Surgical treatment of perineal giant condylomata acuminata (Buschke Lowenstein tumor): Case series from a developing country.

INTRODUCTION: Giant condylomata acuminatum (GCA) also referred to as Buschke-Lowenstein tumor (BLT) is a rare tumor primarily associated with low-risk HPV 6 and 11, which is believed to be a slow growing intermediate tumor with low potential to transform into invasive cancer. CASE PRESENTATION: We presented our experience with three cases of BLT (one woman and two men). CLINICAL DISCUSSION: The three patients had surgical excision and two of them had reconstruction of the surgical defect with good clinical outcome. CONCLUSION: We highlighted the importance of early identification of symptoms, treatment options and risk of recurrence as well as primary preventive strategies.

INTESTINAL OBSTRUCTION FROM MECKEL'S DIVERTICULUM IN AN ADULT; UNSUSPECTED BUT FOUND- A CASE REPORT.

Introduction: Most cases of Meckel's Diverticulum (MD) are asymptomatic and when symptomatic, preoperative diagnosis of MD maybe a dilemma. Intestinal obstruction is a major complication in the adult population. Case presentation: We report a case of a 24-year-old female presenting with intestinal obstruction from Meckels Diverticulum. Conclusion: MD is largely asymptomatic in adults, however may be present and should be included in our array of differential diagnoses.

THE EFFECT OF SKIN ANTISEPSIS AFTER PRIMARY SKIN CLOSURE ON THE INCIDENCE OF SURGICAL SITE INFECTION AFTER ABDOMINAL SURGERY FOR SEPSIS: A PRELIMINARY REPORT OF A RANDOMISED CONTROLLED TRIAL.

Background: The role of skin antisepsis after skin closure in abdominal surgery for sepsis is not well reported. This study assessed the effect of skin antisepsis following primary skin closure on surgical site infection (SSI) after contaminated and dirty abdominal surgery. Methods: This was a randomised controlled trial involving adult patients undergoing laparotomy for sepsis. Patients were randomised into a Control (C) group where the wound edge was cleaned once with 70% isopropyl alcohol before being covered with a dry sterile gauze dressing and a Povidone-iodine (PI) group in whom the wound edge was cleaned once with 70% isopropyl alcohol, then covered with a 10% povidone iodine-soaked gauze dressing. Both groups were compared for the presence of SSI. Statistical significance was set at a p value of < 0.05. Results: Thirty-seven patients (C group = 18; PI group = 19) were recruited. The median age was 36 years (Interquartile range, IQR = 72) with a male-to-female ratio of 2.7:1. The overall incidence of SSI was 48.6% (n = 18), comparable between the C group (n=10, 55.6%) and PI group (n = 8; 42.1%) (p = 0.413). In-hospital mortality rate was 10.8 % (n = 4), equally distributed between the groups (p = 1.000). The length of hospital stay was 8 days (IQR = 15) in the C group and 7 days in the PI group (IQR =9) (p = 0.169). Conclusion: In laparotomy for sepsis, skin antisepsis after primary skin closure had no effect on the incidence of surgical site infection.

Axillary nodal metastasis and resection margins as predictors of Loco Regional Recurrence in Breast Cancer Patients.

Background: Surgical resection margins (RM), axillary nodal involvement and lymph node ratio (LNR) determine loco-regional control (LRC) in breast cancer management. Late presentation precludes breast conservation therefore surgical option is usually mastectomy and adjuvant chemoradiation minimize loco-regional recurrence (LRR). Objective: We investigated the prognostic role of lymph nodes positive for malignancy (pN), LNR and RM on LRR of breast cancer in a tertiary hospital in Ibadan, Nigeria. Methods: Longitudinal cohort study of 225 females with breast carcinoma managed and followed up for 5-years with end point of LRR or not. Chi-square test and logistic regression analysis were used to evaluate the interaction of resection margin and proportion of metastatic lymph nodes with LRR. The receiver-operator curve was plotted to determine the proportion of metastatic lymph nodes which predicted LRR. Results: Ninety-nine percent had modified radical mastectomy and 163 (72.4%) had negative resection margins. A mean of 11 axillary lymph nodes were harvested at surgery. The age, positive resection margin and number of harvested nodes with malignant cells are associated with LRR. The overall 5-year LRR rate was 16%. Conclusion: LRR is dependent on lymph node involvement as well as and tumor aggressiveness.

