Angioleiomyoma as a rare cause of a painful subcutaneous nodule in the leg: a case report.

Angioleiomyomas are benign tumors originating in the vascular smooth muscles. The tumor typically presents as a painful, solitary, small subcutaneous nodule. Herein, we have described a case report of chronic leg pain due to angioleiomyoma. We outline the clinical, radiological and histopathological features of this rare diagnosis for a painful nodule of extremity. Although rare, angioleiomyoma should be included in the differential diagnosis of chronic leg pain.

Radiation-induced femoral head necrosis.

There are very few cases of radiation-induced femoral head necrosis described in the literature, therefore, this case will add new knowledge and highlights important aspects in the diagnosis and management of this uncommon condition. Our patient was 74 years old and presented with left hip and groin pain for 8 months, with no previous history of trauma or osteoarthritis. However, he had been treated for metastatic prostate cancer, to the pelvis and roof of the left acetabulum, with androgen ablation, and radiotherapy 5 years before presentation. Examination of the left hip revealed painful movements, but no restriction in the range of motion. Initial X-rays did not show any abnormalities, but MRI scan revealed a suspicious lesion in the roof of the left acetabulum, with no indication of secondary weakening of the femoral neck. The patient was therefore referred to the oncologists to consider radiotherapy, but they were not convinced it was metastatic, because he had no new urinary symptoms, and the PSA remained normal throughout this period. He was subsequently referred for a bone scan to look for possible secondary lesions (from the prostate gland), but this did not reveal any abnormal increased uptake. Three months later, he was reviewed in the clinic with a repeat X-ray of the pelvis which revealed complete destruction of the left femoral head and the acetabular roof, but CT-guided biopsy revealed no evidence of malignancy in the left hip. However, in view of the persistent pain and radiological evidence of left hip destruction, the patient had left Total Hip Replacement (THR), and excellent post-operative recovery. He mobilised fully, and was discharged on day five. Histology of the femoral head and hip capsule, revealed no evidence of metastasis from the prostate cancer, but confirmed osteonecrosis of the femoral head, presumably caused by the previous radiotherapy. MRI of the spine was clear and he was discharged to the oncologists and urologists for follow up.

Review of hormonal treatment of breast cancer.

This critical review focuses on the role of steroid hormones and their receptors in the development and treatment of breast cancer, with special reference to estrogen receptors, as well as mechanisms of receptor-ligand interactions, response or resistance to hormonal therapy against breast cancer, in conjunction with other modalities like surgery and chemotherapy. Tamoxifen is used in hormonal treatment of breast cancer for up to five years, depending on the presentation. However, there have been recent developments in hormonal therapy of breast cancer in the last ten years, with the introduction of many different alternative therapies for this condition. A critical review of published articles in Pubmed/Medline, Athens, AJOL, NHS Evidence, Science Direct and Google, relating to hormonal treatment of breast cancer, was undertaken, in order to evaluate the mechanisms of estrogen receptor-ligand interactions, their involvement in the etio-pathogenesis of breast cancer, resistance of breast cancer cells to anti-hormonal agents, as well as ways of treating breast cancer using anti-hormone drugs like tamoxifen. Although tamoxifen is the established drug for hormonal treatment of breast cancer, cases of hormone resistance breast cancer have been described recently in the literature. This can happen from the beginning, or during treatment. Therefore, we aim to examine the causes of resistance to hormonal treatment with a view to understand the options of tackling this problem, and suggest other novel alternative hormonal therapies that can be tried, which may overtake tamoxifen in the future. We also seek to emphasize that hormonal therapy has a definite place in the treatment of breast cancer along with surgery, chemotherapy and radiotherapy, as the disease is often considered to be multi-systemic even from the beginning.

Day case surgery in Nigeria.

