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Journal of Bone and Soft Tissue Tumors (JBST) is the official Journal of The Indian Musculo Skeletal Oncology Society
Quality of Life and Functional Outcome of Patients Treated with Revision Limb Salvage Surgery and Amputation: A Cross-Sectional Study
Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 11-14| M S Satish, Srinivasan Vijay, Anand Raja, Surendran Veeraiah. DOI: 10.13107/jbst.2019.v05i02.428
Author M S Satish[1], Srinivasan Vijay[1], Anand Raja[2], Surendran Veeraiah[3]
[1]Department of Physiotherapist, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
[2]Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India,
[3]Department of Psycho-Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India.
Address of Correspondence
Dr. M S Satish,
Department of Physiotherapist, Cancer Institute(WIA), Adyar, Chennai, Tamil Nadu, India.
E-mail: ms.satish@cancerinstitutewia.org
Abstract
Context: Despite the advances in surgical treatments and chemotherapy, obtaining an optimal outcome in the treatment of musculoskeletal tumors or sarcomas is still quite challenging. This can be managed by improving various factors such as survival and recurrence rate, longevity of the prosthesis, functional outcome, and quality of life (QOL) of patients. However, not much attention has been given to this issue in India.
Aims: The aim of the study was to examine the QOL and functional outcome of musculoskeletal cancer patients who were treated with revision limb salvage surgery (LSS) and those who underwent above-knee (AK) amputation followed by rehabilitation with Akprosthesis.
Settings and Design: A cross-sectional study was carried out between May 2015 and April 2016 at Physiotherapy Out patient Department of Cancer Institute, Chennai.
Materials and Methods: Thirty-two patients aged between 15and 60 years, treated with revision LSS (n=15) and those rehabilitated with prosthesis after AK amputation (n=17)were assessed for QOL and functional outcome. Cancer Institute QOL questionnaire was used to assess QOL and Musculoskeletal Tumor Society score was used to find the functional outcome of these patients.
Statistical analysis: Descriptive statistics, student’s t-test, and Chi-square test were used to analyze the data using SPSS version 13.
Results: The revision LSS patients were found to have a better functional outcome as well as QOL than the amputees. Yet another aspect of QOL, namely, fear of recurrence was much lesser among AK amputees than revision LSS patients.
Conclusions: The findings of this study imply that revision LSS has higher advantages in terms of functional outcome and QOL of patients compared to amputation, though patients treated with revision LSS were found to have increased fear of recurrence and pain than the amputees.
Keywords: Revision limb salvage surgery, quality of life, functional outcome, amputation, musculoskeletal tumor.
References
1. Chauhan A, Joshi GR, Chopra BK, Ganguly M, Reddy GR. Limb salvage surgery in bone tumors: A retrospective study of 50 cases in a single center. Indian J Surg Oncol 2013;4:248-54.
2. Allison DC, Carney SC, Ahlmann ER, Hendifar A, Chawla S, Fedenko A, et al. A meta-analysis of osteosarcoma outcomes in the modern medical era. Sarcoma 2012;2012:704872.
3. Reddy KI, Wafa H, Gaston CL, Grimer RJ, Abudu AT, Jeys LM, et al. Does amputation offer any survival benefit over limb salvage in osteosarcoma patients with poor chemonecrosis and close margins? Bone Joint J 2015;97-B:115-20.
4. Yoshida Y, Osaka S, Kojima T, Taniguchi M, Osaka E, Tokuhashi Y, et al. Revision of tumor prosthesis of the knee joint. Eur J Orthop Surg Traumatol2012;22:387-94.
5. Davidson JH, Jones LE, Cornet J, Cittarelli T. Management of the multiple limb amputee. DisabilRehabil2002;24:688-99.
6. Zidarov D, Swaine B, Gauthier-Gagnon C. Quality of life of persons with lower-limb amputation during rehabilitation and at 3-month follow-up. Arch Phys Med Rehabil2009;90:634-45.
7. Robert RS, Ottaviani G, Huh WW, Palla S, Jaffe N. Psychosocial and functional outcomes in long-term survivors of osteosarcoma: A comparison of limb-salvage surgery and amputation. Pediatr Blood Cancer 2010;54:990-9.
