Thyroid cancers in nodular goiters in Kano, Nigeria.

BACKGROUND: Cancer is an occasional incidental finding in nodular goiter, but there has been no formal study on this disease in our locality. AIMS AND OBJECTIVES: To determine the occurrence of histologically diagnosed malignancy in patients who present with nodular goiters. METHODOLOGY: This is a 7-year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters at Aminu Kano Teaching Hospital, Kano. RESULTS: There were 160 multinodular goiters during the study period, out of which 24 (15.0%) had histologically diagnosed cancer, and 1 out of the thirteen patients with solitary thyroid nodule (7.6%) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years, with a mean age of 38.8 years. Eighteen (72%) were females, and 7 (28%) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13 (52%) cases, followed by papillary in 10 (40%), medullary carcinoma in 1 (4%) and anaplastic carcinoma in 1 (4%) patient. CONCLUSION: One-seventh of nodular goiters in our center harboured malignancy, and follicular carcinoma was the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspiration would improve preoperative diagnosis and guide appropriate surgical management.

Thyroid Cancers in Nodular Goiters in Kano; Nigeria

Cancer is an occasional incidental finding in nodular goiter; but there has been no formal study on this disease in our locality. To determine the occurrence of histologically diagnosed malignancy in patients who presentwith nodular goiters. This is a 7- year (2000-2006) retrospective study of all histologically diagnosed malignancies within nodular goiters atAminuKanoTeachingHospital;Kano There were 160 multinodular goiters during the study period; out of which 24 (15.0) had histologically diagnosed cancer; and 1 out of the thirteen patients with solitary thyroid nodule (7.6) had carcinoma. The ages of the patients with carcinoma ranged from 16 to 65 years; with amean age of 38.8 years. Eighteen (72) were females; and 7(28) were males. Six out of the 25 cases of carcinoma were detected preoperatively by fine needle aspiration cytology. Well differentiated follicular carcinoma was the predominant histological type in 13(52) cases; followed by papillary in 10(40); medullary carcinoma in 1(4) and anaplastic carcinoma in 1(4) patient. One-seventh of nodular goiters in our center harbouredmalignancy; and follicular carcinomawas the prevalent histological type. This is consistent with the findings elsewhere in endemic goitrous regions. Ultrasound guided fine needle aspirationwould improve preoperative diagnosis and guide appropriate surgical management

Penile gangrene due to strangulation by a metallic nut: a case report.

BACKGROUND: Penile entrapment and subsequent strangulation is a serious injury that requires a prompt treatment to avoid gangrene. OBJECTIVE: We report our experience dealing with a case of penile gangrene following strangulation by a metallic nut in a middle aged Nigerian. METHODS: We summarise the case history, physical findings, investigations and operative treatment of a middle aged man who slipped a round metallic nut over his penis, entrapping it for five days causing strangulation and subsequent gangrene. The literature on penile entrapment, strangulation and gangrene is also reviewed. RESULTS: The patient presented with acute urinary retention and had complete gangrene of the penis. Suprapubic cystostomy was done and he had total penile amputation and perineal urethrostomy CONCLUSION: Entrapment of the penis leading to strangulation is a rare condition that needs urgent relief, otherwise penile gangrene sets in, the treatment of which has very serious consequences.

Cancer in Nigeria: a 10-year analysis of the Kano cancer registry.

BACKGROUND: Cancer is a major health problem in developed countries and epidemiological evidence shows the emergence of a similar tend in developing countries, particularly in sub-Saharan Africa where HIV/AIDS is predicted to augment the cancer burden. The present study analyses the profile of cancers recorded in the first decade (1995-2004) of establishment of the Kano cancer registry (KCR) a histology/cytology-based registry in Kano, Nigeria. METHODS: Records of cancer cases diagnosed based on histology or cytology and entered into the registry were retrieved and categorized by type/organ sites affected according to International Classification of Diseases for Oncology RESULTS: There was a steady rise in frequency of cancer over the period where a total of 1990 cancer cases were recorded comprising of 1001 (50.3%) males and 989 (49.7%) females. Cancers of the cervix (22.9%), Breast (18.9%), Ovary (8.2%), non-melanoma skin cancer (6.3%), and Uterus (6.2%) were the most frequent female cancers. In males, cancer of the prostate (16.5%), bladder (10.2%), non-melanoma skin (9.9%), colorectum (9.3%) and connective tissue (6.3%) were most common. Burkitt's lymphoma (31.4%), other lymphoreticular cancers (23.8%) and retinoblastoma (20%) predominated in children. CONCLUSION: The KCR supports existing predictions of an increase in incidence of cancers in developing countries. There is need for establishment of comprehensive cancer control programmes in developing countries for the common cancers of the cervix, breast, prostate, bladder, skin and colorectum which are amenable to prevention, early detection and cure.

