Management of patients with obstructive jaundice: experience in a developing country.

BACKGROUND: Surgical Obstructive Jaundice can be life-threatening. Management of these patients can be a major diagnostic and therapeutic challenge. OBJECTIVE: The aim of this study is to determine the sociodemographic data of patients with obstructive jaundice, clinical, laboratory and radiological findings as well as surgical procedures done and immediate postoperative outcome in a tertiary health institution. METHODS: Patients who presented in a Nigerian tertiary health institution with surgical obstructive jaundice between. January 1991 and December 2004 were retrospectively studied. Information was extracted from clinical records, operation notes and histopathology records. Data was entered into SPSS version 11.0 for windows to generate frequency table, percentages, proportion, histogram and pie chart. RESULTS: Sixty-four patients with obstructive jaundice were managed during the study period. Majority of the patients were in the 6th decade of life. More than 50% of the patients have had symptoms for more than 4 weeks before presentation. Carcinoma of the head of pancreas was the cause of obstructive jaundice in more than 60% of the patients. About 47% of the patients had cholecystojejunostomy and operative mortality was 15.6%. CONCLUSION: Carcinoma head of pancreas is the commonest cause of obstructive jaundice in Nigeria with many of the patients in the 6th decade. Diagnosis and management continue to be a challenge especially as a result of late presentation and limited radiological facilities. Patients benefited from palliative surgical intervention in form of bili-enteric diversion.

Macromastia: a review of presentation and management.

BACKGROUND: Macromastia is a condition of abnormal enlargement of the breast tissue in excess of the normal proportion. The condition may be caused by glandular hypertrophy, excessive fatty tissue or combination of both. The usual physiologic enlargement of female breast occurs over 3 to 5 years and the female breast size is related to body habitus and hereditary characteristics. METHOD: A review of the literatures of Macromastia was undertaken with emphasis on presentation and management. RESULT: The aetiology of macromastia is usually undetermined, however, hormonal excesses and hypersensitivity of the target organ have been found in some cases. Cases of hyperprolactinaemia has been reported by some workers. Immunological risk factors for development of macromastia have also been seen in some groups of patients with Myasthenia gravis, Chronic arthritis, and Hashimoto thyroiditis. Ultrasonography may show no breast parenchyma abnormalities, while mammography may be indicated in some patients who are 40 years or older. Hormonal assay can be done but its value in treatment is doubtful. Drugs are only marginally effective in reversing gigantomastia, therefore surgery remains the mainstay of treatment. CONCLUSION: Management of macromastia can be physically, socially and psychologically satisfying to both the patients and the surgeons.

Unusual cutaneous metastatic follicular thyroid carcinoma.

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 - 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 - 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.

Lipomatous lesions around the shoulder: Recent experience in a Nigerian hospital.

We present four cases of shoulder lipomas in two females and two males in their fourth to fifth decades of life. All four lipomas were big. Three were subcutaneous and one was intermuscular. None of them were associated with any functional limitation of the affected shoulder. Subcutaneous or intermuscular lipomas around the shoulder do not appear to affect shoulder functions. Complete surgical excision is rewarding and was achieved under local anesthesia in all our patients with no incidence of recurrence.

Conjunctival Kaposi's sarcoma in HIV-positive heterosexual Nigerian woman--a case report.

BACKGROUND: Neoplastic conditions are increasingly been encountered in HIV/AIDS patients. Till date only two cases of conjunctiva Kaposi sarcoma (KS) have been reported in the background of HIV and both in males. OBJECTIVE: To present a 27-year-old African woman with histologically proven conjunctival KS and marked CD4+ cell depletion and to reinforce the fact that KS is an important differential of conjunctival tumour especially in the background of immunosupression in Africa. METHODS: A 27-year-old housewife, presented to the hospital with a three-month history of a rapidly growing tumour attached to the right upper eyelid, cough and weight loss. Patient was given full workup including x-rays, HIV status determination and histological assessment. RESULTS: She was markedly wasted, with widespread pruritic papular skin lesion, and florid oropharyngeal candidiasis. Clinical and chest x-ray findings were suggestive of bilateral lower lobar pneumonia. Screening and confirmatory tests were positive for human immunodeficiency virus (HIV) with CD4+ lymphocyte cell count of 120 cells/ml. Histologic report of the biopsy revealed the mass to be a conjunctival KS. Patient was subsequently commenced on antibiotics and antiretroviral combination therapy. The mass had regressed in size considerably along with improvement in her clinical condition at six months review. She is still being followed up at the medical clinic. CONCLUSION: This is the first reported case of conjunctival KS in an HIV positive African woman. KS should be considered as a possible differential of conjunctiva mass, especially if the patient is HIV positive irrespective of patient's gender.

Macromastia and bilateralaxillary breast hypertrophy: a case report.

BACKGROUND: Breast hypertrophy presents at puberty or thereafter. It is a condition of abnormal enlargement of the breast tissue in excess of the normal proportion. Gland hypertrophy, excessive fatty tissue or a combination of both may cause this condition. Macromastia can be unilateral or bilateral. OBJECTIVE: To present a case of massive bilateral gigantomastia with huge bilateral hypertrophy of the axillary breasts. METHODS: Review of the prentation, clinical and investigative findings aswell as the outcome of surgical intervention of a young Nigerian woman with bilateral severe breast hypertrophy and severe hypertrophy of axillary breasts. RESULT: The patient was a 26-year-old woman who presented with massive swelling of her breasts and bilateral axillary swellings, both of six years duration.. In addition to the breast pathology, she also suffered significant psychological problems. The breast ultrasonography confirmed only diffuse swellings, with no visible lumps or areas of calcifiCation. She had total bilateral excision of the hypertrophied axillary breasts, and bilateral breast amputation with composite nipple-areola complex graft of the normally located breasts.The total weight of the breast tissues removed was 44.8 kilogram. CONCLUSION: Macromastia of this size is very rare. This case to date is probably the largest in the world literature. Surgical treatment of the condition gives a satisfactory outcome.