Achmad Fauzi Kamal

Autologous mesenchymal stem cell (MSCs) transplantation for critical-sized bone defect following a wide excision of osteofibrous dysplasia

Highlights • No recurrence of osteofibrous dysplasia at 84 week following a wide extraperiosteal excision.• The combination of autologous BM-MSCs, HA granules and BMP-2 successfully created new bone tissue.• The newly formed bone tissue filled in the gap of critical-sized bone defect and was able to improve the patient’s quality of life significantly.• No neoplastic, immunologic or other side-effects were noted at 84 weeks after autologous MSC transplantation.

Lipoblastoma and Lipoblastomatosis of the Lower Leg

Lipoblastoma is a benign lesion of immature fat cells that is found almost exclusively in pediatric population. This tumor is a rare tumor that occurs in infancy and early childhood, accounting for less than 1% of all childhood neoplasm. It is more common in male than in female and often presents as an asymptomatic, rapidly enlarging, soft lobular mass on the extremity. Although benign, it gives great difficulty in its management, due to its extensions into different facial planes, especially in lipoblastomatosis. Thus, complete surgical excision is the treatment of choice.

Wide resection versus curettage with adjuvant therapy for giant cell tumour of bone.

Purpose To determine the association between type of surgery (wide resection versus curettage with adjuvant therapy) and outcome in patients with giant cell tumour (GCT) of bone. Methods Records of 30 male and 52 female consecutive patients aged 10 to 62 years who underwent wide resection (n=57) or curettage with adjuvant therapy (n=25) for primary GCT of bone were reviewed. The surgical decision was based on patient age, tumour location, functional demand, and patient preference. The median tumour size was 8.5 cm. Tumours were classified as stage 1 (n=4), stage 2 (n=60), and stage 3 (n=18), and 25%, 68.3%, and 83.3% of them were treated with wide resection, respectively. Functional outcome was assessed using the Musculoskeletal Tumor Society (MSTS) score; the maximum score was 30. Results The wide resection and curettage with adjuvant therapy groups were comparable in terms of patient age, gender, tumour size, location, symptoms, tumour stage, type of biopsy, and MSTS score. The MSTS score was excellent in 50.2% of patients, good in 38.7% of patients, and fair and poor in the remaining patients. The MSTS score was not associated with tumour stage or type of surgery. Four patients in the wide resection group had metastasis to the lung. They also had lower haemoglobin level (10.6 vs. 12.7 g/dl, p=0.020) and higher percentage of stage-3 tumour (100% vs. 17.9%, p=0.001) but had no recurrence (0% vs. 6.4%, p=0.774), compared with those without metastatsis. All died from massive haemoptysis and respiratory failure. Eight patients died; their haemoglobin level was lower than that of patients who were still living (11.2 vs. 12.7 g/dl, p=0.032). Mortality was associated with metastasis (100% vs 5.2%, p<0.001) but not recurrence or complication. Two patients in each group had recurrence; recurrence was not associated with type of surgery. Conclusion There was no association between type of surgery and tumour recurrence, metastasis, or outcome. Curettage with adjuvant therapy was more commonly performed for stage 1 and 2 tumours, whereas wide resection was more for stage 3 tumours. Metastasis was associated with stage 3 tumour and mortality but not recurrence.

Correlation between Survival and Tumour Characteristics in Patients with Chondrosarcoma

Purpose. To evaluate the correlation between survival and tumour characteristics in 23 patients with chondrosarcoma. Methods. Records of 15 men and 8 women aged 14 to 66 (mean, 37) years who were diagnosed with primary (n=19) or secondary (n=4) chondrosarcoma of the axial skeleton (n=8), proximal extremity (n=9), or distal extremity (n=6) were reviewed. The tumour diameter was <10 cm in 4 patients, 10–19 cm in 12, and 20–30 cm in 7. The tumour involved the intramedullary in 17 and the periosteum in 6 patients; tumour extension was intracompartmental in 5 and extracompartmental in 18 patients. The Evans histological grade for the tumours was grade 1 in 6 patients, grade 2 in 10, and grade 3 in 7. The mean tumour size was 12.3 cm for grade 1 tumours, 18.2 cm for grade 2 tumours, and 18.3 cm for grade 3 tumours. 13 patients had no metastasis and 3 of 10 patients with grade 2 tumours and all 7 patients with grade 3 tumours had metastasis to the lung at presentation. 17 patients underwent surgery, one underwent adjuvant treatment only, and 5 declined treatment. Results. The mean follow-up period for the 23 patients was 3.1 years (range, 3 weeks to 9 years). The 5-year survival rate was 43% overall, 83.3% for grade 1 tumours, 50% for grade 2 tumours, and 0% for grade 3 tumours. The median survival duration was 20 (95% confidence interval, 11–29) months. Two patients had local recurrence and 16 did not, and the 5 patients who declined treatment died. Survival correlated with Evans histological grading (p=0.004), the presence of metastasis at presentation (p=0.026) and local recurrence (p=0.004). Conclusion. The survival rate was lower in patients with higher Evan grading, metastasis, or local recurrence.