Giant and complicated subcutaneous lipoma of the neck.

BACKGROUND: Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare. OBJECTIVE: To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision. CASE REPORT: A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up. CONCLUSION: Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

Cancer in Nigeria: a 10-year analysis of the Kano Cancer registry

Background: Cancer is a major health problem in developed countries and epidemiological evidence shows the emergence of a similar tend in developing countries; particularly in sub-Saharan Africa where HIV/AIDS is predicted to augment the cancer burden. The present study analyses the profile of cancers recorded in the first decade (1995-2004) of establishment of the Kano cancer registry (KCR) a histology/ cytology-based registry in Kano; Nigeria. Methods: Records of cancer cases diagnosed based on histology or cytology and entered into the registry were retrieved and categorized by type/ organ sites affected according to International Classification of Diseases for Oncology.Results: There was a steady rise in frequency of cancer over the period where a total of 1990 cancer cases were recorded comprising of 1001 (50.3) males and 989 (49.7) females. Cancers of the cervix (22.9); Breast (18.9); Ovary (8.2); non-melanoma skin cancer (6.3); and Uterus (6.2) were the most frequent female cancers. In males; cancer of the prostate (16.5); bladder (10.2); non-melanoma skin (9.9); colorectum (9.3) and connective tissue (6.3) were most common.Burkits lymphoma (31.4); other lymphoreticular cancers (23.8) and retinoblastoma (20) predominated in children. Conclusion: The KCR supports existing predictions of an increase in incidence of cancers in developing countries. There is need for establishment of comprehensive cancer control programmes in developing countries for the common cancers of the cervix; breast; prostate; bladder; skin and colorectum which are amenable to prevention; early detection and cure

Paediatric burns: management problems in a teaching hospital in north western Nigeria.

The records of 168 children managed for burns in a teaching hospital in northwestern Nigeria, between April 1998 and March 2003, were assessed to determine the factors that are responsible for high rates of morbidity and mortality in paediatric burns. The causes of burns were hot water in 86 cases (51.2%), flame in 45 (26.8%), hot soup in 32 (19%) and electricity in five (3%). The main complications were wound infections in 109 (64.9%) patients, anaemia in 68 (40.5%), malnutrition in 54 (32.1%), contracture in 50 (29.8%), persistent hypothermia in 27 (16.1%), tetanus in 14 (8.3%) and one case (0.6%) of massive upper gastrointestinal bleeding, possibly as a result of Curling's ulcer.

Pathology of peripheral lymph node biopsies in Kane, Northern Nigeria.

BACKGROUND: Lymphadenopathy is a common clinical problem here in Kano, Northern Nigeria but there has been no formal study. We therefore undertook this review to evaluate the pattern in our locality. METHOD: This is a seven-year (1998-2004) retrospective review of all histologically diagnosed lymph node biopsies received at Aminu Kano Teaching Hospital, Kano. RESULTS: Cervical, axillary and inguinal nodes were the most frequently biopsied accounting for 46%, 23% and 13%, while tuberculosis, lymphomas and metastases were the most commonly diagnosed lesions comprising 30%, 24% and 19% respectively. In general, benign lesions were more common constituting 57% of nodal biopsies. Lymphadenopathy was observed to be most prevalent in the first three decades. CONCLUSION: Our findings were broadly similar to most other Nigerian studies and slightly at variance with other African countries but significantly different from the Western World. The limitations of lymph node histopathology in the absence of modern molecular diagnostic techniques are highlighted.

