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ORIGINAL ARTICLES
Single-layered tissue inguinal hernia repair
Abdulkadir Yakubu, Hazakilu Usain
January-June 2012, 2(1):18-23
DOI:10.4103/2278-9596.101261  
Background: There is still no consensus about the best and most cost-effective surgical approach to inguinal hernia repair. This study analyzes our experience in an open, non-mesh, one-layered inguinal hernia repair. Materials and Methods: From January 2001 to December 2008, 1238 patients who underwent inguinal hernia repair at two general hospitals were retrospectively reviewed. Their age ranged from 18 to 87 years, with a mean of 45.3 ± 11.0 years. Following clinical evaluation, herniorrhaphy was done under appropriate anesthesia. Patients were discharged home the same day on oral drugs. Wound dressing was changed and sutures were removed on the 3 rd and 7 th days of the follow-up visits, respectively. Demographic information, types of hernias, associated diseases, and complications were analyzed. Results: Mean duration of symptoms before presentation was 3.4 ± 0.2 years. There were 742 patients (60.0%) with indirect hernia, 496 patients (40.1%) with direct hernia, 570 cases (46.1%) of inguinoscrotal hernia, 342 patients (27.6%) with bilateral hernia, and 33 patients (2.7%) with recurrent hernia. Local anesthesia was successful in 1046 patients (84.5%). Spinal anesthesia was used in 186 patients (15.0%). Six patients (0.5%) were operated under general anesthesia. The mean inpatient stay was 4.5 h. The average cost per patient was $99:00. The mean duration of surgery was 30 ± 2.0 min, ranging from 25 to 63 min. Postoperative pain syndrome was observed in 8.0% of cases. There was a recurrence of 2.7%. Conclusion: Single-layered tissue inguinal hernia repair under local anesthesia can be confidently performed by skilled surgeons with low complication and recurrence rate and is recommended for low-income communities.
  6,058 13,653 -
REVIEW ARTICLES
Pathophysiology and management of urinary retention in men
Ahmed Muhammed, Abdulkadir Abubakar
July-December 2012, 2(2):63-69
DOI:10.4103/2278-9596.110018  
Background : Urinary retention is a common problem in the elderly. The incidence increases with age so that a man in his 70s has a 10% chance and a man in his 80s has more than 30% chance of having an episode of acute urinary retention. Inadequate management of the condition can lead to unnecessary morbidity and occasionally mortality. Increasing knowledge over the years of its pathophysiology has greatly improved the management. Thus, the objective of this study is to review the current concepts in the management of urinary retention in men. Materials and Methods: Current literature on the pathophysiology and management of urinary retention in men was reviewed. The PubMed database was searched using the key words; pathophysiology, management, urinary retention, and men. Results: Urinary retention is a common problem in the elderly worldwide; the incidence rises with age, and by the 9th decade of life, a man has more than 30% chance of an episode of retention. There are three main pathophysiologic mechanisms: Increased urethral resistance secondary to bladder outlet obstruction, impaired bladder contractility, and loss of normal bladder sensory or motor innervations. It may be acute, acute-on-chronic, or chronic. It is now generally agreed from urodynamic studies that the traditional slow decompression of the bladder in chronic retention does not serve its aim of gradual reduction of vesical pressure; thus, the current practice is immediate and complete decompression and managing anticipated complications of postobstructive diuresis or hematuria whenever they occur. Conclusion: Advanced age and bladder outlet obstruction secondary to benign prostatic hyperplasia remain the commonest risk factors for urinary retention. Secondary bladder dysfunction in bladder outlet obstruction, detrusor myogenic dysfunction, and alteration of bladder innervations are the major mechanisms. Immediate and complete decompression in both types of retention is the current practice.
  13,709 2,023 -
CASE REPORTS
Giant cervical polyp complicating uterine fibroid and masquerading as cervical malignancy
Muhammad A Abdul, Afolabi K Koledade, Nana Madugu
January-June 2012, 2(1):39-41
DOI:10.4103/2278-9596.101273  
Introduction: Huge cervical polyp causing diagnostic dilemma is rarely encountered in gynecologic practice. The objective of this study is to document a case of huge cervical polyp masquerading as cervical cancer seen and managed in Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Case Report: A 39-year-old trader para 5 + 0 who presented at the gynecologic unit with a 7-year history of fleshy mass protruding from the vagina which had been progressively increasing in size but was reducible. Physical examination revealed severe pallor, 16-week sized abdomino-pelvic firm irregular mass, and a huge firm mass protruding through the vagina, measuring 30 cm by 20 cm. The vaginal mass was irregular in shape and occupied the whole of the vagina. The cervix was not reachable. Pelvic ultrasonography revealed features of multiple intramural and subserous fibroids and a right simple cystic adneaxeal mass about 6 cm in diameter. Anemia was corrected, and at examination under anesthesia, a diagnosis of huge cervical polyp (arising from the posterior cervix) with multiple uterine fibroids was made. She had vaginal polypectomy, total abdominal hysterectomy, and bilateral salpingo-ophorectomy using an abdomino-perineal approach. She did well postoperatively and subsequently on follow-up. Histology confirmed cervical fibroid polyp and uterine leiomyoma. Conclusion: Although giant cervical fibroid is rare, it may masquerade as cervical malignancy or uterine inversion. Proper evaluation is needed to make an accurate diagnosis.