The impact of non-closure of the platysma muscle layer on the cosmesis of thyroidectomy scar - a randomised double-blind controlled trial.

BACKGROUND: The relevance of closing the platysma muscle layer after open thyroidectomy has received little interest in terms of research. The objective was to determine whether non-closure of the platysma muscle layer after open thyroidectomy impacts significantly on the cosmetic outcome of the resulting collar scar. METHODS: In this prospective randomised controlled clinical trial, patients were assigned randomly to have the platysma muscle layer closed or not closed. The primary endpoint was the cosmesis of the collar scar six weeks after surgery assessed using the patient and observer scar assessment scale (POSAS). Additional endpoints included operation time and early postoperative wound complications. RESULTS: Ninety-two patients were recruited, with 46 randomised to each group. The patient scar assessment subscale(PSAS) of the POSAS showed no significant difference in the scar cosmesis between the two groups six weeks after surgery (median PSAS: 16.5 vs 17.5; p = 0.514). The observer scar assessment subscale (OSAS) showed that the platysma muscle layer closure group had marginally better scars (median OSAS: 15 vs 17; p = 0.045). The size of the goitre did not make any significant difference in the scar cosmesis. There was no significant difference in the incidence of early postoperative wound complications as well as the median operation time. CONCLUSION: Not closing the platysma muscle layer had no significant impact on the scar cosmesis six weeks after open thyroidectomy, with no significant difference in the incidence of early postoperative wound complications and the operation time.

VOLUMETRIC CLASSIFICATION OF INGUINOSCROTAL SWELLINGS.

Background: External hernias and scrotal swellings are diverse in presentation and are described in many subjective ways. Aim: To create an objective classification of inguinoscrotal swellings in the rural setting. Patients and methods: It was a prospective study on the measurement of inguinoscrotal swellings volume/contents in a cohort of surgical patients in a provincial general hospital in the north of Sierra Leone over a three-year period. For inguinal hernias and other scrotal swellings, the volume ranges of 0- 500ml were used in the classification; for femoral and other external hernias which generally do not reach 'huge' sizes, the volume ranges of 0-100 ml were used. Results: A total of 962 external hernias and hydroceles were classified over a 3- year period. Most, 610 (63.4%) were inguino-scrotal hernias, others were hydroceles, 303 (31.0%) and femoral hernias, 42 (4.3%). The remaining small number consisted of umbilical (4) and epigastric (3) hernias. For the common conditions of hydroceles, inguinal and femoral hernias, about 50% were 'small', more than 40% were 'large', the rest were giant. The same findings were true for epigastric and umbilical hernias. Conclusion: Using the scale that we adopted, majority of the groin hernias and hydroceles were in the small and large categories with a few giant varieties. Volumetric-based classification of hernias and hydroceles can help surgeons communicate more clearly based on standard rather than arbitrary ascription of descriptive terminologies to these very common surgical entities.

PRE-INCISION SKIN ANTISEPSIS: PRACTICE PATTERNS AMONG SURGEONS IN NIGERIA.

