Bristol, United Kingdom
Bristol, United Kingdom

Time filter

Source Type

Shah A.,Royal Infirmary | Amin M.,Kettering General Hospital | Srinivasan S.,Kettering General Hospital | Botchu R.,Kettering General Hospital | Botchu R.,Royal Orthopedic Hospital
Journal of Clinical Ultrasound | Year: 2015

Purpose: Patients often have difficulty performing the various movements required for ideal positioning to enable accurate sonographic (US) assessment of the shoulder; this may result from pain and or unclear oral instructions. We performed this study to ascertain whether the use of a poster depicting the positions required during the examination would decrease scanning time and hence improve the overall efficiency of shoulder US. Methods: We retrospectively compared results from 50 consecutive patients who underwent US examination without (group 1) and 50 with (group 2) the use of an illustrative poster produced by the European Society of Musculoskeletal Radiology. The difference in mean scanning time between the two groups was analyzed with Student's two-tailed t test. Results: There was a statistically significant difference in scanning time between the two groups (group 1: 3 minutes and 5 seconds versus group 2: 2 minutes and 9 seconds; p<0.0001). The patients in group 2, especially those who had hearing difficulty, found the poster useful. Conclusions: The use of a poster illustrating positioning of the shoulder during an US examination is an effective way to improve patient compliance and significantly decreases scanning time. © 2014 Wiley Periodicals, Inc.


Andersson C.,Sahlgrenska University Hospital | Osterlundh G.,Gothenburg University | Enlund F.,Sahlgrenska University Hospital | Kindblom L.-G.,Royal Orthopedic Hospital | And 2 more authors.
Oncology Letters | Year: 2014

Mesenchymal chondrosarcoma is an extremely rare malignant tumour that most commonly originates in the bone, but is also present in extraskeletal sites. The tumour is morphologically characterized by a biphasic pattern of small round cells and islands of cartilage. Spinal mesenchymal chondrosarcomas are even rarer and, therefore, few investigations exist regarding the biological behaviour of the tumours. In the present study, we report a case of a 10-year-old female presenting with 9 months of back pain and radiographic findings of an intradural lesion measuring 1.5 cm at the level of Th4. The tumour was completely excised and subjected to pathological analyses. Following detection of the HEY1-NCOA2 fusion gene, the tumour was morphologically and immunohistochemically defined as an intradural mesenchymal chondrosarcoma attached to the dura mater. In this study, we validate the recent identification of the fusion gene HEY1-NCOA2 in paediatric extraskeletal mesenchymal chondrosarcomas. The relevant literature is reviewed and further discussed in relation to our findings.


Pasquali S.,Queen Elizabeth Hospital | Gronchi A.,Fondazione IRCCS Instituto Nazionale dei Tumori | Strauss D.,Sarcoma Unit | Bonvalot S.,Institute Gustave Roussy | And 12 more authors.
European Journal of Surgical Oncology | Year: 2016

Background Extra-pleural and extra-meningeal solitary fibrous tumour (SFT) is a rare sarcoma histotype curable with surgery in the majority of patients. The behaviour of these tumours ranges from indolent/very low grade to malignant/high grade but it is still not possible to accurately predict prognosis after surgery. We have investigated a multi-centre series to stratify the risk of recurrence to patients with SFTs. Methods We retrospectively analysed the data from 243 patients who underwent surgery (2002–2011) at four sarcoma referral centres. Results Upon univariate analysis, hypercellularity, atypia, necrosis, high mitotic rate (ie >4 mitoses/10 HPF) were associated with both disease-free and overall survival. Surgical margins were a significant prognostic factor for disease-free (P = 0.007) but not for overall survival. Unexpectedly, larger tumour size was associated with a better prognosis (P = 0.038) and fewer recurrences (P = 0.024). Upon multivariable analysis, high mitotic rate (hazard ratio, HR = 2.85, P = 0.002), cellular atypia (HR = 1.62, P = 0.015) and hypercellularity (HR = 1.82, P = 0.031) were significantly associated with recurrences. A SFT recurrence score has been provided to stratify risk of recurrence. Conclusion This study provides a prognostic model to stratify risk of recurrence in patients with resectable SFTs. This allows clinician to decide on an optimal follow-up strategy and to select patients that may benefit from adjuvant treatments. © 2016