  14,501 392 -
Vulva hematoma
Mathew Akpa, Adekunle O Oguntayo
January-June 2012, 2(1):37-38
DOI:10.4103/2278-9596.101272  
Background: Vulva hematoma is a very rare maternal injury that usually presents in the third stage of labor after a normal spontaneous vaginal delivery. Most cases develop insidiously with a sudden collapse and severe groin pain. Causes reported include imperfect repair of episiotomy and rupture of varicose vein of the vulva. We report an interesting case of vulva hematoma. Case Report: We present a case of a 22-year-old primipara referred from a peripheral hospital, having collapsed at home following an unsupervised spontaneous vaginal delivery at home 6 h earlier. At presentation, the patient was pale and in shock. There was a huge left vulva hematoma with a peri-urethral laceration up to the clitoris. Surgical treatment resulted in a good outcome. Conclusion: Vulva hematoma is a rare cause of maternal morbidity and mortality. This case reminds an obstetrician to be suspicious of vulva hematoma in a patient in shock postpartum.
  8,495 437 -
REVIEW ARTICLES
Management of rectal prolapse
Saleh M Al Daqal
July-December 2012, 2(2):57-62
DOI:10.4103/2278-9596.110017  
Background: Rectal prolapse is a chronic disease that commonly affects elderly women in which the rectum partially or fully intussuscepts and comes out through anal canal. Management of this condition is challenging and there are different surgical approaches to this disease. The objective of this study was to evaluate and compare different surgical treatment modalities in the treatment of rectal prolapse. Materials and Methods: Literature review of all articles concerned with management of rectal prolapse which were published in PubMed was done between the periods from January 1990 to July 2012. Different surgical options for rectal prolapse repair were reviewed and the outcome of these procedures in terms of the recurrence rate and the complications were evaluated. Results: Surgical options in management of rectal prolapse are abdominal, perineal, laparoscopic, and robotic approaches. Conclusion: The choice of treatment in rectal prolapse is determined by several factors including the patient age, sex, general condition of the patients, and institutional capabilities. Perineal procedures are less invasive and are the ideal choice for elderly debilitated women and young male patients' consideration, but it is associated with higher rate of recurrence. The open abdominal approach is beneficial to patients with long redundant sigmoid colon and has less recurrence rate, but it is associated with prolonged recovery period and higher morbidities. Laparoscopic and robotic approaches are less invasive and provide the low recurrence rate of the abdominal approach with a recovery period that is more like the perineal approach.
  3,331 3,443 -
ORIGINAL ARTICLES
Ultrasound determination of gall bladder size and wall thickness in normal adults in Abuja, North Central Nigeria
Kolade-Yunusa Hadijat Oluseyi
October-December 2016, 6(4):214-218
DOI:10.4103/ais.ais_50_16  
Background: Diseases of the gallbladder (GB) do affect its size and wall thickness. GB diseases are common pathology frequently encountered in medical practice and presents as right upper quadrant pain. Ultrasound is a relatively safe, inexpensive, and reproducible imaging modality for assessing normal or diseased GB. It is the first method of choice when GB disease is suspected. Objective: The aim of this study is to determine a referential value of normal GB size and thickness which can be used as baseline in this environment to determine GB disease and for follow-up of these patients. Materials and Methods: This is a cross-sectional study conducted on 400 normal adults aged 15–70 years at the radiology department over a period of 10 months. Subjects had their GB scanned with 3.5 MHz transducer after fasting overnight. The length, width, and height were measured and the volume obtained using the ellipsoid formula. GB thickness was also recorded. Results: The overall mean age was 40.70 ± 14.97. Mean age of males and females were 46.32 ± 15.64, and 36.61 ± 12.33 respectively. The mean values for length, width, height, volume, and wall thickness of the GB was 6.40 ± 1.06 cm, 2.38 ± 0.77 cm, 2.77 ± 0.25 cm, 23.46 ± 8.14 cm3 and 0.27 ± 0.08 cm respectively. The mean values for, length, width, height, volume, and wall thickness of GB for males were 6.36 ± 1.03 cm, 2.46 ± 0.87 cm, 2.81 ± 0.29 cm, 24 ± 8.66 cm3 and 0.28 ± 0.76 cm and for females were 6.44 ± 1.10 cm, 2.30 ± 0.67 cm, 2.75 ± 0.22, 22.98 ± 7.63 cm3, and 0.26 ± 0.27 cm. Mean GBV was higher in males than females. Conclusion: Normal values of GB dimensions have been established in the north central Abuja using ultrasound. These values can be used as reference values in management of GB disease.
