Bilateral choanal atresia in a 7-year-old boy: a case study.

Choanal atresia is a developmental failure of the nasal cavity to communicate with nasopharynx. It can be membranous or bony; unilateral or bilateral; complete or incomplete. Bilateral choanal atresia is less common and usually present in neonatal period with severe respiratory distress. Imaging provides definitive diagnosis by choanography. This report shows the value of computed tomography in the diagnosis of choanal atresia in a patient that presented with bilateral choanal atresia, undiagnosed until about seven years.

Palatal avulsion injury by a foreign body in a child.

A 6-year-old girl who claimed to have fallen while playing with metal rod that resulted in palatal avulsion injuries was presented. Neither of the parents was around when the incidence happened. She was brought to the hospital because of pain, bleeding from the mouth, drooling of saliva mixed with blood and inability to feed or phonate appropriately. Examinations of the oral cavity revealed a triangular area of avulsion in the posterior aspect of the hard palate extending to the soft palate. She had examination under anaesthesia and wound repaired with 3-0 vicryl interrupted sutures after thorough wound debridement. She did well and was discharged from the clinic.

Bladder stone in a three-year-old Nigerian child with posterior urethral valve: a case report.

BACKGROUND: Stone in the bladder is an uncommon presentation in the tropics, especially in children. Its rarity makes the index of suspicion to be low. Patients presenting with it may be mistaken for urinary tract infection (UTI) because of the presence of frequency and dysuria. OBJECTIVE: To present a rare cause of urinary bladder stone in a child in the tropics. METHODS: The patient, a three-year-old boy, presented with recurrent episodes of dysuria and stragury for a duration of about one year. Work up included clinical evaluation and laboratory assessments, results of which informed surgical intervention. RESULTS: The child had been treated repeatedly for urinary tract infection. He was acutely ill with suprapubic tenderness dysuria and poor urinary stream. He was hypertensive. Micturating cystourethrography showed posterior urethral valves and a bladder stone. He had vesicolithotomy and valvotomy with improvement of his blood pressure. CONCLUSION: The coexistence of bladder stone with PUV coupled with delayed diagnosis may be a predisposing factor to hypertension in children. Conventional surgical treatment gives good results.

Unusual cutaneous metastatic follicular thyroid carcinoma.

Follicular thyroid carcinoma (FTC) is the second most common thyroid cancer (TCs) after papillary carcinoma, but it is ranked first in producing distant metastases among TCs. It accounts for 10 - 20% of all thyroid malignancies and is most often seen in patients over 40 years of age. Distant metastases at the time of diagnosis are reported in 11 - 20% of the patients and may be the reason for presentation. There have been less than 30 reported cases of cutaneous metastases from FTC in the English Literature, a majority affecting the scalp. We present an unusual aggressive, hypervascular FTC in a 58-year-old man with a previous diagnosis of multinodular goiter. The difficulty in gaining his acceptability of orthodox management resulted in the development of multiple giant scalp and right facial metastatic masses associated with lytic calvarial destruction and the involvement of frontal and right maxillary sinuses. These imposed serious challenges in managing him in a resource-poor community.

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 1.3% at 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 30% of thyroid cancers demonstrated calcification on plain neck radiograph, which were commonly scattered or diffused. CONCLUSIONS: Carcinomatous goiters occurred in 9.3% of the goiter population studied with predominance of follicular variant. Surgery remains the main stay but was inappropriate in about 1.2% of population with goitre. Aside evidence of bony destruction, TC should be suspected in goiters with mixed (diffused or scattered) calcifications.

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

Pyogenic liver abscess in children: is ruptured appendix still relevant as cause? Case report.

Pyogenic liver abscess [PLA] is a rare and life-threatening disease in children. Appendicitis was the leading source of PLA in the pre-antibiotic era, but it essentially has been eliminated in recent times. Most patients with persistent fever after exploratory laparatomy for perforated appendicitis are often found to have residual abdominal collection. We report a 12-year old girl with PLA after laparotomy for perforated appendix. She developed persistent fever and respiratory distress post operatively. Physicians had an impression of pneumonia but abdominal ultrasound showed cystic mass with mobile internal echoes within the right lobe of the liver suggesting an abscess. Patient was successfully managed by percutaneous drainage under ultrasound guidance. Culture of the pus yielded no growth. She was discharged after 7 weeks of hospital stay. Aetiology, evaluation and treatment modalities were reviewed.

Incidence and patterns of lumbosacral transitional vertebrae, in patients with low backpain in a Nigerian hospital.

BACKGROUND: Lumbosacral transitional vertebrae (LSTV), is a structural anomaly, of the lumbosacral spine which has been variably associated with, low back pain (LBP) and its presence can also result in a level being wrongly identified pre-operatively. OBJECTIVES: To determine the incidence, pattern of LSTV and its relationship with LBP in our tertiary hospital. METHODS: A retrospective review of lumbosacral spine radiographs of 561 one consecutive patients with history of LBP was done from January 2006 to January 2008. The presence or absence of LSTV and degenerative changes were documented. RESULTS: Fifty-one ((9.1%)) out of 561 patients had LSTV. Type II (incomplete) LSTV was the commonest type, occurring in 86.3% of patient with LSTV. Patients less than 30yrs with LBP and LSTV had no degenerative changes, while all patients with LSTV above 50 yrs had degenerative changes. CONCLUSION: Lumbosacral transitional vertebrae type II was the commonest seen in this study, furthermore, LSTV appears to be a causative factor of LBP in young individuals. Careful evaluation of spinal radiographs of patients with LBP belonging to this group is advocated to assess for the presence or absence of LSTV.