Radical Cystectomy for Locally Advanced Carcinoma of the Bladder in Kano; Nigeria

Objective: Bladder cancer is the second most common genito-urinary malignancy worldwide. The objective of this study was to assess the benefit of radical cystectomy on locally advanced bladder carcinoma in terms of improved quality of life and survival in our environment. Patients and Methods : The records of 58 patients with bladder carcinoma managed at Aminu Kano Teaching Hospital over a 5-year period (May 2000 to April 2005) were reviewed and analysed. Excluded were 28 patients with distant metastatic disease discovered during clinical investigation. Results: Thirty patients (25 males and 5 females) with a mean age of 50.5 years and variable symptoms underwent radical cystectomy for locally advanced carcinoma of the bladder. Urinary drainage was achieved by orthotopic ileal neobladder in 15 patients (50); continent cutaneous reservoir in 11 patients (36.7) and non-continent drainage in 4 patients (13.3). A 40survival was achieved at 6-60 months. Conclusion : Radical cystectomy is a worthwhile procedure in locally advanced carcinoma of the bladder and cure may be achieved in selected patients

Anorectal anomaly: a review of 82 cases seen at JUTH, Nigeria.

BACKGROUND: The management of anorectal anomaly remains a challenge to Surgeons. This study was carried out to determine the pattern and outcome of management of anorectal malformations (ARM) in a Nigerian tertiary hospital. PATIENTS AND METHODS: The clinical and operative records of consecutive children with anorectal anomaly managed between October 1990 and September 2000 at the Jos University Teaching Hospital, Jos, were reviewed. RESULTS: There were 82 patients, (57.3%) males and 35 (42.3%) females (m:f=1.3:1). There were 20 (24.4%) cases each of the high and intermediate types, 40 (48.8%) low variety and 2 (2.4%) cases of persistent cloaca. The high type was proportionately commoner in the males. Less than one-third presented within 24 hours. Eighty three percent of patients (mainly males) presented in acute intestinal obstruction. Passage of stools from abnormal sites and "imperforate" anus were complaints in 60 (73.1%) patients each. A total of 63 patients had definitive corrective procedure. Four patients with stenotic anus were treated by serial anal dilatations while 29 with low anomaly had anoplasty during the neonatal period. Twenty eight patients with intermediate or high anomalies or persistent cloaca had definitive repair or pull-through operations carried out 6-12 months after an initial colostomy. The definitive pull-through operations included abdominoperineal pull-through in 11 patients, PSARP in 15, while 2 girls with persistent cloaca had posterior sagittal anorectovaginoure-throplasty (PSARVUP). Twenty nine children were fully continent of stools after surgery; three patients developed occasional faecal soiling; while six patients had faecal incontinence. CONCLUSION: Anorectal anomaly is common, but presentation is late in our environment. Although mortality rate was high (26%), early results of definitive operation among survivors were generally good after a mean follow-up period of 19 months.

Congenital inclusion cyst of the subgaleal space: a case report.

BACKGROUND: Subgaleal cysts are epidermal cysts located under the galea aponeurotica. They are rare lesions but are commoner among the children of African descent. To the authors knowledge, none has been described in Kano, Northwestern, Nigeria. METHODS: We present the management of a 6 month old Nigerian boy with scalp swelling. RESULT: The scalp swelling was noticed soon after birth and was progressively increasing in size. There was no preceding fever or trauma to the scalp and no associated pain. At six months, the child could sit without support and had attained adequate neck control. Examination revealed a swelling over the anterior fontanelle, measuring 3x2cm. The swelling was hemispherical, firm, fluctuant, and non-tender. It was not pulsatile. Its size did not increase on crying. Diagnosis was confirmed by plain x-ray film and transfontanelle sonography. Total excision of the mass was carried out under general anesthesia and histology confirmed the diagnosis of epidermal inclusion cyst. The child was discharged home in good condition. CONCLUSION: Awareness of this lesion will avoid misdiagnosis and inappropriate treatment.

Characteristics of colorectal carcinoma in Kano, Nigeria: an analysis of 50 cases.

