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   2015| October-December  | Volume 5 | Issue 4  
    Online since January 21, 2016

 
 
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ORIGINAL ARTICLES
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.
  2,288 3,555 -
Immuno-hematological abnormalities of human immunodeficiency virus-1 infected highly active antiretroviral naïve adults in Zaria, Northern Nigeria
Aliyu Ahmadu Babadoko, Haruna Mohammed Muktar, Aisha Indo Mamman
October-December 2015, 5(4):199-205
DOI:10.4103/2278-9596.174658  
Background: In HIV-1-infected adults, hematological derangements include peripheral cytopenias and bone marrow abnormalities. The level of the CD4+ T lymphopenia is presently considered as one of the best markers of HIV induced immune impairment. Multiple interacting factors contribute to the hematological manifestations of HIV infection. We compare the prevalence of peripheral cytopenias and the level of immunological deterioration in treatment naïve HIV-1 infected patients. Patients and Methods: Four hundred consecutive HIV-1 infected patients undergoing pre-treatment (Highly active antiretroviral therapy naïve) assessment were recruited at the HIV sub-specialty clinic of Ahmadu Bello University Teaching Hospital, Zaria, Nigeria between May 2003 and October 2004. A cross-sectional study of baseline hematological and immunological parameters was undertaken after confirmation of HIV-1 infection by double ELISA methods; complete blood count and CD4+ T cell count (Dynal ® ) were analyzed by manual techniques. Results: Anemia is the most common peripheral cytopenia, 73% in male and 54% in the females. Neutropenia occurred in 10.8% of the patients while 6.25% had thrombocytopenia. Packed cell volume and Absolute lymphocyte count is associated with a reduction of CD4+ T cell counts but this is not consistent following gender and CDC clinical/immunological staging. CD4+ T cell counts decreases significant from asymptomatic stage A through symptomatic stages B to stage C p < 0.001. Conclusion: This study demonstrates that anemia and low CD4+ T cells are the commonest hematological complication in HIV-1 infected patients and these cytopenias deteriorates with increasing advanced stages of the infection.
  2,039 1,053 -
The pure tone audiogram assessment of the students of a special school for deaf in Kaduna
Iliyasu Yunusa Shuaibu, Aminu Bakari, Abdulazeez Ahmed, Mohammed Aminu Usman
October-December 2015, 5(4):206-209
DOI:10.4103/2278-9596.174661  
Background: Hearing impairment in children is an important public health problem. Children with hearing impairment are educated in special schools (schools for the deaf) and in our locality all are assumed to be deaf without necessarily subjecting them to audiological evaluation in some cases. The objective of this study was to identify the cause of hearing impairment, type and degree of hearing loss, and use of hearing aids among students attending special schools for the deaf in Kaduna. Patients and Methods: This was a cross-sectional study conducted over a period of 4 months between February and May, 2014. Students aged 7-18 years attending Kaduna State Special Education School for the deaf, Katsina road, and demonstration school for the deaf, Kawo Kaduna, were recruited for the study. A questionnaire investigating the student's biodata, causes of hearing impairment, and use of hearing aids was administered. This was followed by ear examination and pure tone audiometric tests. The data were analyzed using Statistical Package for the Social Science version 16. Results: A total of 307 participants were recruited as the study group. Among them, 58.6% were males and 41.4% were females. The mean age of the study subjects was 13.5 ± 3.6 standard deviation (SD) years. Only 27.7% of the study population have a known cause of their hearing impairment. Two hundred and ninety seven (97.4%) of the students had sensorineural hearing loss, while out of the remaining subjects 5 (1.6%) have conductive and 3 (0.9%) have mixed hearing losses. Two hundred and sixty eight (87.3%) of the participants had profound hearing loss while 37 (12%) had mild-to-severe hearing loss. Two students (0.7%) were found to have normal hearing. No student was found to be using hearing aid. Conclusion: In majority of the students, the cause of the hearing impairment is unknown. Some of the students have residual hearing and none of them is using hearing aids. Further evaluation and possible amplification may be required to rehabilitate some of these students into normal schools.
