Objectives: To determine the prevalence, seasonal presentation, and management of Ludwig's angina in Northwest Nigerian Tertiary Health Facility. Patients and Methods: Cases of Ludwig's angina that presented and managed by the Dental and Maxillofacial Surgery Unit of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, between 2013 and 2015 were retrieved. Data were stored and analyzed using IBM SPSS (IBM Corp., Armonk, NY, USA) Statistics for windows version 20. Results: Over the review period, 36 patients presented with clinical features of Ludwig's angina. Only 28 cases were analyzed and 8 cases had incomplete data and were excluded from the analysis. Of the 28 patients, 23 (82.1%) were males while 5 (17.9%) were females with a male: female ratio of 4.6:1. The mean age of the sample was 32.3 ΁ 11.6, range 18-60 years. A majority of the patients were in low socioeconomic group with 11 (39.3%) patients being peasant farmers. Odontogenic infection was responsible for the disease in 27 (96.4%) cases while only 1 (3.6%) case was idiopathic. Of those with odontogenic etiology, 18 (64.3%) were due to sequelae of caries. Microbiology, culture, and sensitivity in few cases revealed Streptococcus species, Pseudomonas aeruginosa, and Staphylococcus aureus. Most of the cases recorded no bacterial growth after 24 h incubation period. Twenty-five patients (89.3%) survived the disease while 3 (10.7%) died. Conclusions: Management of Ludwig's angina in a resource- and personnel-scarce setting can be very challenging. Early surgical decompression, aggressive empirical antibiotics, and nutritional support have contributed to the low mortality in our series.

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Solid pseudopapillary tumors of the pancreas are rare tumors commonly found in females. Surgery is the primary treatment and the role of adjuvant chemotherapy or radiation is not well defined. Although they are mostly benign, they have the potential for late metastasis, thereby defining the need for long-term surveillance for such patients. This review article describes these tumors in detail and in addition, focuses on the management of the resected tumors and the need and indications for adjuvant treatment in selective cases.

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Inguinal hernia is relatively uncommon in females as compared to males. The incidence of inguinal hernia in females is 1.9%, the ratio of males to females being 6:1. Primary inguinal hernia occurs in 1-5% of all newborn and 9-11% of those born prematurely. Herniation of the contents through the canal of Nuck is a very rare condition. Approximately, 15-20% contain ovary, sometimes with a fallopian tube. A 1.5-month-old prematurely born female child presented with swelling in the left inguinal region since birth. A 3 cm × 2 cm solitary swelling was visible in the left inguinal region on crying, soft in consistency and reducible. A 2 cm × 1 cm swelling was also seen in umbilical region, soft in consistency and reducible. Ultrasonography - patent canal of Nuck with herniating ovary and part of uterus. The patient was subjected for surgery, content of an inguinal hernia was found to be uterus, with right fallopian tube and right ovary. Contents were reduced. Sac was transfixed and excised. When uterus and uterine adnexa are found in inguinal hernia sac, it is called as hernia uterine inguinale, or uterus-containing hernia. The anterior invagination of parietal peritoneum in females, which is canal of Nuck, is much smaller than the processus vaginalis its male counterpart. The canal of Nuck is often open in premature infants, which can lead to herniation of peritoneal contents such as bowel or the ovary, the fallopian tube, and the uterus. Our patient was a prematurely born infant. The hernial sac containing fallopian tube, ovary, and uterus in the female is very rare. We present a case of female inguinal hernia containing ovaries as well as uterus. The surgical dilemma occurs due to such rare condition at the time of hernia repair and should always be considered.

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Background: Iatrogenic bile duct injuries (IBDIs) remain an important problem in gastrointestinal surgery and represent a big challenge for surgeons. Aim: To review the management of IBDI and describe short- and long-term postoperative complications of surgical repair at our tertiary referral institute. Patients and Methods: This was a retrospective review of the medical record of all patients referred for the management of IBDIs between January 2005 and January 2015. One hundred patients formed the study cohort. Preoperative data including patient demographics, mechanism of injury, operative details, and postoperative outcomes were extracted. Research Ethics Board approval was obtained. Results: There were 36 men and 64 women, with a mean age 45.4 ΁ 11.5 years. Open cholecystectomy was the most common procedure in 61 patients, whereas laparoscopic surgery was the primary treatment in 39 patients. Twenty-nine patients treated by nonsurgical management in the form of endoscopic retrograde cholangiopancreatography (ERCP) and stenting and percutaneous abdominal drainage. Seventy patients underwent operative surgery in the form of Roux-en-Y H.J, and T-tube insertion in the common bile duct in two cases. Short-term complications encountered in 15 (20.8%) cases, with a significant correlation with a previous ERCP intervention (P = 0.047). Long-term complications encountered in 12 (16.6%) patients, with a significant relation with the intermediate timing (within 2 weeks) of repair (P = 0.037). Conclusions: Prompt diagnosis of the type and grade of injury is mandatory before deciding management. Intermediate time for surgical intervention was significantly related to stricture complications. ERCP should be done only in cases that can benefit from conservative management (Strasberg from A-D) as the incidence of postoperative complication is high after surgical repair.

