Early experience with laparoscopic management of nonpalpable undescended testes

Background: Nonpalpable undescended testes (NPT) constitute 20%­30% of undescended testes, and its management has been a challenge both in diagnosis and treatment. Worldwide, laparoscopy is the current gold standard of management. In Nigeria, the management of NPT has largely been by open surgery with consequent high morbidity. In Nigeria, the trend is changing from a largely open management with its attendant high morbidity, to laparoscopic management which is the current worldwide gold standard of care. Aim: This study aims to classify the laparoscopic features of NPT and determine the outcome of managed cases in our center. Methodology: Prospective data were collected from consecutive patients who had laparoscopy for NPT at the Paediatric Surgical Unit of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria from June 2014 to July 2016. Results: A total of 15 patients with 23 testes were treated. There were eight patients with bilateral NPT; four had left and the remaining three right NPT. The age ranged from 1.2 to 29 years with a median of 5 years. Eleven out of the 22 internal inguinal rings were open. The position of the testes was canalicular (2), peeping (2), low abdominal (6), high abdominal (6), blind-ended vas (1), absent vas and vessels (5). No further intervention was needed for the six agenetic/atrophic testes. Standard open orchiopexy was done for the two canalicular testes. Eight testes were brought down by one stage laparoscopic orchiopexy while four were brought down by staged laparoscopic Fowler-Stephens procedure. Laparoscopic orchiectomy was done in two patients (a grossly dysmorphic testes [nubbin] and a high abdominal testis in a 29-year-old). Orchiopexy was successful in 11 out of 15 fixed testes. Of the unsuccessful ones, three testes were atrophic (volume less than what it was initially) while two were high scrotal (one testes has both complications). There was no conversion to open abdominal surgery. All patients were discharged within 24 h of surgery.Conclusion: Laparoscopy provides for a better management of NPT by combining diagnosis and intervention in the same sitting with a good success rate and minimal postoperative morbidity

Clinical Abdominal Palpation for Predicting Oligohydramnios in Suspected Prolonged Pregnancy

Objective. In view of the scarcity of ultrasound in low-resource settings; to evaluate abdominal palpation for prediction of oligohydramnios in suspected prolonged pregnancy; using the ultrasound-obtained amniotic fluid index (AFI) as a gold standard; taking into account maternal and fetal factors that may affect amniotic fluid volume. Methods. A cross-sectional analytical study at Chris Hani Baragwanath Academic Hospital; Johannesburg; South Africa; on women referred from midwife-run clinics with suspected gestational age ?41 weeks. Eligible women had their AFI measured; then had abdominal palpation by the researcher; who was blinded to exact gestational age and AFI findings. Palpation focused on ballottability of fetal parts; ease of feeling fetal parts; and impression of fetal compaction. Gestational age was then recalculated using information from earlier ultrasound scans and menstrual dates. Univariable and multivariable logistic regression was performed with oligohydramnios (AFI 5 cm) as the dependent variable.Results. Of 100 women; 45 had a recalculated gestational age ?41 weeks. Twenty-three had oligohydramnios. Gestational age was a significant independent predictor for oligohydramnios (odds ratio (OR) 1.78; 95 confidence interval (CI) 1.08 - 2.94). The only component of palpation significantly associated with oligohydramnios; after adjustment for gestational age; was non-ballottability of the presenting part (adjusted OR 4.02; 95 CI 1.05 - 15.4). Non-ballottability had a sensitivity and specificity for oligohydramnios of 87 and 40; respectively; with a negative predictive value of 91.Conclusion. When ultrasound is not available; ballottability of the presenting part may have value for excluding oligohydramnios and assisting clinical decisions in suspected prolonged pregnancy

Importance of Fine Needle Aspirationin Evaluation of Single Nodular Goiter

Background:Improvements in the sensitivity and specificity of biochemical thyroid tests; as well as the development of fine needle aspiration biopsy (FNA) and improved cytological techniques; have dramatically impacted clinical strategies for detecting and treating thyroid disorders.Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out.This procedure will provide us with more information about the nature of the lump; and especially differentiate between a benign and malignant mass.Objectives: The current prospective study designed to evaluate the sensitivity; specificity andaccuracy of FNA. The study was performed in the regional major hospital; Khartoum; Sudan.Patients and methods: A thousand and three hundred thirty one patients who underwent thyroid surgery 'between' January 2004 to June 2007 were enrolled.Results: 247 (18.3) had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 (87.6) and 29 (12.4) respectively.The overall sensitivity; specificity and accuracy of FNA were 95.5; 99.5and 99.4respectively.Conclusion: Also there is correlation between the nodule size and the result of FNA; as the nodular size increase there is increase of the probability of malignant changes. So; solitary or dominant nodules 7 1cm in diameter might be evaluated by FNA