Background: Chronic Leg Ulcers (CLU) are common cutaneous manifestation of sickle cell disease (SCD) and a major cause of debility. CLU results from vaso-occlusion, poor venous pressure, hypercoagulabilty and trauma. The incidence of CLU is variable based on geographical region. Treatment modalities include debridement and skin grafting. The aim of this study was to determine the prevalence, incidence, hematological parameters and treatment modalities of CLU among SCD patients in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Patients and Methods: It was a retrospective study of adult SCD patients between January-December 2012 at ABUTH Zaria. Case notes of SCD patients were retrieved and data on socio-demographics, hematological parameters and CLU were extracted and analyzed using Epi Info. Data was analysed using descriptive analysis and comparisom of mean by student's t-test. Results: Of the 446 SCD patients attended to during the study period 14 had CLU. The incidence of CLU was 0.45% among the SCD patients studied. The male to female ratio was (M: F = 1.3:1). CLU occurs commonly around the malleoli in 78.6% whereas other sites constituted 21.4%. In 77.8% of CLU low steady state PCV was seen, 76.9% had reticulocytosis whereas 81.8% had high platelet count > 477 × 10⁹/l. Recurrence rate was 78.5% with osteomyelitis (16.7%) and limitation of movement (16.7%) as a frequent complications of CLU. Wound debridement and dressing was the commonest surgical management option but with a high recurrence rate. Conclusion: Prevalence of CLU is low in SCD patients in Zaria; occurring commonly in patients with low steady state PCV, reticulocytosis and thrombocytosis. Debridement and skin grafting has good cure rate and lower recurrence of CLU.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Small bowel obstruction is a common condition, encountered in the emergency room of the surgery department. Uncommon causes include gallstone ileus, worm infestation, internal hernias, mesentric ischemia, trichobezoars or phytobezoars, Crohn's disease, postoperative strictures, and diverticulosis. Even more uncommon is primary enterolithiasis. Enterolith, the enterogenous foreign bodies, are rare clinical and radiological entities. True enteroliths are formed due to precipitation and deposition of substances from alimentary chime. Primary enterolithiasis is a rare entity, occurring in association with pathological conditions that lead to hypomotility and stasis, like Crohn's disease, small intestine diverticulae, traumatic or postoperative strictures of ileum, ulcerative colitis and blind loops. Primary enterolithiasis may be asymptomatic or may present with sub-acute or acute intestinal obstruction, but specific radiological diagnosis of primary enterolithiasis is uncommon. Definitive treatment of enterolithiasis with small intestinal obstruction is essentially surgical. The options at laparotomy are manual lysis of the calculus without enterotomy or removal by enterotomy. Bowel resection is indicated in cases with definitive bowel pathology. We are presenting five cases of enterolithiasis, which we encountered in the Surgery Department of L.L.R.M. Medical College, Meerut from January 2006 to December 2012. Clinical presentation, diagnosis, investigations and treatment have been discussed along with a review of literature.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The gastrointestinal tract (GI tract) is the most common site for extranodal lymphomas with the majority of the non-Hodgkin's B-cell type. It involves any part of the GI, the most frequent sites in the order of occurrence are the stomach, small intestine, and ileocecal region. A 17-year-old male presented with intermittent abdominal pain, altered bowel habits associated with vomiting of 1 month duration. Computerized tomography of the abdomen revealed an eccentric mass in the jejunum with significant luminal narrowing. Limited resection of jejunum showed an intraluminal polypoidal growth with a homogenous cut surface. Microscopic examination of the mass revealed a diffusely infiltrating monotonous population of large lymphoid cells with round to oval vesicular nucleus, prominent nucleoli and moderate to scanty cytoplasm, admixed with few multinucleated giant cells with wreath like arrangement of nuclei, binucleated cells, and atypical mitosis. The tumor was involving the submucosa, infiltrating the muscularis propria and extending into the sub serosa. Immunohistochemistry showed diffuse positivity for CD45, CD30, anaplastic lymphoma kinase-1 (ALK-1), and focal positivity for CD43. The immunohistochemical stains for B-cell lineage CD20, CD79a, T-cell markers CD3, CD2, CD4, CD8, CD7, and other markers namely bcl2, bcl6, CD5, CD138, CD56, Mum1, and PAX-5 were negative. Six lymph nodes isolated showed features of reactive follicular hyperplasia and were free of tumor. A diagnosis of primary ALK positive anaplastic large cell lymphoma of T-cell type of jejunum was made. Patient has completed three cycles of chemotherapy comprising of cyclophosphamide, prednisone, vincristine, and doxorubicin and is in remission until the last follow-up.