Patient care in Nigeria is mostly government funded, from primary to tertiary levels, with little contribution from private sector and non-governmental organizations. Healthcare provision has become more complex and expensive partly due to increasing population, aging, and frequent cancellations of electives, but also due to the increasing emergence of new diseases, as well as shrinkage of resources in many developing countries like Nigeria, resulting from recent economic downturn, and political instability. Therefore, it is important to introduce and popularize the concept of day case surgery, as this may help hospitals and healthcare providers to streamline resources by reducing length of hospital stay, decreasing morbidity and mortality, and providing valuable bed services to emergencies. It also helps to reduce time lost away from work and indirectly helps to decrease loss of revenue for the individual and state. Many hospitals in Nigeria provide day care services with patients admitted to the general surgical wards, and no dedicated day surgery units (DSUs), as currently practised in developed countries. DSUs are the best way to achieve results and so it is important for all to embrace this concept in order to improve healthcare delivery to the rapidly expanding populations. A systematic search of the current published literature was carried out to look for articles related to day case surgery (day care or day surgery) in Nigeria and to examine some published articles in relation to the surgical subspecialities, with a view to highlighting current practice in Nigeria and how it conforms to ideal practice elsewhere. Recommendations and suggestions are made on how to implement and popularize this concept in our hospitals.

Day case surgery in Nigeria

Patient care in Nigeria is mostly government funded; from primary to tertiary levels; with little contribution from private sector and non-governmental organizations. Healthcare provision has become more complex and expensive partly due to increasing population; aging; and frequent cancellations of electives; but also due to the increasing emergence of new diseases; as well as shrinkage of resources in many developing countries like Nigeria; resulting from recent economic downturn; and political instability. Therefore; it is important to introduce and popularize the concept of day case surgery; as this may help hospitals and healthcare providers to streamline resources by reducing length of hospital stay; decreasing morbidity and mortality; and providing valuable bed services to emergencies. It also helps to reduce time lost away from work and indirectly helps to decrease loss of revenue for the individual and state. Many hospitals in Nigeria provide day care services with patients admitted to the general surgical wards; and no dedicated day surgery units (DSUs); as currently practised in developed countries. DSUs are the best way to achieve results and so it is important for all to embrace this concept in order to improve healthcare delivery to the rapidly expanding populations. A systematic search of the current published literature was carried out to look for articles related to day case surgery (day care or day surgery) in Nigeria and to examine some published articles in relation to the surgical subspecialities; with a view to highlighting current practice in Nigeria and how it conforms to ideal practice elsewhere. Recommendations and suggestions are made on how to implement and popularize this concept in our hospitals

AIDS-associated Kaposi's sarcoma in Sokoto, Nigeria.

BACKGROUND: Since the advent of the HIV/AIDS pandemic, Kaposi's sarcoma (KS) is now seen in places not previously considered endemic for this disease. In Nigeria, the African-endemic KS had been known to be prevalent in the southern parts of the country, particularly the southeast. Until now, reports on the disease from northern Nigeria are few. OBJECTIVE: To describe the prevalence ofKaposi's sarcoma in Sokoto, northwestern Nigeria. METHOD: A retrospective review of 27 cases of histologically confirmed KS seen over an 11-year period (Jan.1994-Dec.2004) at the Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Northwestern Nigeria. RESULTS: The average hospital incidence of KS in this review was 2.5 cases per annum (27 cases in 11 years). The modal age was the 4th decade of life (range 18-70 years). Fifteen percent were females; M: F = 5.8: 1. There was no case of childhood involvement identified. More cases of the disease were HIV-positive (59.3%). The commonest symptom was cutaneous nodules in 96.3% of cases. The body region with the highest affectation of the lesions was the lower limb (70.4%). CONCLUSION: Kaposi's sarcoma is still uncommon in the northwestern region of Nigeria. The epidemic variant of the disease predominates among the few cases diagnosed. The finding of nodular lesions and/or indurated leg swelling in any adult male in our environment must be considered to be KS until histologically investigated.