Recurrent benign schwannoma of the scalp: Case report.

INTRODUCTION: Schwannomas are benign neoplasm's arising from Schwann cells. Malignant change is rare. PRESENTATION OF CASE: A 42-yearold man presented with a 6-year history of a recurrent right sided multinodular scalp lesion. DISCUSSION: Surgery revealed multiple ovoid masses in a scalp lesion. Histology revealed benign schwannoma. CONCLUSION: Schwannoma may present as multiple lesions in a multilobulated scalp lesion and should be considered as differential diagnosis.

Major dermatological malignancies encountered in the University of Calabar Teaching Hospital, Calabar, southern Nigeria.

BACKGROUND: Dermatologic malignancies are among the most common forms of cancer. Sun exposure is the major risk factor in white people, while non-solar factors appear to be the leading risk factor in the darkly pigmented. METHODS: We examined 162 patients with histologic diagnosis of dermatological malignancy who consulted at the University of Calabar Teaching Hospital, Calabar from January 2000 to December 2009. RESULTS: The 162 patient cases observed during the study represent 12% of all cancers diagnosed within the same period. Squamous cell carcinoma (SCC) was the most common (n = 62; 38.3% followed by Kaposi sarcoma (KS) (n = 33; 30.9%). Others were malignant melanoma (MM) (n = 16; 9.9%), dermatofibrosarcoma protuberans (DFSP) (n = 11; 6.8%), and basal cell carcinoma (BCC) (n = 8; 4.9%). The lower limb was the most commonly afflicted site (n = 82; 48.8%) while the head and neck ranked second (n = 32; 22.0%); 146 patients (90%) were darkly pigmented and 16 (10%) were people with albinism. Some patients with SCC and MM consulted late for curative surgery. Surgery resulted in healing in patients with BCC, while the recurrent rate for DFSP was high. The endemic KS responded to cytotoxic chemotherapy but the result was poor for KS associated with human immunodeficiency virus. CONCLUSION: The pattern of dermatologic malignancy revealed in this study is different from that of European skin cancer. Health education, early implementation of preventive measures, early consultation, and treatment will improve outcome in our region.

Epigastirc hernia presenting as a giant abdominal interparietal hernia.

INTRODUCTION: Epigastric hernia is a rare form of ventral abdominal hernia. When neglected it can attain an impressive size causing it un-aesthetic effect in addition to diagnostic difficulties. PRESENTATION OF CASE: Presented is a 60-year-old female farmer with a 10-year history of a voluminous mass in the anterior abdominal wall. DISCUSSION: Surgery revealed an epigastric hernia presenting as an interparietal hernia. The hernia was an omentocele with a grossly distended hernia sac filled with about 2.5 l of serous fluid. No similar case has been found in the medical literature. CONCLUSION: Epigastric hernia can attain voluminous dimensions and present as a non-inguinal interparietal hernia.

Marjolin's ulcer: Sequelae of mismanaged chronic cutaneous ulcers.

OBJECTIVE: This study was to evaluate the current pattern and risk factors of Marjolin's ulcer in the authors' setting. SETTINGS AND PARTICIPANTS: Twenty-one patients with histological diagnosis of skin malignancy at the University of Calabar Teaching Hospital, Calabar, Nigeria. METHODS: Presented are patients with histologic diagnosis of Marjolin's seen in the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2007 through December 2007. RESULTS: Five patients (3 men and 2 women) with Marjolin's ulcer whose ages ranged from 32 to 70 years (mean 46.6 years) accounted for 45.5% of squamous cell carcinoma. All the patients suffered traumatic injuries (4 lower limb injuries from road traffic accidents and 1 puncture wound of the upper limb) and the latency was 21.4 years. CONCLUSIONS: Chronic trauma-induced limb ulceration is the leading risk factor for Marjolin's ulcer. Health education, early detection, and proper management of chronic wounds would improve outcome.

Cutaneous metastatic carcinoma: diagnostic and therapeutic values.

OBJECTIVE: This study was to highlight the diagnostic and therapeutic values of cutaneous metastatic carcinoma. METHODS: Presented are patients with histologic diagnosis of cutaneous metastatic carcinoma seen in the University of Calabar Teaching Hospital, Calabar, Nigeria from 2000 to 2006. RESULTS: Six patients (2 men and 4 women) with cutaneous metastatic carcinoma whose ages ranged from 37 to 55 years presented during the study period and accounted for 6.5% of total cutaneous cancer and 0.6% of total malignancy. CONCLUSION: Cutaneous metastatic carcinoma exhibited a pattern of clinical significance. Clinicians are urged to renew interest in cutaneous nodules, chronic discharging sinuses, and ulcers.

