October 2012 - Week Two - William Schecter

Eveline Shue arrived earlier this week and went straight to work the next and did an exploratory laparotomy.    Eveline and Jessica took call together on Thursday and Thursday night working with Dr. Hussein Hassan Ali.  They did a splenectomy and repair of a colon injury due to a GSW and a diverting colostomy for a malignant obstruction of the rectum due to advanced cervical cancer.  We made ward and ICU rounds Friday.    This week was a 4 day week because Friday was the Muslim Holiday of Eid as Adha celebrating the willingness of Abraham to sacrifice Ismail (Ishmael) before a ram was provided (the story in the Koran obviously differs from the one in Genesis).  This Eid occurs at the end of the month of the Haj (The pilgrimage to Mecca) when the Hajis (the pilgrims) throw stones at the three devils on Mount Arafat outside of Mecca.

Case List

Diagnosis                                                                        Operation
Recurrent fibrosarcomaback                                     Wide local Excision
Advanced rectal cancer                                                 Proctoscopy and biopsy
Multinodular Goiter                                                        Left thyroid lobectomy and
                                                                                        isthmectomy           
Intussusception of stomach                                           Excision ofgastric polyp
Carcinoma right breast                                                  Right modified radical mastectomy
Ventral hernia                                                                 Exploratory laparotomy
Intraductal papilloma-                                                    micodochectomy  
Recurrent cervical cancer                                              Exploratory lap, colostomy 
Gunshot wound to abdomen                                       Splenectomy and repair of colon
                                                                                       injury                   

Non-operative Cases

Evaluation of man with neck mass and impeding airway obstruction
Inflammatory breast cancer management
Initial management of rlq stab wound, perfd peptic ulcer
Consult for ? Intrabdominal injury after blunt trauma

Clinic

There were also a lot of interesting cases in clinic this week including patients with inflammatory carcinoma of the breast, carcinoma of the head of the pancreas (with a Courvoisier gallbladder), Graves Disease, gastric cancer, and a right neck unfortunately full of rock hard lymphadenopathy probably a metastatic head and neck tumor (perhaps laryngeal cancer, the patient was hoarse).  Our residents are obviously being exposed to a lot of far advanced malignancy for which, unfortunately, little can be done.

ICU

Our patient with the 4 day old perforation of the 4th duodenum due to blunt trauma is doing well.  He developed a sympathetic left pleural effusion (not surprising given what was going on in the lesser sac).  We diagnosed it on physical examination and drained it.  He still has a high ng output (also not surprising) but the main challenge is nutrition (we have no way to give nutrition at the moment unfortunately).

Impressions:

We have quickly become part of the service.  The medical and institutional problems here are primarily economic and cultural but we are both making an educational contribution and learning a lot from our Tanzanian colleagues and our patients.