Mittal S.,University of Birmingham | Mittal S.,Royal Orthopedic Hospital | Revell M.,Royal Orthopedic Hospital | Barone F.,University of Birmingham | And 11 more authors.
PLoS ONE | Year: 2013

Aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) has been used to describe the histological lesion associated with metal-on-metal (M-M) bearings. We tested the hypothesis that the lymphoid aggregates, associated with ALVAL lesions resemble tertiary lymphoid organs (TLOs). Histopathological changes were examined in the periprosthetic tissue of 62 M-M hip replacements requiring revision surgery, with particular emphasis on the characteristics and pattern of the lymphocytic infiltrate. Immunofluorescence and immunohistochemistry were used to study the classical features of TLOs in cases where large organized lymphoid follicles were present. Synchrotron X-ray fluorescence (XRF) measurements were undertaken to detect localisation of implant derived ions/particles within the samples. Based on type of lymphocytic infiltrates, three different categories were recognised; diffuse aggregates (51%), T cell aggregates (20%), and organised lymphoid aggregates (29%). Further investigation of tissues with organised lymphoid aggregates showed that these tissues recapitulate many of the features of TLOs with T cells and B cells organised into discrete areas, the presence of follicular dendritic cells, acquisition of high endothelial venule like phenotype by blood vessels, expression of lymphoid chemokines and the presence of plasma cells. Co-localisation of implant-derived metals with lymphoid aggregates was observed. These findings suggest that in addition to the well described general foreign body reaction mediated by macrophages and a T cell mediated type IV hypersensitivity response, an under-recognized immunological reaction to metal wear debris involving B cells and the formation of tertiary lymphoid organs occurs in a distinct subset of patients with M-M implants. © 2013 Mittal et al.


PubMed | Royal Orthopedic Hospital, Sarcoma Unit, Queen Elizabeth Hospital, Institute Gustave Roussy and 3 more.
Type: Journal Article | Journal: European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology | Year: 2016

Extra-pleural and extra-meningeal solitary fibrous tumour (SFT) is a rare sarcoma histotype curable with surgery in the majority of patients. The behaviour of these tumours ranges from indolent/very low grade to malignant/high grade but it is still not possible to accurately predict prognosis after surgery. We have investigated a multi-centre series to stratify the risk of recurrence to patients with SFTs.We retrospectively analysed the data from 243 patients who underwent surgery (2002-2011) at four sarcoma referral centres.Upon univariate analysis, hypercellularity, atypia, necrosis, high mitotic rate (ie >4 mitoses/10 HPF) were associated with both disease-free and overall survival. Surgical margins were a significant prognostic factor for disease-free (P=0.007) but not for overall survival. Unexpectedly, larger tumour size was associated with a better prognosis (P=0.038) and fewer recurrences (P=0.024). Upon multivariable analysis, high mitotic rate (hazard ratio, HR=2.85, P=0.002), cellular atypia (HR=1.62, P=0.015) and hypercellularity (HR=1.82, P=0.031) were significantly associated with recurrences. A SFT recurrence score has been provided to stratify risk of recurrence.This study provides a prognostic model to stratify risk of recurrence in patients with resectable SFTs. This allows clinician to decide on an optimal follow-up strategy and to select patients that may benefit from adjuvant treatments.


Moldavsky M.,Globus Inc. | Salloum K.,Globus Inc. | Bucklen B.,Globus Inc. | Khalil S.,Globus Inc. | Mehta J.S.,Royal Orthopedic Hospital
Indian Journal of Orthopaedics | Year: 2016

