Gabriel Ugare

Marjolin's ulcer: the importance of surgical management of chronic cutaneous ulcers

Chronic cutaneous ulcers are commonplace in the developing world, especially in rural areas with poor living conditions and often result from the trauma of road‐traffic injuries. Chronic cutaneous ulcers may also be due to vascular insufficiency, neuropathy, nodular leprosy, pressure, diabetes, or hemoglobinopathies, or they may be tropical ulcers. If poorly managed, these lesions may undergo malignant transformation. We evaluated the clinical histories and treatment outcomes of patients seen at the University of Calabar Teaching Hospital, between January 2000 and December 2004, who had histologic diagnosis of Marjolins ulcer, in an attempt to identify risk factors for this problem. The six patients were men, age 30–70 years (mean, 42 years). Trauma was the leading cause of injury leading to ulceration: road‐traffic accidents (four patients, 66.7%), fall (one patient, 16.7%), and flame burn (one patient, 16.7%). Most injuries involved the limbs: lower (four patients, 66.7%) and upper (one patient, 16.7%). The histologic diagnosis in all the cases were squamous cell carcinoma and mean latency period from injury to diagnosis of malignancy was 18.5 years. All the patients had been admitted because of poor results from topical treatment. Three patients (50%) were managed with wide excision and skin grafting with the lesions healed. Ignorance as well as economic and sociocultural factors were the underlying issues. Education concerning the risks associated with chronic wounds and the need for prompt and proper surgical management are recommended.

Major dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria.

AbstractBackground: Dermatologic malignancies are among the most common form of cancer. However, dark-skinned individuals of African descent are said to be far less likely than fair-skinned individuals to develop skin cancer. Significant differences in the pattern of skin malignancy have also been observed in different regions of Africa. Objective:The aim of this study was to evaluate the pattern, site incidence, and outcome of treatment of major histologically diagnosed dermatologic malignancies encountered in a teaching hospital surgical department in South Nigeria. Methods: We evaluated patients with histologic diagnoses of major dermatologic malignancies that presented to the University of Calabar Teaching Hospital, Calabar, Nigeria between January 2000 and December 2004 and compared our findings with the total number of patients diagnosed with malignancies at the same hospital over the same period. This hospital is located in South Nigeria. Results: There were 63 histologically diagnosed dermatologic cancers, comprising 10% of all histologically diagnosed cancers at the University of Calabar Teaching Hospital during the study period. Squamous cell carcinoma (SCC) was the most common (n = 23; 37%), followed by Kaposi sarcoma (KS) [n = 17; 27%]. Other malignancies included basal cell carcinoma (BCC), melanoma, and dermatofibrosarcoma protuberans (DFSP) [n = 5; 8% each]. The peak age varied with the type of cancer but none was found in patients in the first decade of life. The lower limb was the most frequent site of SCC (Marjolin ulcer), KS, and melanoma, while BCC was most common on the head, neck, and upper limb. Excision surgery resulted in healing of all cases of BCC. Some patients with SCC and melanoma presented late for curative surgery. Some African KS tumors were chemo- sensitive. There was a high recurrence rate for DFSP. Conclusion: This study revealed a similar pattern of dermatologic malignancies in South Nigeria compared with other parts of Africa but also some regional differences (e.g. in Kano, melanoma ranked second). The pattern was, however, in sharp contrast to that seen with Caucasian populations, in whom 80% of the lesions are BCC and 20% are SCC. Public education, implementation of preventive strategies, and early presentation of disease would improve outcomes of dermatologic malignancies in Nigeria.

Basal cell carcinoma in five albino Africans from the south‐eastern equatorial rain forest of Nigeria

Background  Basal cell carcinoma (BCC) is the most common cutaneous malignancy in the white population and occurs infrequently in dark‐pigmented individuals. Albinism is an established risk factor for skin cancer in black Africans.

A Prospective Study of Blunt Abdominal Trauma at the University of Calabar Teaching Hospital, Nigeria.

Background:Blunt abdominal trauma (BAT) usually results from motor vehicle accidents, assaults, and recreational accidents or falls. This communication is a 3-year report of an ongoing study aimed at providing the current BAT prevalence in our center. It is hoped that this would assist in a better design of prevention and emergency trauma response systems to cope with this epidemic.Methods:All of the patients admitted to the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria, from February 2005 to January 2008 were prospectively studied based on a questionnaire. Hemodynamic stability and sonography formed the basis for selecting patients for non-operative management (NOM); others were offered laparotomy.Results:In total, 4,391 emergencies were seen during the study period, of which 1,654 (38%) were due to trauma. Seventy-nine patients with abdominal trauma accounted for 4.8% of trauma cases. Forty-two (53%) patients suffered BAT and their ages ranged from 14 and 56 years (mean 28.4 years), with a male:female ratio of 2.5:1. Road traffic accidents accounted for 13 (87%) and 26 (96%) patients in the NOM and laparotomy groups, respectively. The most commonly injured organ was the spleen in both groups: 8 (50%) and 15 (56%) in the NOM and laparotomy groups, respectively. Fifteen (36%) patients were managed successfully in the NOM group.Conclusion:Trauma was mainly due to road traffic injuries. Hemodynamic stability and ultrasonography effectively selected patients for NOM. The establishment of trauma systems, provision of ancillary diagnostic and monitoring facilities, well-designed roads and traffic infrastructure, and health education on road safety would reduce injury, morbidity, and mortality.

