Cardiff is a pre-dispersal, arrival centre for asylum seekers (AS) to the UK. Following NICE guidelines, the Cardiff TB team screens and treats AS for latent TB infection (LTBI). However, many of these AS do not remain in Cardiff as they are subsequently dispersed by UK Visa and Immigration (UKVI), often at short notice. We aimed to investigate whether treatment completion is affected by dispersal away from Cardiff and whether treatment initiation should be delayed until it is known whether an AS will be dispersed. We completed a retrospective case note analysis of all AS offered treatment for LTBI in Cardiff, between 1/1/2014 and 31/12/2016. We collected data on patient demographics, dispersal destination, whether treatment completion was confirmed and any reasons for non-completion of treatment. We then contacted 17 other TB teams in the areas to which records showed AS had been dispersed, by mail and telephone, in order to obtain details of treatment outcomes. We identified 264 AS diagnosed with LTBI in Cardiff over 3 years: 122 (46%) remained in Cardiff for the duration of treatment, with 92% of these completing treatment. Confirmation of treatment completion was significantly lower in AS dispersed both prior to starting treatment (69%) and during treatment (71%). We further analysed results after excluding 9 AS for whom follow up information was missing,having been dispersed to the care of 3 TB teams whom we were unable to contact: The difference in completion between AS remaining in Cardiff and those dispersed elsewhere remained statistically significant. Our data highlight the difficulties that TB teams face in following-up AS who are frequently dispersed abruptly around England and Wales. The results of this analysis provide insufficient evidence that treatment should be delayed in case an AS is subsequently dispersed, however this finding may depend on accurate and timely knowledge of AS dispersal destinations and adequate communication between TB teams. A more cohesive relationship between the UKVI service and TB teams and a centralised database of AS receiving treatment for LTBI are two recommendations to improve follow-up and treatment completion.

BACKGROUND:Limb salvage is viable in the majority of patients with malignant bone tumors, but especially in case of extensive tumors and bad soft tissue conditions, it is challenging in upper extremity.OBJECTIVES/METHOD:The clinical and radiological results of 21 patients, who had free vascularized fibular grafts (VFG), for diaphyseal (14), and epipyseal (7) defect reconstruction of the upper extremity, are presented. The indications for VFG were resection after osteosarcoma (9 cases), Ewings sarcoma (9 cases), chondrosarcoma (1 case), rhabdomyosarcoma (1 case), and 1 case of fibrous dysplasia. The 20 malignant tumors were staged as follows: 2a (1), 2b (18), 3 (1). The mean follow-up was 43.6 months (min 6.0-max 131.9). Functional results were described and graded quantitatively according to the MSTS-score.RESULTS:Results were satisfactory with regard to pain, emotional acceptance, manual dexterity, and function. Lifting ability was decreased in two patients. Hypertrophy index was 31% (min 13%-max 71%). Main complications were fracture (5), pseudoarthrosis (4), prolonged wound healing (4), temporary nerve irritation (2), and deep infection (1). Re-operation was required in eight patients (12 operations).CONCLUSION:VFG offers a good possibility for biological reconstruction of large skeletal defects, with an acceptable complication and re-operation rate. When conservative treatment of complications was not successful, further surgery led to recovery in the majority of cases.

Introduction : Infection associated with prosthesis used after tumor resection is a common and serious complication. The purpose of the current retrospective study was to describe the course of infection in patients with a tumor endoprosthesis and the determination of risk factors associated with failed limb salvage. Material and Methods : 30 patients with an infection associated with a tumor endoprosthesis were investigated with regard to treatment strategies, number and type of revision operations, duration of hospital stay, determination of risk factors associated with failed limb salvage and final outcome. Results : Limb salvage related to the complication infection was achieved in 19 patients (63.3%). Two-stage reimplantation of an endoprosthesis was successful in 14 patients but subsequently failed in one patient. Out of 11 patients where limb salvage failed, an amputation was performed in 6 patients, a rotationplasty in 4, and stump lengthening procedure in 1 patient. A poor soft tissue condition was a significant ( P <0.05) risk factor for failed limb salvage. No patient receiving chemotherapy with a poor soft tissue condition had limb salvage surgery. The mean number of revision operations per patients was 2.6. The mean duration of hospital stay was 68 days. Conclusion : Infection associated with prosthesis is a serious complication and is involved with long hospitalization. Limb salvage failed mostly in the case of a poor soft tissue condition. In these cases repeated revision surgery should be avoided and ablative surgery recommended at an early stage. Rotationplasty is an alternative to amputation in the case of an infection of the proximal or distal part of the femur.