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  Citation statistics : Table of Contents
   2016| January-March  | Volume 6 | Issue 1  
    Online since July 28, 2016

 
 
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ORIGINAL ARTICLES
Episiotomy at Aminu Kano Teaching Hospital, Kano, Nigeria: A 3-Year Review
Ibrahim Garba, Mohammed Salihu Ozegya, Idris Sulaiman Abubakar, Rabiu Ayyuba
January-March 2016, 6(1):17-21
DOI:10.4103/2278-9596.187202  
Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X2 = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X2 = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X2 = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.
  6 7,832 531
Surgical outcome of stapled and handsewn anastomosis in lower gastrointestinal malignancies: A prospective study
Abdul Qayoom Khan, Naseer Awan, Waseem Raja Dar, Mufti Mehmood, Muzamil Latief, Najeeb Sofi, Imtiyaz Dar, Pervez Sofi, Basharat Kasana, Moomin Hussain
January-March 2016, 6(1):1-6
DOI:10.4103/2278-9596.187193  
Background: In spite of the wide range of intestinal anastomotic techniques, surgeons are still not so confident with colorectal anastomosis. Invention of surgical staplers has provided some procedural advantages and sense of security to surgeons as well as to patients, in respect to sphincter-saving procedures and thereby improving the quality of life. Outcome measures of applying these devices should be evaluated to see its efficacy and cost-effectiveness over conventional handsewn technique in treatment plan. The result of such comparative study may help surgeons to improve results of their technique. The aim of this prospective study is to observe the results of using stapler in comparison to handsewn colorectal anastomosis. Patients and Methods: A total of 60 patients were selected, of which 30 underwent “stapled” and 30 underwent “handsewn” anastomosis. The two groups were compared on the following points (i) mean operating time (min), (ii) resumption of oral feeding, (iii) wound infection rate, (iv) anastomotic leak rate, (v) duration of hospital stay and return to work in days. The procedures were evaluated and presented. Results: The stapling procedure took shorter operative time compared to the handsewn anastomosis with a mean of 123 ± 21.1 min and 161.5 ± 27.8 min respectively (P < 0.001). Oral feeding was started earlier in patients who underwent stapler anastomosis 4.0 ± 1.0 days, as compared to handsewn anastomosis 5.0 ± 0.83 days (P value = 0.001). There was no significant difference between the two groups in postoperative hospital stay; it was 7.8 ± 1.76 days and in controls group it was 8.1 ± 2.12 (P > 0.0137). Conclusion: Application of the stapler in treating lower gastrointestinal malignancies demonstrated better effects in terms of mean operating time, resumption of oral feeds, and hospital stay.
  3 6,831 569
Burns during pregnancy: A retrospective analysis of 19 cases
Gautam Chandra, Kumar Gaurav, Sharwan Kumar, Sanjay Kumar Yadav, Rakesh Ranjan, Murlikrishnan Nambiar, Amaresh Chandra Agrahari, Shipra Yadav
January-March 2016, 6(1):28-31
DOI:10.4103/2278-9596.187198  
Background: Due to the limited availability of literature on management of burns during pregnancy, many surgical units face the difficult task of handling such cases. Keeping this in mind, a retrospective analysis of all the burnt females with pregnancy was done. Patients and Methods: A total of 19 cases of burns in pregnancy were analyzed in this study. The demographic characteristic and stage of pregnancy of the patients were evaluated. In addition, the causes, severity of the treatment, and outcome were noted. Results: The highest number of cases was in the 2nd trimester. The third trimester was associated with the highest incidence of abortion. Abortion was spontaneous in 70% of the cases. Maternal deaths were least in the 1st trimester. The rate of spontaneous abortion was highest in the 1st trimester. Conclusion: Burns in pregnancy are associated with high fetal loss. Prevention of burns in the pregnant woman is essential in reducing the morbidity and mortality associated with these injuries.
  3 5,658 351
CASE REPORTS
Epithelioid sarcoma: A diagnostic challenge of a rare presentation
Kafil Akhtar, Asha Raj Piyush, Sadaf Haiyat, Arshad Hafeez Khan
January-March 2016, 6(1):57-59
DOI:10.4103/2278-9596.187205  
Epithelioid sarcoma, first described by Enzinger in 1970, is a rare, slow-growing, malignant, soft-tissue sarcoma typically presenting as a subcutaneous or deep dermal mass in distal portions of the extremities of adolescents and young adults. It is associated with a high incidence of local recurrence and metastasis. Due to the tumor's infrequent occurrence and histological similarities with other disease processes, diagnosing epithelioid sarcoma has become extremely difficult. We report a rare case of epithelioid sarcoma occurring as a cauliflower-like growth between the index finger and middle finger of the left hand in a 30-year-old female with pathological challenges in the diagnosis.