8. Aksnes LH, Bauer HC, Jebsen NL, Follerås G, Allert C, Haugen GS, et al. Limb-sparing surgery preserves more function than amputation: A Scandinavian sarcoma group study of 118 patients. J Bone Joint Surg Br 2008;90:786-94.
9. Zahlten-Hinguranage A, Bernd L, Ewerbeck V, Sabo D. Equal quality of life after limb-sparing or ablative surgery for lower extremity sarcomas. Br J Cancer 2004;91:1012-4.
10. Weddington WW Jr.,Segraves KB, Simon MA. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage. J Clin Oncol 1985;3:1393-9.
11. Meyers PA, Gorlick R. Osteosarcoma. Pediatr Clin North Am 1997;44:973-89.
12. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin OrthopRelat Res 1993;286:241-6.
13. Vidhubala E, Kannan RR, Mani SC, Karthikesh K, Muthuvel R, Surendran V, et al. Validation of quality of life questionnaire for patients with cancer Indian scenario. Indian J Cancer 2005;42:138-44.
14. Eiser C, Darlington AS, Stride CB, Grimer R. Quality of life implications as a consequence of surgery: Limb salvage, primary and secondary amputation. Sarcoma 2001;5:189-95.
15. Ruggieri P, Mavrogenis AF, Mercuri M. Quality of life following limb-salvage surgery for bone sarcomas. Expert Rev Pharmacoecon Outcomes Res 2011;11:59-73.
16. Mason GE, Aung L, Gall S, Meyers PA, Butler R, Krüg S, et al. Quality of life following amputation or limb preservation in patients with lower extremity bone sarcoma. Front Oncol 2013;3:210.
17. Hopyan S, Tan JW, Graham HK, Torode IP. Function and upright time following limb salvage, amputation, and rotationplasty for pediatric sarcoma of bone. J PediatrOrthop2006;26:405-8.
18. Davis AM, Devlin M, Griffin AM, Wunder JS, Bell RS. Functional outcome in amputation versus limb sparing of patients with lower extremity sarcoma: A matched case-control study. Arch Phys Med Rehabil1999;80:615-8.
19. Malek F, Somerson JS, Mitchel S, Williams RP. Does limb-salvage surgery offer patients better quality of life and functional capacity than amputation? Clin OrthopRelat Res 2012;470:2000-6.
20. Renard AJ, Veth RP, Schreuder HW, van Loon CJ, Koops HS, van Horn JR, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol 2000;73:198-205.
21. Ginsberg JP, Rai SN, Carlson CA, Meadows AT, Hinds PS, Spearing EM, et al. A comparative analysis of functional outcomes in adolescents and young adults with lower-extremity bone sarcoma. Pediatr Blood Cancer 2007;49:964-9.
22. Bekkering WP, Vliet Vlieland TP, Koopman HM, Schaap GR, Bart Schreuder HW, Beishuizen A, et al. Functional ability and physical activity in children and young adults after limb-salvage or ablative surgery for lower extremity bone tumors. J Surg Oncol 2011;103:276-82.
23. Rougraff BT, Simon MA, Kneisl JS, Greenberg DB, Mankin HJ. Limb salvage compared with amputation for osteosarcoma of the distal end of the femur. A long-term oncological, functional, and quality-of-life study. J Bone Joint Surg Am 1994;76:649-56.
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Heterotopic Ossification Circumferentia Articularis (HOCA) of Hip Joint: A Case Series and Review of the Literature
Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 8-10| R Vaishya, A Goel, A K Agarwal, A Vaish. DOI: 10.13107/jbst.2019.v05i02.426
Author
R Vaishya[1], A Goel[1], A K Agarwal[1], A Vaish[1]
[1]Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India.
Address of Correspondence
Dr. Amit Kumar Agarwal,
Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi – 110 076,India.
E-mail: amitorthopgi@yahoo.co.in
Abstract
Introduction: Heterotopic ossification (HO) is often described as the mature, lamellar bone formed in a non-osseous tissue. This new bone formation usually occurs between muscle planes or between muscle and joint capsule. When it surrounds a joint circumferentially, it is known as (HO) Heterotopic Ossification circumferentia articular is circumferential articularis (HOCA). HOCA of the knee has been described earlier in the literature, but this term has never been described for the hip joint in the literature.