A Prospective Study of Penetrating Abdominal Trauma at the University of Calabar Teaching Hospital, Calabar, Southern Nigeria

Background:Abdominal injuries are on the increase in both developed and developing countries. The frequency of penetrating abdominal trauma (PAT) varies across the globe because it relates to industrialization, the weapons available, and the presence of military conflicts. This study sought to evaluate the current pattern and outcome of managementof PAT in Calabar, which is undergoing rapid urbanization, and with a focus on tourism.Method:Patients admitted to the University of Calabar Teaching Hospital, Calabar with PAT from February 2005 to January 2008 were prospectively studied.Results:Seventy-nine patients presented with abdominal trauma, among which 39 (49%) were PAT. There were 37 males and two females, whose ages ranged from 5 to 54 years (mean 27.8 years). Stab wound (18; 46.1%) was the commonest injury, while gunshot wound (15; 38.5%) ranked second. Others were road traffic accident (two patients), fall, cow horn injury, shrapnel, and criminal abortion (a patient each). The commonest injury was evisceration of the omentum and small intestine, which occurred in 13 (36%) patients. Five (14%) patients suffered small intestinal perforations, while three (8%) had liver, splenic and colonic injuries, respectively. Others were rectal injury (four patients), mesenteric injury and perforated stomach (two patients each), and a patient with diaphragmatic injury. The outcome was fatal in two (5%) patients.Conclusion:Penetrating abdominal trauma is on the increase in Calabar. The pattern of injury revealed areas which, when effectively contained, will lead to an improvement in the safety of our environment.

Trauma in a Teaching Hospital Outpost: Comprehensive Health Centre, Okoyong, Cross River State, Nigeria

Background:Road traffic injuries and other forms of trauma have become a major health problem worldwide, but Africa is the worst hit. This study was designed to evaluate the characteristics of trauma injuries in order to offer solutions for planning in terms of policy formulation and implementation.Patients and Methods:The Comprehensive Health Centre, Okoyong, is a rural outpost of the University of Calabar Teaching Hospital. Calabar is located about 45 km away in a rural community close to the highway. Trauma patients seen from January 2004 to December 2004 were studied.Results:In total, 76 trauma patients were recorded. The ages ranged from 2 to 50 years (mean 26.1 years) with a male to female ratio of 3:1. Trauma was mainly due to road traffic injuries, 54 patients (71.1%) (motor vehicle – commercial in 28 patients and motorcycle in 26), followed by assault in 15 patients (19.7%). Laceration and abrasion accounted for 87.8% of injuries. The head and neck was the most common anatomical site injured in 49 patients (47%), followed by the lower limbs in 27 patients (26.0%). The injuries involved 39 passengers/pedestrians (72.3%), while a driver/14 cyclists (27.7%) ranked second. Mortality was 2.6%.Conclusion:Trauma was mainly due to road traffic injuries. The development of rural trauma systems and improvements in road and traffic infrastructure would reduce injury, morbidity, and mortality.

Mucin as possible cause of early adhesional intestinal obstruction

OBJECTIVES To report the case of a 24 year old female undergraduate who presented with bowel obstruction, three weeks following the excision of a mucinous ovarian cyst. PATIENT AND METHODS The records of the patients past and recent medical history laboratory and imaging studies were reviewed. RESULTS Clinical findings of a distended and a plain abdominal radiogram showing distended loops of bowel(Figure 2) were in keeping with acute bowel obstruction. This was confirmed by the intraoperative finding of fibrous encasement of small bowel. This was excised ,and 12months thereafter, patient has remain in good health. Figure 2Preoperative A-P abdominal X-ray in erect position showing small distension. CONCLUSION Early and absolute adhesional bowel obstruction from abdominal surgery is failing conservative management rate. We attributed this to the ruptured mucinous cyst in our earlier operation. We therefore suggest that should a rupture cyst of this type occurs during a surgical procedure, any of the preventive methods discussed should be tried as a prophylactic measure.

Neurofibromas as bilateral cystic chest wall swellings.

A 35 year old male farmer presented with soft bilateral posterior chest wall swellings. He had no similar swellings elsewhere. There were no associated symptoms, except cosmetic deformity and discomfort when he lies on his back. A clinical diagnosis of posterior chest wall lipomata was made. However at surgery, the two tumours were completely cystic. Following total excision, histology of the two tumours revealed cystic degeneration of neurofibromas. His postoperative recovery was uneventful. The importance of this report is to emphasize the need for histological examination of all excised human tissues, which is not always the case in most of our rural areas and to document the discovery of such a rare clinical entity in our centre. This rare entity should be borne in mind when considering the differential diagnosis of benign cystic chest wall tumours.

Giant Solitary Hepatocellular Carcinoma. A Case Report.

Hepatocellular carcinoma (HCC) is the most common primary malignancy of the liver, among indigenous inhabitants of Africa and it may present as solitary or multiple lesions often running a rapidly fatal course. Presented is a case of a 25 year female in apparent general good health with a giant solitary hepatocellular carcinoma. HCC should be considered in the diagnosis of a right upper quadrant/epigastric mass even when it assumes a gigantic proportion in an apparently healthy patient. Keywords : Hepatocellular Carcinoma, Giant, Solitary Tumour. Nigerian Journal of Surgical Sciences Vol. 17 (2) 2007: pp. 125-128