Pan African Medical Journal最新文献

Adenoid cystic carcinoma infrequently affects paranasal sinuses. It's a slowly progressing, aggressive cancer with a tendency to invade nerves. The research underscores the significance of prompt diagnosis and effective management of adenoid cystic carcinoma. Two cases of adenoid cystic carcinoma of the maxillary sinus are presented. The first, a 73-year-old woman, presented with right nasal obstruction. The second, a 53-year-old woman, presented with a hard palatal mass and right nasal obstruction. The biopsy confirmed adenoid cystic carcinoma in the first patient. Given the extent of the tumor, she was referred to radiotherapy to complement the therapeutic treatment. The second patient underwent mass excision, also confirmed to be adenoid cystic carcinoma, followed by radiation therapy. Adenoid cystic carcinoma of the maxillary sinus is often diagnosed at an advanced stage due to its slow growth and local regional spread, making its diagnosis and therapeutic management particularly challenging.

An aberrant healing reaction to cutaneous injury or inflammation that spreads outside the original wound's boundaries causes keloidal scars. We present the case of a sixty-year-old male patient who initially came with complaints of respiratory system but had spontaneous lesions over his body for 50 years which remained undiagnosed. It was confirmed on histological examination to be keloids. The patient was treated with intralesional triamcinolone acetonide 40 mg plus an injection of lignocaine hydrochloride 2% in the ratio of 1:1 which provided him with a significant reduction in scar appearance over one month and thereby reducing his psychological burden. It is uncommon for spontaneous keloid scars to occur without any prior trauma or surgical intervention. Also, it details a manifestation of spontaneous keloid scars that manifest as numerous sizable lesions at various body locations. This study provides evidence in favor of such spontaneous appearance of keloid scars.

Meningiomas are typically benign and asymptomatic, but complicated or symptomatic cases may necessitate immediate intervention. Specifically, a giant meningioma with high vascularization poses a surgical challenge due to increased risk. In this report, a case of a giant meningioma managed with preoperative embolization (POE) before surgery was presented. A 24-year-old woman presented with severe bilateral visual disturbances and chronic headaches. Upon examination, magnetic resonance imaging (MRI) showed a giant meningioma measuring 97 mm in maximum diameter. Subsequent angiography indicated a significant tumor blush, primarily supplied by the right anterior cerebral artery (RACA) and the right middle cerebral artery (RMCA), with additional dural supply from the distal branches of the right and left middle meningeal artery (R-L MMA). Following this, endovascular embolization was performed, achieving 75% occlusion of the MMA using polyvinyl alcohol (PVA). The tumor was subsequently resected, attaining Simpson grade 1 on the fifth day post-embolization. Theoretically, preoperative embolization offered several advantages, including tumor devascularization, reduced operative blood loss, improved tumor visualization, and potentially higher rates of achieving Simpson grades I or II resection. The MMA was frequently targeted for embolization in meningioma cases, with no additional neurological deficit observed afterward. The optimal timing for resection typically fell within 1-7 days after embolization. During surgery, the patient experienced 1000 ml of bleeding over a 7-hour duration. The results showed that preoperative embolization provided significant benefits in reducing bleeding, shortening operating time, and facilitating mass resection, thereby affecting long-term recurrence rates, reported at 9% over 10 years.

Introduction: hypertension is a major public health problem that is responsible for mortality. In Ethiopia, hypertension is becoming a double burden due to urbanization. The study aims to identify factors that affect the time to recovery from hypertension.

Methods: in this study, a retrospective study design was used, and the data was collected in the patient´s chart from September 2016 to January 2018. Weibull-Inverse Gaussian shared frailty model was employed to identify factors associated with the recovery time of hypertension.

Results: eighty-one percent of the sampled patients were recovered to a normal condition, and nineteen percent of the patients were censored. The median survival time for hypertensive patients to attain a normal condition was 13 months. Weibull-Inverse Gaussian shared frailty model was used for predicting the recovery time of hypertension patients. Unobserved heterogeneity in residences, as estimated by the Weibull-Inverse Gaussian shared frailty model, was θ = 0.385 and p-value = 0.00.

Conclusion: age, systolic blood pressure, related disease, creatine, blood urea nitrogen, the interaction between blood urea nitrogen and age. Therefore, health-care providers give great attention, prioritize those identified factors and provide frequent counseling about reducing hypertension disease.