  1,866 403 1
CASE REPORTS
Penoscrotal injury by stone (tiles) cutter machine
Venkat Arjunrao Gite, Saurabh Ramesh Patil, Sachin Madhukar Bote
October-December 2015, 5(4):210-212
DOI:10.4103/2278-9596.174663  
Injury to penis is relatively uncommon, but several reports of penile injuries related to machinery accidents have been reported. Corporal injuries usually follow forceful injury to erect penis during coitus however tiles cutter injury is very rare and has not been reported in the literature. We report a case of corporal injury due to electrically driven stone (tiles) cutter machine. He sustained an injury of about 20 cm, extending from the coronal sulcus to the left thigh. There was associated corporal injury measuring 6 × 2 cm. Following resuscitation the patient was taken for repair of the penoscrotal wound under spinal anesthesia. The wound was thoroughly washed with normal saline and sutured in layers. The patient had a functionally and cosmetically normal penis at 6 months follow-up.
  1,780 248 -
Excision of benign mature anterior mediastinal teratoma through trapdoor incision: A case report with review of literature
Pankaj Srivastava, Manoj Kumar Srivastava, Shalini Srivastava, Sandeep Roshan
October-December 2015, 5(4):213-216
DOI:10.4103/2278-9596.174667  
A 20-year-old female presented with right-sided chest pain with nonproductive cough. Contrast enhanced computed tomography (CECT) thorax showed well-defined nonenhancing soft tissue density lesion in the anterior mediastinum with the presence of multiple small well-defined cystic lesions showing fat density as well as multiple calcifications within it suggestive of a teratoma. The patient underwent surgical excision of the tumor via a trapdoor incision and the final diagnosis of benign mature cystic teratoma was made. The follow-up of two years was uneventful.
  1,871 156 -
Angiolymphoid hyperplasia with eosinophilia in parotid gland: A diagnostic challenge
Bifica Sofia Lyngdoh, Anadi Roy Chowdhury, Soumya Ghatak, Gautam Bandyopadhyay
October-December 2015, 5(4):217-219
DOI:10.4103/2278-9596.174670  
Angiolymphoid hyperplasia with eosinophilia (ALHE) rarely involves the parotid glands or other major glands. ALHE and Kimura's disease (KD) share many clinical and histopathological features. Ill-defined, deeply seated lesions involving the parotid glands are frequently observed in KD, and only three cases of intraparotid ALHE have been reported in the literature. Often these benign angioproliferative lesions of unknown etiology will be misdiagnosed as parotid tumors clinically. We report a case of ALHE in a 29-year-old Indian male who presented with unilateral parotid enlargement. The previous fine-needle aspiration cytology (FNAC) report indicated parotid sialadenitis but histopathological examination following superficial parotidectomy of the lesion allowed us to make a definitive diagnosis.
  1,716 157 -
Bilateral aberrant axillary breasts in puerperium
Karen G Minoza, Habila U Na'aya, Wadinga D Wadinga, Bukar Bunu
October-December 2015, 5(4):235-238
DOI:10.4103/2278-9596.174680  
Ectopic breast tissue (EBT) is rare with a reported incidence of 0.4-6% worldwide, the commonest site being the axilla. It results from incomplete regression of the embryonic mammary ridges that extend bilaterally from the axillae to the groins, and may be associated with other clinical syndromes. EBT comprises accessory breasts, in which there is an accessory nipple, areola, or both, with or without glandular tissue, and aberrant breast tissue, in which the ectopic glandular tissue is without a nipple or areola. Aberrant breast tissue may remain asymptomatic until menarche, pregnancy, or lactation, when it responds to hormonal fluctuation. Diagnosis is important as EBT is subject to all pathologies of the normal breast, including cancer. We present the case of a 38-year-old multipara with bilateral aberrant axillary breasts noted only during her last pregnancy who had excision of the masses in the puerperium.
  1,725 125 -
Postpartum urinary retention secondary to suture obliteration of the urethral orifice: A complication of home delivery conducted by an untrained birth attendant
Fadimatu Bakari, Adebiyi G Adesiyun, Hajaratu Umar-Sulayman, Nkeiruka Ameh, Solomon Avidime, Zubaida Garba Abdullahi
October-December 2015, 5(4):231-234
DOI:10.4103/2278-9596.174678  
Postpartum urinary retention (PPUR) secondary to suture obliteration of the urethral orifice by a traditional birth attendant (TBA) is a condition that may not have been heard of in modern day obstetric practice and has certainly not been reported before in our locality. Several risk factors to developing PPUR have been reported. However, following a careful search of the literature, there was no documented case of PPUR secondary to closure of the urethral orifice by TBA. We report a rare case of a 23-year-old multipara who had spontaneous vaginal delivery that was supervised by a TBA at home. She presented 3 days later with complaints of inability to pass urine, abdominal pain, abdominal swelling, and dribbling of urine on straining. She was evaluated and found to have a distended urinary bladder up to the level of the umbilicus. Pelvic examination revealed a vestibule that was almost completely obliterated up to the urethral orifice with continuous surgical silk suture. The vaginal orifice was also partially obliterated. Urine was noticed to be dribbling from the region of the urethral orifice on straining. Lochia was normal. About 2 L of clear urine was drained from the urinary bladder following cutting of the silk suture and passage of an indwelling size 16F Foley's catheter. The uterus was contracted to 16 weeks pregnancy size following catheterization. She had successful bladder training and was discharged 5 days later.