  2 5,012 273
Adenocarcinoma arising in a chronic fistula-in-ano and presenting as a gluteal mass
Ibrahim E Suleiman, Umar H Pindiga, Abubakar M Waziri, Babagana M Abubakar
January-March 2016, 6(1):47-50
DOI:10.4103/2278-9596.187197  
The occurrence of adenocarcinoma within a fistula-in-ano is a rare phenomenon, more so when it arises within the fistula. A 54-year-old man presented with a slow-growing, painless, left gluteal mass of 5 years' duration. There was history suggestive of chronic fistula-in-ano, for which he never had orthodox treatment. On examination, he looked well-preserved. The left gluteal mass measured about 20 × 18 × 10 cm with multiple sinuses discharging mucus and pus. There were tracts connecting the mass with sinuses in the anus. The gluteal mass was excised; histology revealed well-differentiated adenocarcinoma, probably from the rectum. He had abdominoperineal excision of the rectum 3 months later, and a fasciocutaneous flap was raised from the right thigh to cover the gluteal defect. Histological examination did not reveal any malignant lesion in the excised rectum. Malignant transformation does occur within a chronic fistula-in-ano. A high index of suspicion is essential to diagnose such cases; histological examination is therefore, very essential for all tissues resected at surgery for fistula-in-ano. Prompt and adequate treatment will save the patient from a protracted and debilitating course of the disease.
  1 5,047 300
Acquired male urethral diverticulum: Report of two cases
Sachin Madhukar Bote, Venkat Arjunrao Gite, Ayub Karam Nabi Siddiqui, Saurabh R Patil, Jayant V Nikose
January-March 2016, 6(1):54-56
DOI:10.4103/2278-9596.187204  
Urethral diverticulum (UD) was first described by Hey in 1805. Two third of UD are acquired and up to a third may be congenital. While UD are more common in women secondary to poor anatomical support of the urethra, it is rarely seen in men. Acquired UD in men may be seen after urethroplasty, after hypospadias repair when flaps are used. We report two cases of acquired UD in male children secondary to catheterization and after hypospadias surgery respectively.
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Wilkie's syndrome with duodenojejunal diverticulosis: A rare combination causing duodenal obstruction
Saravanan Janakiraman, Jeswanth Sathyanesan, Ravichandran Palaniypaan
January-March 2016, 6(1):51-53
DOI:10.4103/2278-9596.187201  
Wilkie's syndrome is an unusual cause of proximal intestinal obstruction. It is a clinical entity characterized by compression of the third or transverse portion of the duodenum between the aorta and superior mesenteric artery (SMA). This results in chronic, intermittent, or acute complete or partial duodenal obstruction. We present the case of a 40-year-old lady who presented with postprandial abdominal pain at the epigastric region, colic type, without radiation accompanied by nausea, postprandial vomiting, and weight loss. She was evaluated and diagnosed with SMA syndrome with duodenojejunal diverticulosis. She was taken for surgery due to chronic malnutrition that did not improve with conservative management. Duodenojejunostomy with transgastric feeding jejunostomy was done. To alleviate postoperative refractive gastroparesis, kinking, and angulation as is our previous few cases, transgastric feeding jejunostomy was done in contrast to modified Witzel's technique. The patient was free of symptoms and recurrence during follow-up. Wilkie's syndrome is an unusual cause of intestinal obstruction. Prompt diagnosis and appropriate surgical intervention are associated with good outcome.
  - 4,137 255
Epithelioid hemangioendothelioma of the femur
Navneet Jain, Neha Jindal, Manisa Pattanayak, Sunil Saini
January-March 2016, 6(1):60-62
DOI:10.4103/2278-9596.187195  
Epithelioid hemangioendothelioma (EHE) of the bone is extremely uncommon and only 0.01% of the cancer population has it. It is characterized by epithelioid endothelial cells and has variable biological behavior. Because the behavior of these tumors is intermediate between angiosarcoma and hemangioma, it is important to not misdiagnose EHE as an angiosarcoma. EHE typically occurs in patients of 20-40 years of age with no sex predilection. Approximately, half of EHE is present with multifocal disease. Here, we describe the case of a 60-year-old female who presented with pain and swelling of the right thigh. Contrast Enhanced Computed Tomography (CECT) of the right thigh revealed multiple lytic lesions in the right femur with cortical destruction with multiple peripherally enhancing lesions in the muscular plane along the shaft of the right femur. Histopathology report from bone tissue showed connective tissue tumor with CK, Vimentin, CD31, and Fil-1 positivity on immunohistochemistry (IHC). In view of multiple lytic lesions of bone, right hip disarticulation was done instead of salvage surgery of the limb. The tumor is locally aggressive and has high rates of local recurrence. Thereby, necessitating aggressive local treatment which is mostly surgical. These tumors are not generally chemo and radiosensitive, hence these modalities cannot be used as adjuvant to incomplete surgery or local recurrence. IHC plays a valuable role in characterizing these tumors due to its variable biological behavior.
