Breast diseases: Comparing the initial clinical diagnosis with the definitive histological report

Background: Breast lump is a common clinical presentation of breast lesions. The physical characteristics associated with breast lumps are very vital in making a clinical diagnosis of breast disease.Objective: To evaluate the accuracy of the initial clinical diagnosis (as obtained from the physical characteristics of the breast lump) with the definitive histopathological report of the various breast lesions.Methodology: A one-year prospective study of all consecutive patients with palpable breast lumps presenting at the general surgery out-patient clinic of a tertiary health institution. Patients were evaluated clinically and then followed up until the histology reports were obtained following open surgical biopsy. The data were entered into a database and statistical analyses carried out using the Statistical Package for Social Sciences (SPSS) version 17.0.Results: Of the 110 patients evaluated, 47.3% had malignant breast lesions while 52.7% others had benign lumps. Fifty-four individuals had masses greater than 5cm in their widest diameter, 13 of which were benign and 41 malignant. Thirty-five subjects had axillary lymphadenopathy, 30 were malignant while five were histopathologically benign. Forty-seven tumours were hard: 3(6.4%) benign and 44(93.6%) malignant. Of the 37 patients with attached growths, 3(8.1%) had benign disease while 34(91.9%) were malignant. Out of 52 cases with malignancy, 23(44.2%) had no cutaneous involvement while 29(55.8%) manifested at least one skin change. Only 4(6.9%) people out of 58 with benign diagnosis had skin changes.Conclusion: The physical characteristics of breast masses still accurately reflect the histopathological diagnosis

Correlation of ultrasound measured testicular volume with waist circumference, hip circumference, waist-hip ratio and conicity index in Nigerian adults

Background: Accurate testicular volume measurement is one way to assess testicular function. Some obese males exhibit altered levels of circulating sex steroids; decreased levels of total testosterone (T) and sex hormone binding globulin (SHBG) and increased estrogens levels. Some anthropometric measurements are markers for obesity.Objective: This study aims to evaluate the correlation of testicular volume measured by ultrasound with some anthropometric measurements: Waist circumference, Hip circumference, Waist-Hip Ratio (WHR), and Conicity Index in adult males.Methodology: One hundred and twenty-five adult male subjects comprising staff and students of a University Teaching Hospital, were recruited. The subjects' height, weight, waist circumference and hip circumference were measured and used to calculate the WHR and Conicity Index. Ultrasound measurement of the length, width and height of both testes were done and used to calculate the volumes.Results: The age of the subjects ranged from 19 to 29 years with a mean of 23.48±2.26. The mean ultrasound testicular volumes for the right and left testes were: 15.38±3.29ml and 15.29±3.89ml using the first formula; 22.86±5.43ml and 23.54±6.88ml for second formula; 21.20±5.28ml and 20.87±5.35ml for the third formula respectively. The calculated mean for height, weight, Waist circumference, Hip circumference, WHR and Conicity Index were: 174.64±6.36cm, 68.68±8.25kg, 77.51±5.44cm, 88.76±4.46cm, 0.87±0.40 and 1.14±0.05 respectively. The left, right and combined testicular volumes showed weak negative correlation with the Waist circumference, Hip circumference, WHR and Conicity Index.Conclusion: Ultrasound measured testicular volume showed weak negative correlation with the Waist circumference, Hip circumference, WHR and Conicity Index in Nigerian adults.Key words: Ultrasound, testicular volumes, waist-hip ratio, conicity index, Nigerian adult

An Unusually Large Submandibular Gland Stone. A Case Report.

A Case of 65 year old man that presented with 40 years history of right lower jaw swelling, that became associated with pain two weeks prior to presentation. Examination revealed an elderly man with an enlarged tender right submandibular gland. The medial margin was suppurating. X-ray of the right lower jaw revealed large stone, while ultrasound scan of the right submandibular region revealed an associated abscess. The latter was incised and drained, while excision of the right submandibular gland and calculus was carried out three weeks later. 5.0cm - sized stone was excised. This turned out to be the second largest salivary gland stone recorded in literature. Conclusion Giant salivary gland stone which ( greater than 1.5cm) is rare. To the best of our knowledge, our index patient with a calculus measuring 5.0 x 3.0cm is the second largest stone in literature is remarkable KeyWords: Giant Salivary Gland Stone, Submandibular Glan

Exploratory laparotomy in a single centre general surgery unit: indications and outcome