Background: Although studies are rife on preoperative skin antisepsis, little is known about what surgeons in Nigeria practice. Objective: To describe the pattern of practice of skin antisepsis prior to skin incision among surgeons in select tertiary hospitals in Nigeria. Methods: This was a questionnaire-based descriptive cross-sectional survey involving surgeons and surgeons in training in the departments of surgery, obstetrics and gynaecology (O&G), otorhinolaryngology (ENT), and oral & maxillofacial surgery (OMS) of 26 select tertiary hospitals from all six geopolitical zones in Nigeria. Data was analysed using version 23 of the SPSS for Windows. Results: A total of 200 surgeons participated in the study with a male-to-female ratio of 9:1. The mean age was 37.2 ± 5.2 years. Senior registrars constituted 60.5% (n=121), followed by registrars (24%; n= 48) and consultants (15.5%; n= 31). The respondents performed a mean volume of 4 surgeries per week. Their most common practice is to perform skin preparation with 3 antiseptic agents with skin scrubbing lasting for 3-4 minutes. Skin scrubbing was performed for longer duration amongst consultants compared with senior registrars and registrars. Of all the surgical wounds encountered in their practice, 57%were clean. The common complications associated with the use of these antiseptic agents include allergic dermatitis and blisters. Conclusion: The practice of pre-incision skin antisepsis varies widely among Nigerian surgeons. The majority use 3 antiseptic agents for skin antisepsis although most of the procedures performed were clean surgeries. We recommend further studies to standardize our practice locally.

PERIOPERATIVE MORBIDITY AND MORTALITY AFTER EMERGENCY AND ELECTIVE COLON AND PROXIMAL RECTAL SURGERY IN IBADAN.

OBJECTIVE: While the epidemiology of benign colonic pathologies has not significantly changed in our region, colorectal cancer has steadily increased with a majority of patients presenting with late stage disease particularly large bowel obstruction. This study reviews the outcome of emergency and elective colon and proximal rectal cases with regards to perioperative morbidity and mortality. SETTING: All patients who had surgery for symptoms of lower gastrointestinal tract disease (caecum and proximal rectum) between January 2008 and January 2018 at University College Hospital, Ibadan were included. Data regarding elective or emergency presentation, peri-operative findings, operative details and postoperative course were recorded prospectively. RESULTS: Out of the 1618 patients with symptoms, 817 were operated on as emergencies (38.1%) and electives (61.9%). The median age of patients who had emergency and elective surgery were 56 (33-81) and 59 (27-87) respectively (p-0.05). Right hemicolectomy (152; 18.6%) was the commonest procedure, followed by anterior resection (115; 14.1%) and colostomy (114; 13.9%). Overall morbidity was 13.7% (elective 4.2%; emergency 9.5%), while mortality was 6.8% (elective 2.1%; emergency 4.7%). The commonest morbidities were superficial surgical site infection (SSSI) and wound dehiscence. Bowel perforation or gangrene was the most significant predictor of mortality. CONCLUSION: Large bowel obstruction complicated with perforation and gangrene is a major risk factor for morbidity and mortality in colorectal surgery.

Incidence of pyramidal thyroid lobe in the university college hospital Ibadan.

INTRODUCTION: The pyramidal lobe of the thyroid gland is derived from remnant of the thyroglossal duct. Its presence may be missed clinically; however radiologic and intra-operative findings reveal its presence in up to 50% of cases. The incidence of pyramidal lobe is however not clearly known in Sub-Saharan Africa, particularly in Nigeria. Our aim is to determine the incidence and histological variation of pyramidal lobe of the thyroid gland among surgical patients who underwent thyroid surgery in the University College Hospital, Ibadan. METHODOLOGY: Consecutive surgical patients that underwent total thyroidectomy in the Endocrine Surgery Division, Department of Surgery, University College Hospital, Ibadan between April 2013 and April 2017 were recruited irrespective of age, sex and clinical diagnosis. The presence, anatomy and subsequent histological diagnosis of the pyramidal lobe were noted. RESULTS: One hundred sixty thyroid surgeries were done. Pyramidal lobe was found in 70 patients (44.0%). The presence of the pyramidal lobe was most often associated with multinodular goitres 42 (61.8%) and least found in thyroids with malignant tumours 3 (4.4%). The pyramidal lobe originated commonly from the midline (50.0%) and least from the right (10.3%). The length of the pyramidal lobes ranged from 8 to 80 mm (average 50 mm) in males and 5 to 54 mm (average 42 mm) in females. CONCLUSION: The presence of a pyramidal lobe is not uncommon in people of southwestern Nigeria with its morphologic and histologic profile akin to what obtains in other geographical locations of the world.

