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Background: Penile cancer is uncommon in Liberia with no record of its occurrence so far in the literature. Its occurrence worldwide is significantly affected by cultural or religious practices like childhood circumcision. Smoking, poor penile hygiene and inflammatory processes in the presence of smegma increase the risk of its occurrence. Objective: To review the first case of penile cancer treated in Liberia. Materials and Method: Case report. Case Presentation/Report: Our index patient is a 65-year old man referred from a peripheral centre in acute urinary retention. He also presented with a year history of progressively expanding ulcerative penile lesion affecting the glans and penile shaft. Local examination of the genitalia revealed an ulcerated lesion extending from the glans up to the mid shaft of the penis. The peno-bulbar urethra was free of induration. The external urethral meatus was infiltrated by the lesion. The scrotum and testes were normal and digital rectal examination revealed a moderately enlarged benign prostate. Bilateral inguinal lymph node enlargement was elicited. A diagnosis of advanced penile cancer with benign prostatic hyperplasia was made. The patient had partial penectomy, reconstruction of new external urethral meatus and inguinal lymphadenectomy. The specimen was histologically confirmed to be Squamous cell Carcinoma of the penis; the resection margins and lymph nodes biopsied were found to be adequate and tumor free respectively. Patient's post operative recovery was uneventful and he was discharged after a week. His follow up status after 6 months has remained satisfactory. Conclusion: Though rare, penile cancer does occur in Liberia and specialist staff with capacity for diagnosing and surgical intervention remains critical to patients' outcome. Early intervention improves the chances of better outcome; counseling is critical to prevent treated patient lapsing into depression.

Background: The incidence of posterior gastric perforation worldwide is low; the literature has no previous record of its occurrence in Liberia. The diffuse symptoms of a perforated posterior gastric ulcer, delay by patients before they present to hospital, and the lack of skilled personnel and facilities in Liberia to diagnose and treat this condition increase the mortality associated with posterior gastric perforation. Objective: To report the first case of posterior gastric perforation encountered in Liberia. Materials and Method: Case report. Case Presentation/Report: A 44 year old male was referred to John F. Kennedy Memorial Hospital (Liberia's principal teaching hospital) with a diagnosis of gastritis after six days of worsening epigastric pain. He had a history of NSAID use for a chronic leg and foot ulcer. Physical examination revealed a moderately distended, markedly tender abdomen characterized by guarding, rigidity and low-pitched bowel sounds. Patient was resuscitated with intravenous fluids, antibiotics and analgesics. An emergency exploratory laparotomy subsequently performed revealed a large collection of purulent peritoneal fluid, a 3 × 4 cm perforation on the posterior wall of the stomach and a 3 × 2.5 cm perforation of the transverse mesocolon. The perforations were repaired and the patient recovered satisfactorily. Conclusion: Though relatively rare and associated with a high morbidity and mortality, this case report shows that the paucity of reported cases of posterior gastric perforation may also be attributable to lack of specialist staff with capacity for clinical diagnosis and surgical intervention in a resource poor setting. Identifying patients with gastric perforation and having the skill to repair the perforations significantly enhance the clinical outcome.

INTRODUCTION: Adequate lighting is a precondition for surgery, however quality surgical lighting is often lacking in operating rooms in low-resource countries. Commercial surgical headlights are not widely available in these settings, as they are expensive and lack suppliers and maintenance mechanisms. We aimed to understand user needs of a fit-for-purpose surgical headlight for use in low-resource settings by evaluating a preselected headlight and the local surgical lighting conditions. METHODS:We undertook observations of 10 surgeons using a single headlight model over two weeks in three hospitals in Addis Ababa, Ethiopia, with fieldnotes, questionnaires and photos. All surgeons completed a baseline survey and qualitative interview. Nine logbooks were completed by surgeons after every headlight use.