Parathyroid carcinoma is a very rare malignant tumour of the parathyroid gland, accounting for less than 0.005% of all cancers, and less than 1% of the aetiologies of primary hyperparathyroidism. This case report aims to describe the incidental discovery of a non-secreting parathyroid carcinoma in a left supraclavicular location and to report on the diagnostic difficulties encountered, together with a review of the literature and current management issues. A 43-year-old female presented with a left supraclavicular swelling with no associated signs. Imaging revealed left supra-clavicular adenopathy (Troisier lymph node) associated with a hetero-multi-nodular goiter classified EU-TIRADS 5. The abdominopelvic region was strictly normal. The patient underwent a total thyroidectomy with a left mediastino-recurrent curage and a homolateral laterocervical functional curage. Pathological examination was consistent with parathyroid carcinoma in the left supraclavicular region.

Lacrimal cutaneous fistula is an uncommon yet clinically significant condition leading to persistent epiphora, recurrent infections, and significant patient discomfort. It can be congenital or acquired. Timely identification and appropriate surgical management are crucial to alleviate symptoms and restore normal lacrimal system functionality. This case report describes the presentation and surgical management of an iatrogenic lacrimal cutaneous fistula in a 68-year-old patient. The surgical intervention involved a novel stripping technique, which successfully resolved the fistula without requiring special instruments. The patient's post-operative recovery was positive, with complete closure of the fistulous tract and restoration of normal lacrimal system function. This report underscores the efficacy of the stripping technique for managing iatrogenic lacrimal fistulas and suggests its consideration for similar cases.

Third nerve palsies that result from head injuries or intracranial aneurysms may sometimes show symptoms of aberrant regeneration and only partially heal. The usual characteristics of oculomotor nerve palsy, caused by compression of the third cranial nerve, are severe ptosis, deficiencies in elevation, depression, and adduction, and a dilated, poorly responding pupil on the afflicted side. The parasympathetic fibres are usually spared from a vasculopathic lesion and impacted by compressive lesions because they are situated in the peripheral segment of the oculomotor nerve as it leaves the brain stem. When pupillary mydriasis coexists with acute third cranial nerve palsy, an aneurysm at the junction of the internal carotid and posterior communicating arteries has to be thoroughly and quickly explored using the necessary neuroimaging techniques.

Tuberculosis is a major public health problem in Morocco and most of the developing countries but tuberculous otomastoiditis is quite rare. Here we report a case where a seven-year-old patient had chronic right otomastoiditis and retro-auricular fistula, whose specificity is its persistence after prolonged unsuccessful medical and surgical therapy for more than 2 months, and its complication by homolateral sigmoid sinus thrombosis. Computed Tomography (CT) scan of temporal bones showed complete destruction of right mastoid cells and a hypodense complement in the right middle ear. A right drainage through the retro auricular fistula with mastoid bone biopsy confirmed the tuberculous otomastoiditis diagnosis. The clinical and radiological outcome was favorable after anti-tuberculosis treatment for 6 months. Tuberculosis otomastoiditis is well described in the literature. However, its very low incidence often impedes consideration when faced with these latent infections. This is more so the case when concomitant pulmonary symptoms are absent. Thus, the importance of such publications is a reminder to think beyond the frequent diagnosis and prevent serious complications due to delayed treatment.

Extraskeletal Ewing's sarcoma is a malignant tumour most often found in children and adolescents, but rarely in the cervicofacial region. When it affects the parapharyngeal space, diagnosis is often delayed, resulting in poor prognosis. We here report the clinical case of a 37-year-old female patient admitted to the emergency department with inspiratory dyspnea, asthenia and anorexia. Cervical spine MRI revealed a process in the right parapharyngeal space obstructing almost the entire pharyngeal lumen. Anatomopathological, immunohistochemical and cytogenetic examinations showed extraskeletal Ewing's sarcoma. The metastatic workup was negative. The patient received chemotherapy. Extraskeletal Ewing's sarcoma of the parapharyngeal space is extremely rare: only four cases have been reported in the literature. Nonetheless, clinical and paraclinical characteristics are similar. It is a neoplasm that must be recognized for early diagnosis to improve prognosis and management.

Traumatic esophageal-tracheal fistulas (ETFs) secondary to a stab wound are rare and often underdiagnosed. Chest computed tomography (CT) scan and opacification of the esophageal lumen help in diagnosis. Surgery is required for treatment. We here report the case of a patient who developed an ETF after being stabbed in the back. Admitted six hours after the incident, he complained of mid-thoracic pain. Physical examination revealed a right paravertebral wound with intrathoracic knife blade. Imagery showed the blade traversing the upper mediastinum, right hemopneumothorax, and mediastinal air bubbles. Surgical exploration revealed a small ETF which was repaired by direct suture of the tracheal and oesophageal orifices with a covering flap. Oral feeding was allowed at D14 after a check-up revealed no residual fistula. The postoperative course was uncomplicated. Esophageal-tracheal fistulas are rare and potentially serious. Early diagnosis and surgical management, combined with good nutrition and infection management, help reduce their morbidity and mortality.