Trauma in a Teaching Hospital Outpost: Comprehensive Health Centre, Okoyong, Cross River State, Nigeria.

BACKGROUND: Road traffic injuries and other forms of trauma have become a major health problem worldwide, but Africa is the worst hit. This study was designed to evaluate the characteristics of trauma injuries in order to offer solutions for planning in terms of policy formulation and implementation. PATIENTS AND METHODS: The Comprehensive Health Centre, Okoyong, is a rural outpost of the University of Calabar Teaching Hospital. Calabar is located about 45 km away in a rural community close to the highway. Trauma patients seen from January 2004 to December 2004 were studied. RESULTS: In total, 76 trauma patients were recorded. The ages ranged from 2 to 50 years (mean 26.1 years) with a male to female ratio of 3:1. Trauma was mainly due to road traffic injuries, 54 patients (71.1%) (motor vehicle - commercial in 28 patients and motorcycle in 26), followed by assault in 15 patients (19.7%). Laceration and abrasion accounted for 87.8% of injuries. The head and neck was the most common anatomical site injured in 49 patients (47%), followed by the lower limbs in 27 patients (26.0%). The injuries involved 39 passengers/pedestrians (72.3%), while a driver/14 cyclists (27.7%) ranked second. Mortality was 2.6%. CONCLUSION: Trauma was mainly due to road traffic injuries. The development of rural trauma systems and improvements in road and traffic infrastructure would reduce injury, morbidity, and mortality.

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

BACKGROUND: Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic. METHODS: All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy. RESULTS: In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group. CONCLUSION: Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

Skin cancers amongst four Nigerian albinos.

BACKGROUND: Albinism is an established risk factor for skin cancer in black Africans, and high levels of ultraviolet radiation increase the risk of the three major forms of skin cancer. METHODS: We present four albinos with histologic diagnoses of skin cancer who were seen at the University of Calabar Teaching Hospital, Calabar, Nigeria from January 2005 to December 2006. Skin cancer in these cases was compared with the total skin cancer affecting 29 patients during the study period. RESULTS: Twenty-nine patients presented with skin cancer during the study period. Four Nigerian albinos (two men and two women) with skin cancer accounted for 13.8% of the skin cancers observed during the 2-year period. They ranged in age from 22 to 40 years (mean, 27.8 years). The sites of the lesions included the head [squamous cell carcinoma (SCC) in two patients and basal cell carcinoma (BCC) in one patient] and the upper limb (melanoma). All tumors were excised; in addition, patients with SCC and melanoma received adjuvant chemotherapy. Two patients, one woman with SCC and the patient with melanoma, showed residual tumor because of inadequate excision. During the evaluation period between 14 and 18 months, the sites appeared to be healed with no evidence of recurrence in the male with SCC and female with BCC. CONCLUSION: Albinism and solar radiation are risk factors for skin cancer. Early implementation of public education strategies on prevention should improve outcome.

Cutaneous cancers in Calabar, Southern Nigeria.

Globally, cutaneous cancers are among the most common form of cancer. Among Africans, there are significant differences in the types of skin cancer compared to those documented in patients from other countries. We evaluated all the patients with a histological diagnosis of skin cancer presenting to the University of Calabar Teaching Hospital from January 2005 through December 2006. Twenty-nine patients (18 males and 11 females) with skin cancer were identified and these accounted for 8.0 percent of total malignancies. Their ages ranged from 16 to 70 years (mean 43.5 years). Kaposi sarcoma (KS) was the most common skin cancer. Kaposi sarcoma associated with HIV represented 81.8 percent of KS cases found. Squamous cell carcinoma (SCC) ranked second and malignant melanoma third. Of the skin cancers in our series, the most common site was the lower limb (55.2%), followed by the head and neck (24%). The 4 albinos accounted for 13.8 percent of the skin cancers found. Immunosuppression (KS), chronic ulcer, inflammation, albinism, and solar radiation were identified risk factors. Public education strategies on prevention, with an emphasis on early identification and surgical treatment of skin cancers are urged. In addition, treatment of and close observation of chronic ulcers are recommended.

A prospective study of burns trauma in children in the University of Calabar Teaching Hospital, Calabar, south-south Nigeria.

BACKGROUND: Burns are among the most devastating injuries seen in the emergency units. The epidemiology varies from one part of the world to another. This communication is a 3-year report of burns in children in an attempt to provide information on the current epidemiology of burns in this centre. METHOD: Children admitted into the University of Calabar Teaching Hospital, Calabar with burns were prospectively studied from February 2005 and January 2008. RESULTS: There were 56 patients (28 males and 28 females). The ages ranged from 9 days and 14 years (mean 3.5 years) and 19 (73.1%) were preschool children. There were 39 (69.6%) who sustained scald injuries while 17 (30.4%) suffered flame injuries. Twenty-six (46.4%) patients sustained burns with total burn surface area above 10%. CONCLUSION: Education of the public on burns prevention based on the factors highlighted, establishment of burns support groups dedicated to publicity on prevention and provision of financial aid would sustain strategies when adopted.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria.