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasias and even malignancies. The aim of this study was to emphasize the importance of a detailed microscopic examination and to study the diverse range of histopathological lesions in cholecystectomy specimens. Materials and Methods: This is a retrospective study of 360 cholecystectomy specimens received in the Department of Pathology over a period of 2 years from November 2010 to October 2012. Clinical details and histopathological data were retrieved from the records. The variety of morphological changes in the diseased gall bladder were correlated with the clinical findings. Results: Overall, there were 360 cases consisting of 74 (21%) males and 286 (79%) females. Maximum number of patients was between 31 and 40 years (30.2%). Most common pathology noted in our study was chronic cholecystitis seen in 280 cases (77.7%). Other benign lesions were cholesterosis in 36 (10%) and acute cholecystitis in 10 (2.7%). Various other associated lesions and variants of cholecystitis were also encountered. A total of nine malignant lesions of gallbladder were observed, which included eight cases of incidental adenocarcinomas and one case showing lymphomatous involvement. Conclusion: Our study emphasizes that a routine cholecystectomy performed for a common condition like gallstone disease can result in a diverse and wide spectrum of histopathological lesions ranging from benign diagnosis to an unexpected gallbladder malignancy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The incidence of multiple primary cancers is reported to be between 0.734% and 11.7%. The occurrence of another malignancy of different organ in patients with known malignant tumor is known as double malignancy and is categorized into synchronous; in which the cancer occurs at the same time or within 6 months and metachronous; in which cancer follows in sequence more than 6 months apart. We review the presentation and management of synchronous malignancies in two different organs. Patients and Methods: All the patients who underwent surgery for malignancy between July 2009 and July 2013 were reviewed and the patients who had synchronous malignancies were identified. Their clinical presentation, treatment and outcome were evaluated. Results: Out of a total of 286 patients with malignancies treated in our institute, four had synchronous primary malignancies (1.39%). Three of them underwent surgery simultaneously for both the malignancies and were given adjuvant chemotherapy. One patient presented with colonic obstruction due to sigmoid carcinoma which was operated in an emergency setting and was later in the postoperative period found to have a synchronous periampullary carcinoma. Two of the patients who were managed with surgery followed by chemotherapy are doing well. Whereas the other two patients have died. Conclusion: Treatment strategies in cases of double malignancy depend on treating the malignancy that is more advanced first, or sometimes both malignancies could be treated simultaneously. If both are amenable to surgical resection as in two of our cases both the malignancies may be dealt with at the same time. The prognosis of the patients with dual malignancies depends on the aggressiveness and the stage of presentation of the more advanced tumor.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Empyema thoracis is quite appreciated as a purulent pleural effusion. The basis for open drainage as an option for the treatment of chronic empyema thoracis is that the lung is trapped beneath a thickened and fibrosed visceral peel, which stabilizes and shields the trapped lung from the possible effect of pneumothorax when such a lung is exposed to the atmosphere either deliberately or accidentally. This is often unappreciated by many clinicians especially those with limited experience. From first principles, pus anywhere requires drainage and this applies equally to pleural space pus. Since these patients are often unfit for stressful procedures like decortication or the underlying lung is often unhealthy and will fail to expand or would be seriously violated in an attempt to free it, open drainage provides a safe and suitable option for the treatment of this pathology. We present the successful management of two patients by this approach as well as the review of literature in this respect.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Abcess within a brain tumor is very rare and is usually seen in a pituitary tumor. We present a patient with glioblatoma that was found to contain abcess at operation. A 50-year-old man presented with a rare case of glioblastoma associated with intra-tumoral abscess formation manifesting as seizures, headache and vomiting after fever, cough, and chest infection. Computed tomography and magnetic resonance imaging demonstrated a ring-enhanced lesion mimicking malignant glioma. Craniotomy and tumor removal were performed. Abscess formation within the intra-axial tumor was found intra-operatively. Histological examination revealed glioblastoma with abscess and the etiological agent was anaerobic gram-negative bacilli. The post-operative recovery of the patient was satisfactory. Abcess in a gliobastoma is uncommon. The suspected route of microbial migration and colonization in