Continuing barriers to care of Wilms tumor in a low-income country.

BACKGROUND/OBJECTIVE: This study evaluates the outcome of Wilms tumor (WT) following introduction of multidisciplinary team management and patient treatment stratification by tumor histology in two referral centers in southeastern Nigeria. METHODS: We analyzed histologically confirmed WT cases managed from January 2008 to June 2017. RESULTS: There were 45 patients, peak age incidence of 2 to 5 years who presented after mean symptom duration of 4.9 months (range, 1-12 months), with mean tumor weight of 1040 g (range, 350-4200 g). Overall, 14 (31.1%) had unfavorable histology of WT. A total of 22 (48.9%) patients received preoperative chemotherapy, 43 (95.6%) received postoperative chemotherapy based on stage of disease and histopathology, but none received adequate radiotherapy. Of these, 19 (44.2%) patients complied with chemotherapy regimen, 15 (33.3%) were lost to follow-up and 12 (26.7%) cases relapsed. With 30 cases available for evaluation and mean follow-up duration of 23 months (range, 6-80 months), the overall 5-year survival is 53.3% (16 cases). Survival in children who complied with postoperative chemotherapy was 73.7%, and abandonment-sensitive survival was 35.6%. Persisting challenges were late presentation, poor compliance to treatment, and lack of radiotherapy treatment. CONCLUSION: Multidisciplinary team management and chemotherapy based on tumor histology might have resulted in slight improvement of outcome since our last report. However, to ensure survival that may approach global benchmarks, there is need for public health measures to improve time to diagnosis, and improvement of facilities and healthcare funding to ensure compliance to all phases of standard therapy.

Testicular Schistosomiasis Mimicking Malignancy in a Child: A Case Report.

Schistosomiasis is an important communicable disease in the developing world. However, testicular schistosomiasis is an extremely rare condition. We report a case of testicular schistosomiasis mimicking testicular tumour in a 13 year old who presented with huge unilateral testicular mass. The dilemma encountered in the diagnosis and treatment of this child is presented to highlight the need for high index of suspicion of this pathology in children with testicular mass presenting from schistosomiasis-endemic areas.

Complications of neonatal circumcision requiring surgical intervention in a developing country.

OBJECTIVE: The recent scale-up in neonatal circumcision (NC) may require strategies to reduce complications. This study evaluated complications of NC requiring surgery. METHODS: A prospective analysis of 64 patients with complications of NC managed by surgery between June 2006 and May 2012 at the University of Nigeria Teaching hospital Enugu was conducted. RESULTS: Circumcision was performed by nurse in 54 (84.4%) patients, traditional practitioner in 5 (7.8%) and doctor in 5 (7.8%), at a median age of 9 days (range: 2-21 days). Complications noticed 1 day to 7 years (mean: 7.8 months) after circumcision were glanular adhesion in 27 (42.2%) children, meatal stenosis in 14 (21.9%), urethrocutaneous fistula in 11 (17.2%), trapped penis in 5 (7.8%), implantation dermoid in 4 (6.2%) and glans amputation in 3 (4.7%). After treatment, outcome was good in 59 (92.2%) patients, whereas 5 (7.8%) had residual defect. CONCLUSION: NC may be associated with serious complications in our setting. Adequate training of providers on safe procedure may minimize complications.