  6,377 130 -
Comparison between tubularized incised plate urethroplasty and other types of urethroplasty for mid and distal penile hypospadias
Anju Verma, Gaurav Gupta, Faisal Ameer, Abhishek Jain, Sunil Kaval
October-December 2015, 5(4):195-198
DOI:10.4103/2278-9596.174656  
Background: Hypospadias is a common congenital anomaly seen in the male child. The aim of this study was to compare tubularized incised plate (TIP) urethroplasty and other types of single stage urethroplasty for mid and distal penile hypospadias. Patients and Methods: Seventy-seven patients having mid and distal penile hypospadias were assessed prospectively and retrospectively from March 2010 to September 2014. The study had retrospective (March 2010-February 2013) and prospective (April 2013-September 2014) divisions. Forty-four patients underwent surgical repair using TIP technique and 33 patients, using other urethroplasties (Mathieu, meatal advancement and glanuloplasty incorporation, and Asopa techniques). Patients were reviewed at 2 weeks, 1-month, and 3 months after discharge. Data including fistula formation, cosmetic disfigurement, and duration of the surgery were collected and the two groups were compared. Results: In both retrospective and prospective groups, TIP urethroplasty has a better outcome than other type of urethroplasties for both mid and distal hypospadias. The fistula formation rates were 31.82% (7) and 64.70% (11) in distal and 31.82% (7) and 62.5% (10) in mid hypospadias in TIP and other urethroplasty group, respectively, significant result in distal hypospadias. The cosmetic disfigurement rates were 5.88% (1) and 17.64% (3) in distal and 9.09% (2) and 18.75% (3) in mid hypospadias in TIP and other urethroplasty group, respectively. Mean operative time duration in TIP urethroplasty was 90.79 min and 110.15 min in other urethroplasty group and was statistically significant. Conclusion: TIP urethroplasty is a simple procedure for treatment of both mid and distal penile hypospadias, with less complications and satisfactory results as compared to other urethroplasties. Cosmetic appearance of urethral meatus was also more satisfactory with TIP urethroplasty than other urethroplasties.
  2,324 3,645 -
Ureterocele in adults: Management of patients in Zaria, Nigeria
Ahmed Muhammed, Maitama Y Hussaini, Bello Ahmad, Mbibu N Hyacinth, Kalayi D Garba
January-June 2012, 2(1):24-28
DOI:10.4103/2278-9596.101262  
Background: Ureterocele is a cystic dilatation of the distal ureter. It remains a rare urologic condition in non-Caucasians and is even less common in adults. Single-system ureteroceles are usually found in adults, and thus the name "adult" ureterocele. Though uncommon, urologists practicing in this region should be acquainted with the management. Materials and Methods: A retrospective review of folders of 10 adult patients who were admitted for surgical treatment of ureterocele in our center between 2000 and 2009 was done. The information obtained included: age, sex, type and number of ureterocele, associated disease, type of surgical intervention, complications, and follow-up. Results: The age range was 20-49 years, with a mean age of 31 years. Of these patients, seven were females and three were males. Six patients had unilateral ureterocele while four had bilateral disease, making a total of 14 ureteroceles. The presenting symptoms were flank pain and painful micturition, each occurring in 60% of the patients. Genitourinary tuberculosis was diagnosed in 4 (40%) patients. Other associated pathologies were impacted stone in the ureterocele and vesical schistosomiasis. The treatment was mainly by open method (70%), while the rest had endoscopic treatment. All the patients did well and there were no significant perioperative complications. Conclusion: The finding of associated pathology in our patients supports the theory of an acquired origin. Urologists practicing in this region need to have a high index of suspicion and be acquainted with the variable clinical presentations, radiographic features, and treatment options in order to be able to effectively manage these occasional cases.
  5,367 376 2
REVIEW ARTICLES
Latex glove allergy: The story behind the "invention" of the surgical glove and the emergence of latex allergy
Anokha Oomman, Susmita Oomman
September-December 2013, 3(3):201-204
DOI:10.4103/2278-9596.129563  
Latex rubber gloves have become increasingly common over the last 30 years. This has led to an increase in allergy to natural rubber latex (NRL) proteins in health care professionals using protective gloves and/or in those exposed to products made of NRL. This has led to a growing need to monitor the allergenicity of gloves and other latex goods to prevent sensitization and clinical allergy. There is still considerable amount of misinformation regarding latex allergy. In this article, we examine the history behind the "invention" of the surgical glove, the emergence of latex allergy and the diagnostic tests available and possible remedies. We searched PubMed and MedLine using key words such as Latex allergy, surgical gloves, rubber, immunoglobulin E proteins, radioallergosorbent test. Recent and old papers on the subject were reviewed and analyzed. Surgical gloves were a huge milestone in the field of surgery as it allowed the development in the field of asepsis. It was instrumental in reducing the rates of infection and making health care professionals think about aseptic techniques. However, the emergence of latex allergy over the last few decades has proved a challenge in the perioperative setting. Surgical gloves are important tools in performing safe surgery. However, the increasing incidence of latex allergy and its effects on theatre personnel is of great concern.