Background: Poor screw-to-bone fixation is a clinical problem that can lead to screw loosening. Under-tapping (UT) the pedicle screw has been evaluated biomechanically in the past. The objective of the study was to determine if pedicle preparation with a sequential tapping technique will alter the screw-to-bone fixation strength using a stress relaxation testing loading protocol. Materials and Methods: Three thoracolumbar calf spines were instrumented with pedicle screws that were either probed, UT, standard-tapped (ST), or sequential tapped to prepare the pedicle screw track and a stress relaxation protocol was used to determine pull-out strength. The maximum torque required for pedicle screw insertion and pull-out strength was reported. A one-way ANOVA and Tukeys post-hoc test were used to determine statistical significance. Results: The pedicle screw insertion torques for the probed, UT, ST and sequentially tapped (SQT) techniques were 5.09 (±1.08) Nm, 5.39 (±1.61) Nm, 2.93 (±0.43) Nm, and 3.54 (±0.67) Nm, respectively. There is a significant difference between probed compared to ST (P ≤ 0.05), as well as UT compared to both ST and SQT (P ≤ 0.05). The pull-out strength for pedicle screws for the probed, UT, ST and SQT techniques was 2443 (±782) N, 2353(±918) N, 2474 (±521) N, and 2146 (±582) N, respectively, with no significant difference (P ≥ 0.05) between techniques. Conclusions: The ST technique resulted in the highest pull-out strength while the SQT technique resulted in the lowest. However, there was no significant difference in the pull-out strength for the various preparation techniques and there was no correlation between insertion torque and pull-out strength. This suggests that other factors such as bone density may have a greater influence on pull-out strength.


Evans S.,Royal Orthopedic Hospital | Brewer P.,Royal Orthopedic Hospital | Vaiyapuri S.,Royal Orthopedic Hospital | Grimer R.,Royal Orthopedic Hospital
Journal of Bone Oncology | Year: 2013

Trichorhinophalangeal syndrome (TRPS) is a rare genetic disorder with typical craniofacial and skeletal abnormalities. Three main subtypes have been described. All variations of the condition affect the hair (tricho), nose (rhino) and fingers (phalangeal). The diagnosis is usually made through clinical examination augmented by hand radiographs that reveal characteristic cone-shaped epiphyses Sporadic case reports detailing TRPS have been described in the literature. We describe the first report of high-grade osteosarcoma presenting in two members of the same family with trichorhino-phalangeal syndrome (TRPS). © 2013 Elsevier GmbH. All rights reserved.


Freeman A.K.,Royal Orthopedic Hospital | Sumathi V.P.,Royal Orthopedic Hospital | Jeys L.,Royal Orthopedic Hospital
Surgery (United Kingdom) | Year: 2015

Primary bone tumours are rare, with a prevalence of approximately 550 cases per year in the UK. Late presentation and identification of tumours delays diagnosis and negatively impacts on the survival of these patients. Characteristic clinical and radiological features of bone tumours should alert the physician to investigate further. Investigations should include blood tests and local and systemic imaging. MRI, CT and isotope bone scans are important in evaluating the tumour. The most common types of bone tumour are osteosarcoma, chondrosarcoma, Ewing sarcoma, spindle cell sarcoma of bone and chordoma. The important pathological features and treatment of each type of tumour are described in this article. Early contact with a supra-regional bone tumour unit is mandatory when a bone tumour is suspected, where a multidisciplinary approach to management is employed. Biopsy and surgical treatment should be carried out in these units wherever possible. Patients should be enrolled in international clinical trials, where feasible, to gather data that will ultimately improve outcomes. The survival rates from most bone tumours are 60-80% with appropriate treatment. © 2014 Elsevier Ltd.


PubMed | Royal Orthopedic Hospital
Type: Journal Article | Journal: Journal of bone oncology | Year: 2016

Trichorhinophalangeal syndrome (TRPS) is a rare genetic disorder with typical craniofacial and skeletal abnormalities. Three main subtypes have been described. All variations of the condition affect the hair (tricho), nose (rhino) and fingers (phalangeal). The diagnosis is usually made through clinical examination augmented by hand radiographs that reveal characteristic cone-shaped epiphyses Sporadic case reports detailing TRPS have been described in the literature. We describe the first report of high-grade osteosarcoma presenting in two members of the same family with trichorhinophalangeal syndrome (TRPS).

Loading Royal Orthopedic Hospital collaborators
Loading Royal Orthopedic Hospital collaborators