CASE REPORT: RETRIEVAL OF AN INTRA-UTERINE CONTRACEPTIVE DEVICE PENETRATING THROUGH THE WALL OF THE RECTUM.

A Copper T intrauterine contraceptive device (IUCD) is a commonly employed method of reversible contraception for women. Its use has been associated with complications such as bleeding, perforation and migration to adjacent organs or peritoneum. Uterine wall erosion and subsequent perforation by an IUCD is not unusual; however the subsequent intraperitoneal migration, to and perforation of the rectum is uncommon. We present a case of 31-year-old female with an IUCD migrating through the uterus possibly into the peritoneal cavity and subsequently eroding into the posterior rectal wall. It was removed easily without complications through the rectum during an examination under anesthesia.

OUTCOME OF LAPAROTOMY FOR PERITONITIS IN 302 CONSECUTIVE PATIENTS IN IBADAN, NIGERIA.

BACKGROUND: Peritonitis is a life-threatening condition and requires urgent surgical management. Despite improvements in the care of patients with peritonitis, its management is still challenging and associated with significant morbidity and mortality. The aim of this study was to determine factors influencing the outcome in patients managed for peritonitis in a tertiary health institution in Nigeria. METHOD: A retrospective study involving 302 patients managed for peritonitis over a 3- year period. The biodata, clinical findings, diagnosis, pre-operative care, mode of anaesthesia, cadre of the surgeon, intraoperative findings, postoperative care, and the outcomes were retrieved from their records. RESULTS: Three hundred and two patients were operated on for peritonitis during the period. The mean age of the patients was 48 ± 12 years. Twenty (6.6%) patients had other co-morbidities, with hypertension being the most frequent. Ruptured appendicitis was the most common cause of peritonitis, 83(27.5). Twenty-eight (9.2%) patients had complications, 19 patients (6.5%) required intensive care unit admission, 25 patients (8.4%) required a second exploratory laparotomy. The mortality rate was 2.4%. There was a statistically significant association between an adverse outcome and presentation with shock, anaemia, jaundice and oliguria. CONCLUSION: The factors influencing outcome are similar to those of other Africa countries. However, the mortality rate in our study is lower. Peri-operative specific organ support and prompt surgical intervention should be instituted to improve outcome. We suggest a prospective study to elucidate the effect of these factors, and to determine the predictive power of the various scoring systems.

EXPERIENCE WITH MANAGING RETROSTERNAL GOITRES IN IBADAN, NIGERIA.

BACKGROUND: There is no general consensus on the definition of retrosternal goitre (RSG) however thyroidectomy remains the gold standard of treatment with or without a sternotomy. AIM: To review the outcome of surgical management of retrosternal goitres. METHODOLOGY: Retrospective review of records of patients who had thyroidectomy for RSG over a 15-year period. RESULTS: Out of a total of 45 patients, 34(76%) were females and 11(24%) were males with a male/female ratio of 3:1; while their age ranged between 28 and 72years with a mean of 57+15SD. All the patients were euthyroid and a quarter did not have symptoms apart from a neck mass. In all, 15% of the patients had recurrent goitre. CT scan of neck and chest was done in 31 (72%) patients; while 44 (98%) patients had cervical retrosternal goitres, 1(2%) patient had ectopic retrosternal goitre. A cervical incision was sufficient in 28 (62%) patients while 17 (38%) patients required additional sternotomy. Total thyroidectomy was done in all the patients. There were post-operative complications in 19 (42%) patients. Histopathology showed that 3(6.6%) patients had papillary thyroid carcinoma while 42(93.4%) had benign pathology findings. CONCLUSION: Surgical removal is the treatment of choice. Most retrosternal goitres can be resected through a collar stud incision; however the possibility of a need for a sternotomy should always be planned. The simultaneous occurrence of cervical and ectopic retrosternal goitre should always be ruled out with a CT scan.

