Case management of childhood tuberculosis in children's hospitals in Khartoum

No published information is available on the case management of childhood tuberculosis [TB] in Sudan. The aim of this study was to describe the case management of childhood TB in 4 children's hospitals in Khartoum State, Sudan. Data on 467 children aged 0–14 years registered in 2009 were collected from patient records; 52.9% males and 53.0% aged 5–14 years. Most cases were registered as new cases [89.5%] and most had pulmonary TB [72.4%]. Of all cases, 31.0% had sputum smear microscopy done, 35.8% had X-ray and none had a record of being culture confirmed. Category III regimen was given to 58.5%. Reported outcomes were: cured [1.5%], completed treatment [14.6%], transferred out [13.1%], default [17.3%], death [4.3%] and treatment failure [0.6%]. Age was significantly associated with treatment outcome, while sex, type of patient, site of TB and treatment category were not significant. Case management of childhood TB is suboptimal in this region

Metastatic signet ring cell adenocarcinoma of proximal femur with uncertain primary site

Although bone metastases can be found commonly in some malignant tumours, diagnosing a primary malignancy site is not a usual event. Secondary signet ring cell carcinoma of the bone is a very rare tumour. We present a case with pure metastatlc signet ring cell carcinoma of the bone, with an uncertain primary site. A 48-year old man was admitted with Rt thigh swelling and inability to walk. One of first diagnostic effort performed was histopathological examination that revealed a metastatic signet ring cell carcinoma, compressing the regional lymphatics. To our knowledge, in Sudan literature, we believe that this case is the first report of metastatic signet ring cell carcinoma of the proximal femur. Because of the very short survival of many patients, all investigational procedures should be judged in view of their rationality, and should be focused on treatable primary tumours

Multiple carpo-metacarpal joint dislocations without fracture

Although carpometacrpal injuries are relatively uncommon, it is rare for multiple carpometacarpal dislocations to occur without associated fractures. Therefore, any pure multiple dislocation of the CMC joint without associated fracture is worth to be reported. Untreated the dislocations disrupt both the longitudinal and transverse arches of the hand resulting in an impaired grip and loss of normal axial length. We would like to report an uncommon case of carpometacarpal dislocation without associated fractures in a 28-year old man following a fall from a vehicle at speed. To the best of our knowledge, this is first case being reported in Sudan literature on such injury

Infanticide attempt by a postpartum depressed mother

To our knowledge, this is the first case report from an Arab culture of an infanticide attempt by a depressed mother towards her 4 month old infant. The attempt failed after intervention by a family member who noticed the mother covering up the face of the infant with multiple layers of blankets. She admitted to the infanticide attempt and was transported to the emergency room for assessment and treatment of her postpartum depression. The authors present this case to heighten awareness among physicians for the need for careful mental health assessment of their patients in the postpartum period. This becomes particularly critical for those women with known risk factors which increase their vulnerability for a serious infant-mother relationship disorder

Laparoscopic versus open retroperitoneal bilateral varix ligation for obese patients presenting with primary sub-fertility: a randomized comparative study

Objectives: To compare the outcome of laparoscopic versus open varicocelectomy in sub-fertile obese men presenting with bilateral testicular varicoceles

Materials and Methods Forty obese [body mass index > 30] primary sub-fertile males with bilateral varicoceles were selected for this study and randomly subjected to either laparoscopic varicocelectomy [Goup I, n=20] or high retroperitoneal open ligation [Group II, n=20]. Semen analysis was performed preoperatively and three months or more postoperatively. Scrotal duplex was done for each case preoperatively and 6 months post-operatively

Results: The average operative time in Group I and Group II was tilde 77.3 minutes and tilde 58 minutes, respectively [P< 0.05]. Analgesia requirements were significantly less in the laparoscopic group. Only one patient of Group I developed subcutaneous haematoma, while in Group II three developed wound infections and six patients developed wound seroma. The average hospital stay of the patients of Groups I and II was 8.4 hours and 52 hours, respectively [P< 0.05]. The patients of Group II returned to their usual daily activities after an average of 5.3 days, while the patients of Group II needed an average of 8.4 days [P< 0.05]. Hydrocele occurred in none of the patients of Group I and in three patients [15. 7%] of Group II [P<0.05]. Recurrence of the varicocele occurred in none of the patients of Group I, but in three patients [15.7%] of Group II [P< 0.05]. The semen parameters improved after surgery in both groups. The mean improvement in sperm concentration was tilde 32.5 million sperm/ml in Group I and tilde 25 million sperm/ml in Group II [p>0.05]. The mean improvement in the total sperm count was tilde 96 million sperms in Group I and tilde 92 million sperms in Group II [p>0.05]. The mean percentage of improvement in sperm motility was tilde 16.5% in Group I and 14.1% in Group II [p< 0.05]. The mean decrease in the percentage of abnormal forms was tilde 20% in Group I and tilde 5.5% in Group II [p< 0.05]. Moreover, the quality of motility [grades] improved significantly after laparoscopic varix ligation, to a higher extent than after open surgery

Conclusion: The laparoscopic approach is an excellent option for varix ligation in obese patients. Morbidity is less and convalescence is shorter compared to open surgery. A particular advantage of laparoscopy over conventional surgery is the possibility of treatment of bilateral varicoceles through the usual three laparoscopic ports. In this study, improvement in some semen parameters was significantly better following laparoscopic varix ligation. This may be explained by the better view and magnification offered by laparoscopy

Congenital penile curvature with orthotopic meatus: a report on the management of 62 cases following a systematic approach

Objectives: We are presenting our experience with a systematic approach in the management of congenital penile curvature [CPC]

Patients and Methods: Between 1993 and 2000, 62 cases of CPC were treated. Ten of 34 cases [30%] presenting with ventral curvature were corrected via excision of the dysgenetic tissue and complete mobilization of the corpus spongiosum only. Two cases [6%] had a minimal corporeal disproportion that required a ventral longitudinal deep intercorporeal incision. Six cases [18%] were managed with Nesbit's procedure, and tunica albuginea plication [TAP] was done in 8 cases [24%]. These cases required mobilization of the neurovascular bundle [NVB]. Four patients [12%] had a small phallus and required ventral grafts [dermal in two and venous grafts in another two]. The remaining four patients [12%] had a short urethra and were managed by excision of the tethering corpus urethrae and neourethral reconstruction. Cases presenting with lateral curvature [14 patients] were managed by a lateral longitudinal incision at the point of maximum curvature followed by TAP in 10 cases [71%] and Nesbit's procedure in four [29%]. Dorsal curvatures [6 cases] were managed by ventral Nesbit in four [67%] and ventral TAP in the remaining two cases [33%]. Patients with a complex curvature [8 cases] were managed by sequential TAP on an individual basis according to the results of intraoperative artificial erection in 5 cases [63%] and by complete penile disassembly: The follow-up period ranged from 6 months to 2 years, and the results were satisfactory in the majority of patients. None of our patients developed impotence. Penile haematoma occurred in 6.4% and penile numbness in 19% [persistent in 3%], while foreign body sensation was felt in 8%. None of our patients experienced painful erections beyond three months after operation. A residual curvature was noticed in 9.6%, and it required a second step Nesbit's procedure in only 3%

Conclusion: Management of CPC can result in a very high success rate as long as a systematic stepwise approach is applied with an appropriate preoperative patients counseling. We recommend the limited use of Nesbit's procedure [unless TAP fails to correct the curvature] together with a gentle handling of the NVB