Promoting Cancer Control Training in Resource Limited Environments: Lagos,Nigeria

In resource limited nations, cancer control is often a lower priority issue creating challenges for the prevention, early diagnosis, and treatment of cancer. Training and education are vital components of efforts to tackle this problem. A 3-day cancer control workshop was conducted at the Lagos State University Teaching Hospital (LASUTH), Nigeria, in 2013. The curriculum included didactic lectures, panel discussions, and interactive sessions on local cancer statistics, preventive strategies, cancer registries, screening and diagnostic options, and treatment approaches with limited resources (chemotherapy, radiotherapy, surgery, and palliative care) and several site-specific (breast, lung, cervical, prostate, and colon) topics. Pre-workshop and post-workshop questionnaires were completed by participants. Eighty-six percent of the 50 workshop participants completed at least one questionnaire. Participants were mainly nurses and physicians (89 % of responders), and 40 % reported >25 years of practice experience. The more common local needs identified were professional education (65 %) and increasing public cancer awareness (63 %). The greatest interest for future programs was on research collaborations (70 %). An immediate impact of the workshop was the commencement of monthly tumor board conferences and a review of the current cancer registry data. Capacity building is critical for the execution of effective cancer control strategies. Conducting collaborative workshops represents a cost-effective means of launching programs and energizing the medical community to pursue ongoing education and research addressing the anticipated cancer epidemic on the African continent.     

Iatrogenic esophagobronchial fistula arising in irradiated Barrett's esophagus

A 47-yr-old male underwent a right upper lobectomy for stage IIB bronchoalveolar carcinoma followed by 4600 Gy of irradiation. One year later a fistula formed from an ulcerated region of Barrett's esophagus into the left main bronchus. Bronchotomy repair with onlay patch intercostal muscle flap and esophageal repair with serratus anterior muscle flap plus postoperative esophageal stent placement for stricture resulted in good functional results.     

Gallstone shrapnel contamination during laparoscopic cholecystectomy

The fate of lost gallstones in the peritoneal cavity following laparoscopic cholecystectomy is unknown. We report a case of microabscesses and granuloma formation in the peritoneal cavity and abdominal wall caused by infected gallstone shrapnel due to rupture of the gallbladder during extraction.     

Iatrogenic esophagobronchial fistula arising in irradiated Barrett’s esophagus

A 47-yr-old male underwent a right upper lobectomy for stage IIB bronchoalveolar carcinoma followed by 4600 Gy of irradiation. One year later a fistula formed from an ulcerated region of Barrett’s esophagus into the left main bronchus. Bronchotomy repair with onlay patch intercostal muscle flap and esophageal repair with serratus anterior muscle flap plus postoperative esophageal stent placement for stricture resulted in good functional results.     

Chylothorax

Chylothorax is a rare complication of pulmonary resection. It requires prompt treatment, which is initially conservative. This treatment consists of drainage, nutritional support, and measures to diminish chyle flow. Surgical intervention is indicated when conservative management is ineffective. Delay in surgical intervention leads not only to serious metabolic, nutritional, and immunologic disturbances from the loss of chyle but also increases the risk for adhesion formation, loculation, organization, and infection of the chylothorax, making subsequent surgical attempts difficult and increasing postoperative morbidity and mortality. VATS provides a minimally invasive approach for the treatment of chylothorax complicating pulmonary resection. Clipping of the thoracic duct or chemical pleurodesis may be performed with minimal morbidity and mortality. Conservative treatment is expensive and fails in most patients who have high-output chylous fistulae. On the other hand, VATS is uniformly effective, is less expensive, and has low morbidity. Indeed, VATS is rapidly becoming the preferred approach for the management of chylothorax complicating pulmonary resection. The need to prevent the occurrence of a chylothorax by careful dissection techniques and liberal clipping of lymphatic vessels particularly in areas of high anatomic risk during the initial operation cannot be overemphasized.