Keloids of the helical rim are disfiguring. A cosmetically acceptable reconstruction is difficult especially in moderate to large sized lesions because the helical rim is a 3-dimensional structure with curved and thin cartilage. We report our experience in the management of moderate (4-10 cm) and large (>10 cm) helical rim keloids in five patients. Six helical rim keloids were reconstructed. There were four moderate (4-10 cm) and two large (>10 cm) helical rim keloids. Four were on the right helix and two on the left helix. One patient had bilateral helical rim keloids. The follow-up period ranged from 6 months to 4 years. No secondary surgical revision was required to improve the contour of the reconstructed helical rim. The aesthetic results were satisfactory in all the patients.

We describe here an unusual case of thrombosis of left subclavian artery in a patient with cervical rib. The patient presented with features of ischaemia of left upper limb. X-ray chest revealed bilateral cervical ribs, longer on the left side. Color Doppler studies showed echogenic thrombus within the left subclavian artery. Angiography revealed complete occlusion of left subclavian artery. Embolectomy was done. She was planned for excision of rib. KEYWORDS:  cervical rib, thrombosis of subclavian artery.

With the emergence of the acquired immunodeficiency syndrome, we witnessed a higher incidence of disseminated and extrapulmonary tuberculosis. It poses a significant diagnostic challenge for the physicians; therefore, a high index of suspicion should be maintained. Here we present a case of isolated chest wall tuberculosis in an immunocompetent patient.

Pulmonary Langerhans' cell histiocytosis (PLCH) is a rare cystic interstitial lung disease that primarily affects young adults. It is caused by a disorder of myeloid dendritic cells [1]. We present a unique case of recurrent pneumothorax secondary to PLCH in a teenager. CASE PRESENTATION: A 16-year-old male patient was admitted to the hospital with a 2-week history of recurrent non-specific right sided chest pain, difficulty breathing and a dry cough. He smoked 8-10 cigarettes daily for the last two years. Systemic review and past history were unremarkable. On examination he was found to have decreased air entry bilaterally, with a hyper-resonant percussion note on the right side. Chest X ray and high resolution computerized tomography showed bilateral cystic changes with relative sparing of the lower zones, and a right sided pneumothorax with subcutaneous emphysema (figure 1, 2). This was initially managed with a right sided intercostal chest drain, resulting in expansion of his right lung. However, a few days later he had a recurrent ipsilateral pneumothorax. Unfortunately, he had a persistent air leak after insertion of a new chest drain. He therefore underwent video-assisted thoracoscopic surgery (VATS) with bullectomy, pleurectomy and a wedge lung biopsy.The histopathological review of the lung tissue showed areas of scaring with numerous Langerhans cells (positive for S-100, Langerin and CD1A) confirming PLCH with emphysematous cysts (figure 3). He had an FDG PET and bone scans which did not reveal any extrapulmonary involvement of LCH .

The incidence of gully erosion in Auchi, Edo State has assumed alarming proportions thereby gaining national recognition as an ecological disaster zone. The aim of this paper is therefore to examine some of the human causes of this menace and its impact on the population of the area and coping strategies adopted by individuals, community and the government. From field survey and observation, some of the anthropogenic causes found were: Dumping of refuse in water channels and drainages, Excavation of soil for building and other purposes, Poor siting of fences, Deforestation, Bush burning, Building and road Construction factors and Erection of residential structures without drainage and some of the possible control measures are: Environmental education, Environmental surveillance, the use of Vegetation and proper Solid waste management.