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   Table of Contents - Current issue
October-December 2019
Volume 9 | Issue 4
Page Nos. 93-124

Online since Wednesday, November 11, 2020

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Comparison of endoscopic-guided silver nitrate cauterization and nasal packing in the treatment of epistaxis p. 93
Auwal Adamu, Abdulrazak Ajiya, Abdullahi Hamisu, Muhammad Ghazzali Hasheem
Background: Epistaxis is a common disorder and often presents as an emergency. The management is challenging and various modalities of the treatment of epistaxis have been described. Nasal packing and silver nitrate chemical cautery are the commonest methods of treatment. However, there is no sufficient literature regarding the comparison of these two methods in the study area. The objective of this study is to compare endoscopic-guided silver nitrate cauterization with nasal packing in the treatment of epistaxis in our institution. Objective: To compare the endoscopic-guided silver nitrate cauterization with nasal packing in the treatment of epistaxis in our environment. Patients and Methods: This was a retrospective review of patients who presented with epistaxis at our clinic. The case notes of all patients with epistaxis who were managed with anterior packing (AP), posterior packing (PP), or endoscopic cauterization (EC) were selected. Patients with incomplete records were excluded. The information obtained included sociodemographic variables, clinical details, method of treatment, complications, and treatment outcome. The data were analyzed using SPSS version 20. Results: One hundred and twenty six patients were reviewed of which 70 (55.6%) were males and 56 (44.4%) females, within the age range of 5–80 years (mean age ± SD = 33.5 ± 17.9). The success rate of EC (93.5%) was higher compared to that of AP (68.3%) and PP (74.3%). The patients treated with EC had a statistically significant lower rate of recurrence (6.5%) compared with AP (31.1%) and PP (25.7%), respectively (P = 0.037). The mean hospital stay for patients treated with EC was significantly shorter (0.8 ± 0.6 days) compared to the group treated with AP (3.2 ± 0.9 days) and PP (6.2 ± 2.7 days), respectively (P = 0.000). Conclusion: Patients with epistaxis that underwent endoscopic-guided silver nitrate cauterization had better success rate, less complication, and shorter hospital stay than the group treated with nasal packing.
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Lumbar spine decompression with or without instrumentation in a limited resource setting p. 99
Adetunji M Toluse, Mustapha F Alimi, Sulaimon A A Gbadegesin, Olorunfemi O Ogundele
Background: Lumbar degenerative spine disease is a leading cause of chronic low back pain and disability. Surgery is indicated to improve clinical condition when non operative measures fail. The objective of this study is to determine the outcome of lumbar spine decompression with or without instrumented fusion in the management of lumbar spine degenerative disease. Objectives: To determine the outcome of lumbar spine decompression with or without instrumented fusion in the management of lumbar spine degenerative disease. Patients and Methods: Study was retrospective in design and carried out at the Orthopedic Department of the National Orthopaedic Hospital, Lagos. Records of patients who had surgery for lumbar spine degenerative disease between 2007 and 2016 were retrieved. Variables of interest extracted included indication for surgery, type of surgery, complications, neurologic outcome, and length of follow-up. Descriptive and Chi-square analysis were done using SPSS version 16.0. Results: Eighty-eight patients had surgery of which sixty-five were analyzed. Duration of follow-up was 12–96 months (mean 31.7 ± 21.4 months). The age range was 32–75 years (mean 58 ± 9 years) with male:female ratio of 1:1.3. Fifty-three (81.5%) had improved pain relief, of which 7 (10.8%) had pain relapse at mean of 27.5 months post operative. Twenty-six (40%) had pre operative limb weakness of which 16/26 (61.5%) improved, 10/26 (38.5%) had no changes, while 2/26 (7.8%) had worse neurology after surgery. The complications included wound infection (7.7%), implant-related (6.2%) and dural tear (3.1%). Surgical technique (“decompression alone” vs “decompression and instrumented fusion”) and complications (none/any complication) are significantly associated with a likelihood ratio of P = 0.023. Reoperation rate was 7.7%. Conclusion: The addition of pedicle screw instrumented fusion does not seem to offer additional benefit with respect to long-term back pain and leg pain control; however, complication rate is notably higher.
