The clinical outcomes of extracorporeal irradiated and re-implanted cemented autologous bone graft of femoral diaphysis after tumour resection

Purpose

We report the outcome of intercalary resection of the femoral diaphysis and extracorporeal irradiated autologous bone graft reconstruction, without the use of vascularized fibular graft.

Methods

Six patients with Ewing sarcoma of the mid-shaft femur who were treated by limb sparing tumour resection and reconstruction with extracorporeal irradiated autologous bone graft with intramedullary cement between 2002 and 2010 were studied.

Results

Mean age at the time of surgery was ten years (range, four–23). The length of resected femoral bone averaged 23 cm (15–32 cm). The ratio of bone resection length to total femoral length averaged 60 % (56–66 %). The patients had been followed up for between 16 and 79 months (mean, 41 months) at the time of the study. There was no infection nor fracture in this series. Primary union of the distal and proximal osteotomy sites was achieved in three patients. Delayed union of the proximal osteotomy site occurred in one patient that was successfully treated with iliac crest bone grafting. One patient developed non-union at the distal osteotomy site which failed to heal with bone grafting and was therefore converted to endoprosthetic replacement, and another patient was converted to rotationplasty at five months post-surgery because of contaminated margins. Function was excellent in all patients with surviving re-implanted bone. Local recurrence arose in one patient.

Conclusion

Our experience suggests that cement augmentation of extracorporeal irradiated and re-implanted bone autografts offer a useful method of reconstructing large femoral diaphyseal bone defects after excision of primary malignant bone tumours.     

Endometrial carcinoma following treatment for breast carcinoma in a Nigerian female. A case report and review of the literature

Tamoxifen is the primary hormonal therapy for breast cancer as well as its chemoprevention. It is used in the management of breast cancer because of its anti oestrogenic effect. It is however an agonist on the endometrium with undesirable effects of endometrial proliferation with the risk of endometrial hyperplasia and carcinoma. Several authors have reported cases of endometrial hyperplasia and carcinoma following tamoxifen therapy for breast carcinoma. No such report has been made from Nigeria .This paper presents the first case of endometrial carcinoma following tamoxifen therapy for breast carcinoma in a 52 year old Nigerian female. It also highlights the recommended guidelines for the follow up of women with breast cancer on tamoxifen therapy.     

Endoprosthetic replacement of the proximal humerus. Long-term results

We studied 100 patients who had undergone endoprosthetic replacement of the proximal humerus between 1976 and 1998. The outcome was assessed with regard to the survivorship of the patients, the salvaged limbs and the prostheses. Function was determined in the 47 surviving patients, of whom 30 were assessed using the Musculo-Skeletal Tumour Society (MSTS) rating scale and 38 completed the Toronto Extremity Salvage Score (TESS) questionnaire. The median age of the patients was 34 years (10 to 80). The mean follow-up period for surviving patients was nine years (2 to 20). The mean MSTS score at follow-up was 79% and the mean TESS score was 72%. The length of bone which was resected influenced the functional outcome. Abduction of the shoulder was to 45 degrees in most patients. The overall survival was 42% at ten years and that of the limb without amputation 93%. The survival of the prostheses using mechanical failure as the endpoint was 86.5% at 20 years. Endoprosthetic replacement of the proximal humerus is a predictable procedure providing reasonable function of the arm with a low rate of complications at long-term follow-up.     

The outcome of perioperative wound infection after total hip and knee arthroplasty

Forty-one consecutive patients with primary knee arthroplasty and 37 with primary hip arthroplasty, all with perioperative wound infections, were followed for 50 (12-130) months. Staphylococci (coagulase negative and positive) accounted for 74% of wound infections. Mixed organisms accounted for 10%. Prosthetic infections developed in eight patients and aseptic loosening in three patients. All the prosthetic infections developed within 6 months of the primary surgery. Organisms responsible for superficial infections were responsible for prosthetic infection in five patients; no organisms were isolated in the remaining three patients. The presence or absence of wound dehiscence, wound haematoma, and postoperative pyrexia did not predict the development of deep sepsis; however, the presence of wound discharge was a significant risk factor.     