Case Presentation: We present a case series of two such patients having HOCA of hip joints. In both the cases, there was a history of brain injury and prolonged intubation, which seems the most likely predisposing factors in the causation of HOCA in these hips.
Conclusion: We believe that in our patient, the responsible factors for the causation of HOCA could be myriad of factors such as prolonged intensive care unit (ICU) stay with mechanical ventilation and hypoxia, long-standing immobilization, and hypomobility with incomplete flaccid paralysis. The surgical excision is quite challenging, extensive and is not advisable in most cases, and they respond symptomatically to conservative methods including analgesics, bisphosphonates, physiotherapy, and radiation.
Keywords: Heterotopic ossification circumferentia articularis, hip joint, neurological injury,
References
1. Damanski M. Heterotopic ossification in paraplegia. J Bone Joint Surg Br 1961;43:286-99.
2. Roberts P. Heterotopic ossification complicating paralysis of intracranial origin. J Bone Joint Surg Br 1968;50-B:70-7.
3. Evans EB, Smith JR. Bone and joint changes following burns; a roentgenographic study; preliminary report. J Bone Joint Surg Am 1959;41-A:785-99.
4. Garland DE. A clinical perspective on common forms of acquired heterotopic ossification. Clin Orthop Relat Res 1991;263:13-29.
5. Sakellariou VI, Grigoriou E, Mavrogenis AF, Soucacos PN, Papagelopoulos PJ. Heterotopic ossification following traumatic brain injury and spinal cord injury: Insight into the etiology and pathophysiology. J Musculoskelet Neuronal Interact 2012;12:230-40.
6. Brooker AF, Bowerman JW, Robinson RA, Riley LH Jr. Ectopic ossification following total hip replacement. Incidence and a method of classification. J Bone Joint Surg Am 1973;55:1629-32.
7. Pape HC, Marsh S, Morley JR, Krettek C, Giannoudis PV. Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br 2004;86:783-7.
8. Dejerne A, Ceiller A. Para-osteo-arthropathies des paraplegiques par lesion medullaire: Etude clinique et radiographique. Ann Med1918;5:497.
9. Bushinsky DA. Metabolic alkalosis decreases bone calcium efflux by suppressing osteoclasts and stimulating osteoblasts. Am J Physiol 1996;271:F216-22.
10. Singer BR. Heterotopic ossification. Br J Hosp Med 1993;49:247-51, 254-5.
11. Vaishya R, Agarwal AK, Vijay V, Vaish A. Heterotopic ossification circumferentia articularis (HOCA) of both knee joints after guillain-barré syndrome. Cureus 2016;8:e480.
12. Melamed E, Robinson D, Halperin N, Wallach N, Keren O, Groswasser Z, et al. Brain injury-related heterotopic bone formation: Treatment strategy and results. Am J Phys Med Rehabil 2002;81:670-4.
13. Spielman G, Gennarelli TA, Rogers CR. Disodium etidronate: Its role in preventing heterotopic ossification in severe head injury. Arch Phys Med Rehabil 1983;64:539-42.
14. Banovac K, Williams JM, Patrick LD, Haniff YM. Prevention of heterotopic ossification after spinal cord injury with indomethacin. Spinal Cord 2001;39:370-4.
15. Sautter-Bihl ML, Liebermeister E, Nanassy A. Radiotherapy as a local treatment option for heterotopic ossifications in patients with spinal cord injury. Spinal Cord 2000;38:33-6.
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A Giant Parosteal Lipoma with Exostosis of the Right Proximal Humerus
Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 4-7| Abdaud Rasyid, Mujaddid Idulhaq, Pamudji Utomo, Ambar Mudigdo, Handry Tri Handojo. DOI: 10.13107/jbst.2019.v05i02.424
Author Abdaud Rasyid[1],[2], Mujaddid Idulhaq[1],[2], Pamudji Utomo[1],[2], Ambar Mudigdo[3], Handry Tri Handojo[4]
[1]Department of Orthopaedic and Traumatology, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia,
[2]Department of Orthopaedic and Traumatology, Prof. DR. R. Soeharso Orthopaedic Hospital, Surakarta, Indonesia,
[3]Department of Anatomical Pathology, Sebelas Maret University, Surakarta, Indonesia,
[4]Department of Radiology, at Prof. DR. R. Soeharso Orthopaedic, Hospital, Surakarta, Indonesia.
