Spinal Malignant Peripheral Nerve Sheath Tumours in Nigerians.

BACKGROUND: Spinal Malignant peripheral nerve sheath tumours (MPNSTs) are very rare aggressive tumours with poor prognosis. Little is known about these tumours in sub-saharan Africa. OBJECTIVES: This study aims to evaluate the clinical profile and outcome of management of these tumours in a resource limited country. METHODS: We retrospectively analysed data from the records of patients who had surgery for spinal MPNSTs at our center between January 2004 and December 2018. RESULTS: There were four patients in this study (M:F= 1:1). The ages ranged from 27-53 years with a mean of 43.25 ± 11.84 years. The tumour was located in the thoracic region in 2 of the patients (50%), the lumbar region in one (25%) and thoracolumbar in the 4th patient. Three patients (75%) presented with back pain while limb weakness, sensory deficit and sphincteric dysfunction were present in all patients at presentation. The duration of symptoms were 2 months in 2 patients (50%) and 3 months in the other 2. None of the patients had neurofibromatosis. Gross total tumour excision was achieved in 2 patients (50%) and subtotal resection in the other 2. The tumours were high grade in three patients (75%) and low grade in one. Two patients had adjuvant radiotherapy. Two of the patients were dead within 6 months of the diagnosis, another one within 18 months while one patient is still alive 3 years after. CONCLUSIONS: MPNSTs are very rare in our practice. Most of the tumours were high grade tumours and ran an aggressive course.

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 ankle.

Comparison of postoperative pain in diathermy and conventional scalpel Skin incision after mastectomy in Ibadan, Nigeria.

INTRODUCTION: Pain control is a challenge after surgery. Inadequate control of acute postoperative pain in mastectomy patients may lead to chronic post mastectomy pain syndrome. The study aimed to compare the effect of diathermy incision with scalpel incision on the severity of acute postoperative pain after mastectomy. METHOD: Sixty three females had mastectomy under general anaesthesia. Thirty two patients had skin incisions made with scalpel while 31 patients with diathermy. Both groups received intraoperative Fentanyl and Tramadol. Tramadol was also employed as postoperative analgesic while Paracetamol was given as the rescue analgesic. The outcome measures were pain scores using visual analogue score (VAS) and analgesic consumption within the twenty four hours postoperatively. RESULTS: The mean VAS in the diathermy group versus scalpel group at 6th, 12, 18th and 24th hour post operatively were 11.84 +/- 6.15 mm versus 16.18 +/- 8.5 mm (p=0.001), 11.10 +/- 4.26 mm versus 15.84 +/- 5.12 mm (p=0.001), 11.07 +/- 4.15 mm versus 17.32 +/- 6.01 mm (p=0.001), 10.6 +/- 8.08 mm versus 19.19 +/- 8.7 mm (p = 0.001) respectively. The mean dose of Tramadol was 264 +/- 84 mg in the diathermy group versus 278 +/- 64 mg in the scalpel group p=0.189, three patients required rescue analgesic (paracetamol) in the diathermy group mean dose 1.5.7 +/- 0.54 g versus 7 patients in the scalpel group, mean dose 1.67 +/- 0.58 g p=0.75. CONCLUSION: Diathermy can contribute to reduction in the acute postoperative pain in patients undergoing mastectomy.

Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country.

INTRODUCTION: Giant condylomata acuminatum (GCA) also referred to as Buschke-Lowenstein tumor (BLT) is a rare tumor primarily associated with low-risk HPV 6 and 11, which is believed to be a slow growing intermediate tumor with low potential to transform into invasive cancer. CASE PRESENTATION: We presented our experience with three cases of BLT (one woman and two men). CLINICAL DISCUSSION: The three patients had surgical excision and two of them had reconstruction of the surgical defect with good clinical outcome. CONCLUSION: We highlighted the importance of early identification of symptoms, treatment options and risk of recurrence as well as primary preventive strategies.

Clinical implication of pretreatment neutrophil to lymphocyte ratio in soft tissue sarcoma.

INTRODUCTION: Elevated neutrophil to lymphocyte ratio has been identified as a prognostic indicator in malignancies whereas; its association with extremity and trunk soft tissue sarcoma remain unclear. The aim of this study is to determine the utility of full blood neutrophil lymphocyte ratio (NLR) in preoperative diagnosis and its predictive value for survival in patients managed for soft tissue sarcoma of the trunk and extremities. METHOD: 223 patients who presented with a soft tissue tumor were retrospectively reviewed. The study period was from January 2002-December 2009. Preoperative NLR as well as demographics, clinical and histopathological data were analysed. RESULTS: Full blood NLR was significantly higher in patient with a soft tissue sarcoma compared to benign soft tissue tumors (p < 0.001). Cox regression analysis demonstrated that elevated NLR >5 (p < 0.05) may be an adverse prognostic factor for Overall Survival. CONCLUSION: The preoperative NLR is a simple, investigation predicting the preoperative diagnosis of a soft tissue sarcoma and a predictor of worse overall survival for patient with a soft tissue sarcoma.