  2,393 3,276 -
ORIGINAL ARTICLES
Cyto-morphologic correlation of equivocal C3 and C4 breast lesions
Ibrahim Yusuf, Akinfenwa T Atanda, Mohammed I Imam
September-December 2014, 4(3):131-135
DOI:10.4103/2278-9596.146401  
Background: National Cancer Institute (NCI) formulated a five-tiered system for reporting cytological smears from the breast. Of these, C1, C2 and C5 are usually unequivocal. The equivocal categories C3 (atypical probably benign) and C4 (suspicious probably malignant) need to be evaluated to determine their cyto-morphologic correlation and thus provide useful information on the degree of clinical weight that can be put on them in patient management. Patients and Methods: A retrospective study of cytological smears made from palpable breast lesions performed over a 5-year period from 2008-2012. The C3 and C4 smears were then compared with final histological diagnoses for these categories and their diagnostic value calculated. Result: There were 1,162 smears taken over the study period, and 200 (17.2%) had subsequent histology. Of the 200 smears, 20 were C3 and 27 were designated as C4. Subsequent histology upgraded 7 (35%) of the C3 cases to malignant and 23 (85%) of the 27 C4 cases were malignant. The difference between these two proportions is statistically significant (P < 0.005). The overall Suspicious Rate was 23.5% and C4 reports had a sensitivity of 76.7%, specificity of 76.5%, positive and negative predictive values of 85.2% and 65.0% respectively. Conclusion: A fair degree of clinical reliance can still be placed on cytologically categorized C3 and C4 breast smears. However, the rate of reporting of these categories can be reduced with availability of ancillary radiological techniques such as mammography and ultrasonography.
  1,927 3,250 -
CASE REPORTS
Management of clavicular non-union with plate fixation and bone grafting
Mazharuddin A Khan, Sujitkumar R Vakati
January-April 2013, 3(1):49-51
DOI:10.4103/2278-9596.117118  
Symptomatic clavicular non-union is a rare clinical condition which causes pain and functional disability, if not managed on time. We report the long-term consequences in a 25 year old young male patient with established atrophic and aseptic non-union of the middle third of the clavicle. Patient was treated by open reduction and internal fixation with Arbeitsgemeinschaft für Osteosynthesefragen (AO) Dynamic Compression Plate and autologous cancellous bone grafting harvested from the iliac crest. There was no operative or post-operative complications and the patient returned to the previous level of activities. We conclude that plate fixation with bone grafting is a reliable and safe method for the management of symptomatic non-united fractures of the middle third of the clavicle.
  4,555 271 -
ORIGINAL ARTICLES
Comparative study between Moss-Miami pedicle screw system and Hartshill rectangle for lumbar spondylolisthesis
Ajit Swamy, Amit Swamy, Vikram Jaisoliya
July-December 2012, 2(2):83-90
DOI:10.4103/2278-9596.110031  
Background: Many different treatment modalities have been advocated by different authors from time to time for lumbar spondylolisthesis. The principle underlying surgery includes stabilization of the slipping vertebrae. Various operative methods encompassing this principle include posterior interbody fusion, posterior stabilization, facet joint fusion, posterolateral fusion, excision of loose segment, and anterior interbody fusion. The objective of this study was to compare Moss-Miami pedicle screw system with Hartshill rectangle in the management of isthmic and degenerative lumbar spondylolisthesis. Materials and Methods: A prospective study was carried out to compare clinical and radiological outcomes between Moss-Miami pedicle screw fixation with facet joint fusion and Hartshill rectangle fixation with facet joint fusion after adequate decompression for Isthmic and Degenerative Lumbar spondylolisthesis. All patients of spondylolisthesis as per inclusion criteria admitted undergoing decompression, posterior stabilization, and facet fusion during the period 2009-2011 in D.Y. Patil Medical College, Pimpri, Pune were included in the study. Results: A total of twenty patients were included with mean age 47.15 years. Fifteen were females and five males. Seven females and three males underwent Moss-Miami pedicular fixation and eight females and two males underwent Hartshill fixation. Oswestry disability scoring (ODS) scores of the two groups was 4.25 and 4.23 respectively at the end of 12 months. Patients in both the groups improved significantly as assessed by the ODS system. Conclusions: Our results show that both the Moss-Miami Pedicle screw fixation and Hartshill rectangle fixation were of similar benefit as regards the stabilization of the lumbar spine.
