SARCOMA OF THE THIGH

This elderly male came with a slow growing thigh tumor for 5 years. It appeared to be a sarcoma of the medial compartment of the thigh. We did a compartment excision. The specimen appears to be a liposarcoma on sectioning. He has an incidental right groin hernia that we will fix in the future.

Medial compartment excision

Specimen-it appears to be a liposarcoma

ADDENDUM (5/23/12)-The patient is doing well-the wound is still draining but slowing down.

HOLY GRAIL

Patient with deep jaundice secondary to biliary obstruction

This lady is not possessed! She has a problem that is the surgeon's holy grail of operations-operable cancer of the head of the pancreas. While we don't like our patients to half terrible diseases, most surgeons do like interesting cases. This patient will require a Whipple procedure which we plan in 3 days time. Drs. Mike and Uche will come to NCH and we will do the procedure together.

DRAPES

These are our new cloth drapes from the USA. They are a heavy cloth and great for our work. They replace the drapes that are disintegrating. Note Taylor estes (left), Dr. Mike (middle) and Smart Uruakpa (right)

SPLENOMEGALLY

Today we operated on a patient with a large spleen. She was symptomatic with  pain and satiety. Splenomegally is common in the tropics. The causes can be many including parasitic infections (especially malaria), viral infections, blood disorders, infiltrative conditions, congestive splenomegally and tropical splenomegally syndrome. We suspect our lady has a lymphoproliferative disorder since she has a high white count.

Splenomegally

SUBSTERNAL

Not all thyroids are in the neck. Today we operated on a lady who had a previous left thyroid lobectomy. She came in with a large goiter on the right and some difficulty breathing at night. This is an unusual complaint since most Nigerians I have encountered do not have breathing difficulty, even when they have giant goiters. We removed the left thyroid remnant and then the right goiter but there was a large mass extending into the mediastinum. I could feel the mass between the left carotid, left subclavian and innominate arteries and extending around the aortic arch. With some struggling, I was able to deliver the substernal goiter into the neck and remove it. 

Unfortunately, she bled after the surgery and required a left anterior thoracotomy. There was no blood available, so I scrubbed out of the case and donated, since she was my blood type. I feel like I am in an episode of the Vampire Diaries. We finally controlled the bleeding. We are both anemic now!

Goiter-the substernal component is next to the scalpel

Another episode of the Vampire Diaries

UNNA BOOT

Leg ulcer of unknown etiology

Leg ulcers are the bane of the surgeons existence. These ulcers are common in Nigeria from various causes. Occasionally, I use an old fashioned method of treatment-the Unna Boot. Unna Boots are named after a German dermatologist, Paul Gerson Unna. Dr. Unna specialized in diagnosing and treating diseases of the skin. The Unna Boot itself is a compression dressing, usually made of cotton, that has a zinc oxide paste applied uniformly to the entire bandage. The zinc oxide paste in the Unna Boot helps ease skin irritation and keeps the area moist. The zinc promotes healing within wound sites, making it useful for burns and ulcers.

Unna Boot with Coban wrap

KNOWLEDGE IS POWER

A significant problem in the third work is access to knowledge. Textbooks are prohibitively expensive. GLOBAL HELP is working to solve this problem by disseminating free online textbooks. This group is making a difference in the world. I have used their Paediatric Surgery: A Comprehensive Text for Africa and is is great.