this tumor was probably bacteremia from chronic lung infection. Careful evaluation and appropriate treatment would lead to a good outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The child development from conception through early years of life is marked by many changes. Tooth eruption follows the chronology corresponding to the date, when tooth erupts into the oral cavity. These dates have been established in the literature and are subject to small variations depending upon hereditary, endocrine, and environmental factors. However, the chronology of tooth eruption suffers a more significant alteration in terms of onset and the first tooth or teeth may be present at birth, called as natal teeth. Natal teeth are rare in extremely preterm infants. In this paper we present a rare case regarding the eruption of mandibular natal tooth in a 10-day old, 7-month preterm normally delivered infant.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Rapunzel syndrome is an extremely rare form of trichobezoar extending from the stomach to the small intestine and sometimes even beyond the ileocecal valve. Approximately 50 cases of Rapunzel syndrome have been reported in the literature, and most of them being young women. The aim of this study was to review the clinical features and outcome of pediatric patients with Rapunzel syndrome. Patients and Methods: We present a retrospective study performed from January 1995 to December 2013. The study included eight paediatric patients. The clinical features including history of trichophagia, intraoperative findings, bezoar characteristics and operative were analyzed. Results: The age of patients ranged from 4 years to 15 years. Only one (12.5%) child was in teenage group, whereas the rest of the patients (87.5%) were below the teenage group. There were five (62.5%) females and three (37.5%) males. Patients had varied presentations like chronic abdominal pain (100%), abdominal distension (75%), epigastric fullness (75%), features of intestinal obstruction (50%), and anorexia (25%). Trichophagia could not be elicited in four patients (50%). Impending intestinal perforation and Intussusception was seen in one (12.5%) each. Six (75%) patients had trichobezoar, while plastobezoar (plastic bezoar) and mixed bezoar was present in one (12.5%) each. Conclusions: Rapunzel syndrome is also seen in children below the teenage group. Although more common in females, it is seen in both sex. Chronic abdominal pain and distension are main presenting features, while history of trichophagia is absent in 50% cases. It should be included in the differential diagnosis in children, especially females with chronic abdominal pain, even if history of trichophagia is absent.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Oral cancers are not uncommon. We have analyzed the incidence of nodal metastasis in oral cancer clinically and compared it with the final histopathology examination (HPE) report, correlating the pathologically positive lymph nodes with different parameters such as tumor sites, pathological stage, differentiation, lymphovascular, perivascular extension and perineural invasion. Materials and Methods: This retrospective study was carried out on patients who were evaluated with a histological diagnosis of oral cancer from 2008 to 2012. Lymph node positivity was established by clinical and ultrasound evaluation in 218 patients who underwent neck dissection for oral cancer. This was compared with the histopathology findings. Results: The most common site of oral cancer was buccal mucosa. Histopathologically, majority were squamous cell carcinoma (SCC). Lymph node positivity was observed for different sites as follows: buccal mucosa (26.7%), gingivo-buccal sulcus (20.8%), retromolar trigone (40%), tongue (50%), and floor of mouth (100%). In well-differentiated SCC, node positivity was 25.4%. In moderately differentiated SCC, it was 52.3% and in poorly differentiated SCC, it was 50%. Five cases of verrucous carcinoma did not show any lymph node positivity. According to the pathological staging, the lymph node positivity was as follows: T1 (25.58%), T2 (23.59%), T3 (37%), and T4 (34.78%). Out of 218 patients, 5.5% patients showed positive resected margin, 1.8% patients showed skip metastasis, and 14.6% patients had lymphovascular or perivascular invasion. Univariate analysis showed significant correlation of lymph nodal metastasis with various clinicopathological parameters like tumor site, stage, and differentiation. Conclusion: In our female predominant study group, mostly locally advanced tumors were encountered involving the alveobuccal subsites. Standard neck dissections play an important role in the control of neck disease.