Positive tumor margins in wide local excision of breast cancer: a 10-year retrospective study

Background. The safety of wide local excision as a standard surgical option for early stage breast cancer management in Ghana has not been evaluated. The aim of this study was to use retrospective histopathological descriptive study to evaluate the prevalence of positive tumor margins in wide local excision specimens and offer recommendations. Study design. We reviewed 147 breast lumps; following wide local excision; which were received in the Department of Pathology; for positive tumor margins. The data was analyzed using SPSS software (version 16). Results. A total of 2;751 female breast cancers were diagnosed during the study period; of which 147 (5.3%) were from wide local excisions (lumpectomies). Thirty-one (21.0%) had positive tumor margins. The mean age of women with positive margins was 53.4 (SD = 17.1) years. The mean size of primary tumor was 4.0 (SD = 2.1) cm; the majority (53.0%) of which were greater than 2.0?cm; but less than or equal to 5.0?cm (T2). A total of 26 (83.4%) of these tumors were invasive ductal carcinomas (NOS); 24 (92.3%) of the cases had combined Bloom-Richardson grading; and many; 10 (41.7%); were grade 1. Conclusion. Our study shows that 21.0% of all wide local excision biopsies had positive tumor margins; a figure that is comparable to those of other studies. Tumors with positive margins in this study were large; 4.0?cm (T2); and common in relatively young women. Treatment failure is therefore likely to occur in these patients

Laparoscopic Cholecystectomy at the Korle Bu Teaching Hospital; Accra; Ghana: an Initial Report

BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones; information was obtained on demography; duration of various stages of the operation; analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation; muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44) and previous cholecystitis 15(29). There were scars from previous abdominal surgery in 22 (42); mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77). Only one patient (1.9) had the operation converted to open cholecystectomy. Most patients; 47/51 (92); were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes); pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6); infection of the umbilical wound 3(5.9); right shoulder tip pain (3; 5.9) and bile leak 1(2). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra

Upper gastrointestinal endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana

Objectives: To study the indications for endo-scopy, the endoscopic diagnosis and other lessons learnt.. Methods: A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results: A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 + 0.5 and females 43.7 + 0.6 years. Epi-gastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duo-denal ulcer (19.6%), acute gastritis (12.7%), duo-denitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion: The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ul-cer is usually associated with H. pylori infection and is the commonest cause of upper gastrointesti-nal bleeding