Fracture of the femoral neck, the risk of serious underlying pathology

Between 1997 and 2003, a total of 2223 patients presented to our hospital with the neck of femur fracture. This retrospective study examines the histological results of 90 patients (4%) suspected of having a fracture associated with serious underlying pathology. The mean age at the time of fracture was 80 years (44-97). The patients were divided into four groups. Group I: 34 patients with fracture without history of fall or trauma. Group II: 21 patients with suspicious lesions on the standard pelvic radiograph taken on admission. Group III: 27 patients with past history of malignancy without known bone metastases. Group IV: 8 patients with past history of malignancy and known bone metastases. None of the patients in groups I and II had significant abnormalities other than osteoporosis. Four patients (15%) in group III and six patients (75%) in group IV had metastases on histological examination. It is concluded that only groups III and IV are likely to have fractures due to metastatic disease.     

Endoprosthetic replacement of diaphyseal bone defects. Long-term results

We retrospectively studied 35 patients who underwent endoprosthetic reconstruction of diaphyseal bone defects after excision of primary sarcomas. The patients were treated between February 1979 and May 1999 and had more than 5 years follow-up. There were 22 males and 13 females and the median age at diagnosis was 29 (8–75) years. The bone defect measured a mean of 19 (10–27.6) cm. There were 29 femoral reconstructions, three tibial and three humeral. Cumulative overall survival for all patients was 65% at 10 years. Cumulative overall survival for prosthetic reconstruction, using revision surgery as an end point, was 63% at 10 years. Cumulative risk of failure of reconstruction, including infection, fracture, aseptic loosening, local recurrence and amputation, was 60% at 10 years. Tibial and humeral reconstructions fared less well than femoral. Endoprosthetic replacement is a useful method of reconstructing long intercalary defects, especially if situated in the femur.

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Résumé Nous avons étudié rétrospectivement 35 malades qui ont subi une reconstruction endoprothétique après excision diaphysaire dun sarcome primaire. Les malades ont été traités entre février 1979 et mai 1999 et avaient plus de 5 ans de suivi. Il y avait 22 hommes et 13 femmes et lâge médian au diagnostic était de 29 (8–75) ans. Le défaut osseux mesurait en moyenne 19 (10–27.6) cm. Il y avait 29 reconstructions fémorales, trois tibiales et trois humérales. La survie totale cumulative pour tous les malades était 65% à 10 ans. La survie totale cumulative pour la reconstruction prothétique, en utilisant la chirurgie de révision comme élément final, était de 63% à 10 ans. Le risque cumulatif déchec en incluant: linfection, la fracture, le démontage aseptique, la récidive locale et lamputation étaient de 60% à 10 ans. Les reconstructions tibiales et humérales sont allées moins bien que les fémorales. Le remplacement endoprothétique est une méthode utile pour reconstruire de longues pertes de substance intercalaires, surtout si elles sont situées sur le fémur.

     

Risk factors for ectopic pregnancy in Lagos, Nigeria

BACKGROUND: Ectopic pregnancy is an important cause of maternal deaths in Nigeria and in other developing countries. In Lagos, Nigeria, it is responsible for 8.6% of maternal deaths, and has a case fatality rate of 3.7%. The purpose of this study was to determine the risk factors for ectopic pregnancy in Lagos. METHODS: A case-control study of 100 patients and 280 controls was performed in the three hospitals--Lagos University Teaching Hospital, Ayinke House Maternity Hospital, and Lagos Island Maternity Hospital--in Lagos from June 1999 to December 1999. Data were analyzed by using logistic regression. RESULTS: The incidence was 23.1/1000 (1 : 43) deliveries and was responsible for 48.5% of gynecologic emergencies. Age, marital status, socioeconomic status, and parity were not the significant risk factors for ectopic pregnancy. An early age of sexual debut increased the risk of ectopic pregnancy almost two-fold (adjusted OR = 1.93; 95% CI = 1.71-2.93), whereas a late age of sexual debut was protective (adjusted OR = 0.37; 95% CI = 0.19-0.59). History of multiple lifetime sexual partners, induced abortions, pelvic inflammatory disease, sexually transmitted disease (STD), miscarriage, and pelvic surgery independently and significantly increased the risk of ectopic pregnancy. Induced abortion and STD increased the risk 14-fold and nine-fold, respectively. Previous use of intrauterine contraceptive device increased the risk almost four-fold (adjusted OR = 3.76; 95% CI = 2.12-6.69), whereas the use of condoms was protective (adjusted OR = 0.35; 95% CI = 0.17-0.71). CONCLUSIONS: Proper sex education, prevention of unwanted pregnancy, and prevention and proper treatment of sexually transmitted infections will reduce the incidence of ectopic pregnancy.     

