Multiple recurrences and late metastasis of adamantinoma in the tibia: a case report.

Adamantinoma is a rare, low-grade, malignant bone tumour. We report on a 46-year-old woman who had early multiple recurrences of adamantinoma of the right tibia and late metastasis to the lung and ribs 13 years after the first surgical treatment. She underwent multiple complete tumour excisions and eventually below-knee amputation and removal of the left lung and sixth to eighth ribs.

Outcome of fetal exomphalos diagnosed at 11-14 weeks of gestation.

OBJECTIVE: To determine whether sonographic findings in cases of exomphalos detected at the 11-14-week scan can be used to guide pregnancy management. METHODS: Retrospective study of cases of exomphalos identified from the Fetal Medicine Unit database, University College London Hospitals between January 1998 and January 2010. Pregnancy and neonatal data were ascertained from maternal and neonatal records. Fetal exomphalos was categorized into three groups: exomphalos associated with other major structural malformation(s), isolated exomphalos with increased nuchal translucency (NT) and isolated exomphalos with normal NT. RESULTS: A total of 98 cases of exomphalos were identified, of which 45 (45.9%) were associated with other major structural malformation(s), identified antenatally. Isolated exomphalos was found with increased NT in 22 cases (22.4%) and with normal NT in 31 cases (31.6%). Of 80 (81.6%) fetuses that were karyotyped, 43 (53.8%) had a chromosomal abnormality; the most common aneuploidy was trisomy 18 (n = 31; 72.1%). Where exomphalos was associated with other major structural abnormalities, or was isolated with increased NT, the incidence of aneuploidy was high, at 78.9% and 72.2%, respectively. Cases of isolated exomphalos with normal NT were all euploid. In 21 cases (21.4%), exomphalos resolved later in pregnancy and none had apparent abnormalities at birth; isolated exomphalos persisted in only three neonates (3.1%). CONCLUSIONS: The finding of a major structural abnormality or of increased NT in association with exomphalos in the first trimester implies a high risk of aneuploidy. Parents can be reassured that fetuses with isolated exomphalos and normal NT are likely to be euploid.

Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues.

One of the most difficult ethical dilemmas facing health care professionals working in oncology is whether, when, how and how much to tell terminal cancer patients about their diagnosis and prognosis. The aim of this article is to review the trends in this issue worldwide. While a majority of physicians in both developed and developing countries tell the truth more often today than in the past, the assumption that truth-telling is always beneficial to patients can be questioned. The issue of truth-telling is still approached differently in different countries and cultures and there is a need for an increased awareness of cultural differences to truth-telling among patients from ethnic minorities.

Disclosing the truth to terminal cancer patients: a discussion of ethical and cultural issues

One of the most difficult ethical dilemmas facing health care professionals working in oncology is whether, when, how and how much to tell terminal cancer patients about their diagnosis and prognosis. The aim of this article is to review the trends in this issue worldwide. While a majority of physicians in both developed and developing countries tell the truth more often today than in the past, the assumption that truth-telling is always beneficial to patients can be questioned. The issue of truth-telling is still approached differently in different countries and cultures and there is a need for an increased awareness of cultural differences to truth-telling among patients from ethnic minorities

Outcome of antenatally diagnosed fetal anterior abdominal wall defects from a single tertiary centre.

OBJECTIVE: The aim of this study was to review the outcome of all cases of antenatally diagnosed anterior abdominal wall defects at a single tertiary centre. METHOD: 41 cases from the database of the Centre of Fetal Care at Queen Charlotte's and Chelsea Hospital in London from 2000 to 2005 were reviewed and both obstetric and neonatal data were collected. RESULTS: 25 cases were exomphalos (61%), 9 were gastroschisis (22%), 6 were body stalk anomaly (15%) and 1 case was cloacal exstrophy (2%). 17 cases (41%) were associated with other major malformations and 4 (10%) were aneuploid. There was 1 case of intrauterine death (2%). Termination of pregnancy was performed in 24 cases (63%). Of the cases that continued (exomphalos and gastroschisis), all babies survived surgery and were discharged home. CONCLUSIONS: This study demonstrates a high termination rate for fetuses diagnosed with anterior abdominal wall defects. However, the surgical outcome for euploid neonates with isolated exomphalos or gastroschisis appears to be good. Babies with gastroschisis required a longer period of parenteral feeding compared with babies with exomphalos. These infants however had a longer duration of hospitalization.

Back pain caused by benign tumors and tumor-like lesions of the thoracolumbar spine.

Twenty-two patients with benign tumors or tumor-like lesions of the spine (vertebral echinococcal cysts, eosinophilic granuloma) presented with back pain and deformity. The duration of pain ranged from 1 to 6 years. Five patients had incomplete paraplegia at admission. Spine deformity was observed in patients with osteoid osteoma, osteoblastoma, hemangioma, and vertebral echinococcal involvement. All patients underwent clinical evaluation, laboratory studies, and histologic studies. Electromyogram studies were performed in patients who had a neurologic deficit or nerve root irritation. Imaging evaluation consisted of plain films, bone scans, computed tomography scans, and magnetic resonance imaging scans. Fifteen patients had lumbar involvement; 7 had thoracic involvement. For 18 patients, management included tumor excision and thorough debridement of the lesion. Spinal instrumentation and fusion were used to correct the deformity and treat the instability in 5 patients. Patients were followed for 1 to 8 years. Of the 5 patients with incomplete paraplegia, 4 recovered completely, and the fifth (who had spinal cord hemangioma) improved 2 grades on Frankel's scale. The remaining patients were disease free and returned to routine daily activities. Benign tumors or tumor-like lesions of the thoracolumbar or lumbar spine are very rare and easily misdiagnosed in patients with persistent back pain. Patients whose symptoms progress or fail to respond over an appropriate period of time should be evaluated further. Complete excision of the tumor followed by spinal instrumentation in the presence of deformity or instability is the treatment of choice.