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An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life.
To study the predilection sites, presentation and treatment of haemorrhoidal disease.
A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY.
One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively.
The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.
Résumé Contexte: Un engorgement et un prolapsus du coussin anal entraînent une maladie hémorroïdaire. Il existe différents sites anatomiques et présentation de cette pathologie commune qui affecte la qualité de la vie. Objectifs:Étudier les sites de prédilection, la présentation et le traitement de la maladie hémorroïdaire. Patients et méthode:Étude de cohorte de patients chez lesquels des hémorroïdes ont été diagnostiquées dans un centre d\'endoscopie à Port Harcourt, dans l\'État de Rivers, au Nigéria, de février 2014 à juillet 2017. Les patients ont été divisés en 2 groupes: A - asymptomatique et B - symptomatique. Les variables étudiées comprenaient: la démographie, les variations anatomiques, le grade des hémorroïdes, la présentation clinique et le traitement. L\'analyse statistique a été réalisée à l\'aide de IBM SPSS Statistics pour Windows, version 20.0. Armonk, NY. Résultats: Cent vingt et un cas ont été inclus dans l\'étude. Il y avait 76 hommes et 45 hommes âgés de 15 à 80 ans (moyenne de 51,9 ± 13,1 ans). Les saignements per rectum étaient la présentation la plus courante. La fréquence de positionnement des hémorroïdes par ordre décroissant était la suivante: droite postérieure (34,1%); antérieur droit (28,2%); latéral gauche (17,1%); postérieur gauche (7,6%). Des quadrants multiples ont été touchés dans 58 (72,5%) cas d\'hémorroïdes externes. Des hémorroïdes de grade I, II et III ont été observées dans 38 (31%), 31 (26%) et 21 (17%) cas, respectivement. Conclusion: Le site anatomique le plus commun des hémorroïdes externes est la position du quadrant postérieur droit; fréquemment, plusieurs sites sont affectés simultanément. Classification de Goligher Les hémorroïdes de grade 1 sont efficacement traitées par sclérothérapie par injection en utilisant une solution de dextrose à 50%; un agent de sclérothérapie bon marché et physiologique.

Excision of multiple fibroadenomas (MF) in separate breast quadrants presents difficulties of number and location of incision(s) and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST) dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s). The lump(s) were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.

UK breast cancer incidence rates suggest that upper outer quadrant (UOQ) cancers have risen disproportionately compared with other areas over time. We aimed to provide a comparison of the trend in quadrant-specific breast cancer incidence between the United States (US) and England, and determine whether a disproportionate UOQ increase is present.
Surveillance Epidemiology and End Results (SEER) cancer registry data were obtained on 630,007 female breast cancers from 1975 to 2013. English cancer registry data were obtained on 1,121,134 female breast cancers from 1979 to 2013. Temporal incidence changes were analysed using negative binomial regression. Interaction terms determined whether incidence changes were similar between sites.
English breast cancer incidence in the UOQ rose significantly from 13% to 28% from 1979 to 2013 whereas no significant increase was observed among SEER data. The significant interaction between quadrant and year of diagnosis (p<0.001) in both SEER and English data indicates that breast cancer incidence in each quadrant changed at a different rate. Incidence in the UOQ rose disproportionately compared to the nipple (SEER IRR=0.81, p<0.001; England IRR=0.78, p<0.001) and axillary tail (SEER IRR=0.87, p=0.018; England IRR=0.69, p<0.001) in both SEER and England. In addition, incidence rose disproportionately in the UOQ compared to non-site-specific tumours in England (Overlapping lesions IRR=0.81, p=0.002; NOS IRR=0.78, p<0.001). The proportion of non-site-specific tumours was substantially higher in England than SEER throughout the study period (62% in England; 39% in SEER).
Breast cancer incidence in the UOQ increased disproportionately compared to non-site-specific tumours in England but not in SEER, likely due to the decrease in non-site-specific tumours observed in England over time. There may be real differences in incidence between the two countries, possibly due to differences in aetiology, but is much more likely to be an artefact of changing data collection methods and improvements in site coding in either country.