BACKGROUND: Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism. METHOD: Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied. RESULTS: Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients. CONCLUSION: Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.

Major dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria.

BACKGROUND: Dermatologic malignancies are among the most common form of cancer. However, dark-skinned individuals of African descent are said to be far less likely than fair-skinned individuals to develop skin cancer. Significant differences in the pattern of skin malignancy have also been observed in different regions of Africa. OBJECTIVE: The aim of this study was to evaluate the pattern, site incidence, and outcome of treatment of major histologically diagnosed dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria. METHODS: We evaluated patients with histologic diagnoses of major dermatologic malignancies that presented to the University of Calabar Teaching Hospital, Calabar, Nigeria between January 2000 and December 2004 and compared our findings with the total number of patients diagnosed with malignancies at the same hospital over the same period. This hospital is located in South Nigeria. RESULTS: There were 63 histologically diagnosed dermatologic cancers, comprising 10% of all histologically diagnosed cancers at the University of Calabar Teaching Hospital during the study period. Squamous cell carcinoma (SCC) was the most common (n = 23; 37%), followed by Kaposi sarcoma (KS) [n = 17; 27%]. Other malignancies included basal cell carcinoma (BCC), melanoma, and dermatofibrosarcoma protuberans (DFSP) [n = 5; 8% each]. The peak age varied with the type of cancer but none was found in patients in the first decade of life. The lower limb was the most frequent site of SCC (Marjolin ulcer), KS, and melanoma, while BCC was most common on the head, neck, and upper limb. Excision surgery resulted in healing of all cases of BCC. Some patients with SCC and melanoma presented late for curative surgery. Some African KS tumors were chemosensitive. There was a high recurrence rate for DFSP. CONCLUSION: This study revealed a similar pattern of dermatologic malignancies in South Nigeria compared with other parts of Africa but also some regional differences (e.g. in Kano, melanoma ranked second). The pattern was, however, in sharp contrast to that seen with Caucasian populations, in whom 80% of the lesions are BCC and 20% are SCC. Public education, implementation of preventive strategies, and early presentation of disease would improve outcomes of dermatologic malignancies in Nigeria.

A prospective study of burn trauma in adults at the university of calabar teaching hospital, calabar (South eastern Nigeria).

BACKGROUND: Burn injuries are among the most devastating injuries seen in the emergency units. The epidemiology of this injury varies from one part of the world to another. This is a 3-year report in an attempt to provide information on the current epidemiology of burns in this center. METHOD: Patients admitted into the University of Calabar Teaching Hospital, with burn injuries were prospectively studied between February 2005 and January 2008. RESULTS: The 59 patients (33 males and 26 females) accounted for 3.7% of trauma patients and their ages ranged from 15 to 70 years (mean 29.4 years). Flame burn was the commonest injury seen in 48 (81.3%) patients because of petrol and kerosene, whereas chemical burn that involved 7 (11.9%) patients ranked second. Morbidity included burns wound infection in 13 (22%) patients and contractures in 6 (10.2%) patients. The outcome was fatal in 15 (25.4%) patients. CONCLUSION: The establishment of burn support groups dedicated to publicity on prevention based on areas of risk highlighted in this study and provision of financial aid as well as provision of modern burn care facilities would improve outcome.

Basal cell carcinoma in five albino Africans from the south-eastern equatorial rain forest of Nigeria.

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the white population and occurs infrequently in dark-pigmented individuals. Albinism is an established risk factor for skin cancer in black Africans. METHODS: We evaluated the clinical histories and treatment outcomes of patients with a histologic diagnosis of BCC, who were seen at the University of Calabar Teaching Hospital, Calabar, Nigeria between January 2000 and December 2004. RESULTS: Five albino Nigerians (two men, three women) with BCC represented 8% of the patients with cutaneous malignancies observed during the 5-year period. The five patients ranged in age from 21 to 60 years (mean, 38 years); six BCCs (67%) were located in the head and neck area, and three tumors (33%) involved the upper limbs. Lesions were removed by excision with primary closure, except for large fleshy tumors that were treated by excision and electrocautery. During evaluation from 9 months to 3 years after treatment, all sites appeared healed, and there was no evidence of recurrence or new tumors. CONCLUSIONS: Albinism and environmental exposure to ultraviolet light were identified as risk factors for the development of BCC. Implementation of public education strategies concerning prevention would improve the prognosis and healthcare costs associated with these tumors.