Extra-adrenal Pheochromocytoma: Experience in Mulago Hospital

Exta-adrenal pheochromocytomas are rare tumors that arise from extra-adrenal chromaffin cells of the sympathetic ganglia. Experience with two cases is reported here and a review of literature was conducted. Like pheochromocytomas, extra adrenal pheochromocytomas present with episodic hypertension, tachycardia, headache, and diaphoresis, and can be either benign or malignant. Diagnosis is made by serum and urine analysis for catecholamines and metanephrines, and confirmed with imaging studies including computed tomography scanning, magnetic resonance imaging, or 123-I metaiodobenzylguanidine imaging. Ultrasound scanning in the developing world is beneficial. Genetic testing should be offered were available, particularly patients who are young, have multiple tumors, or have a family history of malignancy. Management of extra-adrenal pheochromocytoma is enblock en-mass surgical resection. Chemotherapy, and radiation therapy may be necessary in malignant disease. Longterm follow-up is essential, as extra-adrenal pheochromocytomas can recur many years after initial diagnosis

Trends in upper gastrointestinal diagnosis over four decades in Lusaka, Zambia: a retrospective analysis of endoscopic findings

BACKGROUND AND AIMS: There a shortage of robust information about profiles of gastrointestinal disease in sub-Saharan Africa. The endoscopy unit of the University Teaching Hospital in Lusaka has been running without interruption since 1977 and this 38-year record is largely intact. We report an analysis of endoscopic findings over this period. METHODS: Written endoscopy records from 29th September 1977 to 16th December 2014 were recovered, computerised, coded by two experienced endoscopists and analysed. Temporal trends were analysed using tables, graphs, and unconditional logistic regression, with age, sex of patient, decade, and endoscopist as independent variables to adjust for inter-observer variation. RESULTS: Sixteen thousand nine hundred fifty-three records were identified and analysed. Diagnosis of gastric ulcer rose by 22 %, and that of duodenal ulcer fell by 14 % per decade. Endoscopically diagnosed oesophageal cancer increased by 32 % per decade, but gastric cancer rose only in patients under 60 years of age (21 % per decade). Oesophageal varices were the commonest finding in patients presenting with haematemesis, increasing by 14 % per decade in that patient group. Two HIV-related diagnoses, oesophageal candidiasis and Kaposi’s sarcoma, rose from almost zero to very high levels in the 1990s but fell substantially after 2005 when anti-retroviral therapy became widely available. CONCLUSIONS: This useful dataset suggests that there are important trends in some endoscopic findings over four decades. These trends are not explained by inter-observer variation. Reasons for the divergent trends in incidence of peptic ulceration and apparent trends in diagnosis of upper gastrointestinal cancers merit further exploration

Cancer of the esophagus: histopathological sub-types in northern Uganda.

Background: Esophageal cancer is the eighth most common cause of cancer death worldwide with squamous cell carcinoma and adenocarcinoma carcinoma as the main histopathological subtypes. Esophageal cancer is known for its marked variation by geographic region, ethnicity, and gender. Hitherto, the histopathological subtype of this cancer in Northern Uganda were not known. Therefore the aim of the study was to describe the characteristics of esophageal cancer with respect to the histopathologic subtypes, different sites of occurrence, age and gender in this region since its distribution varies with location. Methods: The study was carried out at Lacor Hospital, in northern part of Uganda. The record of 71 patients who had endoscopic and histopathological diagnosis of cancer of esophagus over a period of 3 years between January 2009 and December 2011 were retrospectively analyzed. Results: A total of 140 patients had endoscopic diagnosis of cancer of the esophagus and of these, 71 patients had both endoscopic and histopathological diagnosis of cancer of esophagus during the three-year period covered in the study between January 2009 to December 2011. The female to male ratio was 1:3 with mean age of 55.5 years ± SD 11.8. The common histopathological pattern of cancer of esophagus was squamous cell carcinoma of esophageal consisting of 66 patients (93.o%). The ratio of squamous cell carcinoma to adenocarcinoma was 13:1.The majority of the esophageal cancers were found in the middle third with 38 patients (53.52%), followed by lower third with 27 patients (38.0%) and the upper third which was only 6 patients (8.5%). Conclusions: Squamous cell carcinoma is the most common histopathological subtype in this geographical location with overall cancer of the esophagus mainly affecting the lower 2/3 of the esophagus with the majority in the middle third

Comparision of Fine Needle Aspiration Cytology and Fine Needle Sampling without Aspiration in Diagnosis of Palpable Breast Lumps in Mulago Hospital

Background: Open biopsy of the breast used to be the main traditional method of diagnosis of breast lumps. Fine Needle Aspiration Cytology (FNAC) was later introduced which depends on suction and thus yields hemorrhagic material for cytological study.This study was undertaken to find out if there is a difference in diagnostic accuracy in using Fine Needle Aspiration Cytology and Fine Needle Sample (FNS) without aspiration in the diagnosis of palpable breast lumps.Methods: This was a cross-sectional study of women with palpable breast masses of 2cm and above in the widest diameter by ultrasound. Patients were subjected to FNS, FNAC and excision biopsy of the lump or mastectomy where appropriate. Cytodiagnosis of all the cases was compared to the histodiagnoses of the biopsies to establish the sensitivity, specificity and diagnostic accuracy.Results: Some 85 patients had FNS, FNAC and excision biopsy/mastectomy done. The findings demonstrated that both FNS and FNAC have the same sensitivity of 83.3%, specificity of 100% and diagnostic accuracy of 98.7% in the diagnosis of palpable breast lumps. FNS had good quality smears in 88.2% of the patients as compared to FNAC smears which was 58.8%of the patients.FNS smears were adequate in 95.3% of the patients as compared to FNAC smears which was adequate in 90.6% of the patients.Conclusion: There was no difference in the diagnostic accuracy of FNS and FNAC in the diagnosis of palpable breast lumps. These findings may suggest that it is probably the adequacy of the cells harvested rather than the quality of the cells harvested which determines the difference in the diagnostic accuracy of the two techniques

Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda

Background: Upper gastrointestinal bleeding (UGIB) is a common emergency medical condition that may require hospitalization and resuscitation, and results in high patient morbidity. Upper gastrointestinal endoscopy is the preferred investigative procedure for UGIB because of its accuracy, low rate of complication, and its potential for therapeutic interventions. Objective: To determine the endoscopic findings in patients presenting with UGIB and its frequency among these patients according to gender and age in Lacor hospital, northern Uganda. Methods: The study was carried out at Lacor hospital, located at northern part of Uganda. The record of 224 patients who underwent endoscopy for upper gastrointestinal bleeding over a period of 5 years between January 2006 and December 2010 were retrospectively analyzed. Results: A total of 224 patients had endoscopy for UGIB which consisted of 113 (50.4%) males and 111 (49.6%) females, and the mean age was 42 years ± SD 15.88. The commonest cause of UGIB was esophagealvarices consisting of 40.6%, followed by esophagitis (14.7%), gastritis (12.6%) and peptic ulcer disease (duodenal and gastric ulcers) was 6.2%. The malignant conditions (gastric and esophageal cancers) contributed to 2.6%. Other less frequent causes of UGIB were hiatus hernia (1.8), duodenitis (0.9%), others-gastric polyp (0.4%). Normal endoscopic finding was 16.1% in patients who had UGIB Conclusions: Esophageal varices are the commonest cause of upper gastrointestinal bleeding in this environment as compared to the west which is mainly peptic ulcer disease