Address of Correspondence
Dr. Abdaud Rasyid,
Jalan Ahmad Yani, Pabelan, Kartasura, Sukoharjo, Jawa Tengah, 57162, Indonesia.
E-mail: abdaudry@gmail.com
Abstract
Introduction: Lipomas are the most frequent benign soft-tissue tumors. Soft -tissue lipomas are categorized by anatomic location as either superficial (subcutaneous) or deep (intermuscular). Deep lipomas can be located in any part of the body, including the superior extremities. Lipomas typically reach a diameter of several centimeters and are localized in a single anatomical region. Parosteal lipoma is a rare subtype of deep lipoma that has a broad attachment to the underlying periosteum that forms an exostoses-like bone prominence. There has been no reliable literature; about two pathological processes occur in one extremity at the same time.
Case Presentation: A 49-years -old female presented at our institution with a painless, slow -growing lump in her right shoulder region since for 2 years ago, with no other symptoms, and no history of trauma. A palpable non-tender mobile mass was present on the right shoulder region. Plain radiographs showed a well-delineated ovoid radiolucent lesion and a radiopaque lesion over the right proximal humerus. The fine -needle biopsy result suggested a liposarcoma. Wide-excision surgery was performed for both the masses. On contrary, the histological examination of the specimen confirmed a giant lipoma with pieces of adult bone tissues.
Conclusion: Deep-seated lipomas are most commonly discovered in men between the ages of thirties 30s and sixties60s. In our patient, the lipoma also accompanied with an exostoses-like cartilaginous mass over the proximal humerus as in parosteal lipoma. Plain radiographs study of parosteal lipoma is associated with a false osteochondroma appearance, which also found in this patient. Histological examination suggested a giant lipoma for this patient, but the possibility of two pathological processes is still in question.
Keywords: Giant lipoma, shoulder, exostosis, surgery.
References
1. Slavchev S, Georgiev PP, Penkov M. Giant lipoma extending between the heads of biceps brachii muscle and the deltoid muscle: Case report. J Curr Surg 2012;2:146-8.
2. Stevenson J, Parry M. Tumours. In: Apley and Solomon’s System of Orthopaedics and Trauma, 10th ed. Vol. 9. Ch. 9. Florida: CRC Press; 2018. p. 223-4.
3. Singh V, Kumar V, Singh AK. Case report: A rare presentation of giant palmar lipoma. Int J Surg Case Rep 2016;26:21-3.
4. Elbardouni A, Kharmaz M, Salah Berrada M, Mahfoud M, Elyaacoubi M. Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases. Orthop Traumatol Surg Res 2011;97:152-8.
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Sternal Mass with Respiratory Compromise in a 10-year-old Child
Case Report | Volume 5 | Issue 2 | JBST May – August 2019 | Page 2-3| Ranjit K Sahu, Alok K Sharma, Surendra Patel, Prakash Kala, Amit Goyal, Sourabha K Patro. DOI: 10.13107/jbst.2019.v05i02.422
Author: Ranjit K Sahu[1], Alok K Sharma[2], Surendra Patel[2], Prakash Kala[1], Amit Goyal[3], Sourabha K Patro[3]
[1]Department of Plastic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,
[2]Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India,
[3]Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
Address of Correspondence
Dr. Sourabha Kumar Patro,
Department of Otorhinolaryngology, All India Institute of Medical Sciences, Jodhpur – 342 005, Rajasthan, India.
E-mail: sourabhlipi@gmail.com
Abstract
Context: Enlarging sternal masses are critical to manage due to proximity of various vital structures nearby. Association of respiratory compromise or vascular compression still worsens the issue. We here present a case of multiple enchondromas primarily affecting the ribs and upper part of sternum and presented as a swelling in upper chest and lower neck with a history of compressive respiratory compromise. The child was later taken for shaving off of the lesion for relieving the respiratory compromise. Absence of the swelling was a definite cosmetic outcome for the child and the parents; however, relieve of respiratory compromise was a worthy addressed need.
