ABSTRACT
Background. Duodenal ulcer is the most common peptic ulcer disease worldwide. In the past, sub-Saharan Africa has been described as an area of mixed prevalence for peptic ulcer disease, but recent reports have disputed this. Changes in the prevalence of duodenal ulcer have been reported, with various reasons given for these.Objective. To describe the change in endoscopic prevalence of duodenal ulcer at Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife, Nigeria, between January 2000 and December 2010.Methods. This was a retrospective, descriptive study of patients who underwent upper gastrointestinal endoscopy in the endoscopy unit of OAUTH between January 2000 and December 2010. The data were obtained from the endoscopy register, demographic indices, presenting symptoms and post-endoscopic diagnoses being retrieved for each patient. The study period was divided into the years 2000 - 2004 and 2005 - 2010, the frequencies of duodenal ulcer and other post-endoscopic diagnoses being compared between these two time periods to see whether there were changes.Results. Over the study period, 292 patients (15.8%) were diagnosed with duodenal ulcer, second only to 471 patients (26.2%) with acute gastritis. The prevalence of duodenal ulcer for 2000 - 2004 was 22.9% (n=211 patients) compared with 9.2% (n=81) for 2005 - 2010 (p<0.001).Conclusion. There was a significant decline in the endoscopic prevalence of duodenal ulcer over the decade
Subject(s)
Duodenal Ulcer , Endoscopy , Hospitals, Teaching , Nigeria , PrevalenceABSTRACT
Objectives:Breast disease remains a major public health issue worldwide.It is the most common cancer among Nigerian women.Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease.This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex; Ile-Ife; Osun state Nigeria Method:All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result; final histology result and the clinical staging for breast cancer were analyzed.Results:Eight hundred and sixty-four patients had FNAC during the studied period; however only 632 cases had available final histological report.Of these; 20 (3.2) were male while 612 (96.8) were female; the age ranged from 15 years to 99 years; median of 36.50.We found that absolute sensitivity for malignancy to be 70.8.The false negative rate was 14.9; while the false positive rate was 1.8.The suspicious rate was 9.8while the inadequate rate was 5.4.Conclusion:FNAC remains the least invasive; the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy; however; the test has high false negative rate.We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also; multi-disciplinary audits of difficult case should be part of the work routine
Subject(s)
Breast Neoplasms/diagnosis , MammographyABSTRACT
Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria were reviewed. Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3(6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63); lung parenchyma (51); pleura (26) and contralateral breast in 25. On immunohistochemistry; basal like tumours were found in 46.1. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27. Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation
Subject(s)
Breast Neoplasms/therapy , Hospitals, Teaching , Mass Screening , NigeriaABSTRACT
Backgrounds: Of all forms of gastrointestinal malignancy; adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence; sociodemographic characteristics; managements and management's outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Material and methods: We reviewed 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex; Ile -Ife; Nigeria; from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1of all malignancies seen and 238/100000 total admissions during the study riod. The median age is 55.0. There were 62 (64.6) male and 34 (35.4) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1) patients has mor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had creaticoduodenectomy; one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation; had poorer prognosis than other patients. Conclusion: Pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis; screening; treatment and research
Subject(s)
Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Pancreas , Pancreatic NeoplasmsABSTRACT
Background: Gastrointestinal schistosomiasis may involve the appendix and there is no specific clinical picture associated with the same. Methods: The clinical records and histopathological slides of all patients diagnosed with schistosomal appendicitis between January 1989 and December 2006 in Ile-Ife, south west Nigeria, were reviewed. Result: Of 956 patients who had appendectomy at the Obafemi Awolowo University Teaching Hospital within the study period, 22 (2.3%) had histopathological diagnosis of schistosomal appendicitis. Eighteen (81.8%) were male whilst 4 (18.2%) were female. Their ages ranged between 15 and 63 years with a mean of 28.2 (+5.6) years. The mean duration of right lower quadrant abdominal pain was 4.2 years. Appendiceal and periappendiceal adhesions were noted intraoperatively in 17 (77.3%) and the appendix was adjudged grossly inflamed in 9 (40.9%) patients. Submucosal fibrosis and eosinophilia were the common histopathological findings aside from submucosal oviposition. All patients received antischistosomal drugs and one patient developed adhesive intestinal obstruction 9 months after surgery. Conclusion: Schistosomal appendicitis may present acutely but diagnosis is only reliably made at histopathological examination. Adequate follow-up is however required to ascertain long-term outcome
ABSTRACT
Injection sclerotherapy has a prominent role in the treatment of bleeding hemorrhoids. The commonly used sclerosants are not available or very expensive in Nigeria. We prospectively evaluated 50% dextrose water, used as a nonallergenic sclerosant, in the treatment of bleeding internal hemorrhoids. Forty consenting adult patients (median age 50 years [range 35–67]; 22 women) with bleeding hemorrhoids, seen over a 2-year period, were offered injection sclerotherapy with 50% dextrose water. They were assessed for response, tolerance and complications. The duration of symptoms before presentation was 3 months to 15 years. The bleeding stopped after the injection in all patients. No patient needed a repeat procedure. No complication was recorded during follow up which ranged from 2 months to 12 months. We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.
ABSTRACT
Background:Aim: Incisional hernia is still relatively common in our practice. The aim of the study was to identify risk factors associated with incisional hernia in our region. The setting is the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria during a period when prosthetic mesh was not readily available. Patients and Methods: All the women who presented with incisional hernia between 1996 and 2005 were prospectively studied using a standard form to obtain information on pre-hernia (index) operations and possible predisposing factors. They all had open surgical repair and were followed up for 18-60 months. Results: Forty-four women were treated during study period. The index surgeries leading to the hernias were emergency caesarian section 26/44 (59.1); emergency exploratory laparotomy 6/44 (13.6); and elective surgeries 12/44 (27.3). Major associated risk factors were the use of wrong suture materials for fascia repair; midline incisions; wound sepsis; and overweight. Conclusion: For elective surgeries; reduction of weight should be encouraged when appropriate; and transverse incisions are preferred. Absorbable sutures; especially chromic catgut; should be avoided in fascia closure. Antibiotics should be used for complicated obstetric cases