Increased tumor marker ca-125 in multiple myeloma: a case report

Multiple myeloma (MM) is a malignant B-cell lymphoproliferative disorder of the marrow, with plasma cells predominating. It is unlikely to encounter rising level of any tumor marker in MM patient. We present a case of 46-year-old female came to the orthopaedic clinic with chief complains of pain on her right arm, left shoulder and right hip after 5 months. The results of the bone survey of these patients showed multiple lytic lesions with a punched-out appearance in calvaria. The expansive lytic mass was seen with cortical destruction in one third proximal metaphysis to diaphysis of humerus with periosteal reaction and surrounding soft tissue mass. The basic metabolic panel (BMP) result of these patient is hipocellular with decrease of erythroid, myeloid, and megakaryocytes activity and there are 30% plasma cells with positive myeloma cells. Therefore, the patient was diagnosed with MM. The laboratory result of these patient also showed elevation of carbohydrate antigen 125 (CA-125) marker to 56 and 92 (normal range is <35). The patient reported herein showed clear signs and symptoms of MM accompanied by elevated level of CA-125 and CA-15.3 tumor markers. Elevated CA-125 values most often are associated with epithelial ovarian cancer, although levels also can be increased in other malignancies such as endometrial, fallopian tube, breast, lung, esophageal, gastric, hepatic, and pancreatic. However, there were no clear mechanism of how a malignant B-cell lymphoproliferative disorder of the marrow stimulates the production of tumor marker such as CA-125.

Functional outcome in patient with giant cell tumour distal radius after reconstruction by en-bloc resection and non-vascularized fibular bone graft: a case report

Giant cell tumor (GCT) is a relatively common benign primary bone tumor, commonly seen in end of long bones. Treatment goals for GCT of the distal radius are complete excision of the tumor and preservation of wrist function. Usually it can be treated by en-bloc resection and reconstruction using autogenous non vascularized ipsilateral proximal fibular graft. Authors present a case of twenty two years old female complaining of pain and lump in left wrist since two years ago. The pain worsened since 1 month before consultation, but did not radiate elsewhere. Pain was aggravated by movement and decreased with rest. Physical examination revealed a 3 cm mass with tenderness over left wrist. With clinical suspicion of benign bone tumor on left wrist, further evaluation was needed. Plain radiograph revealed an expansile, lytic lesion and soap bubble appearance on her left distal radius like a GCT. Open biopsy result revealed similar morphology with GCT. Reconstruction by en-bloc surgical excision, followed with non-vascularized fibular bone graft fixed with dynamic compression plate (DCP) and wrist ligament reconstruction and fixation of the head of the fibula with carpal bones and distal end of the ulna using K-wires along with palmaris longus tendon were performed. En-bloc resection of giant cell tumors of the lower end radius is a widely accepted method. Reconstruction with non-vascularized fibular graft, internal fixation with DCP with trans fixation of the fibular head and wrist ligament reconstruction minimizes the problem and gives satisfactory functional results.

Comparison between the results of bipolar hemiarthroplasty with lateral approach and posterior approach in Sanglah General Hospital in 2018: a case series

The purpose of this study was to compare the preoperative, intraoperative and postoperative parameters of Bipolar Hemiarthroplasty procedure using lateral approach and posterior approach in Sanglah General Hospital in 2018. Thirty-five patients diagnosed with femoral neck fracture or intertrochanter fracture underwent Bipolar Hemiarthroplasty using either lateral approach or posterior approach at our institution between January 2018 and December 2018. The primary outcome measures were postoperative complication and hip function. The secondary outcome measures were surgical time, transfusion rate, length of hospital stay, intraoperative blood loss and postoperative haemoglobin. There were 14 patients in Lateral Approach group and 21 patients Posterior Approach group included for analysis. There were no significant differences between the two groups regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between Bipolar Hemiarthroplasty with Lateral Approach and Bipolar Hemiarthroplasty with Posterior Approach group in comparison of intraoperative blood loss (p<0.05) and length of stay (p<0.05). The present study concluded that both lateral and posterior approaches are comparable in terms of functional outcomes and complications. However, there is a tendency of longer hospital of length of stay and more of intraoperative blood loss using posterior approach which should be kept in mind when orthopaedic surgeon is performing a bipolar hemiarthroplasty.