Marjolin’s Ulcers: A Review

Background: Marjolin's ulcers though thoughtto be rare have been reported to have a higher incidence in sub-Saharan Africa. These tumours typically run an aggressive course with a poor prognosis. Late presentation has been reported to be typical of these cancers and some of the reasons adduced for this, are difficulties in both clinical and pathological diagnosis. This review therefore aims at enlightening the medical community on Marjolin's ulcers with a view to improving early recognition, treatment and outcome.Method: Literatures on marjolin's ulcers were sourced from available journals and internet based searches using Pubmed, Medline and Google search.Results: The incidence of Marjolin's ulcers appears higher in developing countries. First recognized in the first century AD, a lot is yet to be  understood about the evolution of these cancers. Late presentation still remains a feature of this pathology even in recent times. Prognosis improves drastically with early recognition and treatment.Conclusion: The key to improving outcome in Marjolin's ulcers is early recognition and adequate treatment.Key Words: Marjolin's Ulcers; Review; Literatur

Pattern and Management of acquired Facial defects in Imo State University Teaching Hospital, Orlu, Nigeria.

Background: The face combines function with important aesthetic implications. With organs and units so closely related a fine balance and symmetry must be maintained in reconstructing facial defects. Imo State University Teaching Hospital Orlu, has the bulk of its patients drawn from neigbouring rural communities and are mainly of a low socioeconomic group. They therefore tend to present late with relatively complicated pathologies. This article looks at the pattern, aetiology and management approach for facial defects in our centre and highlights the challenges faced in managing these patients.Method: A review of clinical records of consecutive patients with acquired defects of the face managed at the Imo State University Teaching Hospital over a 12 month period was performed. Socio-demographic and clinical data were retrieved and analyzed.Results: There were 31 patients (15 males and 16 females) with 33 facial defects, and a mean age of 36.2 years. The lips were most commonly involved (30%). The eyelids and eyebrows were least affected. Most defects (48%) followed excision of neoplastic tumors and 87% of these were in Albinos. Human bite was the commonest cause of lip defects. The nasal defects more often required a combination of procedures with multiple theatre sessions. Ninety one percent (91%) of the defects were reconstructed primarily with good results.Conclusion: Surgical excision of squamous cell cancers in albinos and human bite are the commonest causes of facial defects in our  environment. In reconstructing facial defects of diverse aetiologies, adherence to laid down principles of facial reconstruction is necessary to achieve consistently acceptable results. We recommend primary repair of acquired facial defects as this gives optimal results. Keywords: Acquired facial defects; Pattern; Management; Nigeri

Skin Cancers Among Albinos at a University Teaching Hospital in Northwestern Tanzania: A Retrospective Review of 64 Cases.

Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. The challenges associated with the care of these patients are numerous and need to be addressed. The aim of this study was to outline the pattern and treatment outcome of skin cancers among albinos treated at our centre and to highlight challenges associated with the care of these patients and proffer solutions for improved outcome. This was a retrospective study of all albinos with a histopathological diagnosis of skin cancer seen at Bugando Medical Centre from March 2001 to February 2010. Data collected were analyzed using descriptive statistics. A total of 64 patients were studied. The male to female ratio was 1.5:1. The median age of patients was 30 years. The median duration of illness at presentation was 24 months. The commonest reason for late presentation was financial problem. Head and the neck was the most frequent site afflicted in 46(71.8%) patients. Squamous cell carcinoma was the most common histopathological type in 75% of cases. Surgical operation was the commonest modality of treatment in 60 (93.8%) patients. Radiotherapy was given in 24(37.5%) patients. Twenty-seven (42.2%) of the patients did not complete their treatment due to lack of funds. Local recurrence following surgical treatment was recorded in 6 (30.0%) patients. Only thirty-seven (61.7%) patients were available for follow-up at 6-12 months and the remaining patients were lost to follow-up. Skin cancers are the most common cancers among albinos in our environment. Albinism and exposure to ultraviolet light appears to be the most important risk factor in the development of these cancers. Late presentation and failure to complete treatment due to financial difficulties and lack of radiotherapy services at our centre are major challenges in the care of these patients. Early institution of preventive measures, early presentation and treatment, and follow-up should be encouraged in this population for better outcome

Histological Review of Skin cancers in African Albinos: A 10-year Retrospective Review.

Skin cancer is rare among Africans and albinism is an established risk for skin cancer in this population. Ultraviolet radiation is highest at the equator and African albinos living close to the equator have the highest risk of developing skin cancers. This was a retrospective study that involved histological review of all specimens with skin cancers from African albinos submitted to The Regional Dermatology Training Center in Moshi, Tanzania from 2002 to 2011. A total of 134 biopsies from 86 patients with a male to female ratio of 1:1 were reviewed. Head and neck was the commonest (n = 75, 56.0%) site affected by skin cancers. Squamous cell carcinoma (SCC) was more common than basal cell carcinoma (BCC) with a ratio of 1.2:1. Only one Acral lentiginous melanoma was reported. Majority (55.6%) of SCC were well differentiated while nodular BCC (75%) was the most common type of BCC. Squamous cell carcinoma is more common than basal cell carcinoma in African albinos

