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.
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 ankle.
In spite of the widespread availability of image intensifier for fracture fixation and storage of images on a radiological computer system, routine check radiography is still a common practice. This is even so in situations with no clear indications such as fall or increasing patients' discomfort.
Background: Phaeochromocytoma is a rare catecholamine producing tumor of the adrenal gland. The anaesthetic management for the excision of this tumor can be challenging because of the haemodynamic fluctuations encountered preoperatively, during induction of anaesthesia, manipulation of the tumor and after the excision of the tumor.Objective: To report a case of a 36-year-old Nigerian female who presented with phaeochromocytoma for surgical excision.Methods: Combined general and epidural anaesthesia was used in the patient. Preoperatively, the patient presented with high blood pressure which was adequately controlled with alpha and beta blockers. Intraoperatively she developed severe hypertension during the manipulation of the tumor this was managed pharmacologically with labetalol, Magnesium sulphate and epidural anaesthesia while hypotension that developed after the excision of the tumor was managed with intravenous fluid and vasopressors. Postoperatively she was transferred into the intensive care unit for monitoring and pain management, she made an uncomplicated recovery. Conclusion:It is therefore required that the anaesthetist be familiar with the physiology of the disease and pharmacology of drugs to treat the fluctuating haemodynamics to achieve a good outcome.
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