Keywords: Enchondroma, multiple enchondroma, Ollier’s disease, giant sternal mass, sternal mass with respiratory compromise.
References
1. Demetriou GA, Marcou M, Demetriou A, Kyriakides C. A fast growing sternal mass. BMJ case Rep 2013;2013:bcr2013008673.
2. Sunny G, Hoisala VR, Cicilet S, Sadashiva S. Multiple enchondromatosis: Olliers disease-a case report. J Clin Diagn Res 2016;10:1-2.
3. Pansuriya TC, Kroon HM, Bovee JV. Enchondromatosis: Insights on the different subtypes. Int J Clin Exp Pathol 2010;3:557-69.
4. Wee HE, Akbar FA, Rajapaksha K, Aneez DB. Anterior chest wall resection and reconstruction for locally advanced breast cancer. Multimed Man Cardiothorac Surg. 2015 Sep 11;287(6)
5. Chen C, Huang X, Chen M, Yu F, Yin B, Yuan Y. Surgical management of a giant sternal chondromyxoid fibroma: a case report. Journal of cardiothoracic surgery. 2015 Dec;10(1):178.
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How to SetUp an ADP Portal Account?
A big motivator for ADP is “Automatic Data Processing.” It is an American provider of HR executives programming and administrations. ADP was established in the year 1949 by Henry Taub. In excess of 650,000 benefactors utilize this product, and it serves in excess of 110 nations. The motto of ADP is to help associations of any sort and size in unlocking their marketing potential. The link to ADP’s authentic site is ‘ADP’ this. Here, you can get to different administrations, for example, Human asset, payroll, assessment, and advantages, and so on.
ADP portal login & sign up to employee portal which enables employees to log into the portal and make changes alone without having to visit the HR office and invest their important energy standing in the long line.
Employees can utilize different capacities which include viewing pay explanations, deal with a retirement account, set up their very own immediate store, update contact information, and so on. An employee can likewise document life change information, for example, moving, the introduction of a tyke, marriage which currently needs benefits inclusion. Using these online tools, an employee can likewise oversee different accounts. You will likewise find payroll calculators which help in calculating payrolls.
How to Set Up an ADP Portal Account?
Stage 1-Fist, Open “https://www.adp.com” and then Go to ‘Contact and Support’ >> ‘Deals.’
Stage 2-You will be diverted to a new page. Here, plan a business counsel. On the whole, you have to enter the name of your organization, your first name, last name, number of employees, and so on you likewise need to choose the administration zone you are interested in. A devoted space is assigned to enter any kind inquiry or remark.
Stage 3-Now, click on ‘Contact Sales’ and you can approach any of without toll number which is accessible 24 hours every day and 7 days seven days. On the off chance that you like to visit with deals, this administration is accessible just open from Monday to Friday, lasting from 8:00 am – midnight ET. The business official will guide you through the further procedure.
At the bottom of this page, you will find a choice to get your quote. When you join, you may get a free administration for a month or two depending on the offer accessible.
How to Login to your ADP Account?
Stage 1-Click on ‘User Logins’ choice situated at the top right corner of the site.
Stage 2-You will be diverted to a page where you will find all the different logins accessible on ADP. You can choose the fitting choice and snap on ‘Employee Login’ on the off chance that you are an employee or snap-on ‘Administrator Login’ on the off chance that you are an administrator.
Stage 3-Now, enter your username and password and then, click on ‘Login’ to log into your ADP account. You can check the ‘Recollect User ID’ box with the goal that you don’t have to enter your user ID whenever you attempt to login to your ADP account. It will automatically show up in the field.
What to do in the event that you overlook your ADP iPay password?
On the off chance that you overlook your password, click on ‘Overlooked Password’ and then, answer all the security inquiries to change your password. Then, you will be provided with a new user ID and new password to log in to the application.
The above procedure remains the equivalent in the event that you overlook your user ID.
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How and Where to Buy USPS Stamps?