Limb Trauma in a University Teaching Hospital Setting

BackgroundImo State University Teaching Hospital is located in Orlu, a sub-urban town in Imo State, South-Eastern Nigeria. With a high prevalence of road traffic crashes commonly involving motor bikes used for commercial purposes, trauma appears to be assuming epidemic proportions.AimThe aim of the study was to examine the causes of trauma involving the upper and lower limbs seen at the Imo State University Teaching Hospital, Orlu, determine the causative factors, and the treatment given.Patients and MethodsThe study was a 12 month retrospective study of the cases of limb trauma in adults that presented at the accident and emergency (A&E) department of the hospital.ResultsTwo hundred cases of trauma involving the upper and lower limbs were seen in the A&E department within the period of the study. Road traffic crashes accounted for most of the cases seen (78%), while soft tissue injuries were the commonest injury type seen (54%). Treatment given included wound care (46%), closed reduction and casting (9.4%), as well as open reduction and plating (3.5%). Twenty percent (20%) of the patients left the hospital against medical advice. Of the patients that left against medical advice, 87% had fractures as their primary diagnosis.ConclusionMajority of the limb trauma cases were as a result of road traffic crashes; thus efforts should be directed at improving safety on our roads to reduce the burden of trauma on the health care system. There is also a need to create awareness in the community on the role of orthodox medicine in the management of fractures.Key Words: Limb, trauma, sub-urba

Groin flap for coverage of upper extremity defects in Enugu, Nigeria

No Abstract. Nigerian Journal of Medicine Vol 15 (3) July-September: 295-29

Advanced squamous cell carcinoma of the upper lip in an albino: A reconstructive challenge

Background: Albinos are prone to developing non melanomatous skin cancers. Late presentation constitutes a reconstructive challenge. We present an adult albino who presented with an advanced squamous cell carcinoma.Patient and method: A case of a 68 year old woman with a near total loss of the upper lip (loss of the upper lip sparing both commissures) following tumour resection presented with an 18 month history of an upper lip growth. The fungating mass occupied almost the entire upper lip, sparing about 1 to 1.5 cm of lip tissue on both sides. Its upper limit was about 0.7cm from the floor of the nasal cavity. The tumour was resected with a 0.5 cm margin and the lip reconstructed primarily using bilateral cheek advancement and an Abbe flap under local anesthesia. Flap division and inset was done after two weeks and sutures removed one week later. The patient tolerated the procedure very well. The early results appeared satisfactory both at rest and with lip animation.Conclusion: Near total loss of the upper lip can be reconstructed with bilateral cheek advancement for the lateral part and an Abbe flap for the central portion. The procedure is simple, can be performed under local anesthesia and is recommended for this type of defect as it tries to replace like tissue with its kind.Keywords: Albino, squamous cell carcinoma, local flap, local anaesthesi

Acquired lip defects - presentation and management at Orlu, Nigeria

No Abstract Availabl

Pattern of severe electrical injuries in a Nigerian regional burn centre

Background: The causes and incidence of the commonly observed phenomenon of leaving against medical advice (LAMA) in our hospitals have not been studied. This retrospective study was aimed at evaluating its incidence and pattern in order to suggest possible solutions. Methodology: The case files of patients who left against medical advice at the Casualty unit of the University of Calabar Teaching Hospital between July 2002 and December 2003 were retrieved from the Medical Records Department and information regarding age, sex, education/occupation, religion, diagnosis, reason(s) for leaving and duration of stay in casualty were extracted. Results: A total of 3708 patients were seen at the casualty unit within this period. Ninety-seven patients left against medical advice but only ninety case notes were analyzable. Seven folders had incomplete information. Male /Female ratio was 2:1 and the ages ranged between 7 and 70 years (average 31.5 years).The average duration of stay in Hospital was 2.4 days (1—10days). Sixty-five patients (72.2%) were those who had various forms of trauma while 8 (8.8%) had general surgical problems. 19% (17) patients had medical emergencies. Conclusion: The youths are the most vulnerable group and the principal causes in our environment are ignorance and poverty. Because of poor documentation in our centres, it was not possible to know where these patients go and the results of their treatments. There is therefore a need for further studies. Keywords: Incidence; Leaving against medical advice (LAMA); Casualty Nigerian Journal of Clinical Practice Vol. 9 (2) 2006: pp.124-12

The abdomino-hypogastric flap in soft tissue reconstruction of the hand

Background: The hand is the most frequently injured part of the human body. Extensive tissue losses of the hand have remained a big reconstructive challenge to the plastic and reconstructive surgeon. Advances in microsurgery have transformed hand reconstruction, but in the Nigerian environment limited facilities necessitate that the pedicle abdomino-hypogastric flap should remain an option. We aim at discussing the use of abdomino-hypogastric flap for hand reconstruction in our centre, and make suggestions for improvement.Method: The case records of patients with upper extremity defects treated with abdomino-hypogastric flap at the National Orthopaedic Hospital, Enugu over a six year period – January 2000 to December 2005 werereviewed. Information on bio data, presentation, management and outcome were extracted and analysed.Results: Eleven patients’ case files met the inclusion criteria. There were eight males and three females. Their ages ranged from two years to 47 years. The injuries were mainly post traumatic/crush (in five patients)and defects following release of post burns contractures (in four patients). All flaps had satisfactory survival and complications such as shoulder discomfort and a wide scar were few and well tolerated giving an overallsatisfactory outcome.Conclusion: Use of pedicled abdomino-hypogastric flap for reconstruction of upper extremity defects remains a very viable option in our environment and is recommended to those working under similarconditions of very limited resources.Key words: Abdomino-hypogastric, pedicle flap, hand defects reconstruction