  1,583 77 -
Primary neuroendocrine carcinoma of the breast: A case report and review of literature
Gopalakrishnan Ravikumar, Gopalakrishnan Ravikumar Naveen Prasad, Gopalakrishnan Ravikumar Sugapradha, Thiagarajan Sivakami
October-December 2015, 5(4):224-227
DOI:10.4103/2278-9596.174676  
Neuroendocrine tumors of the breast are rare, accounting for less than 0.1% of all breast cancer and less than 1% of all neuroendocrine (NE) tumors. The papillary NE carcinoma of the breast (NECB) with classic morphological and phenotypic features is rare. We describe a case of a 45-year-old woman admitted with a lump in the left breast, initially diagnosed by fine-needle aspiration cytology (FNAC) as intraductal carcinoma. After undergoing modified radical mastectomy, the histopathology showed evidence of alveolar-type primary NECB. A 16-month follow-up of the patient showed no evidence of metastasis. The in situ component of primary NECB may prevail in a core biopsy sample increasing the probability of underdiagnosing this tumor preoperatively. Misdiagnosing primary NECB is detrimental because patients may not receive the optimal adjuvant treatment they need.
  1,496 100 1
Schistosomiasis and second trimester tubal pregnancy in a multiparous female: A report and review of its pathology
Modupeola Omotara Samaila, Fatima Yalaraba Abdulquadir, Kasimu Adoke, Adekunle Oguntayo, Afolabi Korede Koledade, Nasiru Abubakar
October-December 2015, 5(4):228-230
DOI:10.4103/2278-9596.174677  
Schistosomiasis remains a burden in sub-Saharan countries and detection is often incidental in females. Also, there is an increase in the incidence of tubal ectopic pregnancy due to pelvic inflammatory diseases (PIDs). The coexistence of these two pathologies in the female reproductive organs may lead to impaired fertility. We present a 28-year-old gravida 7, para 4 + 2 female with 2-months amenorrhea, 6 days lower abdominal pain, and 2-h history of dizzy spells seen at the Accident and Emergency Unit of our hospital. Clinical examination and ultrasound findings confirmed a ruptured right tubal gestation. She had salpingectomy and specimen was sent to the histopathology laboratory for analysis. Grossly, a well-formed male fetus consistent with 4-lunar-month gestation was seen in the expanded fallopian tube. Histopathologic sections from the tube revealed a ruptured expanded wall containing chorionic villi, decidua, and numerous Schistosoma haematobium ova. There was extensive fibrosis of the tubal wall. The diagnosis of schistosomiasis in reproductive age females is often incidental due to either absent or nonspecific symptoms, while tubal ectopic gestation is common and there are many factors attributable to its rising global incidence. Both schistosomiasis and ectopic gestation are strongly associated with infertility. Thus, the occurrence of schistosomiasis and second trimester tubal pregnancy in the same location in a multiparous female is a novelty.
  1,416 100 -
Paraganglioma: A rare retroperitoneal tumor
Edwin Oduagbon Obarisiagbon, Jude Orumuah Agbugui, Gerald Forae
October-December 2015, 5(4):220-223
DOI:10.4103/2278-9596.174674  
Paraganglioma is a rare catecholamine-secreting tumor, that is, found anywhere in the line of the sympathetic chain and that of the parasympathetic ganglia. They usually present with severe hypertension which can be challenging to the surgeon during the management. We successfully managed a 28-year-old lady who presented with a 6 year history of episodic hypertension, palpitation, insomnia, excessive sweating, and weight loss. An abdominal ultrasonography and computed tomography scan showed a retroperitoneal mass in front of the left kidney. She subsequently had exploratory laparotomy and excision of the tumor with resolution of symptoms. Histology of the mass revealed features consistent with a paraganglioma. She is presently being followed up in our surgical out-patient clinic.
  1,324 99 -
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