Surgical consideration for benign bone tumors

Background: The surgical management of symptomatic benign bone tumor has been described in various manners in medical literature. However, there are few published reports on the presentation and surgical management of benign bone tumors in black African patients.Objectives: To determine the pattern of presentation of benign bone tumors and evaluate the common indications for surgery in a Nigerian Orthopedic Center.Materials and Methods: This is a prospective study of 67 patients, surgically treated for benign bone tumors, over a three-year period, at the National Orthopedic Hospital, Lagos, Nigeria.Results: The common histological types include, osteochondroma, giant cell tumor, and the simple bone cyst. These tumors have varying anatomic locations, but are more commonly located around the knee joint. In this series, most of the patients have presented with an active or aggressive stage of the disease. The most common indication for surgery is painful swelling; other indications include a pathological fracture, restricted range of movement, and peripheral nerve compression. The surgical procedures performed are simple excision, curettage, and stabilization; and 1-stage and 2-stage wide resection with reconstruction. Patients with significant bone defects have autologous bone grafting or methylmethacrylate cement application. Further stabilization is achieved with intramedullary or compression plate and screw fixation. Amputation has only been necessary in one patient with a huge aneurysmal bone cyst. At the average follow-up period of 28.6 months, five patients showed recurrence. All were with a histological diagnosis of giant cell tumor.Conclusions: The mode of presentation of benign bone tumors in this group of black African patients is heterogenous, demanding various surgical options. Limb sparing is a largely feasible option, but the recurrence rate is particularly higher for giant cell tumors. Increase in the number of patients presenting with giant cell tumors raises the possibility of an increase in the incidence of this condition in the black African population. Larger multicenter studies in the black African population may shed more light on the actual incidence of giant cell tumors and other bone tumors in this group of patients

Imprint cytology of osteosarcoma of the jaw: a case report

Introduction. Osteosarcomas are highly malignant bone-forming neoplasms that account for about 20% of all sarcomas. In light of their aggressive behavior, early diagnosis is crucial for determining adequate treatment. Dental professionals may be the first to detect jaw osteosarcomas in their initial stages. The aim of this case report is to draw attention to the possibility of diagnosing this tumor based on clinical, radiographical and cytological characteristics before confirmation by histology. Case presentation. A 24-year-old Afro-Brazilian man presented with swelling and pain on the left side of the mandible in the region of the third molar (tooth 38). Radiography showed a poorly delimited intraosseous lesion with radiolucent and radiopaque areas. The cytological aspects were consistent with the diagnosis of osteosarcoma, which was confirmed by biopsy. Conclusion. Imprint cytology was found to be a reliable, rapid and easy complementary examination. An early diagnosis of osteosarcoma of the jaw is fundamental to the early determination of an adequate treatment. © 2009 Cabral et al; licensee BioMed Central Ltd

Tissue Harvester with Functional Valve (THFV): Shidham's device for reproducibly higher specimen yield by fine needle aspiration biopsy with easy to perform steps

BACKGROUND: Fine needle aspiration biopsy (FNAB) cytology has been a highly effective methodology for tissue diagnosis and for various ancillary studies including molecular tests. In addition to other benefits, FNAB predominantly retrieves the diagnostic loosely cohesive cells in the lesion as compared to the adjacent supporting stroma with relatively higher cohesiveness. However, FNAB procedure performed with currently available resources is highly skill dependent with inter-performer variability, which compromises its full potential as a diagnostic tool. In this study we report a device overcoming these limitations. METHODS: 'Tissue Harvester with Functional Valve' (THFV) was evaluated as part of a phase 1 National Institute of Health (NIH) research grant under Small Business Technology Transfer (STTR) Program. Working prototypes of the device were prepared. Each of the four cytopathologists with previous cytopathology fellowship training and experience in performing FNAB evaluated 5 THFV and 5 hypodermic needles resulting in 40 specimens (20 with THFV, 20 with hypodermic needles). A piece of fresh cattle liver stuffed in latex glove was used as the specimen. Based on these results a finished design was finalized. RESULTS: The smears and cell blocks prepared from the specimens obtained by THFV were superior in terms of cellularity to specimens obtained with hypodermic needles. The tissuecrit of specimens obtained with THFV ranged from 70 to 100 μl (mean 87, SD 10), compared to 17 to 30 μl (mean 24, SD 4) with conventional hypodermic needles (p < .0001, Student t-test). The technical ease [on a scale of 1 (easy) to 5 (difficult)] with THFV ranged from 1 to 2 as compared to 2 to 3 with hypodermic needles. CONCLUSION: The specimen yield with the new THFV was significantly higher when compared to hypodermic needles. Also, the FNAB procedure with THFV was relatively easier in comparison with hypodermic needles. The final version of Shidham's THFV device would improve the FNAB specimen yield by eliminating the skill factor. The increased specimen yield by this device would also facilitate wider application of FNAB specimens for various ancillary tests, including molecular tests

Knowledge, Attitude And Practices Of University Students On Cancer Prevention

Background: Scientifically proven evidences exist that the risk for developing cancer can be significantly reduced through exercise, adequate nutrition diets, avoiding cigarette and alcohol and among others. Youths are strategic in cancer prevention because they are in their habit formative years, have longer years to live ahead, and might not have had damage to their DNA yet. Objective: This study aimed to determine knowledge of undergraduates about the relationship between lifestyle changes and development of cancer, and how much of it they practice, if at all. Methodology: Pre-tested, self-administered questionnaire was used to collect data on sociodemographic features, knowledge, attitudes and practices of 400 undergraduates selected by multistage sampling technique about cancer. Data was analyzed using descriptive and inferential statistics. Results: The study revealed a poor knowledge about cancer and/or its prevention: two-third did not know there is a relationship between fruits intake, exercise and diet with the development of cancer. It was also reported by 30% of the respondents that cancer can be cured. However, more than half reported good attitude towards lifestyle changes to prevent cancer. Less than one-third reported good practice of cancer prevention. Conclusion: The students had poor knowledge about cancer and/or its prevention though they reported strong willingness towards positive behavioural change for cancer prevention. This might be responsible, for the low proportion of respondents with good practice of cancer prevention habits and lifestyles. Health campaign about cancer prevention could improve the behaviour Keywords: Cancer, Cancer prevention, Undergraduate students, Knowledge, Attitudes, Practice Sahel Medical Journal Vol. 11 (3) 2008: pp. 84-8