Background: Exploratory lapamtomy is a surgical procedure pertòrmed in a patient who requires surgery when the actual cause and nature Of the disease is not certain. Exploratory laparotomy is usually carried out as an emergency procedure in patients who are acutely ill and require urgent operation for control and stabilization Of their disease condition. Objective: The aim Of this study is to evaluate the common indications for exploratory laparotomy among general surgery patients and to assess their post-operative outcome and complications. Methodology: This is a three-year retrospective study extending from January 2014 to December 2016. All the consecutive general surgery patients who had exploratory lapamtomy within the study period were recruited into the survey. Patient's demographics including: age, sex, diagnosis, intra-operative findings, operative procedures, complications and outcomes were extracted and analysed. Analysis was done using the SPSS version 2 1.0. Results: A total Of 120 exploratory laparotomies were performed out Of 1,908 surgical operations conducted within the study period (6.29% of total surgery). The age range was 4 - 85 years with a mean Of 40.25±17.23 years and peaks in the 21-30 years and 31-40 years age groups. Seventy-six patients were males and 44 tèmales giving a male to female ratio of I .73: I . Intestinal obstruction from colonic turnours was the commonest indication constituting 28 (23.3%) followed by complicated appendicitis at 26 (21.6%). Bowel obstruction from post-operative bands, perforated peptic ulcer disease (PPUD) and abdominal trauma accounted for 25 (20.8%), 17 (14.2%) and 16 (13.3%) respectively. A total Of 12 patients had complications following surgery representing a complication figure Of 10.0%. Mortality rate was 4.2%. Conclusion: Exploratory laparotomy is still very relevant in general surgery practice. Intestinal obstruction from colonic tumour was the commonest indication in the study. Post-operative complications and mortality rate were relatively low at 10.0% and 4.2% respectively

Diagnostic accuracy of clinical breast examination for breast cancer in patients with palpable breast lump in a middle income country

Background: Breast cancer assessment using breast self-examination (BSE), clinical breast examination (CBE) and mammography are secondary measures that aid in early detection of breast cancer and better management.Objective: The aim of this study is to evaluate the sensitivity, specificity, false positive and false negative rates of clinical breast examination for palpable breast masses at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.Methodology: This is a one-year prospective study from February 2009 to January 2010. All the consecutive patients with palpable breast lesions presenting at the general surgery out-patient clinics were recruited and evaluated clinically. Biopsy was performed on all the patients (open or core needle) and histology reports obtained. Data collected were recorded in a proforma and subsequently analyzed.Results: The age range of the patients was 16-73years (mean=36.9 SD 14.5). Out of the 110 patients, 109 were females and one was male, giving a male to female ratio of 1:109. Clinical breast examination achieved true positive value of 47(42.7%); true negative value 52(47.3%); false positive and false negative values 6(5.5%) and 5(4.5%), respectively. It also achieved the following diagnostic validities: sensitivity of 90.4%; specificity 89.7%; false positive rate 11.3%; false negative rate 8.8%; positive predictive value 88.7%; negative predictive value 91.2% and overall diagnostic accuracy of 90%.Conclusion: Clinical breast examination in trained hands is a useful tool for assessing breast cancer especially in resource poor countries where mammography is still largely unavailable. We recommend this examination to all women from the age of 20years especially in people with positive family history of breast cancer.Keywords: Biopsy, false-negatives, false-positives, family history,mammograph

Cost effectiveness of fine needle aspiration cytology for breast masses

Background: Fine Needle Aspiration Cytology (FNAC) is an excellent method for diagnosing palpable lesions. It is very cost effective and saves huge amounts of money for the patients when compared with open surgical biopsy.Objective: A prospective study carried out to evaluate the cost effectiveness of FNAC for palpable breast masses at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi.Methodology: A total of 180 patients were recruited into the study. All the patients had FNAC but only 110 patients had histopathological reports and the latter were used for test of validity. The total cost for FNAC and histopathology as well as cost saving between FNAC and histopathology for the 110 patients were calculated.Result: The total cost for FNAC procedure and cytological evaluation of each smear was one thousand, seven hundred naira (N1,700.00 = US$11). The total cost for open surgical biopsy and histopathological evaluation was thirteen thousand, six hundred naira (N13,600 = US$88) per patient. It took an average of 2 days +/- SD 1 day to obtain FNAC results while, on the other hand, it took an average of 28 days +/- SD 7 days to obtain histopathological diagnosis.Conclusion: Fine Needle Aspiration Cytology (FNAC) is very cost effective and saves huge amount of money and time for the patients when compared with open surgical biopsy.Keywords: Accuracy, biopsy, cost effective, histology, safet