PROGRESS

We have been working for 13 days and have completed 117 operations. Today two volunteers from the USA arrive-Taylor Estes, a pre-veterinary student who has been to NCH twice and Erna Winkler, an RN.  Patients continue to pour arrive. We hope the next week will be our most productive.

FAKE GUCCI

We have all heard of fake Gucci Bags. But have you heard of fake surgery? Unfortunately, this happens in Nigeria sometimes. Patients will come in with right lower quadrant pain, for example-having had an appendectomy. We explore the patient and find an appendix with no scarring and no evidence of past surgery except a scar on the skin. 

Today I saw a woman who apparently had a incomplete abortion. She went to a local doctor and had an ultrasound that showed retained products of conception. A D&C was performed but she kept bleeding and came to us. I performed a repeat D&C and found a uterus full of retained products. Clearly, no D&C had been performed. She got a sham operation but not a sham bill!

DISCHARGE

Our lady with the malignant parotid tumor is ready for discharge. Her wounds have healed well. As expected, she has a 7th nerve deficit. She will need radiation therapy.

Parotid tumor

Post excision

ANOTHER HELL

When she took off her shirt,  I thought I was in Zombieland-Brian Camazine

To die with the stench of rotting flesh is a special hell. We can't do much for this lady. I always wonder why they come so late. 

AN OLD FRIEND RETURNS

Diseases desperate grown
By desperate appliance are relieved.
Or not at all.


Hamlet


Some may remember the following post from 9/29/11. There is some followup at the end.

Ngozi arrived at the hospital several days before I came. She was told that I was coming and might be able to help her. She reportedly has a recurrent Spindle cell tumor that has been operated on four times in the past-the last surgery being about 1.5 years ago.  She has no evidence of metastatic disease so we decided to resect the tumor.

The surgery was quite dramatic. We had to remove all the skin that was involved, perform a radical neck, as well as remove the clavicle, the upper pectoralis major muscle, the deltoid muscle and part of the trapezius muscle. The capsule of the shoulder joint was completely exposed. We had a big hole! Using a somewhat radical solution to fill the hole, we mobilized the breast, removed most of the breast tissue and used the resulting skin as a cutaneous flap. In a few days we will cover the rest of the wound with a contralateral pectoralis flap. I hope this will be her last surgery.

Specimen including deltoid and pectoralis

Addendum (10/21/11) : After her big surgery, this patient was not nutritionally well enough to tolerate more operations so we dressed her wound and fed her well. She slowly improved. and her wound started granulating. At the time of my departure she is almost ready for discharge. Dr. Mike has agreed to do a skin graft in the near future.

Ngozi came back to visit today. The final pathology showed dermatofibrosarcoma protuberans-a non-malignant tumor,  but one that can be very locally invasive. The surgery was radical but she is doing well.

SUBMANDIBULAR GLAND

This lady came with a large submandibular mass. It was freely mobile and is certainly a pleomorphic adenoma-a benign tumor of the salivary gland. Occasionally these masses turn out to be a mucoepidermoid carcinoma-a malignant tumor. This mass was removed without difficulty. We await the pathology results.

Cut section of tumor

JEJUNAL ATRESIA

This 2 day-old baby came in today with a distended abdomen and inability to pass meconium since birth. We operated and found complete situs inverts, malrotation and jejunal atresia. We resected the non-functioning segment, and did a Ladd's Procedure. 

Jejunal atresia Type 1. Notice the sharp transition zone on
 the left between distended bowel and collapsed distal bowel.