  4,303 280 -
CASE REPORTS
Gossypiboma in the scrotum with unusual cutaneous manifestations
Maitama Y Hussaini, Ahmed Muhammed, Bello Ahmad, Ajibola O Hafeez, Mbibu N Hycinth
January-June 2012, 2(1):33-36
DOI:10.4103/2278-9596.101270  
Background: Gossypiboma is retained cotton gauze in a patient after a surgical procedure. It is generally rare with incidence ranging between 1 per 1000 and 1500. Retained gauze in the scrotum is even rarer. Gossypiboma has occurred in virtually every surgical procedure despite taking adequate precautions and performing routine gauze count. The use of radio-opaque markers and radiofrequency tags on gauze is hoped to prevent the occurrence and aid in its detection. Case Report: A 65-year-old man presented with scrotal swelling, scrotal and groin skin nodular lesions 9 months after bilateral hydrocelectomy for vaginal hydrocele. Clinical evaluation revealed bilateral hemiscrotal swellings with a thickened hyperkeratotic skin, and multiple, firm, non-tender, nodular growths on the scrotum, groin, and mons-pubis. The enlarged scrotum contained a firm non-tender mass. The phallus was edematous and tortuous. He was also found to have metastatic carcinoma of the prostate. Scrotal ultrasound scan showed bilaterally enlarged testes with distorted echo pattern and a few abscess cavities. Multiple biopsies of the groin and scrotal nodular lesions showed non-specific chronic inflammation with no evidence of malignancy. The cause of the scrotal and groin lesions could not be determined before surgery. He had orchidectomy and scrotoplasty during which gauze was found in the scrotum. Conclusion: Retained gauze in the scrotum is uncommon. Our patient presented with unusual cutaneous lesions, making the diagnosis very difficult. Foreign body reaction should be considered as a possible cause of unusual skin lesions when seen around a site of previous surgery.
  4,052 265 -
Cystic lymphangioma of the vulva: A rare case report
Anandhi Amaranathan, Sankappa Sinhasan, Simon D Dasiah, Basavanandswami Hartimath
May-August 2013, 3(2):158-160
DOI:10.4103/2278-9596.122948  
Lymphangioma is a benign congenital malformation, most commonly diagnosed in infants and children. The vulva is a rare site for the development of lymphangioma. Around 30 cases of lymphangioma circumscriptum (capillary variety) have been reported, only 7 cases of cystic lymphangioma have been reported in the literature so far. We report a case of vulval, multiloculated, cystic lymphangiomas in a 27 year old female, for its rarity and to consider this in the differential diagnosis of a vulval pathology. Viewing vulval lymphangiomas as a differential diagnosis in mind while examining a vulval swelling, will help in proper plan of complete excision.
  4,073 205 -
ORIGINAL ARTICLES
Evaluation of intraoperative peritoneal lavage with super-oxidized solution and normal saline in acute peritonitis
Pankaj K Garg, Ashwani Kumar, Vijay K Sharda, Ashok Saini, Arun Garg, Amit Sandhu
January-April 2013, 3(1):43-48
DOI:10.4103/2278-9596.117121  
Background: The fundamentals in the treatment of acute peritonitis include resuscitation, treatment of septicemia, control of the contaminating source and peritoneal toilet. Numerous studies have shown the roles of different solutions such as normal saline, antibiotics and betadine as intraperitoneal lavage, in reducing morbidity and mortality of peritonitis. The objective of this study was to present our findings on the role of intraperitoneal lavage with normal saline and normal saline followed by super-oxidized solution in patients with acute peritonitis. Materials and Methods: The patients were randomly allotted by slip method into two groups of 50 each. In the control group, after the definitive surgery for the pathology of peritonitis, the peritoneal cavity was lavaged with normal saline and closed after putting drains. In the study group, after the definitive surgery the peritoneal cavity was lavaged with saline followed by 100 ml of super-oxidized solution and drains were closed for 1 h after abdominal closure. The patients were followed-up for morbidity and mortality. Results: Surgical site infection (SSI) was present in 27 out of 100 cases in both groups. In the study group, out of 7 infected cases, intraperitoneal fluid cultures were positive in 6 cases, but only 3 had positive swab cultures. In the control group, out of 20 infected cases, swab culture was positive in 16 cases (p = 0.0399). Among the study group, bowel sounds return in 4.10 ± 1.20 days compared to 5.9 ± 1.17 in the control group. In the study group, fever >100°F developed in 14 (28%) patients in the post-operative period whereas in the control group it was 29 (58%) (p < 0.0024). SSI rates in the two groups were (7/50) 14% and (20/50) 40% respectively (p = 0.0034). Conclusion: This study suggests that super-oxidized solution is effective and safe in reducing post-operative complications including SSI, burst abdomen and episodes of post-operative fever.
  3,750 491 3
Intra-abdominal cystic lymphangiomas in children: A case series
Parag J Karkera, Gursev R Sandlas, Ritesh R Ranjan, Krushnakumar Kesan, Abhaya R Gupta, Rahul K Gupta, Paras R Kothari
July-December 2012, 2(2):91-95
Background: Lymphangiomas are hamartomas of lymphatic vessels commonly arising in the head, neck, and axilla. Intra-abdominal cystic lymphangiomas are rare and are located in the retroperitoneum, the mesentery, omentum, or visceral organs. Radiological imaging in the form of ultrasound and computed tomography (CT) scan helps in preoperative diagnosis. The objective of this study is to present the management of children with intra-abdominal cystic lymphangioma in our institution. Materials and Methods: Six cases of intra-abdominal cystic lymphangiomas comprising three males and three females, which presented over 15 months, were studied. Clinical presentation, location, mode of surgical intervention, and outcome were studied. Results: The site of origin was retroperitoneum, omentum, and the mesentery, with two cases of each. Age of presentation ranged from 5 days to 7 years. Abdominal lump was the most common presenting feature. All the patients underwent complete surgical resection - four had open excision, one had a laparoscopy converted to open excision, and one had a complete laparoscopic excision. Postoperative recovery was uneventful in all of them, with no recurrence at 6 months follow-up. Conclusion: Intra-abdominal cystic lymphangiomas in children are usually symptomatic. CT scan is more accurate than ultrasound to diagnose the lesion. Complete excision of the lesion with or without intestinal resection provides symptomatic relief and prevents recurrence.