  - 4,080 249
ORIGINAL ARTICLES
A 5-year retrospective review of singleton term breech deliveries seen at a tertiary hospital in northern Nigeria
Idris Usman Takai, Aliyu Salihu Kwayabura, Mohammed Bukar, Audu Idrissa, Jessy Yaffi Obed
January-March 2016, 6(1):7-11
DOI:10.4103/2278-9596.187203  
Background: Most singleton breech deliveries in the developing countries are unplanned and therefore, associated with poor perinatal outcome. This is because despite high antenatal attendance, most patients present in advanced labour, coupled with inadequate work force and skill attendants for the management of such cases. This study was undertaken to determine the incidence and outcome of term singleton breech deliveries at the University of Maiduguri Teaching Hospital (UMTH). Patients and Methods: This is a retrospective study of term singleton breech deliveries at the UMTH, a tertiary health facility in northeastern Nigeria over 5 years from January 1, 2003 to December 31, 2007. The delivery and theater records for all singleton breech deliveries at term were collected while the case notes were retrieved from the central medical records department. Information on age, parity, booking status, type of breech, level of skill of the attendant (accoucheur), Apgar scores, and birth weight were extracted. The main outcome measures were still births, low Apgar scores, birth weight, and accoucheur. Data were analyzed using Statistical Package for the Social Sciences (SPSS) 16.0 statistical computer package. Results: There were 173 term singleton breech deliveries among the 10,203 patients who delivered during the study period, giving an institutional incidence of 1.69%. The age of the patients ranged 18-44 years; 51.9% of the patients were aged 25-34 years. The likelihood of breech presentation at term increased with increasing parity, being 25.5% among nulliparae, 34.4% in women with 2-4 children, and 40.1% in women who had delivered 5 or more children (P = 0.001). Extended or Frank breech was the most common type of breech presentation, accounting for 54.8%. Most patients (80.3%) were booked. 52.2% were delivered by cesarean section (CS). Only 30.6% of the deliveries were planned despite the large proportion of booked patients in the study. There were 147 live births and two fresh stillbirths. Senior obstetricians or senior midwives were involved in the conduct of almost all the live births. The only two fresh still births resulted from the junior registrars' delivery. Birth asphyxia — Apgar score of less than 6-was more common in the unplanned group than in the planned group (P = 0.01), and all instances were found in the patients delivered by junior registrars. Conclusion: Despite the high antenatal attendance in the study group, breech deliveries were largely unplanned and the fetal outcome was directly related to the level of skill of the accoucheur. There is a need to plan and have skilled and senior obstetricians in attendance at delivery for this high-risk group.
  - 5,996 468
Short-term report on transurethral diode laser vaporization of the prostate at Ahmadu Bello University Teaching Hospital, Zaria-Nigeria
Muhammed Ahmed, Ahmad Tijjani Lawal, Ahmad Bello, Hussaini Yusuf Maitama
January-March 2016, 6(1):32-35
DOI:10.4103/2278-9596.187196  
Background: Laser vaporization of the prostate is an evolving addition to the armamentarium for prostate surgery. This is despite the availability of cheaper treatment modalities such as open prostatectomy and transurethral resection of the prostate (TURP). However, diode laser vaporization in this regard has the advantages of a shorter learning curve and minimal complications. This paper was aimed at assessing the effectiveness of this mode of therapy and to share our initial experience with this procedure. Patients and Methods: This was a prospective study carried out over a period of 18 months. All men requiring surgery for bothersome prostatic obstruction with benign prostate size ≤100 g were included. Those with malignant prostatic obstruction irrespective of size were also included. The exclusion criteria were benign prostate of size >100 g, and indication for open prostatectomy/channelization or medical therapy. Clearance was obtained from the Health Research Ethics Committee of the institution and informed consent was obtained from all the patients. Each patient's demographics and pre-, intra-, and post-operative details were entered into a pro forma. Results were analyzed using descriptive statistics. Results: Eleven men were included in this study, aged 59-81 years with a mean of 67 years. 63.6% had benign prostatic hyperplasia (BPH) while the remaining 36.4% had carcinoma of the prostate. The mean prostate size was 88 g with a range of 54-182 g. Main symptoms were severe or bothersome lower urinary tract symptoms (LUTS). The mean operating time (lasing time) was 65 min. There were no intraoperative complications and none required blood transfusion. Most had irrigation for only 24 h, one didn't require irrigation while two others required irrigation for 48 h and 72 h, respectively. Out of all the patients, 90.9% had catheter removed at ≤48 h, while one had catheter removed on the fifth postoperative day. All except one were discharged at 72 h or less postoperatively. All the patients had satisfactory subjective outcome at a mean follow-up of 9 months with a range of 1 to 18 months. Conclusion: We found transurethral laser vaporization of the prostate to be effective and safe in the treatment of prostatic obstruction. However, a study involving larger number of patients and longer follow-up will establish its true place in the management of prostatic obstruction in our environment.