A Fifteen Year Experience of Total Thyroidectomy for the Management of Simple Multinodular Goitres in a Low Medium Income Country.

INTRODUCTION: Total thyroidectomy as a treatment for simple multinodular goitre is not well recognised in most centres in low middle income countries. METHOD: This paper is a retrospective review of outcomes of total thyroidectomy for simple multinodular goitres in the last fifteen years in a tertiary hospital in Nigeria. RESULTS: A total of 652 thyroidectomies were done from January 2001 to December 2015. Simple multinodular goitres were indication for a total thyroidectomy in 447 patients (68.6%) with a male to female ratio of 1:6. Postoperative complications were hypocalcaemia in 22 (4.9%), unilateral recurrent laryngeal nerve palsy in 13 (2.8%) and haemorrhage in 2 patients. Others were seroma and cellulitis. Tracheostomy was required in 35 (5.8%) patients but none was permanent. CONCLUSION: Total thyroidectomy is a relatively safe treatment option for patients who have simple multinodular goitre. It provides a permanent cure with a low postoperative morbidity risk. The burden of replacement l-thyroxine needs to be discussed with the patients.

Comparison of postoperative pain in diathermy and conventional scalpel Skin incision after mastectomy in Ibadan, Nigeria.

INTRODUCTION: Pain control is a challenge after surgery. Inadequate control of acute postoperative pain in mastectomy patients may lead to chronic post mastectomy pain syndrome. The study aimed to compare the effect of diathermy incision with scalpel incision on the severity of acute postoperative pain after mastectomy. METHOD: Sixty three females had mastectomy under general anaesthesia. Thirty two patients had skin incisions made with scalpel while 31 patients with diathermy. Both groups received intraoperative Fentanyl and Tramadol. Tramadol was also employed as postoperative analgesic while Paracetamol was given as the rescue analgesic. The outcome measures were pain scores using visual analogue score (VAS) and analgesic consumption within the twenty four hours postoperatively. RESULTS: The mean VAS in the diathermy group versus scalpel group at 6th, 12, 18th and 24th hour post operatively were 11.84 +/- 6.15 mm versus 16.18 +/- 8.5 mm (p=0.001), 11.10 +/- 4.26 mm versus 15.84 +/- 5.12 mm (p=0.001), 11.07 +/- 4.15 mm versus 17.32 +/- 6.01 mm (p=0.001), 10.6 +/- 8.08 mm versus 19.19 +/- 8.7 mm (p = 0.001) respectively. The mean dose of Tramadol was 264 +/- 84 mg in the diathermy group versus 278 +/- 64 mg in the scalpel group p=0.189, three patients required rescue analgesic (paracetamol) in the diathermy group mean dose 1.5.7 +/- 0.54 g versus 7 patients in the scalpel group, mean dose 1.67 +/- 0.58 g p=0.75. CONCLUSION: Diathermy can contribute to reduction in the acute postoperative pain in patients undergoing mastectomy.

Case reports of adult colo-colonic intussusception.