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction: Hand complications of diabetes mellitus are rare compared to those in the foot. They occur in the ratio of 1:20 in our observations. We managed 36 patients with tropical diabetic hand syndrome and propose a classification for the disease that will allow communication between physicians and prognostication. Materials and Methods: Patients with hand infections and background diabetes mellitus were admitted. Their age, sex and occupations were noted. A clinical diagnosis was made and drained. Wound swab for culture was taken. Wounds were generally serially debrided at bed side with wound being allowed to granulate over time to be subsequently closed by split thickness skin graft. Results: Thirty six patients were studied. Based on their clinical diagnosis, they were classified into three (I,II,III) groups in increasing order of severity. The classification correlated with the type and severity of the disease. It also guided the choice of appropriate treatment. Conclusion: Based on our findings, tropical diabetic hand syndrome was classified and prognosticated based on the degree of soft tissue and bone involvement. The classification allows for communication with other physicians.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. Materials and Methods: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. Results: Bactibilia was found in 27/50 (52%) of patients. Polymicrobial flora was found in 10% of bile samples. Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis were the predominant organisms isolated. None of the anaerobes were isolated. Extended spectrum β-lactamase and AmpC β-lactamase (AmpC) production was seen in 47% and 31.5% of Enterobacteriaceae isolates respectively. Post-operative wound infection was found in six (12%) patients who had bactibilia. Combination of piperacillin-tazobactam and amikacin was most effective in prophylactic regimen. Conclusion: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing open cholecystectomy should receive prophylactic antibiotics to prevent post-operative wound infections.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Introduction : The incidence of AIDS-associated Kaposi's sarcoma (AAKS) is increasing in the West African sub-region. The objective of this study was to describe the epidemiologic and clinical features of AAKS. Materials and Methods : This study was carried out in a tertiary health center with a federal government supported AIDS treatment program in Zaria, Nigeria. The subjects comprised 137 consecutive patients evaluated for AAKS from 2006 to 2011. Following evaluation appropriate specimens were taken for histologic, virologic, and immunologic assessment. Result : There were 137 patients representing 1.4% of HIV infected patients seen during the study period. The male to female ratio was 1.3:1. Their ages ranged from 2 to 58 years, mean of 32 ± 6 and females were younger than males. Mean duration of symptoms was 4.2 ± 1.5 months. Kaposi's sarcoma was the AIDS-defining disease in 95 (69.3%) patients while in 42 (30.7%) it was diagnosed between 1 and 15 months after the diagnosis of HIV infection. The lower limbs were the most frequent sites of lesions. Females had more disseminated lesions involving an increased number of lesions at multiple anatomical sites compared with more localized lesions in the males (OR 2.7, 95% CI 1.5-7.0). The CD4 count ranged from 19 to 798 cells/mm ³ , median 132; interquatile range 102-317 cells/mm ³ while the median HIV RNA copies/ml of plasma was 51,723 (ranged 250-917, 254). Conclusion : The prevalence of AAKS is increasing in our institution. Female patients were younger and had more disseminated disease that progressed faster than in males. Timely identification of HIV-infected patients is essential to avoid the consequences of immunological deterioration associated with delayed anti-retroviral therapy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies across the world. In developing countries, gastrointestinal perforations have very high morbidity and mortality rates, irrespective of the type of operative procedure performed. The aim of the present study was to evaluate and find out various determinants for safe outcome in gastrointestinal perforation in terms of decreased morbidity and mortality and applying Clavien–Dindo classification for postoperative complications for evaluating the outcome. Patients and Methods: A nonrandomized retrospective study with collected data from 350 patients with gastrointestinal perforations was conducted over a period of 3 years. Data from various preoperative and operative factors, surgical technique, and complications were recorded. The output was measured as better and worse, as per the classification proposed by Clavien–Dindo. Results: The study enrolled 350 patients with a male:female ratio of 3.3:1; 58% of the patients were <40 years of age. The most common etiologies of perforation peritonitis were peptic perforation (duodenal 42%, gastric 8%), small bowel perforation (jejunum 3.14%, ileal 26.28%), appendicular perforation (10%), and cecum and colon constituting 4.85% each. The incidence of major complications was wound infections 18%, respiratory complications 16.57%, burst abdomen 5.14%, leak 4%, and septicemia 7.14%. Overall mortality was 10.85%. High mortality was observed in ileal perforation. Conclusion: Preoperative comorbidities, operative techniques, and postoperative complications in this setting are associated with morbidity and mortality. Proper screening on admission should be done to identify premorbid illness, and with the use of some recommendations in surgical technique we can achieve safe outcome of gastrointestinal perforations. The Clavien–Dindo classification can be adapted to assess the severity of postoperative complications following gastrointestinal perforations.