  3,893 329 -
Laparoscopic versus open appendectomy: A retrospective study in the Kingdom of Bahrain
Nour Al Hoda Amiri, Ahmed Al Ansari
January-April 2013, 3(1):39-42
DOI:10.4103/2278-9596.117124  
Background: Both open and laparoscopic appendectomies are commonly performed procedures. The aim of this study was to investigate the differences between open and laparoscopic appendectomy (LA) in the management of acute appendicitis. Patients and Methods: This study was conducted at Bahrain Defence Force Hospital in the Kingdom of Bahrain. A total of 106 patients who underwent appendectomies in the year 2009 were included in the study. A total of 71 patients had laparoscopic appendectomies, while the remaining 35 underwent open procedures. Clinical outcome measures were compared between the two groups with respect to six variables. Results: The study included 106 patients: 71 underwent LA while the remaining 35 underwent open appendectomy (OA). The operating time was shorter for the OA patients than for the LA patients (LA, 73.5 +/- 35 min vs. OA, 59.5 +/- 23 min; p value 0.033), which is statistically significant. The difference in hospital stay of 1.55 +/- 1.0 days for the LA group and 1.77 +/- 1.3 days for the OA group with P-value 0.323 was not statistically significant. Return to oral diet was the same in both groups with no statistical difference (LA, 14.4 +/- 7.6 h vs. OA, 15 +/- 7.9 h; p = 0.720), return to work (LA, 11 +/- 4.8 days vs. OA, 11+/- 4.1 days; p = 0.964). Although the rate for overall complications was lower in the LA group (2.8% vs. 5.7% in OA), it was not statistically significant (p value = 0.452). Conclusions: The overall results showed no significant difference between the laparoscopic and open appendectomies, except for the operating time that was significantly shorter in the OAs.
  3,877 258 -
CASE REPORTS
Penetrating orbito-cranial injury in a child
Abdullahi O Jimoh, Joseph O Obande
January-June 2012, 2(1):29-32
DOI:10.4103/2278-9596.101265  
Introduction: Penetrating brain injury is a very common form of head injury all over the world. It commonly follows missile injury and impalement from assaults and fall on a sharp object. Rarely, however,self-inflicted injury from playing with a sharp object can occur. The objective of this report was to present an unusual injury from a nail that the patient was playing with. Case Report: A 7 year-old, right-handed primary two pupil presented to our center with a 2-hour history of a 6-inch nail on the head. He fell over a 6-inch nail he was holding while playing. The boy gave an account of what happened at presentation. There was no focal neurological deficit. Skull X-ray showed an orbito-cranial radio-opaque nail through the orbit. He was placed on anticonvulsant, antibiotics, and full course of tetanus prophylaxis. Neither computed tomography scan nor angiography could be done. The nail was removed successfully by craniotomy. He had an 8-week course of intravenous and oral antibiotics and had 2-year course of anticonvulsant. He has been followed up for 2 years without complications. Conclusion: Although penetrating brain injuries are common worldwide, we present the peculiar accidental injury in a child who was managed with a good outcome.
  3,807 279 -
REVIEW ARTICLE
Ductal carcinoma In situ: The challenges and approaches
Sujan N Agrawal
July-September 2016, 6(3):137-145
DOI:10.4103/2278-9596.202366  
Cancer cells are in situ or invasive depending upon whether they have invaded basement membrane or not. Ductal carcinoma in situ (DCIS) signifies in situ growth in the ductal system of the breast. Screening mammography has revolutionized the screening and diagnosis of this clinically occult disease. Diagnosis may be further improved by ultrasonography and magnetic resonance imaging in selected cases. Suspicious area in the breast is subjected to fine needle aspiration cytology (FNAC). The drawback of this simple procedure (FNAC) is that basement membrane cannot be assessed, and hence, image-guided, core needle biopsy or tru-cut biopsy is used to overcome this drawback. After confirmation of the diagnosis, DCIS may be treated by breast conservation or mastectomy and/or radiation. This paper discusses the various challenges encountered at every step in this clinically occult disease during screening, diagnosis, and treatment. Means and ways are highlighted to overcome the challenges.