Spinal and general anaesthesia for emergency caesarean section: effects on neonatal Apgar score and maternal haematocrit

This is a prospective comparative study to determine the effect of the type of anaesthesia used for emergency Caesarean section on neonatal and maternal outcome. The patients were recruited into the study after being given either general or spinal anaesthesia. Neonatal outcome was assessed using Apgar scores and need for respiratory assistance at birth. Maternal outcome was assessed using the difference between pre- and post-operative packed cell volumes (PCV), need for blood transfusion and estimated blood loss. The groups were matched for pre-existing risk factors. Apgar scores at 1 and 5 minutes were found to be significantly lower for the general anaesthesia group (GA) than the spinal anaesthesia group (SA) and need for respiratory assistance was greater for the GA group. Difference between pre- and post-operative PCV and need for blood transfusion were also significantly greater in the GA group. This study confirms that the current practice of spinal anaesthesia for Caesarean section in the Lagos University Teaching Hospital is a good one, but further studies need to be done to assess other outcome variables.     

Prevalence of trichomonas vaginalis in patients with vaginal discharge in Lagos, Nigeria

Trichomonas vaginalis is the most prevalent, non-viral sexually transmitted infection worldwide and probably the most commonly treatable in Africa and worldwide. The purpose of this study was to determine the prevalence of T. vaginalis among women with vaginal discharge attending a gynaecologic clinic in Lagos and to identify the common characteristics of the vaginal discharge in T Vaginalis. High vaginal swabs were taken from consenting adults with vaginal discharge. The quantity, colour and odour of the discharge were noted. Amine (10% KOH) test and pH were determined. Wet-mount microscopy Giemsa staining and culture in Oxoid (R) Trichomonas Medium were performed on each swab. A total of 200 patients were examined. One hundred and forty-nine (74.5%) had T. vaginalis. There was no statistically significant association between age, marital status, parity, number of sexual partners and prevalence of T vaginalis. The colour of the discharge was white in 104 (69.8%), yellow in 30 (20.1), clear in 15 (10.1%). None was frothy or greenish. The discharge was heavy in 50 (33.6%) and malodorous in 51 (34.2%). The pH range was 4-7 and 42 (28.2%) normal pH of4. In 47 (31.5%) the amine test was negative. The prevalence of T vaginalis among women with vaginal discharge is high. Women complaining of vaginal discharge should be thoroughly screened for T. vaginalis using all available methods.     

Plasma volume in normal pregnant Nigerian primigravidae

Plasma volume was measured in 10 non-pregnant, healthy nulliparous Nigerian and 30 normal primigravid Nigerians at various times of gestation by the Evans blue dye dilution technique. The mean plasma volume of 2098 ml for the non-pregnant Nigerians was statistically different (P less than 0.001) from values in non-pregnant caucasian primigravidae of comparable status. A mean maximum plasma volume increase of 1387 ml above non-pregnant value was found. Essentially, pregnancy imposed a much higher physiological load on Nigerian primigravidae compared to caucasian primigravidae. There was a significant negative correlation between plasma volume and packed cell volume (PCV) in pregnancy (r = -0.51, P less than 0.001), which may be related to excessive hemodilution in the primigravid Nigerian. Differences found may be due to geographical and/or racial factors.