You realized it was all consuming, instant adoration when you saw a lot of US postage stamps. Be that as it may, just like any Romeo, you are somewhat worried to start stamp gathering because you have a disrupted inquiry regarding American stamps.
You have gone to the perfect spot as we have assembled the who, what, when, who, and other conceivable questions you need to be replied about the United States postal stamps.
On the off chance that you are another stamp authority who is intrigued about the US stamp history and different raw numbers on American philately, this article will definitely be convenient in charming the USPS stamp you have been longing for.
1) Who were the main men to be included on US postage stamps?
Did you realize that the principal US postage stamp highlighted Benjamin Franklin and George Washington? Both were remarkable figures amid the American Revolution and they earned their distinctions as the initial two men to be included on the primary United States stamps in 1847.
2) What was the littlest measure of US stamps made?
The Graf Zeppelin stamps have the most modest number of issues of complete stamps in the twentieth century. Just 61, 296 bits of these USPS stamps were sold.
Then again, the Norse American stamps were known to be the least delivered dedicatory stamps in the USA. They were imprinted in sheets of 100 stamps rather than the usual 200 stamps.
3) Are US stamps legitimate delicate?
No. US postage stamps are not legitimate delicate and thus they can’t be taken for the installment of merchandise and enterprises.
4) Are US postage stamps made in China?
No. US postage stamps are made by the United States Postal Service and they are not produced outside the nation.
General data on the United States stamps
1) Who approves USPS stamps?
The USPS alone is the main specialist to issue United States stamps. In any case, the USPS has a few approved sellers or merchants who can make custom stamps, for example, Click-N-Ship and Stamps.com.
2) What division stamps are sold by the US postal administration?
USPS postage stamps are accessible in the accompanying divisions:
$0.01, $.02, $.03,$ .04, $.05, $.09, $.10, $.17, $.20, $.23, $.24, $.27, $.28, $.40, $.42, $.44, $.50,$ .59, $.60, $.61, $.62, $.64, $.70, $.72, $.79, $.80, $.83, $.94, $.98, $1, $2, $4.80, $4.95, $5, $16.50, and $17.50
3) What are non named American stamps?
USPS non named stamps are postage stamps that are not printed with assumed estimations in spite of the fact that they have comparing groups or postage esteems.
Be that as it may, non named stamps can be printed with letters called nonesteem pointers. Thus, these are called nonesteem pointer (NVI) stamps, and they are issued by USPS in the accompanying sections:
4) Do stamps have expired date?
No. Postage stamps, when all is said in done, don’t have expiry dates. You can use your United States postage stamps – regardless of whether it’s an old or new issue – for whatever length of time that it is mint or it’s anything but a used stamp or a dropped stamp.
5) What are the assumed worth of US everlastingly stamps?
The USPS perpetually stamps don’t have face esteems. These non-named stamps are legitimate for top-notch sends. They are called always stamps because their esteem remains ceaselessly the equivalent regardless of whether the postal administration rates go up.
For instance on the off chance that you purchased an eternity stamp for $ 0.39 and the top-notch mail increments to $0.44, you can, in any case, use your eternity stamp in your postage for no extra charge.
How and where to buy USPS stamps?
1) How to buy stamps from USPS on the web?
Buying USPS stamps online is simple. You can buy stamps from the USPS online postal store and from other philatelic sites that issue US stamps. Keep in mind, read and comprehend the terms and conditions first before you buy stamps on the web.
2) what number of US stamps are a proportional per ounce of mail?
The quantity of US stamps identical to the ounce per mail relies upon the US postal administration rate. The USPS rate may increment every now and then. To find out about the stamps per ounce equal, you can visit the USPS postage number cruncher.
3) Where to buy US postage Christmas stamps?
You can buy Christmas stamps from any USPS branches amid the Christmas season. You can likewise have customized Christmas photograph stamps from USPS-approved sites like Zazzle.com.
4) Where to buy US stamps in Canada?
You can buy dropped US postage stamps from most neighborhood stamp sellers in Canada. Be that as it may, on the off chance that you need to buy mint American postage stamps, you can generally arrange over the web, all things considered, gathering stamps online are turning into a philatelic prevailing fashion. The American Postal Service ships USPS stamps to all goals around the globe.
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