Risk factors for pressure ulceration in a resource constrained spinal injury service.

STUDY DESIGN: Pressure ulceration and other complications constitute an encumbrance in the management of spinal cord injury in many services with limited resources in developing countries. These services undertake patients' care without adequate prehospital care, limited modern infrastructure and limited number of trained staff. OBJECTIVES: To evaluate the associated risk factors for pressure ulceration in traumatic spinal cord injured managed in a resource constrained spinal injury unit in Lagos, Nigeria. A regional acute trauma and rehabilitation centre serving a population of >20 million. METHODS: This is a prospective study in patients presenting with traumatic spinal cord injury between 1 October 2004 and 30 November 2006. The data collected include demographic characteristics, interval before admission in the unit, type of spinal cord injury and serum albumin. The incidence of pressure ulcers and the isolated organisms was recorded for patients who developed pressure ulcers on admission and during the period of stay in the unit. The length of hospital stay was also recorded for all the patients. RESULTS: The overall incidence of pressure ulceration on admission was 57.1%. There was an average lengthening of hospital stay of 33.1 days in the group of patients with pressure ulceration compared to patients without pressure ulcers. The nutritional status on admission, interval before admission and the type of neurological injury were significant factors for the incidence of pressure ulcers. CONCLUSION: The incidence of pressure ulceration was high, delay in admission and poor nutritional status may be significant factors in the incidence of pressure ulceration in spinal cord injury.

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.

Segmental endoprosthesis replacement in a resource-constrained setting.

PURPOSE: Indications for the use of endoprosthesis have continued to expand over the years, especially as an alternative to ablative surgery. This mode of treatment which was initially limited to orthopaedic oncology is now being applied in complex trauma with significant bone loss and end-stage arthroplasty. However, use of endoprosthesis in a resource-constrained setting such as sub-Saharan Africa is limited by various factors. These factors include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field. METHODS: Twelve patients who had segmental endoprosthetic replacement for various aetiologies were studied in this case series. Resection lengths, complications and functional outcomes were noted. RESULTS: The resection length varied between 12 and 27 cm. Using the Henderson classification system, one patient (8.3%) had a Type 1A complication, one had a Type 3A complication (8.3%), and two patients had Type 4A complications (16.6%). Functional outcomes were graded using the MusculoSkeletal Tumour Society scoring system, and scores were good to excellent in ten patients, moderate in one and poor in one patient. CONCLUSION: Early results indicate fair outcomes; however, factors limiting the use of endoprosthesis still persist. These include high cost of endoprosthesis, restricted availability of appropriate equipment and the requisite trained specialists in the field.

Tumor Necrosis Factor-Alpha and Interleukin-1 Alpha as Predictors of Survival in Peritonitis: A Pilot Study.

CONTEXT: Peritonitis induces an inflammatory response characterized by the elevation of various cytokine levels. Included in this cascade of cytokines are tumor necrosis factor-alpha (TNF-α) and interleukin-1 alpha (IL-1α). The outcome of patient care may be associated with the pattern of elaboration of these cytokines. AIM: The aim of this study was to describe the pattern of cytokine response (TNF-α and IL-1α) in the course of peritonitis and evaluate them as predictors of mortality in peritonitis. SETTING AND DESIGN: This was a prospective study conducted in the Division of Gastrointestinal Surgery, University College Hospital, Ibadan. METHODS: Consenting patients with clinical diagnosis of generalized peritonitis over a 6-month period (July to December 2015) were recruited. The serum samples of these patients were obtained at presentation, immediately after surgery, and 24 h and 48 h after surgery with a follow-up period of 30 days. RESULTS: Twenty-six samples out of thirty could be analyzed. Serum TNF-α and IL-1α levels were both elevated at presentation in all patients. However, the patterns of change after intervention varied between the survivors and nonsurvivors. CONCLUSION: Peritonitis triggers a simultaneous increase in serum levels of TNFα and IL-1α. Lower serum level of TNF-α is associated with survival, while on the contrary, higher level of IL-1α is associated with survival.

Routine repeat radiographic examination post fracture fixation: is it necessary?

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.