Autologous blood transfusion practice seven years experience (1992-1998) at the National Orthopaedic and Military Hospital in Lagos, Nigeria

Nigerian Quarterly Journal of Hospital Medicine Vol.10(1) 2000: 15-1

Perioperative Haemorrhage and Transfusion in Musculoskeletal Tumour Surgery.

Background and Objectives: Musculoskeletal tumor surgery in the West African subregion is rapidly evolving. These procedures are associated with significant blood losses necessitating large amount of transfusion, of which there is inadequate documentation. Allogeneic blood transfusion has been associated with increased recurrence of malignancies and is fraught with various complications. This study is aimed at evaluating the blood loss and transfusion requirements in various musculoskeletal tumor surgeries at a tropical Orthopedic Oncology unit. Method: A prospective study was conducted in patients with musculoskeletal tumors, undergoing surgery over a 5 year period. 74 procedures were performed in 58 patients and data such as age, sex, tumor type, surgical procedure, total blood loss, amount of blood transfused and attendant complications were retrieved. Results: The age range of the patients was 7 to 85 years with a mean age of 26.1 years. [M:F ratio 1.6: 1]. Surgery for benign bone tumors accounted for 55% of the procedures performed, while primary malignant lesions were the diagnosis in 41% of cases. Surgery was performed for secondary malignant tumor in 4% of cases. Tourniquet use was possible in only 36% of the surgeries, and the operation time range from 42 to 184 minutes [mean 67.5 minutes]. The range for total blood loss was 5 to 4950 mls. The mean blood loss was more for extensive procedures such as, forequarter amputations, above knee amputations, and resection / reconstruction. There was significant correlation between the total blood loss and the operation time. Blood transfusions were required in 57.1% of the surgeries and the total number of units transfused range from 0 to 4500 mls. The early complications of blood transfusion noted in these patients include, febrile reaction [33%], malaria fever [21%], hemolytic reaction [6%]. Conclusions: Blood loss in Orthopaedics musculoskeletal tumour surgery is significantly high, warranting large amount of blood transfusion. Adoption of standard blood management strategies by individual units, the use of autologous blood transfusion, and recombinant erythropoietin may reduce the attendant complications associated with blood transfusion. Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 63-6

Child mortality from sickle cell disease in Nigeria: a model-estimated, population-level analysis of data from the 2018 Demographic and Health Survey

Background Child mortality from sickle cell disease in sub-Saharan Africa is presumed to be high but is not well quantified. This uncertainty contributes to the neglect of sickle cell disease and delays the prioritisation of interventions. In this study, we estimated the mortality of children in Nigeria with sickle cell disease, and the proportion of national under-5 mortality attributable to sickle cell disease. Methods We did a model-estimated, population-level analysis of data from Nigeria's 2018 Demographic and Health Survey (DHS) to estimate the prevalence and geographical distribution of HbSS and HbSC genotypes assuming Hardy-Weinberg equilibrium near birth. Interviews for the survey were done between Aug 14 and Dec 29, 2018, and the embedded sickle cell disease survey was done in a randomly selected third of the overall survey's households. We developed an approach for estimating child mortality from sickle cell disease by combining information on tested children and their untested siblings. Tested children were aged 6–59 months at the time of the survey. Untested siblings born 0–14 years before the survey were also included in analyses. Testing as part of the DHS was done without regard to disease status. We analysed mortality differences using the inheritance-derived genotypic distribution of untested siblings older than the tested cohort, enabling us to estimate excess mortality from sickle cell disease for the older-sibling cohort (ie, those born between 2003 and 2013). Findings We analysed test results for 11 186 children aged 6–59 months from 7411 households in Nigeria. The estimated average birth prevalence of HbSS was 1·21% (95% CI 1·09–1·37) and was 0·24% (0·19–0·31) for HbSC. We obtained data for estimating child mortality from 10 195 tested children (who could be matched to the individual mother survey) and 17 205 of their untested siblings. 15 227 of the siblings were in the older-sibling cohort. The group of children with sickle cell disease born between 2003 and 2013 with at least one younger sibling in the survey had about 370 excess under-5 deaths per 1000 livebirths (95% CI 150–580; p=0·0008) than children with HbAA. The estimated national average under-5 mortality for children with sickle cell disease born between 2003 and 2013 was 490 per 1000 livebirths (95% CI 270–700), 4·0 times higher (95% CI 2·1–6·0) than children with HbAA. About 4·2% (95% CI 1·7–6·9) of national under-5 mortality was attributable to excess mortality from sickle cell disease. Interpretation The burden of child mortality from sickle cell disease in Nigeria continues to be disproportionately higher than the burden of mortality of children without sickle cell disease. Most of these deaths could be prevented if adequate resources were allocated and available focused interventions were implemented. The methods developed in this study could be used to estimate the burden of sickle cell disease elsewhere in Africa and south Asia. Funding Sickle Pan African Research Consortium, and the Bill & Melinda Gates Foundation