  2,899 1,181 -
ORIGINAL ARTICLES
Effect of cholelithiasis and cholecystectomy on serum lipids and blood glucose parameters
Neha Jindal, Gurjit Singh, Iqbal Ali, Gaurav Sali, Raghuveer Reddy
May-August 2013, 3(2):97-101
DOI:10.4103/2278-9596.122926  
Background: Association between gallstone disease (GSD) and dyslipidemia has been shown in many studies. The aim of this study was to compare the serum lipid and serum glucose levels in patients with and without gallstone and also to determine changes in same parameters in gallstone patients before and after cholecystectomy. Materials and Methods: A total of 71 patients with gallstone (Group A) and 96 without gallstone (Group B) were studied prospectively. Patients in both groups were investigated for GSD. Total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), atherogenic index (AI) and fasting glucose (FG) levels were estimated in both groups pre-operatively. Further, same parameters were studied in Group A post-operatively at 1 week and 1 month intervals. Results: The serum levels of TC, TGs, LDL-c, AI and FG were found to be higher and levels of serum HDL-c were lower in gallstone patients than that of the control group, though not statistically significant. In patients with gallstone, significant decrease in TC, LDL-c, TG, AI and increase in HDL-c levels were observed post-cholecystectomy at both intervals. Post-operatively, rise in serum glucose levels at 1 week interval and decrease at 1 month interval were noticed in patients with GSD. Conclusion: GSD is associated with abnormal lipid profile and serum glucose. Cholecystectomy leads to a significant decrease in these parameters except HDL-c in patients with GSD. The presence of gall stones should be perceived in the context of metabolic disorder, which may be investigated and treated. Asymptomatic gallstone patients may also be treated surgically resulting in improvement of above mentioned biochemical parameters.
  3,488 359 -
Fournier's gangrene: A study of 18 cases
Gurjit Singh, Iqbal Ali, Pragnesh Bharpoda, Neha Jindal
July-December 2012, 2(2):74-78
DOI:10.4103/2278-9596.110021  
Background: Fournier's gangrene (FG) refers to necrotizing fasciitis affecting the perineal, rectal or genital areas. This can have a fulminant presentation, and its clinical course is unpredictable. It can be fatal unless there is prompt recognition and aggressive surgical treatment. We report our experience and results in the management of FG. Materials and Methods: We conducted a prospective analysis of cases of FG presenting to our institute from April 2007 to September 2009. All patients with signs and symptoms of FG were admitted and evaluated. A policy of aggressive surgical debridement under the cover of broad spectrum antibiotics was adopted, often in multiple sittings. Supportive therapy was also provided. Skin grafting and thigh pouch implantation were undertaken where indicated. Results: There were a total of 18 patients. Seven patients were in the age group of 50-59 years. There was delay of 11-15 days in reporting after onset of symptoms in 44.4% of cases. The main pre-disposing risk factors were age above 50 years (61.1%) and diabetes mellitus (33.3%). The route of infection was mostly cutaneous (27.7%). All infections were polymicrobial aerobic infections, and the commonest organisms were Escherichia coli and Klebsiella species. Aggressive surgical debridements were done, often in multiple sittings. The average number of procedures per patient was 3.27 with a range of 2-4. Conclusion: Early and aggressive surgical management are essential to ensure a successful outcome in FG.
  3,512 289 -
Gastrointestinal stromal tumor of the stomach: Evaluation and treatment in a poor-resource setting
Dauda M Mohammed, Adamu Ahmed, Ukwenya A Yahaya, Khalid Lawal, Liman A Almustapha, Sani M Shehu
January-June 2012, 2(1):11-17
DOI:10.4103/2278-9596.101256  
Background: Gastrointestinal stromal tumors (GISTs) represent mesenchymal tumors arising from the gastrointestinal wall, mesentery, omentum, or retroperitoneum that express the c-kit proto-oncogene. In low-income countries, facilities for diagnosis are limited and the patients present late with large tumors. We present the evaluation and treatment of gastric GIST and highlight the difficulties in management of these patients in a setting of limited resources. Materials and Methods: We retrospectively reviewed patients who were managed for gastric GIST from January 2001 to December 2010 in the Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information recorded included patient's demographic characteristics, clinical presentation, treatment, operative findings, and outcome. Results: There were 13 patients with histological diagnosis of gastric GIST. Their age ranged 31-67 years, with a mean of 48 years. All the patients were symptomatic and had palpable abdominal masses at presentation. Tumor size ranged 13.4-39.5 cm. Six patients had preoperative diagnosis of GIST, including two with immunohistochemical confirmation. Overall, seven patients had complete resection of their tumors. Four patients presented with gastric outlet obstruction and both peritoneal and liver metastasis. Five patients were on imatinib which they had taken for 3-13 months. Three patients had tumor recurrence 1-3 years after complete resection. Follow-up ranged from 1 month to 4.5 years. Five patients were followed up for more than 1 year. Conclusion: Due to lack of facilities for endoscopic ultrasound guided biopsy and immunohistochemistry, preoperative diagnosis was based on clinical and radiological features. Despite the large tumor size, complete resection is associated with good control of symptoms and prolonged survival.