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Objective: The present study was conducted to investigate the levels of antioxidant glutathione (GSH), lactate dehydrogenase (LDH), and lipid peroxidation (LPx) in the excised appendicitis tissue and investigate as to whether there is any correlation with the histopathological grading and clinical scoring. Materials and Methods: Appendix was collected from people requiring appendectomy (n = 30) and people with normal appendix but requiring gastrointestinal (GI) surgery for some other GI diseases and willing for complementary appendectomy (n = 4). The levels of GSH, LPx, and LDH were evaluated and statistically compared. In addition, statistical analysis is used to observe for correlation between these parameters with histological grading and Alvarado scores. Results: When compared to the normal appendix, in the tissues of appendicitis, the levels of LPx were high and that of LDH and GSH were significantly low. A negative correlation for GSH and positive correlation for LPx were observed. With respect to LDH, a negative correlation for tissue was observed with both histopathological and clinical grading. Multiple regression analysis for the biochemical endpoint in tissue showed that these parameters contribute 67.9 and 30.1% toward the histopathological and clinical grading, respectively. Conclusions: The results of the study indicate that the levels of LPx are increased and that of LDH and GSH are decreased in appendicitis and they are dependent on the pathological and clinical manifestation.

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Tailgut cyst (retrorectal cystic hamartoma) is a rare known entity that has been described in the surgical and pathological literature. There may be delay in diagnosis and treatment owing to rarity and absence of definite features. We experienced an unusual case of retrorectal cystic hamartoma presenting as subcutaneous swelling and infected sinus along with true tail in sacrococcygeal region.

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Background: Oral cancer is one of the common cancers in India with dismal survival in advanced stages. Most of the patients present in advanced stages with borderline operability and such patients may be helped by chemotherapy to render them operable. It is well known that tumor growth is angiogenesis-dependent and thus vascular endothelial growth factor (VEGF) may be a surrogate marker of growth and angiogenesis. At present, there is a scarcity of predictive markers for oral cancer. In this prospective study, we studied VEGF expression and its role as a predictive marker in oral cancer. Materials and Methods: Patients with locally advanced oral cancer having borderline operability or unfit to undergo surgery in the primary setting were included in the study. VEGF expression of the cancerous tissue was studied in all patients. Three cycles of neoadjuvant chemotherapy (NACT) was administered before definitive treatment in locally advanced cases and response is assessed. VEGF levels were analyzed in cancer tissue and compared with normal surrounding mucosa. The response to chemotherapy was then correlated with VEGF score in patients receiving NACT to evaluate it as a predictive marker. Results: All forty patients were VEGF-positive and had a mean score of 1023 with 63% patients having Grade 3 expressions, whereas the normal surrounding mucosa had a VEGF score of 30. It was seen that in patients showing no response to treatment, the mean total VEGF score was significantly higher as compared to those showing complete or partial response. VEGF score correlated inversely with chemotherapy response, but no significant association was seen between VEGF grade and chemotherapy response. Conclusion: We can conclude from this study that VEGF is significantly overexpressed in cancer mucosa as compared to normal mucosa and overexpression of VEGF was found to be associated with chemoresistance and thus may serve as a negative predictive marker.

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Introduction: Blast injuries to the hands are more common in the war zones as part of the multiple injuries sustained by the patients. However, there have been few reports of the same injuries among the civilians. Isolated blast injuries to the hands are usually due to accidental explosions of firecrackers or fireworks and gunshot injuries. There has been a sudden increase in these injuries and their severity in our hospital in the last few years. Materials and Methods: This is a retrospective study of patients that presented to the Plastic Surgery Unit of the Irrua Specialist Teaching Hospital over a period of 3 years. All the data were retrieved from the patient case files, preoperative radiographs, clinical photograph, s and the operation records. These data were collated and analyzed. Results: There were 22 patients that presented to the unit, during the period reviewed, via the emergency room. Male constitutes 82% (18), whereas the rest were females. The majority were in the pediatric age group 63.6% (14). The injuries ranged from the simple lacerations to complex injuries with fractures, crush, avulsion, degloving, and autoamputation. The right dominant hand was more common than the left in the unilateral injury. Unilateral injuries occur in almost all the cases except one, which presented 10 days after the injury with associated acute kidney injury. About 82% of them presented during the Christmas and New Year celebrations. Conclusion: Isolated blast injuries to the hand from the fireworks and firecrackers affect mainly the children with severe injuries and profound morbidity. There is a need for the government to strictly enforce the law that regulates the use of fireworks and other low-order explosives. There is also need to encourage the development of hand surgery and therapy in the subregion to improve outcome.

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Papillary thyroid carcinoma within the thyroglossal duct (TGD) cyst is a very rare finding and its presentation is similar to benign TGD cyst. We report a case of a 47-year-old female with a thyroglossal duct cyst with papillary thyroid carcinoma. Following a standard Sistrunk operation, the histopathological examination reported a possibility of carcinoma.

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Unilateral isolated adrenal metastasis from occult hepatocellular carcinoma (HCC) is extremely rare and seldom reported. We report a case where radiological and biochemical evidence of HCC was absent in a patient with metastatic adrenal mass. A 69-year-old male patient was investigated for abdominal pain which revealed a left adrenal mass. Contrast-enhanced computed tomography was suggestive of adrenocortical carcinoma (ACC). Resection was performed and the histopathology revealed metastasis from HCC. However, the primary in the liver could be radiologically and biochemically demonstrated only 6 months later. Even though rare in occurrence, radiologically undetectable HCC can present as unilateral adrenal mass, which can be mistaken as ACC.

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