BACKGROUND: Several recent publications have shown a rising incidence with high morbidity and mortality of colorectal cancer amongst blacks. The aim of this study was to determine the epidemiological profile of the colorectal carcinoma in our hospital, a major referral centre in northwestern Nigeria. METHODOLOGY: A retrospective analysis of all histologically proven cases of colorectal carcinoma was performed from January 1999 to December 2002. RESULTS: Fifty patients were managed during the study period with an average presentation of 12.5 cases per year. There were 36 (72%) males and 14 (28%) females (M:F = 2.5 to 1). The mean age at presentation was 42.9 years with 36 patients (72%) below 50 years of age. Carcinoma of the colon occurred in 22 (44%) patients and rectal carcinoma in 28 (56%) patients. Twenty (71.4%) of the 28 rectal cancers were digitally palpable. Thirty-eight (92.7%) patients had palliative resection, while 3 (7.3%) had curative resection. Adenocarcinoma was the only histologic type, with 15 (30%) cases of the mucinous variety. CONCLUSION: There is need to increase awareness through public education about this malignancy and its management. Any adult with complaints of vague abdominal pain, blood or mucus in the stool or features of haemorrhoids which may herald the onset of colorectal cancer should be adequately investigated with digital rectal examination (DRE) and proctosigmoidoscopy and barium enema where appropriate.

Intestinal malrotation: presentation in the older child.

BACKGROUND: The clinical diagnosis of intestinal malrotation in the older child is not always easy because of its non-specific presentations. The aim of this study was to determine the pattern of presentation of malrotation in older Nigerian children. METHODS: The clinical, radiological and operative records of all the children aged 2 years or above, managed for malrotation at the Jos University Teaching Hospital between March 1992 and December 2002 were retrospectively reviewed. RESULTS: There were 9 patients, with a median age of 5 years (range: 3-14 years). The commonest complaint was intermittent colicky abdominal pain in 9 (100%), followed by recurrent vomiting in 8 (88.9%), haematemesis and constipation each in 5 (55.6%) and repeated episodes of bloody stools and diarrhoea. Other features included abdominal distension in 5 (55.6%) and failure to thrive in 4 (44.4%). Preoperative diagnosis was possible only in 3 patients, through the use of barium meal. Operative findings included obstructing bands of Ladd, partial volvulus and mesocolic hernias. Surgery promptly and satisfactorily relieved the symptoms. CONCLUSION: The diagnosis of intestinal malrotation should be considered in any child with prolonged history of recurrent colicky abdominal pain, vomiting or diarrhoea, especially if there is associated history of failure to thrive. Surgical intervention provides satisfactory relief of symptoms and should be implemented as soon as the diagnosis is made.

Glomus tumour--the report of a case in an adult Nigerian.

BACKGROUND: Glomus tumour, a relatively common lesion in Caucasians is reported to be rare in blacks. METHOD: A case of glomus tumour is reported in an adult male Nigerian to highlight its distinctive clinical presentation and the literature reviewed. RESULT: A 60-year old man presented with a painful skin nodule on the ventral surface of his right forearm. The pain was far in excess of the size of the lesion. There was however no relief from previous medications. Following complete excision of the lesion, pain relief was dramatic. Histopathological examination of the lesion showed sheets of round to polyhedral glomus cells and elongated endothelium lined vascular channels diagnostic of glomus tumour. CONCLUSION: Severe pain is a very important feature of glomus tumour of the skin. This is relieved by complete excision of the lesion.

Intraoperative colonic lavage in emergency surgical treatment of left-sided large bowel lesions.

There has been a trend towards resection and primary anastomosis after on-table lavage in patients with left sided colonic emergencies. This study will analyse the outcome in our centre. Thirty-two patients underwent the operation for various lesions of the left colon and the rectum between December 1998 and December 2002. The mean age of the patients was 37.7+/-11.1 years. Mean extra time for the procedure was 37.4+/-5.2 min. The mean hospital stay was 11.2+/-2.9 days. Postoperative complications included four cases (12.5%) of wound infection, and one (3.1%) right sub-phrenic abscess. No clinical anastomotic leakage or mortality was recorded. This study shows that primary anastomosis with on-table colonic lavage can be a safe procedure in selected, low risk patients.

Typhoid enteric perforation in north western Nigeria.

