Spindle cell lipoma is a rare histological variant of lipoma accounting for 1.5% of adipocytes tumors. It is composed of an admixture of mature adipocytes and fibroblast-like spindle cells in a myxoid stroma. Retroperitoneal atypical spindle cell lipomatous tumor are extremely rare only a single report in the literature reported. Herein we describe a case of a giant lipomatous tumor that was causing partial bowel obstruction. Successful excision with en block resection of the tumor, distal ureter and posterior wall of the bladder was achieved by teamwork between gastrointestinal surgeons and Urologist. The bladder defect was repaired, and left ureteric reimplantation was done. The patient made a good recovery with excellent progress. He has resumed his normal activities as a farmer.
Chronic kidney disease (CKD) is increasingly diagnosed and thus more patients are in need of hemodialysis (HD) to sustain their life. The quality of vascular access for HD should be suitable for repeated puncture and allow a fast blood flow rate for high-efficiency dialysis with minimal complications. Our study aimed to document local experience and early outcomes after arteriovenous fistula (AVF) creation for hemodialysis access including complications related to AVF creation.This was a hospital based clinical audit in which case notes of patients who had undergone AVF creation between May, 2017 and March, 2018 at Muhimbili National Hospital (MNH) were reviewed using a structured data collection tool. Information regarding preoperative assessment for AVF creation, outcome of AVF, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables. A total of 57 case notes of patients who underwent AVF creation for HD access with males contributing majority of patients (77.2%) were reviewed. The predominant age group was 41 to 60 years of age (56.2%) with mean age 47 years and age range of 18 -69 years. Three patients had procedure abandoned on the table due to sclerotic vein. The functional maturation rate was found to be 64.9% and post AVF complications in 15 patients (26.3%). Recorded post AVF creation complications were fistula stenosis/revision (27.8%), bleeding/haematoma (22.2%), limb oedema (22.2%), aneurysm (11.1%), surgical site infection [SSI] (11.1%) and thrombus formation (5.6%).AVF creation for HD access is common at MNH with a functional maturation rate of 64.9%, which is an acceptable rate. The preoperative vascular assessment in this survey was mainly found to be physical examination while preoperative vascular imaging was not commonly done to assess suitability of veins and arteries for AVF creation although post AVF complications are relatively few.
Background: Prostate cancer (PC) is a common health problem among men globally with high incidence and mortality. The mortality following PC is associated with advanced disease progressing to castrate resistance following androgen ablation therapies. While advances to addresscastrate resistant prostatic cancer (CRPC) have shown good results, the burden of castrate resistant cancer in Tanzania has remained unknown hence our patients cannot benefit from such advances. This study therefore aimed to determine the magnitude and clinical presentation among patients with a diagnosis of castrate resistant cancer at Muhimbili National Hospital in 2018-2019. Methods: This was a retrospective descriptive hospital based study carried out at Muhimbili National Hospital. Patients who were treated with androgen blockade, had evidence of attainment of castrate levels of testosterone with a diagnosis of castrate resistant prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables and figures. Results: We recruited 293 patients with prostate cancer treated by androgen deprivation therapy. Bilateral orchiectomy was the most common treatment modality offered for advanced PC. Castrate levels of testosterone were achieved in 189 (95.5%) of the patients who had testosterone levels checked. Ninety-Six (50.8%) had met the criteria for diagnosis of castrate resistant prostate cancer with mean age of 71.23±4.2 years. Patients presented with lower urinary tract symptoms and metastatic features. Most of the patients had a poorly differentiated histology with prostate specific antigen (PSA) over 100ng/l. Only 13.5% of the patients had spine magnetic resonance imaging (MRI) for their work up. Conclusion and recommendation: Half of patients treated for advanced PC at MNH will progress to castrate resistance following androgen deprivation therapy. More studies are needed to understand the predictors of CRPC and related treatment strategies. Key words: Castrate Resistant Prostate cancer, androgen deprivation therapy, advanced prostate cancer
Prostate cancer (PC) is the most common type of cancer in men and is of major public health importance worldwide. This study aimed to establish the clinicopathological presentation and its impression in disease progression like to Castrate Resistant Prostate Cancer (CRPC) of patients treated for Prostate Cancer at Muhimbili National Hospital (MNH) in Dar es Salaam.This was a retrospective descriptive hospital based study at Muhimbili National Hospital. Patients who were treated for prostate cancer were identified. Information regarding primary prostatic cancer treatment, clinical disease progression symptoms, and age of the patients were collected. A total of 293 case notes were reviewed of which 189 patients who were treated for prostatic carcinoma with androgen deprivation, 96(50.8%) met the criteria for the diagnoses of Castrate Resistant Prostate Cancer (CRPC) and their mean age was 71.23±4.2. About half of our patients 146(49.7%) presented with history of urine retention necessitating urethral catheterization but also patients had hard, nodulated, grade three prostate though 48.2% had missing documentation of Digital Rectal Examination (DRE) findings. Most of the patients had a poorly differentiated histology with PSA over 100ng/l. Almost all patients had a clinical progression signifying a metastatic disease. Majority of patients presented with symptomatic prostate cancer contrary to the natural history of prostate cancer at its early stage. Urine retention and hard nodulated grade three prostate were the commonest clinical presentation whereas poorly differentiated carcinoma of the prostate was a common pathological finding among patients with prostate cancer MNH in Dar es Salaam, Tanzania.
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