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Evaluation of surgical teaching methods by medical students at academic centers at Jeddah, Saudi Arabia
Hana’a Tashkandi, Nisar Haider Zaidi, Yousef Qari, Murad Aljiffry, Ali Alshahari, Munaser Alamoodi
January-March 2016, 6(1):36-40
DOI:10.4103/2278-9596.187192  
Background: The present times have seen a transformational change in teaching methods in medical schools. The aim of this study was to present medical students' evaluation of various teaching methods and their opinions of different means of assessment. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital in March 2015 on fourth-, fifth- and sixth-year medical students at the Faculty of Medicine, King Abdulaziz University, Ibn Sina Medical College and Batterjee Medical College, Jeddah. The survey instrument consisted of a self-filled questionnaire, which was developed with closed-ended format questions that were easy to read and non-intrusive. Students were asked their opinion regarding different surgical teaching methods as well their effectiveness and drawbacks. Descriptive statistics was computed for all variables. Results: A total of 187 questionnaires were completed and analyzed (response rate, 100%). Most students (65.2%) graded the efficiency of lectures as medium. Active learning (51.9%), feedback (45.6%) and knowledge gained (63.1%) from lectures were also graded as medium by most students. Most students (41.2%) considered the efficiency of self-directed learning to be medium; 47.1% graded active learning as medium. The majority of students (72.7%) considered problem-based learning (PBL) to be student-oriented. About 70.6% of the students thought that PBL encouraged teamwork, while 46.5% responded that students acquired less knowledge through PBL. Whiteboards, lecture notes, and PowerPoint presentations were graded as high, while overheads were graded as medium. The respondents had a poor opinion of e-learning. Most students graded multiple-choice questions, short-answer questions, verbal assessments, and skill-based Objective Structured Clinical Examination as high. Conversely, most students graded essays as low. Conclusion: Although medical students at King Abdulaziz University had a favorable opinion of lectures and PBL, most perceived that they gained more knowledge from lectures, suggesting that traditional methods of teaching such as lectures still have value in medical education.
  - 4,197 248
Magnetic Resonance Imaging of multiple sclerosis: A rare but real disease entity in Africans
Muhammad Zaria Ibrahim, Abdulkadir Musa Tabari, Joseph Bako Igashi, Turaki Tahir Mohammed, Sani Atta Abubakar, Reginald Onyeadumarakwe Obiako
January-March 2016, 6(1):41-46
DOI:10.4103/2278-9596.187199  
Background: Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system in young and middle-aged adults; it also affects older people. There is an important role for magnetic resonance imaging (MRI) in the diagnosis of MS since an MRI can show multiple lesions, some of which can be clinically occult and MRI can show new lesions on follow-up scans. This is aimed to create awareness on the existence of MS in our environment and the role of MRI in the diagnosis of MS. Patients and Methods: Five cases (three females and two males) of MS referred from the medical outpatient clinic and medical ward were seen in the MRI suite at the Department of Radiology, Ahmadu Bello University Teaching Hospital Zaria, Nigeria in the year 2014 whose diagnoses were missed on computed tomography (CT) but clinched on MRI were reviewed. The findings on MRI were correlated with clinical presentation. Results: Titubation and amnesia were the most common mode of clinical presentation in the patients examined. Typical MS lesions involving the corpus callosum, U-fibers, temporal lobes, brainstem, cerebellum, and spinal cord were best depicted on MRI while CT scan did not show any evidence of such lesions. Conclusion: MRI is the imaging modality of choice in the diagnosis of MS. Patients with typical symptoms in Africa should be subjected to MR examination in order to exclude MS.
