I came across this picture, painted by a medical missionary, Kuhn Hong. It depicts a scene at the Mbingo Hospital in Cameroon. When I saw it it reminded me of the Nigerian Christian Hospital and Dr. Farrar, its founder.
This specimen came from a woman with a SBO. We operated and found a hard calcified mass in the omentum with a loop of attached small bowel. If you look carefully you can see an eye (one eye is covered by omental fat), mouth and the femurs. This woman had an intraabdominal pregnancy that died and calcified!
This lady is sweet and tough. She always had a smile. She underwent 3 courses of chemo for her breast cancer and then we did a mastectomy. She never complained and was raising her hands up to praise the Lord on day one. We all hope she does well.
This your girl came with a neck cyst that was slowly growing for years. It was a thyroglossal duct cyst. This is not uncommon in Nigeria. I was proud of this case since we were able to remove it without rupturing the cyst. We performed a Sistrunk procedure.
Brendan Madu is an upper level resident at the Federal Medical Center in Umuahia, Nigeria. I have known Brendan for several years and he is a humble, extremely pleasant chap who is eager to learn surgery. These qualities make him a very easy to teach. In just a few weeks during this past trip, Brendan became quite adept at thyroid surgery. He will be a great surgeon one day and I am glad to have the opportunity to teach him.
|Brendan Madu, MD|
As I arrived at NCH this trip, I met this young man, Kingsley, on the road. I examined him right then and told him we would help. His case turned out to be a big challenge. He had a massive tumor that extended into the oral cavity. After a radical resection, the left side of the oral cavity was gone. We let him rest for a few days, then returned to surgery. First, we performed a temporalis flap to close the oral cavity. Then we performed a pectorals major myocutaneous flap to provide coverage for the face. Amazingly, it all worked! By the time I left, he was eating a regular diet. He will need radiation therapy.
|Large parotid mass|
|Note involvement of skin|
|After resection-mandible exposed and left buccal mucosa resected|
|Temporalis flap raised|
|Temporalis flap used to reconstruct oral cavity|
|Pectoralis flap raised|
|One week post surgery|
|One week post surgery|
Last trip, this young lady came to NCH with a terribly disfiguring right maxillary mass. We removed the tumor. The orbital floor was destroyed so we made a sling of Vicryl mesh to support the eye and transferred a temporalis muscle flap into the maxillary cavity. The pathology was fibrous dysplasia-a non-malignant, but not so benign disease where normal bone is replaced by fibrous tissue. Today she came to visit us. She is very happy with the results of her surgery. I explained that we could make her look even better with some smaller surgeries but she refused. As long as she is happy, that is the most important thing.
|Massive fibrous dysplasia of the right maxilla|
|Three months post surgery|
A 16 year old girl came in with a recurrent swelling of the right maxilla. She had surgery several years ago. She arrived with a CT which is unusual. We took a picture of the CT and emailed it to my friend and radiologist John Melvin in the USA. His report: "expansile lesion of the maxilla which may be originating in the area of a tooth root. The bone appears expanded and remodeled (rather than destroyed) suggesting a relatively slowly growing mass. The first thing that comes to my mind is a dentigerous cyst or periapical cyst with ameloblastoma being my next choice. Dr. Melvin was correct. We explored her maxilla and found an ectopic tooth with a dentigerous cyst. There was a molar tooth in the lateral aspect of the maxillary wall. We removed the tooth and she recovered without problems.
|CT of maxilla (note image is reversed|
|Molar tooth in superior, lateral aspect of sinus|
On October 1, Team Camazine joined Dan Kama, President of Professionals for Humanity, in Ogoni Land, for a mini-surgical clinic at the Gokana General Hospital-Terabor. Also participating were Drs. Gbaanador, Dimpka, Jombo, Okpa, Akpanudo, Madu, Nkeonye, and Oje; nurse anesthetists, Wilson, Oje and Uruakpa, surgical technician Micah and photographer Azuka. In two days we did 43 cases-34 hernias, 3 neck cases, 1 splenectomy, 1 ganglion, 3 lipomas and an I&D!!!
This was a free surgical clinic. When we arrived the patients had been pre-screened and more than 500 patients showed up for 2 days of surgery. It was chaos and many fights broke out.
|The surgical team|
|Chaos-lining up for a surgical slot|
|Dr. Jombo, NCH Administrator, addressing the crowd|
|Giant abdominal mass-patient referred to NCH for operation|
|Basic operating room with three tables!|