WHAT IS THE DIAGNOSIS?

Empyema (infection in the chest), post drainage via an extended Eloesser Flap. This man came in 3 months ago near death from an empyema. We drained the chest by removing 2 ribs and packing the chest with gauze daily. This allowed the pus to drain. If you look in the hole you can see the inside of the chest. The cavity has shrunk 50% in the last 3 months and the patient has gained about 15 pounds. This simple procedure (rather than a decortication), can be life-saving.

BREAST CANCER

Patients with advanced breast cancer continue to appear at the hospital. We give neoadjuvant chemotherapy then surgery. Males also suffer from this disease although not as commonly as males.

WHAT IS THE DIAGNOSIS?

Thyrotoxicosis with Exophthalmos. Once we get this man's disease medically controlled we will perform a total thyroidectomy. His eyes will probably not improve, however.

GETTING GOING

Yesterday, we did 11 surgeries including 2 orchiectomies (for prostate cancer), 2 thyroidectomies, a gastrectomy (for gastric outlet obstruction),  a fistula in ano, an inguinal hernia, a recurrent ureterocutaneous fistula,  2 pediatric hernias, and a bone biopsy. We have done a total of 35 surgeries in 5 days. There are 30 patients waiting for surgery. The hospital is full and patients are sleeping on mattresses on the floor. We are just warming up!

MOTHER OF ALL GOITERS 1

This lady has had a growing thyroid mass for 10 years. Today we removed it. The gland  weighed 850 grams-almost 2 pounds. The piece on the right was substernal, lying on top of the aortic arch.

Dr. Mike and I operated on their lady yesterday. She has a large parotid tumor. We were able to find the 7th nerve and save it. These are some of our most difficult and tedious cases but can be much easier with a great assistant like Mike.

WHAT IS YOUR DIAGNOSIS?

This young man came in with nausea and vomitting. He is holding a film from his upper GI series.

He has a gastric outlet obstruction. We operated today and did a subtotal gastrectomy with a Billroth l anastomosis. His stomach was quite distended with barium from the previous day.

MONDAY, MONDAY

Yesterday was so busy that I didn't get to the blog. It was the first Monday since my arrival and the word had gotten out that I was around. Patients pored in to the hospital. Between the 9 surgeries, I saw about 50 patients with all types of horrendous problems.

We are glad that Eric, the chief nurse anesthetist, is feeling better. He has chicken pox!!! He and his children are all recovering. Nonetheless, he came to work and helped us. We now have 3 anesthetists-Wison, Prince and Eric. All 3 are experts. With their help we were able to do nine surgeries today including a splenectomy, a goiter, a LN biopsy, fuguration of skin cancers, a breast lumpectomy, bilateral salpingoophorectomy rectopexy, excision of an abdominal wall mass and an incarcerated, strangulated ovary in a  pediatric hernia.The last case was very interesting from an anesthesia viewpoint. I saw the patient in clinic and decided to operate. Eric had the 3 month-old baby asleep within 15 minutes. A record for any part of the world.

We had a great surprise. Ngozi, our patient from last trip with advanced dermatofibosarcoma protuberans, came for a check up. You may remember that we did a radical resection of her shoulder area including her pectorals muscle, deltoid muscle, upper trapezius muscle, upper breast and clavicle. We transposed her lower breast for tissue coverage over the shoulder joint. She later had a skin graft. She is doing great!!!

This little girl came in with a thyroglossal duct cyst. I was surprised when I asked her to open her mouth. She has several accessory teeth.

Our patient, Chinaka, from last trip came for a check-up. We performed a left hemimandibulectomy for an ameloblastoma. He is doing great and gaining weight despite the loss of most of his right mandible.

We have 21 patients waiting for surgery and many more are still coming.