Managing Soft Tissue Sarcomas in a Developing Health System.

BACKGROUND: The gold standard for treatment of soft tissue sarcomas (STS) includes wide local excision and limb salvage surgery. There is currently a lack of reports on the effectiveness of these techniques in a resource-poor setting with a lack of access to imaging and adjuvant therapies. This article reports the experience and outcome of patients presenting with STS to the Children's Surgical Centre (CSC), Phnom Penh, Cambodia. METHODS: Patients with a diagnosis of STS and the operations they received were retrospectively sourced from the CSC database. Follow-up data were obtained through a telephone questionnaire and home visits. RESULTS: Forty STS patients were identified. Definitive surgery was performed in 31 cases, the majority receiving initial local excision of the lesion (19/31), some went on to have secondary amputations (5/19), and the rest had primary amputation (12/31). Eight patients suffered perioperative complications: 6 had infections, 1 haemorrhage, and 1 patient suffered from prolonged pain. Follow-up information was available for 25 patients, 8 of whom survived whilst 17 had died. Two of the deceased and 2 of the surviving patients had received adjuvant therapy. Seven survivors reported that they had resumed employment. Estimated average survival for STS in Cambodia was 25 months with a 58 % 1-year survival rate in treated cases. CONCLUSIONS: Despite the loss to follow-up, some STS patients in Cambodia have been successfully managed by the CSC. An evolving increase in survival will hopefully be seen as access to adjuvant therapies and imaging technology improves.

Anterior hip dislocation in conjunction with a stroke: a diagnosis not to miss.

Anterior dislocation of the native hip joint is an uncommon presentation accounting for around 15% of all hip dislocations. It is usually the result of a high-energy impact in circumstances such as a motor vehicle accident or a fall from a significant height. A delay in relocation of more than 6 h has been associated with a high risk of avascular necrosis of the femoral head. We report the case of a 75-year-old man who suffered an anterior dislocation of his native hip following a fall from a standing height, associated with an acute cerebrovascular stroke. There was significant delay in the recognition of the dislocation due to the coexistent signs of the stroke. This case illustrates that hip dislocation can occur following a low-energy mechanism of injury with the possibility of serious long-term consequences if it is not promptly recognised and treated.