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Acute Pancreatitis (AP) is an inflammatory process. The average mortality rate in severe AP approaches 2%–10%. Gall stones and alcohol abuse account for 70% of cases of acute pancreatitis. Almost all patients have acute upper abdominal pain. Systemic complications and multi organ system failure may develop. Patients and Methods: A prospective study conducted from November 2016 to December 2017 in Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India, in patients who were diagnosed to have acute pancreatitis. A total of 54 patients were enrolled in the study out of which four patients had left against medical advice. The data collected were evaluated to see the outcome. Results: Majority of patients 22 (44.0%) were in age group ranging from 41 to 60 years. Males were dominant (58%). The most common etiology was alcoholism followed by gall stone. The majority of patients were found with abdominal pain (100.0%). The majority of the patients were having moderate Balthazar CT Severity Index (CTSI) (54.0%). In all, 43 patients were having pancreatic complications and pancreatic necrosis was the commonest; 31 developed extra-pancreatic complications, among which pleural effusion was the commonest. Some patients were having multiple complications. The duration of hospital stay was highest in severe group of Balthazar CTSI. Rise in total leucocyte count, serum amylase level and low calcium levels were significantly associated with increase in pancreatic/extra-pancreatic complications. There was only 1 (2%) patient who died and remaining 49 (98%) patients were discharged. Conclusion: Most common etiology of acute pancreatitis was alcohol consumption (50%) followed by gall stones (32%). Increases in total leucocyte count, serum amylase level and low level of serum calcium were significantly associated with increase in pancreatic/extra-pancreatic complications leading to higher morbidity and hospital stay. Patients with higher Balthazar CTSI were having higher morbidity.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The Zaria Cancer Registry (ZCR) documents cancer cases within Zaria and environ with the objective of monitoring, planning, and screening of population at risk of developing cancer. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR. Materials and Methods: A 5-year analysis of cancer cases recorded from January 2009 to December 2013 was made. Data sourced were grouped into those primarily from the hospital (A) and referrals from hospitals within (B) and outside (C) Kaduna state. Data compilation was done using CANREG4 software and the International Classification of Diseases (ICD)-0 classification and coding system. Results: A total of 2,536 new cancers were recorded with 1,014 males and 1,522 females. Cancer diagnosis from the histology of primary disease cases accounted for 86.3%, while cytology diagnosis cases comprised 10.6%. Over 90% of the diagnosis was based on symptomatic presentation by patients, while 81.6% were well-differentiated cancers. The peak age distribution was in 4 ^th -6 ^th decades of life in 58.9% cases, while 138 cancers were recorded in children aged 10 years and below. A total of 68 (2.7%) cases were also recorded in adolescents. Morphologically, squamous cell carcinoma (SCC), adenocarcinoma (not otherwise specified (NOS)), and infiltrating duct carcinoma were the commonest. About 60% of patients received two or more treatment modalities. Conclusion: The cancer distribution pattern from this registry is reflective of the cancer distribution in the larger population. Breast cancer was most common in females and ranked first overall, while prostate cancer was the commonest in males. This information is useful in planning for effective cancer screening, prevention, and management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

In maxillofacial surgery, head and neck reconstruction of surgical defects caused by oral cancer is considered a challenging problem. Till recently, most oral and pharyngeal defects were closed primarily using skin flaps or tubed-pedicle flaps of skin from the trunk such as forehead flap, deltopectoral flap, pectoralis major myocutaneous flap; however, these were associated with compromised aesthetic and functional results. The advent of microvascular free tissue transfer over the past two decades has helped us overcome these disadvantages and has enabled the ablative surgeon to undertake surgical procedures that could not have been attempted in the past. Innovations in the field of microsurgery have resulted in better techniques, microscopes, and microinstruments, which have made free flap harvesting much easier. This article will review the various techniques of microvascular anastomosis used in head and neck reconstruction and analyze the newer techniques and methods employed today. It also attempts to provide a brief gist of the various free flaps used in head and neck reconstruction and the ones most expedient in the surgeons' arsenal.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]