BACKGROUND: Adult colo-colonic intussusception is a rare abnormality and it may pose a diagnostic challenge. OBJECTIVE: To report two cases of adult colo-colonic intussusception with benign lesion as the lead points. METHODS: The Clinical records of the two patients containing the management details were retrieved and reviewed. RESULTS: The 1st case was a 60 year old man presenting with a year history of recurrent left abdominal pain a two week history of fullness left upper and lower abdomen. Examination showed an 8cm by 6 cm mass in the left hypochondrium continuing with another 16cm by 8 cm mass spanning the left lumbar and left iliac fossa. Abdominal ultrasound scan showed a huge mixed echogenic mass in the central abdomen spanning the left hypochondriac, left lumber and suprapubic regions. He had exploratory laparotomy which revealed cob-cobonic intussusception involving the ascending colon up to sigmoid colon. He had subtotal colectomy done. The lead point was a hamartomatous polyp The 2nd case was a 35 year old man with a two month history of recurrent abdominal pain and haematochezia, a month history change in bowel habit and five day history of abdominal distension. Examination showed distended abdomen with generalised tenderness. There was a firm mass in the left hypochondrium extending to the left iliac fossa. Abdominal ultrasound scan confirm intussusception: Exploratory laparotomy showed perforation of transverse colon at the neck of cob-colonic intussusception involving the distal third of the transverse colon to the rectum. He had extended left hernicolectomy and Devine colostomy done. He died 36 h6urs post operation. The lead point was an inflammatory polyp. CONCLUSION: Adult colo-colonic intussusception is an uncommon disease which may not present in a typical feature of intussusception as occur in children thus posing diagnostic dilemma. High index of suspicion with radiological investigation will serve to aid rapid and accurate diagnosis.

ADULT ABDOMINAL WALL HERNIA IN IBADAN.

BACKGROUND: Abdominal wall hernias are very common diseases encountered in surgical practice. Groin hernia is the commonest type of abdominal wall hernias. There are several methods of hernia repair but tension-free repair (usually with mesh) offers the least recurrent rate. AIM: To describe the clinical profile of anterior abdominal wall hernias and our experience in the surgical management of identified hernias. METHOD: The project was a retrospective study of all patients with abdominal wall hernia presenting into surgical divisions of University College Hospital Ibadan during a 6 year period (January 2008 to December 2013). Relevant information was retrieved from their case notes and analysed. RESULTS: The case records of 1215 (84.7%) patients out of 1435 were retrieved. Elective surgery was done in 981(80.7%) patients while 234 (19.3%) patients had emergency surgery. There were 922 (84.8%) groin hernias and post-operative incisional hernia accounted for 9.1% (111) of the patients. About half (49.1%) of those with incisional hernia were post obstetric and gynaecologic procedure followed by post laparotomy incisional hernias 16 (14%) and others (23.5%). The ratio of inguinal hernia to other types in this study is 3:1. Hollow viscus resection and emergency surgery were predictors of wound infection statistically significant in predicting wound infection (P < 0.001). Peri-operative morbidity/mortality at 28 days post operation was documented in 113 patients (12.1%). One year recurrence rate of groin hernia was 2.1%. CONCLUSION: The pattern of presentation and management of anterior wall hernias are still the same compared with the earlier study in this hospital. New modality of treatment should be adopted as the standard choice of care. Abdominal wall hernias are very common clinical presentation. Modified Bassini repair was the preferred method of repair due to its simplicity. Mesh repair is becoming more common in recent time but high cost and initial non-availability of the mesh limit its use in our centre.

PERCUTANEOUS LAPAROSCOPIC TROCAR DRAINAGE OF HEPATIC ABSCESS IN A SICKLE CELL DISEASE PATIENT - A CASE REPORT.

Hepatic abscess as a manifestation of sickle cell disease is rare. A 25 year old Nigerian male with sickle cell disease presented with right sided upper abdominal pain, fever, massive hepatomegaly, neutrophilic leucocytosis and mildly deranged liver enzymes. Sonographic findings were a large thin walled right hepatic lobe abscess; with an estimated volume of 2000ml. He had percutaneous laparoscopic trocar drainage of 2250mls of pus with insertion of a drain. The drain was removed after ten days and the patient was discharged home.

HER 2 expression status in gastric carcinomas in Ibadan, Nigeria: a preliminary study using immunohistochemistry.

