Thyroid cancers in nodular goiters in Kano, Nigeria.

BACKGROUND: Cancer is an occasional incidental finding in nodular goiter, but there has been no formal study on this disease in our locality. AIMS AND OBJECTIVES: To determine the occurrence of histologically diagnosed malignancy in patients who present with nodular goiters. METHODOLOGY: This is a 7-year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters at Aminu Kano Teaching Hospital, Kano. RESULTS: There were 160 multinodular goiters during the study period, out of which 24 (15.0%) had histologically diagnosed cancer, and 1 out of the thirteen patients with solitary thyroid nodule (7.6%) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years, with a mean age of 38.8 years. Eighteen (72%) were females, and 7 (28%) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13 (52%) cases, followed by papillary in 10 (40%), medullary carcinoma in 1 (4%) and anaplastic carcinoma in 1 (4%) patient. CONCLUSION: One-seventh of nodular goiters in our center harboured malignancy, and follicular carcinoma was the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspiration would improve preoperative diagnosis and guide appropriate surgical management.

Giant and complicated subcutaneous lipoma of the neck.

BACKGROUND: Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare. OBJECTIVE: To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision. CASE REPORT: A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up. CONCLUSION: Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

Paediatric burns: management problems in a teaching hospital in north western Nigeria.

The records of 168 children managed for burns in a teaching hospital in northwestern Nigeria, between April 1998 and March 2003, were assessed to determine the factors that are responsible for high rates of morbidity and mortality in paediatric burns. The causes of burns were hot water in 86 cases (51.2%), flame in 45 (26.8%), hot soup in 32 (19%) and electricity in five (3%). The main complications were wound infections in 109 (64.9%) patients, anaemia in 68 (40.5%), malnutrition in 54 (32.1%), contracture in 50 (29.8%), persistent hypothermia in 27 (16.1%), tetanus in 14 (8.3%) and one case (0.6%) of massive upper gastrointestinal bleeding, possibly as a result of Curling's ulcer.

Use of protective eyewear among surgeons in a tertiary hospital in northern Nigeria.

The study was a prospective study during which a hand-held lens was used to examine the goggles of all surgeons who used them during surgery at Aminu Kano Teaching Hospital, Kano, Nigeria. Only 169 (54.8%) of the 308 surgeons used eye protection during surgery. There was at least a bloodstain on 70 (41.4%) of the goggles. There is need to enforce universal precautions during surgery to protect the eyes of surgeons from blood drops of the patient being operated.

Congenital inclusion cyst of the subgaleal space: a case report.

BACKGROUND: Subgaleal cysts are epidermal cysts located under the galea aponeurotica. They are rare lesions but are commoner among the children of African descent. To the authors knowledge, none has been described in Kano, Northwestern, Nigeria. METHODS: We present the management of a 6 month old Nigerian boy with scalp swelling. RESULT: The scalp swelling was noticed soon after birth and was progressively increasing in size. There was no preceding fever or trauma to the scalp and no associated pain. At six months, the child could sit without support and had attained adequate neck control. Examination revealed a swelling over the anterior fontanelle, measuring 3x2cm. The swelling was hemispherical, firm, fluctuant, and non-tender. It was not pulsatile. Its size did not increase on crying. Diagnosis was confirmed by plain x-ray film and transfontanelle sonography. Total excision of the mass was carried out under general anesthesia and histology confirmed the diagnosis of epidermal inclusion cyst. The child was discharged home in good condition. CONCLUSION: Awareness of this lesion will avoid misdiagnosis and inappropriate treatment.

Glomus tumour--the report of a case in an adult Nigerian.

BACKGROUND: Glomus tumour, a relatively common lesion in Caucasians is reported to be rare in blacks. METHOD: A case of glomus tumour is reported in an adult male Nigerian to highlight its distinctive clinical presentation and the literature reviewed. RESULT: A 60-year old man presented with a painful skin nodule on the ventral surface of his right forearm. The pain was far in excess of the size of the lesion. There was however no relief from previous medications. Following complete excision of the lesion, pain relief was dramatic. Histopathological examination of the lesion showed sheets of round to polyhedral glomus cells and elongated endothelium lined vascular channels diagnostic of glomus tumour. CONCLUSION: Severe pain is a very important feature of glomus tumour of the skin. This is relieved by complete excision of the lesion.

Prey dominance in discrete predator-prey systems with a prey refuge.

The effects of a prey refuge in a multiprey discrete system with predation is studied. We demonstrate the stable coexistence of species that would otherwise exclude each other without a prey refuge. With a prey refuge, we show that an endangered prey not only recovers from the brink of extinction, but also dominates the system. We invent notions of dominance that guarantee the extinction of all the dominated prey in the system. With the extermination of most of its prey, the predator either coexists with the dominant prey or is driven to extinction. By using a precise mathematical definition, we obtain that a prey with a sufficiently high carrying capacity persists in a predator-prey system with a prey refuge.

