Epidemiology, etiology, and treatment of chronic leg ulcer: experience with sixty patients

Background: Chronic leg ulcer (CLU) is reported to have an impact on virtually all aspects of life. Treatment is expensive and has large economic burden on many countries' health services. This presentation is to determine the impact; etiology; and presentation of CLU as well as the procedures for processing in a Nigeria tertiary care facility. Methods: All patients with CLU seen that were prospectively managed in our hospital between 2004 and 2006 have been included in the study. The data were analyzed by SPSS version 11.0 of software. Results: Sixty consecutive patients seen over a period of 3 years (2004-2006) were prospectively studied. There were two peak period of age presentation 30-39 and 50-69 years. The male female ratio was 1:1. Most of the patients (93.3) had unilateral ulcers and it was as common on the right as on the left. Fifty percent of patients had medical disorders. The commonest cause of CLU was poorly managed traumatic wound. Conclusion: Most patients benefited from debridement with or without split thickness skin graft or flap

Thyroid Cancers amongst Goiter Population in a Nigerian Tertiary Hospital:Surgical and Radiographic Perspective

Background: Goiters are commonly benign; but cases of malignancy can develop. Thyroid cancer is known to be commoner in whites than in blacks and in females than in males. Bone metastasis is a common occurrence and may be the initial manifestation in a small subset. We hope to determine the incidence and the cervical radiographic patterns of thyroid cancer amongst goiter population in Nigeria. Method: Surgical; histological and radiographic findings in patients with goiter who had thyroidectomy in our hospital from 1999 to 2006 were reviewed.Those with proven cancer were analyzed for sex; age and radiographic changes using SPSS 11.0 for windows. Results Thirteen (8.2) cases out of the 160 goiters were malignant and distant metastases were present in 1.3at presentation. The histological sub-types of malignant goiters were follicular (5.0); papillary (1.9) and poorly differentiated or anaplastic thyroid carcinoma (1.3). As much as 30of thyroid cancers demonstrated calcification on plain neck radiograph; which were commonly scattered or diffused. Conclusions: Carcinomatous goiters occurred in 9.3of the goiter population studied with predominance of follicular variant. Surgery remains the main stay but was inappropriate in about 1.2of population with goitre. Aside evidence of bony destruction; TC should be suspected in goiters with mixed (diffused or scattered) calcifications

Bacteriological Pattern of Wound Swab Isolates in Patients with Chronic Leg Ulcer

Purpose: To determine the pattern of bacterial pathogens and their antibiotic sensitivity profile in patients with infected chronic leg ulceration. Methods: Sixty swab specimens obtained from chronic leg ulcer (CLU) patients were cultured aerobically and the antibiotic sensitivity pattern of the recovered organisms determined by the modified Kirby -Bauer disc-diffusion method. Results: 47 (78.3) of the ulcers were infected out of which 39 (83.0) were culture positive. Most of the culture positive ulcers were on the distal third of the leg. The isolated bacteria from the wounds were Pseudomonas aeruginosa (33); Staphylococcus aureus (24); Proteus spp (15); Klebsiella spp (13); Citrobacter spp (13) and Escherichia coli (2). None of the patient without clinical evidence of wound infection had bacterial positive wound swab culture. All isolates were sensitive to third generation cephalosporin and floroquinolones but majority were resistant to ampicillin. Conclusion: Pseudomonas aeruginosa; Staphyloco-ccus aureus. Proteus spp; Klebsiella spp; Citrobacter spp and Escherichia coli sensitive to third generation cephalosporin and floroquinolones have been recovered from 78of patients with chronic leg ulcers in a tertiary health facility in Nigeria

A review of soft tissue sarcoma

Background : Soft tissue sarcomas (STS) are a heterogeneous group of rare tumours that arise predominantly from the embryonic mesoderm. They present most commonly as an asymptomatic mass originating in an extremity but can occur anywhere in the body; particularly the trunk; retroperitoneum; or the head and neck. They account for about 0.7of all adult malignancies. Method : A review of the literature of STS was undertaken with emphasis on current approach in management. Result : Despite recent advances in the knowledge of the molecular biology of STS; there is yet no identifiable aetiology in most cases. Tru-cut biopsy is a safe; accurate and economical procedure for diagnosing STS. Enough tissue is usually obtained for use in several diagnostic tests such as electron microscopy and cytogenetic analysis. With the advent of Computed Tomography (CT); Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA); tumours can easily be delineated from muscle groups; bone and neurovascular structures. Surgery remains the main potentially curative therapy for STS. In the last two decades; the role of adjuvant radiotherapy has revolutionized the treatment from a situation where amputation was the standard treatment for extremity STS to the present time where limb sparing surgery is appropriate in more than 90of patients. Postoperative adjuvant chemotherapy significantly improves the overall and disease free survival for patients with large size and high grade sarcomas. Conclusion : optimal results of treatment require multidisciplinary interaction between the referring practitioner; the treating surgeon; the pathologist; the radiotherapist and the chemotherapist.1