MATERIALS AND METHODS- Archival formalin fixed paraffin embedded gastric Adenocarcinoma tumour tissue from the Department of Pathology, University College Hospital, Ibadan were studied for HER 2 protein status using immunohistochemistry. RESULTS- HER 2 protein receptor status was determined in 36 cases using immunohistochemistry. The male: female ratio was 1.4:1. The age range of the patients was 30 to 86 years, with peak age-groups being in the 6th and 7th decade of life. Mean age of the patients was 57.6 years while the median age was 56years. Four cases were positive for the HER 2 receptor protein representing about 11% of the cases. Two cases had staining score of 2+ while another 2 cases had score of 3+. The four positive cases were intestinal variants of gastric adenocarcinomas based on Laurens classification. Three were well differentiated tumours and one was moderately differentiated. CONCLUSION- HER 2 protein overexpression by immunohistochemistry can be demonstrated in black Africans with gastric carcinoma. More detailed and multicentre studies will be needed to draw firm conclusions in this regard.

Regional anaesthetic technique for laparoscopic appendicectomy in Ibadan.

BACKGROUND: Laparoscopy is now readily being deployed for abdominal surgeries in our centre, thanks to the surgeons' interest and the desire to follow best practice as obtained in other climes. General anaesthesia (GA) with intermittent positive pressure ventilation is usually the preferred mode of anaesthesia for this procedure. There are reports of laparoscopic surgery of abdomen performed under spinal and or epidural anaesthetic techniques. METHODS: With Intra-Abdominal Pressure (IAP) from CO2 insufflations limited to 10-12 mmHg, Laparoscopic Appendicectomy (LA) was performed under Combined Spinal Epidural (CSE) for ten consenting ASA 1 and II patients with mean age 23.6 years and BMI of 24.9 kg/m2 in University College Hospital Ibadan, Nigeria. Intra-operative events and ease of operation were studied; systemic drugs were administered if patients complained of pain and discomfort, and G.A if regional techniques and sedation failed. RESULTS: Eight(8) patients had the procedure completed under spinal anaesthesia supplemented with sedation, two (2) patients whose block went as high as T4 had no need of sedation. There were operative difficulties in four patients out of which 2 had sedations and the surgeons could continue operating. We converted to GA in two (2) patients when regional techniques and sedation failed. CONCLUSION: We concluded that with proper selection of patients and limiting IAP to 10-12 mmHg, LA can be safely performed with spinal anaesthesia with some supplementation.

Bone Scintigraphy in Breast Cancer Patients in Ibadan, Nigeria.

BACKGROUND: The bone is the commonest site of metastases from breast carcinoma. Radionuclide isotope scanning is a sensitive scanning procedure for the demonstration of bone pathology. In May 2006, a gamma camera was introduced into clinical use for skeletal scintigraphy at the University College Hospital, Ibadan, Nigeria. OBJECTIVE: To review the first five years findings of skeletal scintigraphy in our breast cancer patients. METHODS: We retrospectively reviewed the clinical data and scintigraphic bone studies of patients with histology proven breast carcinoma managed in the Surgical Oncology Division, University College Hospital, Ibadan, Nigeria between May 2006 and April 2011. RESULTS: Within the period, a total of 597 breast cancer patients had skeletal scintigraphy (SS). Of the 594 (99.5%) SS reports available for review, scintigraphic evidence of bone metastases was found in 232 (39.1%) patients. Correlation of bone involvement and clinical stage showed that a large majority of the patients had stage IV (83.3%) and III (15.7%) disease. Most patients (71.6%) had multiple bone lesions. The bone lesions were osteoblastic in 88.9% of the patients; only 1.8% had purely osteolytic lesions with the remainder being a mix of both. CONCLUSION: There was scintigraphic evidence of bone metastasis in most of our patients with stage four breast cancer and in some with locally advanced disease. Multiple bone lesions were found in many of them and almost all the lesions were osteoblastic. Moreover, both the truncal and axial skeletal bones were involved in similar proportions.