  - 6,281 303
Surgical treatment of priapism in sickle cell patients: A noble therapy in preserving erection
Ahmad Bello, Hussaini Yusuf Maitama, Muhammed Ahmed, Abdullahi Sudi
January-March 2016, 6(1):12-16
DOI:10.4103/2278-9596.187200  
Background: Priapism is a pathological condition of erectile tissue tumescence characterized by prolonged erection without any sexual stimulation and excitement. A classification commonly used to differentiate clinical presentation of priapism divides priapism into ischemic (low-flow) and nonischemic (high-flow) priapism. They have different pathological consequences and also differ in the overall management. The present study reviewed the modes of presentation and management and results of treatment of priapism in sickle cell patients. Patients and Methods: All consecutive sickle cell patients with priapism who were managed by surgical intervention at our unit between January 2000 and December 2011 were included in this study. The demographic characteristics, predisposing factors, and mode of treatment were reviewed. The outcomes of the treatment were analyzed using statistical software Statistical Package for the Social Sciences (SPSS) version 16. Results: Thirty-three patients with priapism due sickle cell disease were seen over 12 years; two patients were lost to follow-up and were excluded. Their age range was 2-35 years with a mean of 22.5 years. The patients who had an El-Ghorab cavernospongiosus shunt (ECS) had better results than those who had a conventional perineal cavernospongiosus shunt (PCS). Eleven patients with recurrent previous episodes of priapism had reduced or absent erection. Erection was better in patients with shorter duration of priapism and not more than one previous episode. The mean duration of symptoms from the time of presentation to treatment was 3 days. Of the twenty-one patients who presented in ≤2 days, 18 had normal erections and 3 had reduced erections at 12 weeks. Of the 12 patients who presented in ≥3 days, 5 had normal erections, 2 had reduced erections, and 5 had no erection. Ten patients had treatment with sildenafil during the follow-up period with some improvement. One patient who had PCS developed perineal urethrocutaneous fistula. Conclusion: Early surgical intervention is recommended in patients with ischemic priapism; regardless of the delay in presentation, and immediate unilateral distal venous shunt should be considered the best way to preserve erection. More prospective randomized studies are required to confirm these assertions.
  - 5,915 317
Sociodemographic and clinicopathologic characteristics of 249 elderly cancer patients seen at the Radiotherapy and Oncology Department, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Sunday Adeyemi Adewuyi, Adekunle Olanrewaju Oguntayo, Modupeola Omotara Adegbemisola Samaila, Shehu Abubakar Akuyam, Kehinde Roseline Adewuyi, Festus Igbinoba
January-March 2016, 6(1):22-27
DOI:10.4103/2278-9596.187194  
Background: The rate of cancer incidence is expected to rise in the ageing population. The objective of this study is to evaluate the sociodemographic and clinicopathologic characteristics of elderly cancer patients as there is a paucity of data in this environment. Patients and Methods: Elderly cancer patients seen between 2006 and 2009 were studied retrospectively. The patient's folders were reviewed for relevant clinical information using standardized structured pro forma. Data were analyzed and results were presented in a table. Results: A total of 249 patients were analyzed (mean age 67 years, M:F = 2:3). There is no formal education in 70.7% of the patients. Only 20.5% of the patients had history of alcohol ingestion and 14.1% smoke cigarette. Ten (4%) patients had family history of cancer and 1.2% was seropositive for HIV antibodies. The most common cancer in males was head and neck cancer (14.1%) followed by prostate cancer (10%). In the females, the most common cancer was cervical cancer (31.3%) followed by breast cancer (12.4%). Only 8.4% of the patients presented with early stage disease. Hypertension was the most common comorbidity seen in 35.3% of the patients followed by diabetes mellitus (7.6%). The surgery was done in 36.9% of the patients, while 63.5% of the patients had diverse chemotherapy and 42.2% had radiotherapy. Chemotherapy-induced morbidity and mortality were seen in 36.9% and 26.9% of the patients, respectively. Similarly, radiotherapy-induced morbidity and mortality were seen in 8.8% and 0.4% of the patients, respectively. Conclusion: More female elderly patients are seen. Cervical cancer and head and neck cancers are the most common cancers seen in elderly female and male patients, respectively. Most patients presented with advanced disease, and hypertension is the most common comorbidity. There should be a cautious use of chemotherapy in order to reduce mortality.
  - 5,411 380
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