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

Nutritive value of ripe and unripe(green) plantain peels (Musa paradisiaca) for broiler chicken

No Abstract

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

Endoprosthetic replacement of distal femoral tumors in Nigeria: A case series

In this observational study, three consecutive patients who were treated for distal femur tumours using endoprosthetic replacement between June 2013 and June 2014 were studied. The patients were within the ages of 28-47 years at the time of surgery. All three patients had modular endoprosthesis fixation and were evaluated using the Musculoskeletal Tumour Society (MSTS) Scoring System. Numerical values from 0 to 5 points were assigned for each of the following 6 categories: pain, function, emotional acceptance, use of supports, walking ability and gait. These values were added and the functional score was presented as a percentage of the maximum possible score. The results for each patient were graded according to the following scale: Excellent – 75-100%; good – 70-74%; moderate – 60-69%; fair – 50-59% and poor - <50%. Of the 3 patients evaluated, 2 had a diagnosis of Giant Cell Tumour (GCT) of the distal femur; the third patient was diagnosed to have plasmacytoma. All underwent wide local resection with modular endoprosthetic distal femur reconstruction. The MSTS functional scores calculated were 70%, 78%, and 52% respectively. Complications noted included wound dehiscence in two patients and thrombosis of the Pulmonary artery needing an arterial embolectomy in one of these two patients. The same patient also had a post operative loss of motor and sensory function below the level of the ankleKeywords: Bone tumors, distal femur, endoprosthesis, resectio

The preoperative lymphocyte to monocyte ratio predicts clinical outcome in patients with stage III colon cancer

BACKGROUND: Inflammation has a critical role in the pathogenesis and progression of cancer. The lymphocyte to monocyte ratio (LMR) could be shown to be prognostic in haematologic neoplasia. In this study, we analysed the LMR with clinical outcome in stage II and III colon cancer patients. METHODS: Three hundred and seventy-two patients with stage II and III colon cancer were included in this retrospective study. Kaplan–Meier curves and multivariate Cox-regression analyses were calculated for time to recurrence (TTR) and overall survival (OS). RESULTS: Including all patients, the elevated preoperative LMR was significantly associated with increased TTR and OS in multivariate analysis (HR: 0.47, 95%CI: 0.29–0.76, P=0.002; HR: 0.51, 95%CI: 0.31–0.83, P=0.007; respectively). In subanalyses, the association was limited to patients with stage III (HR: 0.40, 95%CI: 0.22–0.72, P=0.002), in contrast to patients with stage II (HR: 0.40, 95%CI: 0.28–1.66, P=0.397). When the subgroup of patients with ‘high-risk' LMR⩽2.83 was analysed, no benefit of adjuvant 5-FU-based chemotherapy could be found (HR: 0.99; 95%CI: 0.60–1.63; P=0.953). CONCLUSION: The LMR might be an independent prognostic marker for TTR in stage III colon cancer patients. Our results further suggest that high-risk patients based on the LMR do not benefit from adjuvant chemotherapy. Independent validation of our findings is warranted