PubMed Health⌕ Search

Biomedical subjects

M E Pitcher

Publications and source records attributed to M E Pitcher.

8 recordsLinked to original sources
PubMed2000

Outcome of treatment for limb and limb girdle sarcomas at the Royal Marsden Hospital.

AIMS: In this study we aimed to determine local recurrence, mortality an d amputation rates in patients presenting with limb and limb girdle soft tissue sarcomas. METHOD: A review of all 439 patients presenting with p rimary or recurrent soft tissue sarcomas of limb and limb girdle to the Royal Marsden Hospital between 1989 and 1995 was carried out. RESULTS: The local recurrence rate was 15.5% and the mortality rate was 30%, with a median follow up of 3.2 years and an overall amputation rate of 4.8%. CONCLUSION: The outcome of limb and limb girdle sarcomas in this study i s comparable to those reported elsewhere.

Amputation, Surgical↗
PubMed1998

Pre-operative core biopsy of soft-tissue tumours facilitates their surgical management.

BACKGROUND: Soft-tissue sarcomas are rare, and clinical differentiation of benign tumours from sarcomas is sometimes impossible. Further, the diagnosis of soft-tissue sarcomas may be unsuspected pre-operatively, and the presenting mass enucleated. While enucleation (excisional biopsy) is acceptable for benign lesions, it is inappropriate for sarcomas, because the opportunity for the most effective management resulting in both adequate local control and functional limb salvage surgery is compromised. A high rate of wound complications following open incisional biopsy may also compromise local treatment. Inappropriate siting of the incision for both incisional and excisional biopsies may adversely affect subsequent surgery and radiotherapy. METHODS: We therefore assessed the accuracy of core biopsy in the diagnosis of soft-tissue tumours, and planning of definitive surgery. All patients with primary soft-tissue tumours managed by two surgeons with a special interest in soft-tissue sarcomas since 1991 were reviewed. More than half (53%) were referred from other specialists. RESULTS: Of 45 cases, 37 (82%) were referred with the tumour intact, and of these 31 (84%) underwent core biopsy. The overall accuracy of core biopsy was 84%. The sensitivity was 94%, with 100% specificity. In most patients this allowed planning of definitive one-stage surgery (P < 0.005). Of the remaining five non-diagnostic cores, four were benign and one was a non-specific malignancy. CONCLUSIONS: Core biopsy has a high degree of accuracy in the diagnosis of soft-tissue tumours, particularly malignant lesions, and is not misleading. Core biopsy avoids the complications of open biopsy, and enables planning of one-stage surgery when used in combination with appropriate imaging.

Adult↗
PubMed1994

Management of soft tissue sarcoma.

A total of 485 patients with a proven or suspected diagnosis of soft tissue sarcoma were referred over a 3-year period. Of these, 61 were referred for opinion only and 424 for definitive treatment. Overall there were 223 patients with primary soft tissue sarcoma and 84 with recurrent sarcoma, 84 with benign soft tissue tumours and 22 with non-soft tissue sarcoma malignancy; 11 patients were referred with known metastatic disease. The commonest benign tumours mimicking soft tissue sarcoma were fibromatosis and benign intermuscular or intramuscular lipoma. The malignant tumours suspected clinically of being soft tissue sarcoma were bone tumours, lymphoma and metastatic carcinoma. Of the 172 patients with primary soft tissue sarcoma referred with a proven diagnosis this had been established by excision biopsy in 94 and open incision biopsy in 48. By contrast, of those undiagnosed at referral, 44 of 51 patients with soft tissue sarcoma had the diagnosis made by Tru-cut core biopsy. Amputation was performed in four of 165 patients with primary extremity soft tissue sarcoma and in five of 54 with recurrent extremity sarcoma, giving an overall amputation rate of 4 per cent. It is proposed that the amputation rate for extremity soft tissue sarcoma can be reduced by the use of reconstructive procedures, particularly myocutaneous flaps to the proximal limbs and limb girdles, and free vascularized flaps to sites distal to the midthigh and midarm.

Adolescent↗
PubMed1994

Functional compartmental resection for soft tissue sarcomas.

The necessary extent of surgical resection in soft tissue sarcomas of the extremities remains controversial. In the absence of effective adjuvant therapy to prevent metastatic disease the aim of treatment is to minimize local recurrence and to preserve function. Intracompartmental soft tissue sarcomas arising entirely within a muscle compartment may be treated by a resection which preserves some innervated muscle within that compartment rather than by total compartmental resection. The functional outcome of patients with quadriceps and buttock sarcomas treated by such functional compartmental resection is reported. Thirty-seven patients whose tumours were entirely intra-compartmental, were identified from a consecutive series of 179 patients with soft tissue sarcomas of the pelvic girdle and lower limb seen at the Royal Marsden Hospital between October 1989 and April 1993. Twenty-four were still alive for assessment of range of movement, muscle strength and functional ability. Although objective limitation of movement and muscle power were identified in the majority, the level of function was either normal or only mildly impaired in the entire group. All walk independently and of those undergoing functional compartmental resection of quadriceps or buttock, eight of the nine patients employed at the time of diagnosis have returned to their previous employment. Sporting activities were more commonly affected but the majority were able to continue previous activities with minor modification such as wearing a knee support. Functional compartmental resection is associated with a satisfactory functional outcome, is not associated with an increased risk of local recurrence and patients can be reassured that they should be able to return to their previous level of activity.

Adolescent↗
PubMed1994

Post irradiation sarcoma of soft tissue and bone.

Thirty-eight patients with sarcomas of soft tissue and bone which followed previous radiotherapy have been treated at the Royal Marsden Hospital between 1951 and 1992. The commonest reasons for initial radiotherapy were carcinoma of the breast and lymphoma, and the median time to development of sarcoma was 11 years. The only long term survivors were those who had complete surgical excision. Seven patients required forequarter amputation (30% of the extremity sarcomas) which reflects their frequent situation in the shoulder girdle and upper arm and the close proximity to the brachial plexus and vascular bundle. The overall prognosis was poor (5-year survival 30%) and probably reflects the poor prognostic factors (size, grade and tumour site) present at the time of diagnosis.

Adolescent↗
PubMed1989

Splenectomy for trauma: morbidity, mortality and associated abdominal injuries.

Management of ruptured spleen still frequently requires splenectomy. A retrospective analysis of patients undergoing splenectomy for trauma at Box Hill Hospital, Melbourne, over a 14-year period was conducted; 141 of 145 cases were due to blunt trauma. The mortality rate was 10% and all deaths occurred as a result of road traffic accidents. The overall complication rate was 43%, varying from 25% in those with an isolated splenic injury to 100% with multiple system injuries. There was zero incidence of associated intra-abdominal injury in the group sustaining a ruptured spleen as a result of a fall, assault or sporting injury, in contrast to a nearly 50% incidence following road traffic and bicycle accidents. Whether these associated injuries would have been neglected had laparotomy for splenic trauma not been performed is uncertain, and so non-operative management of splenic trauma remains contentious, particularly in cases following vehicular accidents.

Abdominal Injuries↗