  3,337 412 -
CASE REPORTS
Pseudotumor cerebri in a post-mastectomy Nigerian
Dawotola A David, Odigie I Vincent, Yusufu M. D. Lazarus, Jimoh O Abdullahi, Ibinaye O Philip, Ketiku K Kingsley
January-June 2012, 2(1):45-47
DOI:10.4103/2278-9596.101276  
Background: Pseudotumor cerebri, commonly known as idiopathic intracranial hypertension, is a rare syndrome that manifests mainly as a consequence of raised intracranial pressure. Headache is the major presenting symptom. The diagnosis of this condition is established by exclusion, with the aid of computerized tomographic scan, magnetic resonance imaging, and examination of cerebrospinal fluid tap. We present a patient with advanced invasive ductal carcinoma that was successfully managed for pseudotumor cerebri. Case Report: The patient was a 46-year-old female with stage III invasive ductal carcinoma of the right breast that was treated with modified radical mastectomy, radiotherapy, and combination chemotherapy. She had also taken tamoxifen for 8 months when she developed headache and persistent non-projectile vomiting. She had two episodes of generalized seizures with associated dizziness which resolved on phenobarbitone. She had no neurological deficits. Computerized tomographic scan of the brain revealed features of raised intracranial pressure, and there was no focal intracerebral or cerebellar lesion. A diagnosis of idiopathic pseudotumor cerebri was entertained using the modified Dandy Criteria. She responded well to acetazolamide and dexamethasone. Conclusion: Pseudotumor cerebri should be considered in cancer patients presenting with raised intracranial pressure of sudden onset in the absence of clinical and radiological evidence of brain metastases. We advocate prompt therapy in patients with pseudotumor cerebri to prevent or minimize morbidity.
  3,484 230 -
ORIGINAL ARTICLES
Proximal hypospadias repair with principles of progressive perineal urethroplasty
Altaf M Shaikh, Sunil M Mhaske, Pranav C Chhajed, Mohammad I Attar, Sanjay Swain, Sujata Patwardhan
January-April 2013, 3(1):19-22
DOI:10.4103/2278-9596.117133  
Background: Proximal hypospadias with chordee is the most challenging variant of hypospadias to reconstruct. Significant variability exists for preferred approaches of repair. Often combinations of procedures are required in staged manner. Here, we have combined steps of pelvic fracture urethral distraction defects (PFUDD) repair with tubularized incised plate procedure in a single stage. Materials and Methods: A total of 8 patients consisting of 5 adults (mean age 20 years) and 3 children less than 3 years old that presented with proximal hyposphadias were included. All patients underwent degloving and progressive perineal approach as described by Webster for repair of PFUDD including mobilization of the entire bulbar urethra from the neomeatus to the membranous urethra with division of lateral attachments, division of attachment from perineal body and corporal separation. Mobilization of the urethral plate from the corpora cavernosa to the glans was carried out. The urethral plate was tubularized with a dorsal incision. Results: The neomeatus was advanced by a distance of 2.5-3.8 cm in all eight patients. Dartos fascia was used in 5 adults and 1 child for cover. Two patients required a tunica vaginalis flap as dartos was tethered during the harvesting. Catheter drainage was 18 days on an average (14-21 days). Fistula (pinpoint) occurred in one adult, which healed with further catheter drainage. All the patients were voiding normally and satisfied in terms of cosmetic appearance. None of the patients had wound infection or total disruption, residual chordee, meatal stenosis or any erectile difficulties. Conclusion: The steps of progressive perineal approach for repair of posterior urethral distraction defects if followed aids in achieving the goals of proximal hypospadias surgery in a single stage.
  3,440 227 -
Bulking agent injection for fecal incontinence in patients with anorectal malformation
Seyed M. V. Hosseini, Mohammad Zarenezhad, Babak Sabet, Mohammad Maleki
July-December 2012, 2(2):70-73
DOI:10.4103/2278-9596.110020  
Background: Patients with anorectal malformation (ARM) frequently suffer from fecal incontinence after surgery because they do not have many of the normal mechanisms of continence. The objectibe of this study was to determine the effects of bulking agent for improving the continence in patients with ARM by correcting the high pressure zone during the toilet training process. Materials and Methods: From December 2008 to June 2011, 16 cases of mid to high ARM that had posterior sagital anorectoplasty were studied prospectively after perianal injection of a bulking agent (Vantris, Promedon/Argentina) into the submucosal layer in high pressure zone of the anal canal about 5 mm from the dentate line, before the start of toilet training. All patients were followed 3 months and 6 months later by manometery, modified defecation pattern scoring and physical examination for complications. They received metronidazole (10 mg/kg/q8h) for 7 days. Result: Eleven male (68.75) and five female (31.25%) included; age range from 1 year to 2 years (mean 3 ± 1.96); Six patients (37.5%) had high type ARM and the remaining were mid type ARM. Internal sphincter pressure ranged from 19.6 ± 6.7 mmHg before intervention to 27.5 ± 6.5 mmHg, after injection until 28.4 ± 8.3 mmHg 6-months after injection ( P < 0.0001). Defecation pattern score on this study changed from 7.4 ± 1.9 to 6.1 ± 1.4, 6 month after study ( P = 0.002). Conclusion: The bulking agent injection could be a cornerstone of post-operative management in patients with ARM.
  3,295 282 1
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