Neoadjuvant chemotherapy for locally advanced premenopausal breast cancer in Nigerian women: early experience.

BACKGROUND: Breast cancer, the commonest female malignancy in Nigeria presents late, with bulky locoregional masses and predominantly in a pre and peri-menopausal setting. Treatment when feasible has been with mutilative surgery with a poor patient acceptance rate. Chemotherapy which is widely used in adjuvant and metastatic settings has recently been indicated in the neo-adjuvant setting. METHODS: Locally-advanced female breast cancer patients [AJCC Stages IIIA, IIIB, IIIC], seen in the breast clinic from July, 2006 to March 2007 were recruited into the study after informed consent. Patients received doxorubicin, 5-fluoro-uracil and cyclophsphamide by intravenous bolus or infusional injection on a three weekly regimen as day cases. The dominant lesion was assessed by calipers at each visit. Therapeutic clinical responses were assessed as none; partial, complete. RESULTS: During the period 32 women (33 breast cancers) were seen and recruited. The numbers steadily declined over time and only 28 completed the treatment modality. Mean pre-chemotherapy tumour size was 13.5cm which declined to 7 cm at the 5th. One patient (3.6%) exhibited complete clinical response, 25 (89%), partial response and 2 had no response. No serious toxicities were noted. CONCLUSION: Neo-adjuvant chemotherapy using anthracycline based regimens is efficacious and safe in reducing tumour bulk in locally advanced breast cancers. The use should be encouraged to make bulky tumours operable.

Duodeno-pleural fistula: a rare complication of peptic ulcer perforation.

Duodenopleural fistula is a very uncommon complication of peptic ulcer perforation and usually follows empyema after a subdiaphragmatic abscess rupture. We present a rare case of duodenopleural fistula following subdiaphragmatic abscess, which resulted in thoracic empyema after gastric perforation.

Undescended testis at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria : a ten year audit

Introduction: Undescended testis is a global problem; and late diagnosis and treatment can lead to disastrous consequences. We undertook this study to evaluate our management protocol and see how it fits into changing trends in management and compare our results with those obtained in other centers. Material and Methods: A retrospective study of all patients with undescended testes seen and operated at Nnamdi Azikiwe Teaching Hospital; Nnewi; Nigeria during a 10-year period (1993-2003) was carried out. Results: Twenty-seven patients were analysed. 66.7of them were above 2 years of age. Eighteen patients had unilateral crypt-orchidism and 12 patients (44.4) had associated inguinal hernia. The undescended testis was found predominantly in the inguinal region (17 patients) and orchidopexy was done in 16. Half of our patients (51.7) were lost to follow up immediately after the intervention. Conclusion: The late presentation and inability to follow up these patients make the monitoring of such patients very difficult. We suggest that thorough examination of the external genitalia should form part of the normal post-natal check up and that a mass education campaign be undertaken

Comparison between two warm ischemic models in experimental liver transplantation in pigs.

BACKGROUND: Experimental models of warm ischemia in liver transplantation have been employed to study the mechanisms and treatment of ischemia reperfusion injury. METHODS: We compared a control group without (group A, n = 10) versus two models of warm ischemia of liver transplants in pigs: namely, occlusion of the hepatic artery and portal vein for 30 minutes (group B, n = 23) and extraction of the liver 60 minutes after cardiac arrest (group C, n = 5). Liver function tests, coagulation studies, and liver biopsies were performed during the first 24 hours post-liver transplant. RESULTS: Clamping of the hepatic vasculature in group B produced a significant liver injury compared with the control group: elevation of the ALT and an abnormal 1-hour post-revascularization biopsy similar to that observed in the cardiac arrest group C. The transaminase levels were lower among group A animals (P <.05). But the hepatic synthetic functions as reflected in the protrombin time (PT) were not affected in group B versus group A. The alteration in PT with respect to the initial value was similar among group A and group B animals, which were significantly less than that in group C (P <.05). CONCLUSIONS: Occlusion of the hepatic artery and portal vein, a simple surgical maneuver, causes moderate damage to a liver graft but less alteration of hepatic synthetic function. Clamping of the hepatic vasculture obtains more long-term survivors after OLT than cardiac arrest.

[Surgical resection of recurrent pulmonary metastases]. / Resección quirúrgica de metástasis pulmonares de repetición.

The lung is a common site of metastasis. Resectability seems to be the only prognostic factor acknowledged in the literature. Other variables, such as time until tumoral reproduction, duration of the disease-free period, number of metastases and ganglia involvement are not grounds for ruling out surgery. Between February 1996 and January 1998 we operated on 45 patients with pulmonary metastasis, 16 of whom underwent surgery for the same reason more than once. The total number of chest operations in the study group was 42. Retrospectively, we studied all patients undergoing chest surgery more than once, with histologically confirmed resection of pulmonary metastases. One hundred twenty-five metastases (7.8 metastases/patient) were resected. We recorded 3 cases of persistent air leaks that stopped after aspiration through chest tubes was continued. No postoperative (1 to 30 days) mortality was observed. Repetition of pulmonary metastasis should not by itself be considered a reason for ruling out surgery.

Mediastinal paraganglioma: a case report.

Mediastinal paragangliomas are unusual neoplasms that have been described in the medical literature. The microscopic features of paragangliomas are well established and are essentially similar, regardless of the anatomic site, although some minor differences have been noted according to the location of the tumor. We present a case of nonfunctioning anterior mediastinal paraganglioma in a 33-year-old woman. The mediastinal tumor was accidentally discovered on a thoracic tomographic scan performed for an unrelated minor nasal discomfort. Diagnosis was confirmed by 123I-metaiodobenzylguanidine scintigraphy and mediastinoscopy. Complete resection of the tumor was done through a median sternotomy and the patient received intraoperative radiotherapy.