Bilateral iliopsoas haemophilic “soft tissue pseudotumours”: A case report

Highlights • Haemophilic pseudotumour was caused by repetitive bleeding.• This is a bilateral iliopsoas pseudotumour with neurologic deficit and contracture.• After excision, there was improvement in muscle power from score 2/5 to 4/5.• Recurrent bleeding will cause joint contractures chronic pain and nerve compression.• Surgery should be performed in major center by an integrated surgical team.

Pelvic haemophilic pseudotumour: a case report.

We report on a 30-year-old haemophilic man with a pelvic pseudotumour compressing adjacent structures causing pain and swelling and destruction of surrounding soft tissues and bones. He underwent evacuation of the pseudotumour, acetabular reconstruction using the Harrington procedure, and total hip arthroplasty.

Management of aggressive giant cell tumor of calcaneal bone: A case report

Highlights • This is an advanced case of aggressive GCT of calcaneus.• It is not only a rare case but also an interesting diagnosis and surgical management.• Limb salvage surgery which consists of wide excision-total calcaneoctomy, followed by reconstruction with femoral head allograft and soft tissue coverage with sural flap is a good option.

Trauma and Injury Severity Score in Predicting Mortality of Polytrauma Patients

TRISS (Trauma and Injury Severity Score) is one of the most commonly used trauma score. Currently, there is no data about using TRISS in the care of polytrauma patients at emergency department of dr. Cipto Mangunkusumo Hospital (CMH). This research was intended to evaluate whether TRISS can predict the mortality of polytrauma patients at CMH. This was an analytic descriptive study with retrospective cohort design. Data was collected from medical records of polytrauma patients who were admitted to emergency department of CMH from 2011-201 4 then we analyzed the relationship between TRISS and patients prognosis. Furthermore, we conducted bivariate and multivariate analysis by SPSS 20 software. Seventy medical records were included in this study. The majority of patients were male (65%) in young age. There were 69 patients who experienced blunt trauma, with the majority (94.3%) were caused by motor vehicle accident. After receiving trauma care, there were 26 deaths, while other 44 patients survived. From bivariate and multivariate analysis, we found a significant difference between TRISS and patients prognosis. TRISS strongly predicts polytrauma patients mortality (AUC 0,899; IK95% 0,824-0,975). TRISS has 84,6% sensitivity and 81.8% specificity with optimal intersection point ≤ 90,5. TRISS is able to predict the mortality of polytrauma patients at CMH.

Isolation, Culture and Characterization of Cancer Stem Cells from Primary Osteosarcoma

RESEARCH ARTICLE Isolation, Culture and Characterization of Cancer Stem Cells from Primary Osteosarcoma Achmad Fauzi Kamal , Deded Yudha Pranatha, Waluyo Sugito, Faisal Rahman, Eka Susanto, Silmi Mariya and Wei Ming Chen Department of Orthopaedic & Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Stem Cell Integrated Medical Technology Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia Department of Anatomic Pathology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia Primate Research Center, Bogor Agricultural Institute, Bogor, Indonesia Department of Orthopaedic Surgery, Taipei Veterans General Hospital, Taipei, Taiwan

Low-grade intramedullary osteosarcoma presenting with multiple sclerotic bone lesions

Low-grade intramedullary osteosarcoma is a less-aggressive type of osteosarcoma for which delays in diagnosis are common. We present the case of a 42-year-old woman with complaints of low back pain. Multiple imaging evaluations and biopsy procedures were necessary to make the final diagnosis. The key radiologic feature was multiple sclerotic lesions throughout the skeleton, best seen on the bone scan. The difficulties in diagnosing this condition are evident in this case.