Utilization of banked blood in pediatric surgical procedures in Calabar, Nigeria

Background: Performing major surgery in a child demands that blood is cross-matched and saved to be transfused as indicated. Because the cost of cross-matching and donation of blood can be enormous and may equal or surpass the cost of surgery in our setting; it is pertinent to evaluate its utilization. The aim of this study was to determine how banked blood meant for pediatric surgical procedures was utilized with the hope of streamlining our blood requisition policy. This may be useful to pediatric and other surgeons involved in the operative care of children in similar settings. Materials and Methods: This was a prospective study of all children who had ELECTIVE or EMERGENCY surgical procedures between January 2009 and June 2010. The age; sex; nature of surgery; blood loss; banked units of blood and amount transfused were collected and analyzed. Results: Eighty two patients had 81 units of blood banked for them. Forty - eight and half units (59.9) of the banked blood were for the emergency group but only 18 units (22.2) were actually transfused at the end (P = 0.044) leading to inadequate use of the product. Conclusion: Banking large quantities of blood but utilizing only little is tantamount to inadequate use and delays surgical intervention. Indirectly; it increases cost of surgery. There is need to rationalize our blood ordering habits without causing harm to patients

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10 years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Cholecystectomy: Indications at University of Calabar Teaching Hospital; Calabar; Nigeria

Background/objective: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. Methods: This is a retrospective study of 18 open cholecystectomies in 10years. Results: The ages ranged from 13 and 65 years (mean 39.2years). There were 15 females and 3 males (F: M=ratio 5:1). Calculous cholecystitis 9(50) in patients; acalculous cholecystitis 8(44.4) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. -Conclusion: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria

Kaposi Sarcoma: Changing Trend in Calabar; South Eastern Nigeria

Background/objective: Kaposi sarcoma (KS) is now the most frequently reported malignant skin tumour in some areas of Africa and was endemic in Africa before the advent of the human immunodeficiency virus (HIV) infection. The prevalence has increased with the emergence of HIV infection. The objective of this report is to describe the frequency; current clinical pattern; and anatomic distribution of KS in Calabar; south-eastern Nigeria and compare this with total malignant skin tumour. Method: All the patients with histologic diagnosis of KS presenting to the University of Calabar Teaching Hospital from January 2005 and December 2006 were analyzed as part of the wider study of malignant skin tumorus. Diagnosis of HIV was based upon enzyme linked immunosorbent assay. Results: In our study; there were 11 patients (7 males and 4 females); with a male: female ratio of 1.75: 1. This was the commonest malignant skin tumor (38) followed by squamous cell carcinoma (SCC) (34.5) and the age ranged from 21 - 60 years (mean 42.9years). Nine patients (81.8) were HIV positive including the 4 females (age ranged from 21 -45 years) and 2(18.2) HIV negative; aged 59 and 60years. The lower limb was the commonest site (50). Atypical lesions involved the eyelids/ nose and penis. Conclusion: KS is now the commonest malignant skin tumour in our region with the HIV related KS as the commonest clinical type. Successful prevention and treatment of HIV infection would reduce the prevalence of this tumour

Basal and Squamous Cell Carcinomata on the Same Patients: Report of Two Cases in Aibinos

Background: Skin cancer is the most common cancer among the lightly pigmented individuals in Europe; North America and Australia. It occurs infrequently in darkly pigmented individuals because they have more melanin. Melanin and albinism are a known risk factors for skin cancers in Africans. Those already treated for skin cancer run a risk of developing another skin cancer. Method: Two case reports of albinos who developed basal cell carcinoma (BCC) and squamous cell carcinomata (SCC) later are presented. The two female albinos aged 61 and 21 years had BCC and SCC involving the left arm and the dorsum of the left hand in case1 and involving the face and the medial side of the right elbow in case 2. Both patients had numerous actinic keratoses that indicated chronic exposure to sunlight. Results: The outcome was good for the BCC's as the wounds healed post excision. There was no evidence of recurrence when the patients represented with SCC at 12 and 18 months respectively. Conclusion: Albinos run a risk of developing both BCC and SCC with chronic exposure to sunlight. Health education strategies on the need for early institution of preventive measures and follow up are emphasised as they run a risk of developing another cancer

Primary Malignant Tumours of the Small Intestine

Background: Primary malignant tumours of the small intestine are rare. These tumours constitute 1-5 of gastrointestinal tract malignancies despite the high rate of epithelial cell turnover and a large mucosal surface area. Clinical; radiological and endoscopic diagnostic difficulties continue to present challenges to surgeons. Primary malignant tumours cause intestinal obstruction necessitating emergency surgery following which diagnosis is made. The consequences of these are significant delay in diagnosis and finding of advanced tumour at surgery. Aim: This study set out to evaluate the management challenges of small intestinal malignancies and proffer solutions for improved outcome. Method : All the cases of primary malignant tumours of the small intestine were retrospectively reviewed for clinical presentation; diagnosis and outcome of treatment and compared with total gastrointestinal malignancies. Result: Seven patients were seen over a 10 - year period. The M: F ratio was 2.5:1 with an age range of 19-55 years and a mean of 43.3 years. The peak age group was in the 4th decade. Small intestinal malignancies accounted for 14.2 of gastrointestinal malignancies during the period of study. Intestinal obstruction was a common mode of presentation with the finding of advanced tumours at surgery. The most common tumour was adenocarcinoma 4(57.1) followed by lymphoma 2(28.6) and 1 case (14.3) of ileal carcinoid. The ileum was the most common site involved 6 (85.7). Conclusion: Malignancies of the small bowel should be considered in patients with recurrent abdominal pain; mass or intestinal obstruction. Aggressive investigation of patients with non specific abdominal symptomatology aimed at tumour localization and histologic diagnosis is important for early diagnosis and treatment for improved outcome

Giant Solitary Hepatocellular Carcinoma. A Case Report

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver; among indigenous inhabitants of Africa and it may present as solitary or multiple lesions often running a rapidly fatal course. Presented is a case of a 25 year female in apparent general good health with a giant solitary hepatocellular carcinoma. HCC should be considered in the diagnosis of a right upper quadrant/epigastric mass even when it assumes a gigantic proportion in an apparently healthy patient

Small Intestinal Carcinoid Tumour : a Case Report and Review of Relevant Literature

Background : Carcinoid tumours have long been known to be a morphologically distinct class of rare intestinal tumours. The prevalence vary with geographical area; most are clinically silent and are found incidentally at surgery. They may occasionally cause intestinal or vascular obstruction necessitating emergency surgery following which the dia- gnosis is made. We report this first case of intestinal carcinoid seen in this centre in over twenty years. Methods: The case report discussed here is an intestinal carcinoid in- volving the distal ileum. Results:Clinical presentation was recurrent abdominal pain with a tender mass in the periumbilical region extending to the right iliac fossa with noisybowel sounds. Plain abdominal x-ray; barium meal and abdominal Ultrasonography were not diagnostic. A laparatomy on account of intestinal obstruction was performed which revealed a tan yellow tumour extending into the mesentery. Histology revealed carcinoid tumour.Conclusion : Carcinoid tumours should be considered in patients presenting with recurrent abdominal pain or mass or intestinal obstruction. Localization of the tumour is impor- tant since the diagnosis of all carcinoids without systemic features from hormone production depends on the histological structure and staining properties