Local recurrence after 'standard' abdominoperineal resection: do we really need ELAPE?

Introduction Low rectal cancers requiring abdominoperineal resection tend to have a worse prognosis than higher tumours, which may be treated by anterior resection. One of the reasons for this may be inadequate local surgery, in particular the narrow waist of the resection specimen of a standard abdominoperineal resection may be associated with a high positive circumferential resection margin. The extralevator abdominoperineal excision (ELAPE) aims to improve the R0 resection rate but carries significant morbidity. We examined our own results of standard abdominoperineal resection to assess the need for a change of policy. Methods We operformed a retrospective analysis of consecutive standard abdominoperineal resections for rectal cancer in a single centre from June 2002 to December 2011. Results A total of 102 patients underwent standard abdominoperineal resection with curative intent; 19 had no preoperative treatment, 42 had short course radiotherapy, 9 had long course radiotherapy and 32 had neoadjuvant chemotherapy followed by long course chemoradiotherapy. In 17/102(16.6%), there was a positive circumferential resection margin. Over a median follow up of 32 months, 20 patients developed recurrence of any type. Local recurrence occurred in five patients (two of which also had distant recurrence), of whom two had a positive circumferential resection margin (P = 0.10). Actuarial two-year local only recurrence was 3.4% and any recurrence was 17.7%. Overall five-year cancer specific survival was 77%. Conclusions In this series we found low rates of local recurrence after standard abdominoperineal resection even with a circumferential margin rate positivity of 16.6%.Performing an ELAPE in selected cases may improve these results further but is not necessarily required for all patients.

Knowledge, attitude and practice of family planning amongst community health extension workers in Kaduna State, Nigeria.

A self-administered opportunistic questionnaire was given to 232 community health extension workers (Chews) in Kaduna state, Nigeria. Seventy-eight were male and 154 female. All could recall at least one modern method of family planning. The oral contraceptive pill (OCP) (85.8%), injectable contraceptives (85.3%), and the intra-uterine contraceptive device (IUCD) (56.0%), were most widely known about. Emergency contraception was not known about. A high percentage of female Chews have practised family planning: 115 (74.7%) have used at least one method and this is more among the married women. Methods ever used included injectable contraceptive (57.4%), OCP (47.0%), and IUCD (22.6%). Fifty percent of females were current users. Non-current users were likely to be between the ages of 25 - 29 years especially when not married, and 35 - 39 years when married. Reasons for the non-use of family planning by female Chews were side effects, not being married, not being sexually active and religious beliefs.

Measles antibody levels from birth to 9 months of age in Nigerian infants.

Measles antibody (HAI) titres were measured in healthy Nigerian infants at birth and at 3, 6 and 9 months of age. At birth only one baby out of thirty-five had HAI titre of less than 1:4, but at 3 months of age titres had fallen to this level in 33% of children. The percentage increased further to 78.6% at 6 months of age. At 9 months, nine out of twenty-seven (33%) infants had HAI titre of 1:16 and above, suggesting recent measles infection or immunization. The rapid fall in HAI titres up to 6 months could explain the occurrence of measles in early age in tropical countries. We recommend that children in Nigeria be immunized at 7-8 months of age.