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.

The relationship between gallstone disease and gall bladder volume.

BACKGROUND: The role of a large gallbladder volume with regards to a predisposition to gallstones is unknown. It is likely that an increase in gallbladder volume could result in impaired gallbladder motility and bile stasis which may encourage gallstone formation. This study is therefore to determine the relationship between the presence of gallstone disease and gall bladder volume. METHODOLOGY: One hundred type 2 diabetic patients and 100 age and sex-matched controls underwent real time ultrasonography to determine the relationship between the presence of gallstone disease and gallbladder volume. Their demographic characteristics were recorded and compared. The ultrasound examinations was done in the morning following an overnight fast (to prevent gall bladder contraction) without sedation. Longitudinal and transverse scans of the right upper quadrant was done in both the supine and left lateral positions The gallbladder volume was measured. RESULT: The mean gallbladder volume in diabetic patients with gallstone disease 28.4 +/- 18.6 ml was higher than in those without gallstone disease 27.4 +/- 14.8 ml p = 0.844. The mean gallbladder volume in the controls with gallstone disease 26.5 +/- 14.7 ml was also higher than in those without gallstone disease 24.1 +/- 12.7 ml p = 0.189. CONCLUSION: The fasting gallbladder volume tended to be larger in patients with gallstones (i.e. both diabetic patients and controls).

Current views on ultrasonography in the management of pyogenic liver abscess-challenge to practitioners in sub-Saharan Africa.

The aim of this review of the recent literature on the current practice in the management of pyogenic liver abscess (PLA) is to highlight the important roles radiological procedures, particularly ultrasonography (US) now play in it. US equipment is now widely available in many African nations, yet not much is being done to embrace this current line of management. This is evidenced by the dearth of published work in this area from especially sub-Saharan Africa. It is being suggested that general surgeons and radiologists in this region collaborate more to reduce the cost of treating all cases by operations.

Gallstone disease and type-2 diabetes mellitus-the link.

OBJECTIVE: To determine the factors predisposing patients with type-2 diabetes mellitus to gallstone disease. DESIGN: Case-control study. PLACE AND DURATION OF STUDY: The medical outpatient clinic of the University of Ilorin teaching hospital, Ilorin, Nigeria, from July, 2003 to June, 2004. PATIENTS AND METHODS: One hundred type 2 diabetic patients and 100 age and gender-matched controls underwent real time ultrasonography to study factors predisposing patients with type 2 diabetes mellitus to gallstone disease. The age, gender, body mass index (BMI), duration of diabetes mellitus and serum lipids were determined in the individuals enrolled for the study. RESULTS: Fifteen percent of the diabetic patients had ultrasound evidence of gallstone disease as compared to 7% in non-diabetic controls. There was a steady increase in the incidence of gallstone disease in diabetic patients with age with a peak incidence in the seventh decade i.e. 60-69 years, and a decline in the eighth decade i.e. 70 - 79 years. The average age of the diabetic patients with gallstone disease - 59.1+ 9.5 years was significantly higher than in those without gallstone disease - 51.8 + 10.5 years (p = 0.014). The mean duration of disease in the diabetic patients with gallstone disease was 5.0 + 4.9 years compared with 4.5 + 3.8 years in the diabetic patients without gallstone disease (p=0.772). The mean serum cholesterol and triglyceride levels - 4.3 + 1.3 mmol/L and 1.5 + 0.8 mmol/L respectively in the diabetic patients with gallstone disease was higher than in those without gallstone disease - 3.4 + 0.5 mmol/L (p=0.0941) and 1.4 + 0.7 mmol/L (p=0.712) respectively. The mean body mass index for the diabetic patients with gallstone disease was 26.2 + 5.5 kg /m2 compared with 25.7 + 6.7 kg/m2 in those without gallstone disease (p=0.755) . CONCLUSION: Increasing age is a risk factor for gallstone disease in diabetic patients. Hyperlipidaemia, female gender, heavier weight and a longer duration of diabetes mellitus appear to be associated risk factors.