The effects of planting and harvesting on endangered species in discrete competitive systems.

The influence of planting the endangered species in a discretely reproducing ecosystem is studied. By applying constant rate and variable rate planting strategies we obtain that coexistence of species that would otherwise exclude each other with no planting occurs. We also show that with a high planting rate the endangered species not only recovers from the brink of extinction but it excludes the other competing species. A similar reversal of exclusion principles occurs if the dominant species is harvested with a sufficiently high harvesting constant while the endangered species is left undisturbed. In addition, we obtain mutual exclusion of species with harvesting where there is exclusion of only one species without harvesting.

Childhood intestinal obstruction in Northwestern Nigeria.

BACKGROUND: Intestinal obstruction is a common cause of childhood surgical emergency in the tropics. The aim of this paper was to assess the pattern and the outcome of mangement of intestinal obstruction in Nigerian children. STUDY DESIGN: The clinical reccords of all the cases of childhood intestinal obstructions managed at a teaching hospital in northwestern Nigeria between 1999 and 2003 were retrospectively reviewed. RESULTS: There were 54 children, 44(81.5 %) were boys and 10 (8.5 %) were girls (m:f=4.4:1). Fifteen (27.8%) and 22 (46.2%) were neonates and infants, respectively. The causes of the intestinal obstruction were intussusception 16(29.6 %), Hirschprung's disease 14(25.9%), anorectal anomaly 12 (22.2%), external hernias 6(11.1%), atresia 5(9.3%) and congenital bands 1(1.9 %). The clinical features were consistent with those reported from other parts of the world, except that many patients with intussusception presented late with gangrenous intestines. The overall mortality was 6(11.1 %); the mortality in the neonates was 5(33.3 %). CONCLUSION: Apart from the obvious absence of worm infestation, the aetiological pattern and the clinical presentation of childhood intestinal obstruction in this study agrees with those reported from other parts of the country. Their management is associated with high mortality in our environment, especially when there are associated anomalies or the presentation is late.

Typhoid enteric perforation in north western Nigeria.

BACKGROUND: Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality. AIMS AND OBJECTIVES: To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano. METHOD: A retrospective Analysis of patients treated for typhoid perforation over a 6-year period. RESULTS: There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis. CONCLUSION: Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Right lobar pneumonia complicated by sub-phrenic abscess in a child.

A 14-year old boy presented with chest and abdominal pain and fever for one week. He had been treated with several antibiotics at home and in a peripheral hospital for respiratory infection. Physical examination showed features of right lobar pneumonia and peritonitis. Chest radiograph showed consolidation in the right lower lung field and abdominal ultrasonography showed a subphrenic collection. At exploratory laparotomy, a right subphrenic abscess and general peritonitis without an intra-abdominal focus were found. The abscess was drained and broad-spectrum antibiotics given. Death, however, occurred from overwhelming infection. Subphrenic abscess complicating pneumonia is unusual but can be the cause of poor response to treatment. The diagnosis should be excluded in a child with pneumonia and persisting abdominal symptoms. Prompt treatment is necessary to avoid morbidity and mortality.

Giant retroperitoneal lipoma in an infant.

Retroperitoneal lipomas have remained the essentially rare tumors seen in clinical practice. The tumors are rarer in children, with very few reported cases in surgical literature worldwide. We are reporting the case of a six-month-old child who presented with a giant retroperitoneal lipoma that was successfully managed by complete excision. There has been no recurrence noticed during follow-up.

Two-patch dispersal-linked compensatory-overcompensatory spatially discrete population models.

We study the role of asynchronous and synchronous dispersals on discrete-time two-patch dispersal-linked population models, where the pre-dispersal local patch dynamics are of mixed compensatory and overcompensatory types. Single-species dispersal-linked models behave as single-species single-patch models whenever all pre-dispersal local patch dynamics are compensatory and dispersal is synchronous. However, the dynamics of the corresponding two-patch population model connected by asynchronous dispersal depends on the dispersal rates. The species goes extinct on at least one patch when the asynchronous dispersal rates are high, while it persists when the rates are low. We use numerical simulations to show that in both synchronous and asynchronous mixed compensatory and overcompensatory systems, symmetric and asymmetric dispersals can control and impede the onset of cyclic population oscillations via period-doubling reversal bifurcations. Also, we show that in mixed systems both asynchronous and synchronous dispersals are capable of altering the pre-dispersal local patch dynamics from overcompensatory to compensatory dynamics. Dispersal-linked population models with 'unstructured' overcompensatory pre-dispersal local dynamics connected by synchronous dispersal can generate multiple attractors with fractal basin boundaries. However, mixed compensatory and overcompensatory systems appear to exhibit single attractors and not coexisting (multiple) attractors.