparative clinical trial.

Background: Radiotherapy is considered a cornerstone as adjuvant or neo adjuvant to surgery in extremity soft tissue sarcoma (ESTS). Wound complications are the most agonizing complication that may have an impact on patient's functional outcome following radiotherapy. The best care for ESTS is by combining extensive surgical excision with safety margin and radiotherapy either preoperative (neoadjuvant) or postoperative. Preoperative radiotherapy allows for lower dose of radiation over smaller fields which is supposed to decrease long-term complications. However, several studies have shown that early complications which include wound dehiscence, infection, seroma and burn may be more frequent with preoperative radiotherapy than with postoperative radiotherapy. Most of these studies were retrospective. This study aims to prospectively assess and compare the early complications associated with radiotherapy in both techniques. Hypothesis: Preoperative radiotherapy is not inferior to postoperative radiotherapy regarding early wound complications. Patients and methods: Between January 2021 and June 2022, we prospectively studied 22 patients and categorized them into two groups, group A (preoperative radiotherapy) and group B (postoperative radiotherapy). We included patients with extremity soft tissue sarcoma in skeletally mature patients who were randomized into two groups with follow up 9-12 months. Wound complications, local complications, recurrence, time for wound healing and survival rate were recorded and analyzed using SPSS 25. Results: 22 patients were included, 10 in group A and 12 in group B, their mean age was 46.4 years with mean follow up 9 months. The major wound complications were higher in group A (preoperative radiotherapy). in comparison with group B (postoperative radiotherapy), however, this was not statistically significant. While other local complications were higher in group B, it was also statistically insignificant. Time for wound healing was higher in group A more than group B and was statistically significant (p value = 0.011). Conclusion: No increase in the wound complications rate with preoperative radiotherapy by using low fractionated doses of radiotherapy and increasing interval before surgery to six weeks, although there is increased risk of delayed wound healing time after surgery. The size and site of the tumor may increase the risk of wound complications unrelated to the type of radiotherapy. Level of evidence: II: clinical trial.

Evaluation of the BL-RED (Beta-Lactamase Rapid Electrochemical Detection) test for the rapid detection of resistance to third-generation cephalosporins in Enterobacteriaceae.

The sensitivity of NG-test CTX-M Multi assay and BL-RED test incubated 10 min for the detection of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae was 80.6% and 90.3% respectively. Using an extended 60 min incubation with the BL-RED test, its sensitivity was increased to 100% and 60.9% for ESBL-producing and cephalosporinase-overexpressing Enterobacteriaceae respectively.

Total trapeziectomy for osteoarthritis of the trapeziometacarpal joint: Clinical and radiological outcomes in 21 cases with minimum 10-year follow-up.

INTRODUCTION: Trapeziectomy is a technique of choice for osteoarthritis of the trapeziometacarpal joint, but few studies have assessed long-term radiological and clinical outcome in total trapeziectomy, mean follow-up being rather between 2 and 6 years in most cases. The main aim of the present study was to assess loss of trapezial space height at a minimum 10 years' follow-up. Secondary endpoints comprised functional outcome at the same follow-up. HYPOTHESIS: There is systematic loss of trapezial space height, with discrepancy between radiological and clinical results, beyond 10 years' follow-up. MATERIAL AND METHODS: Sixteen patients were retrospectively reassessed at a mean 13.8 years' follow-up (range, 10-17.8 years), for 21 total trapeziectomies. Criteria for the main endpoint comprised trapezial space height (TSH) and trapezial space ratio (TSR=TSH/thumb P1 phalanx length). Secondary endpoint criteria comprised pain, Kapandji opposition and retropulsion scores, active abduction, dynamometric parameters (key-pinch, tip-pinch and grip strength compared to the contralateral side), QuickDASH and satisfaction. RESULTS: Mean TSH and TSR were respectively 3.7mm (range, 0.5-6.1) and 0.14 (0.02-0.25) at last follow-up. Ranges of motion were conserved, with mean Kapandji score of 9.3 (6-10), Kapandji retropulsion score of 2.8 (1-4) and active abduction of 43° (30-45°). Strength measurements were comparable to contralateral values except for key-pinch, which was significantly weaker on the operated side (4.8kg (1.5-8.5kg) versus 5.5kg (1.5-8kg); p=0.041). Mean QuickDASH was 23.5 (0-68.2), and overall satisfaction on VAS was 9.5/10 (6-10). Statistical testing confirmed the absence of correlation between radiological and clinical criteria. DISCUSSION: Despite systematic trapezial space height loss, functional results were satisfactory and stable at a mean follow-up of 13.8 years. There was no correlation between radiological and clinical criteria in the long term. LEVEL OF EVIDENCE: IV, single-center retrospective study.