Methyl methacrylate cement is a self-polymerizing acrylic compound used in securing joint prostheses. Insertion of cement into the reamed bone medulla is associated with marked decreases in blood pressure and with decreases in SaO2 and end-tidal carbon dioxide levels. These have been attributed to three factors:

1. emboli forced into the circulation from prosthesis insertion;

2. release of vasoactive substances by the cement;

3. release of acrylic monomer into the blood stream.

It is essential that patients are not hypovolemic at the time of cement insertion and intraoperative esophageal Doppler monitoring may be useful. Bone tumors

Most patients with primary bone tumors are managed by tertiary referral hospitals and may present for major resection following chemotherapy and/or radiotherapy. Side-effects from both these treatments vary from minor inconvenience to life threatening. Myelosuppression is common and may result in anemia, leukopenia, and thrombocytopenia. There is an increased association between malignancy and deep vein thrombosis. Cardiomyopathy, pulmonary fibrosis, and renal and liver damage are associated with various chemotherapeutic agents and should be sought.

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