Ameloblastoma in young persons: a retrospective study of the Clinocopathologic Features and treatment of 19 cases from a Semi-Urban Nigerian Teaching Hospital

19 cases of ameloblastoma of the jaws in children and young adolescents were reviewed. During the period of evaluation, 113 patients with ameloblastoma of the craniofacial region were managed of which 16.8% were in patients aged < 18 years. The mean [SD] age of patients was 14.7 [ +/- 2.5] years [range, 10-18 years]. Male to female ratio 2:1; and mandible to maxilla ratio 18:1. Duration of the tumours at presentation ranged from 8 months to 5 years, [mean: SD = 3.3:1.5 years], 73.7% were of the multilocular type on radiographs and the most frequent histologic pattern was the plexiform type [n-12, 63.2%]. Due to the large size at presentation, radical mandibulectomy was the method of treatment in 12 cases [63.2%]. Recurrence was noticed in 4 patients [21%] within 5 years after primary surgery. Ameloblastoma is relatively rare in Nigerian children, the clinical features, radiologic and histologic patterns however, were found to be similar to that of adults

Typhoid ileal perforations: a study of 75 patients

The results of surgical treatment of 75 cases of typhoid ileal perforation are presented. Fifty-eight% of the patients were between 20 and 40 years of age. Seventy-five% of the patients were seen after an illness of 2-4 weeks. Most of the patients reported late to the hospital so upto 72% of the patients were explored 24 hours after the perforation occurred. At operation the peritoneal cavity was full of pus and small bowel contents. More than 85% of the perforations were located within 60cm from ileocecal valve. Only 16% patients had multiple perforations. Thirty-eight patients [50.7%] underwent simple closure of their perforations. Nineteen patients [25.3%], underwent wedge-excision of the ulcer and 2-layer closure and eighteen [24%] underwent exteriorization of the perforation as an ileostomy, mostly because of multiple perforations. Peritoneal toilet with warm saline was performed in all patients. The overall mortality was 12%. Chloramphenicol, genticyn and metronidazole were used in combination in all the patients. We recommended early limited surgery to improve results

Oral cholecystography or ultrasonography in the diagnosis of alcalculous gallbladder disease

A total of 300 patients with gallstone disease were studied in surgical unit-l, Nishtar Hospital, Multan during a period of 6 years [January 1986 to December 1991]. Diagnosis of gallstones was made by ultrasonography, oral cholecystography or both. Oral cholecystography [OCG] was performed in 105 patients. Ultrasound [USG] of the liver and gallbladder was obtained in 195 patients. Forty patients underwent both ultrasonography and oral cholecystography. The results were compared with the operative findings to find out the reliability of oral cholecystography and ultrasonography in the diagnosis of calculus gallbladder disease. The sensitivity for OCG was73% and the specificity was 60%; the respective figures for USG were 86% and 93%. The predictive value of positive OCG was 91%; the respective value for USG was 99%. A combination of OCG and had sensitivity of 95%, specificity 100% and the predictive value for positive test 100%. Ultrasound was of special help in the diagnosis of gallstones in patients with jaundice, pregnancy, vomiting, allergy to the contrast and acute cholecystitis. These observations suggest that OCG and ultrasound are very accurate but not infallible in diagnosing gallstone disease. We also conclude that ultrasound should be the initial imaging technique in patients suspected of having gallstone disease. When ultrasound fails or is inconclusive, a combined strategy of applying both the tests should be considered

Post-operative bile duct strictures: Management of eight patients

Management of eight patients with benign bile duct stricture following cholecystectomy is discussed. Seven patients had been operated for gall stones while one had undergone cholecystectomy and repair of hepatic duct confluence after blunt abdominal trauma. Five patients had undergone multiple operations before referral to this hospital on admission, all the patients had abnormal liver function tests. Three patients had low serum albumin, 4 had a history of previous major infection and one patient had associated cirrhosis and portal hypertension. Five patients had an external biliary fistula. All the patients were operated upon: 4 by mucosal graft operation [Bismuth type-IV], 3 by hepatico-jejunostomy by direct suture [Bismuth type-III and II] and one by choledocho-duodenostomy [Bismuth type-I]. There were no post-operative deaths in patients treated by hepaticojejunostomy. One of the 4 patients treated by mucosal apposition died in the immediate postoperative period; he had associated cirrhosis and portal hypertension. Six patients [75%] have a good result with a mean follow up of 3.5 years [range 2-8 years]. One patient has occasional attacks of jaundice and fever and persistently raised serum alkaline phosphatase. Factors influencing outcome were prolonged jaundice, site of stricture, number of previous attempts at stricture repair, associated cirrhosis and portal hypertension

Treatment of perianal fistula: analysis of 108 cases

One hundred and eight patients who underwent treatment for peri-anal fistula have been studied. Eighty-nine patients had a low anal fistula while 19 patients had high fistulae. Low fistulae were treated by fistulotomy achieving uniformly good results. The difficult high anal fistulae were treated by two stage fistulotomy [n=6], cutting seton [n=9], and re-routing technique [n=4]. The techniques and outcome of treatment are discussed

Incidence of gall stone disease, a hospital based study

Three hundred patients with gall stone disease admitted in Surgical Unit-1 Nishtar Hospital, Multan during a period of 6 years [January 1986 to December 1991], have been studied. Twenty-five were male [8.3%] while 275 were female patients [91.7%]. The male to female ratio was 1: 11. Peak incidence was between 30-50 years of age. Ninety patients presented with pain right hypochondrium [30%] and 54 with flatulent dyspepsia [18%]. Twenty-seven patients presented with acute cholecystitis [9%]. Thirteen patients presented with obstructive jaundice [4.3%]. Most of the patients had chronic cholecystitis [37%]. Fifteen patients had carcinoma of the gall bladder [5%]. Eighty-two% of the stones on analysis proved to be cholesterol stones while only 18% were pigment stones. Ultrasound was found accurate in 86% while Oral Cholecystography was accurate in 73% of the patients