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Evaluation of autologous composite colo-peritoneal grafts in the repair of experimental urinary bladder defects in dogs p. 104
Sa'idu Tanko Muhammad, Cheh Augustine Awasum, Bisalla Mohammed, Adamu Zoaka Hassan
Background: Urinary bladder (UB) defects are most often associated with embryologic development and pelvic trauma. The cause of the defects could be congenital abnormalities or various aetiologies connected with modern life, including road traffic accidents, assault (gunshot injuries) and occupational hazards (neoplasia). industrial, and criminal activities. Medical treatment for these defects is mostly limited thereby necessitating surgical intervention. This study was aimed at finding alternative reconstruction tissue for restoring bladder storage and voiding capability. Materials and Methods: The surgical procedure was aseptically performed under general anesthesia. The dorsal aspect of the urinary bladder served as the recipient site, while sero-muscular colonic pedicle flap of the descending colon along with free peritoneal sheath formed a composite tissue (donor), colo-peritoneal pedicle graft. The surgical procedure included preparation of the colonic pedicle flap, preparation of free peritoneal flap, formation of composite colo-peritoneal graft, preparation of urinary bladder graft bed, and colo-peritoneo-cystoplasty. The dogs were evaluated in the post-operative period by physical examination, urinalysis, and cystography within the duration of 14 weeks. Results: Cystographic evaluations performed on the 2nd, 10th, and 14th weeks post surgery revealed gradual transition of the urinary bladder architecture at the point of graft with clear delineation and minimal blurring at initial assessment, which gradually disappeared later. Complications observed were straining and constipation, which responded positively following appropriate interventions. Post surgical urinalysis showed transient changes in specific gravity and urine pH values, but returned to pre surgical level after day 18 post surgery. Post surgical proteinuria was observed for the first 7 days, but disappeared on day 12. Hematuria occurred within the first 16 days post surgery. Conclusion: It was concluded that autologous composite colo-peritoneal tissue graft was successfully formed and effectively used in the repair of urinary bladder defects in the dogs. This surgical management intervention could be evaluated in human subjects with similar urinary bladder defects.
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Abdominal necrosis due to mucormycosis following lower segment cesarean section p. 112
Shailesh Shah, Esheet Shah, Riddhi Shah
Mucormycosis is a rare, invasive infection caused by saprophytic fungi Mucorales. It is predominantly seen in immunocompromised patients with devastating scenario. Clinically, it presents with necrosis of the parts causing ulcers and invasive wounds. Despite treatment it has a high mortality rate. Here we present a rare case of mucormycosis that was secondary to cesarean section in a young female which caused necrosis of the entire abdominal wall and septicemia. Her initial diagnosis was of necrotizing fasciitis but later tissue culture revealed presence of Mucorales. But unfortunately, patient's condition deteriorated despite aggressive treatment and debridement. This clearly reveals the invasive and fatal nature of the fungi with poor prognosis.
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The role of radiology in the management of omphalopagus: Our experience at university of Abuja teaching hospital p. 116
Joshua O Aiyekomogbon, Ukamaka D Itanyi, Samson Olori, John Y Chinda, Philip Mshelbwala, Daphnie M A Leslie, BA Ekele
Conjoined twins result from incomplete division of embryonic cell mass in monozygotic, monochorionic, and monoamniotic twins occurring at very early stage of development. We present a set of male conjoined twins referred from a peripheral hospital to our health facility 18 h after cesarean birth on account of abnormal body fusion at the abdominal regions. Both babies passed meconium within 6 h of birth and were clinically stable. Radiological evaluation of the babies using ultrasound, echocardiography, and computed tomography showed hepatic fusion but their respective bowels and remaining viscera were separate and distinct for each of the twins. They were managed at the special baby care unit for 4 months to enable them achieve appreciable weight and clinical stability before having a successful surgical separation. They were discharged home following a good clinical outcome on the 23rd day of surgery as two separate babies.
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Spontaneous intercostal hernia: A rare occurrence p. 120
Siddharth P Dubhashi, Atri Kumar
Intercostal hernias can occur with or without diaphragmatic defects. This is a case of a spontaneous intercostal hernia in a 55-year-old diabetic, with a defect in the right 8th intercostal space, along with an asymptomatic umbilical hernia. After CT imaging, the patient was managed with a tension-free mesh repair. A high index of clinical suspicion is warranted in all cases presenting with palpable reducible chest wall swelling. The occurrence of a spontaneous intercostal hernia is rare and hence reported.
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Symptomatic ventrolateral proatlas anomaly—A rare and under recognized cause of Chiari malformation with hindbrain herniation p. 123
Hrishikesh Sarkar
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