BACKGROUND: Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality. AIMS AND OBJECTIVES: To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano. METHOD: A retrospective Analysis of patients treated for typhoid perforation over a 6-year period. RESULTS: There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis. CONCLUSION: Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Thyroid gland diseases in Kano.

Goiter is endemic in some parts of Nigeria. Kano is populated by people from various geographical areas. There has not been any report of thyroid gland diseases pattern in Kano, hence the need for this study. A retrospective review of 75 cases of thyroid gland diseases seen and managed at Aminu Kano Teaching hospital, Kano over a 5-year period forms the basis for this study. Of the 75 patients with goiters 69(92% ) were females. Simple non-toxic goiter was the most common histologic type accounting for 51 (68.0% ) of cases. There were 10 cases (13.3% ) of thyrotoxicosis, 4 (5.4% )with follicular adenoma, and 10 (13.3% ) other patients had proven carcinoma. Well-differentiated follicular carcinoma was the most common malignant type, 7 of which were not recognised as such preoperatively. All cases were treated by surgery with minimal morbidity and mortality. Thyroid surgery constitutes a significant proportion of surgical practice in Nigeria. While increase in dietary iodine will reduce the incidence of goiter everywhere, the impact of iodinisation of salt is yet to be determined. A population based survey of the prevalence of thyroid gland disease in Kano northwest, Nigeria is strongly indicated.

Giant fibrolipomatous polyp of the oesophagus: a case report.

Giant pedunculated oesophageal polyps are rare intraluminal tumours which are usually benign. they include fibrovascular polyp, liposarcoma, harmatomas and lipomas. They may be asymptomatic for a long time and thus attain an enormous size. We present one of such cases of giant oesophageal polyp in a 28 year-old man with a history of difficulty in breathing and vocalisation, easy fatigability and cough. Dysphagia was late in the complaint and he also had lost 7 kg in the last six months before his presentation. A chest radiograph, barium swallow and oesophagoscopy gave the clinical diagnosis. The thoracic CT examination gave a better delineation of the site of the pedicle, the nature and extent of the tumour mass. The tumour was surgically removed and the final pathological diagnosis was afibro-lipoma of the oesophagus. The patient has since been discharged to follow-up in the Surgical out-patient.

Childhood intestinal obstruction in Northwestern Nigeria.

BACKGROUND: Intestinal obstruction is a common cause of childhood surgical emergency in the tropics. The aim of this paper was to assess the pattern and the outcome of mangement of intestinal obstruction in Nigerian children. STUDY DESIGN: The clinical reccords of all the cases of childhood intestinal obstructions managed at a teaching hospital in northwestern Nigeria between 1999 and 2003 were retrospectively reviewed. RESULTS: There were 54 children, 44(81.5 %) were boys and 10 (8.5 %) were girls (m:f=4.4:1). Fifteen (27.8%) and 22 (46.2%) were neonates and infants, respectively. The causes of the intestinal obstruction were intussusception 16(29.6 %), Hirschprung's disease 14(25.9%), anorectal anomaly 12 (22.2%), external hernias 6(11.1%), atresia 5(9.3%) and congenital bands 1(1.9 %). The clinical features were consistent with those reported from other parts of the world, except that many patients with intussusception presented late with gangrenous intestines. The overall mortality was 6(11.1 %); the mortality in the neonates was 5(33.3 %). CONCLUSION: Apart from the obvious absence of worm infestation, the aetiological pattern and the clinical presentation of childhood intestinal obstruction in this study agrees with those reported from other parts of the country. Their management is associated with high mortality in our environment, especially when there are associated anomalies or the presentation is late.

Bladder cancer in Kano--a histopathological review.

Malignant tumours of the bladder have been observed to be quite common in Kano but there has been no formal study. This four-year (1998-2001) retrospective review sought to document the pattern of these neoplasms. Vesical malignancies constituted 6.4% of all cancers in Kano with squamous (53%) and transitional (35%) carcinomas as the most common histological types. Males outnumbered females more than five times (M:F = 5.2.:1). Cancer of the bladder was most prevalent in the 5th and 6th decades with a mean age of 48.8 years. In general our findings are similar to bladder cancer in other schistosomal endemic regions of Africa.