Discrete Breast Masses in Female Children and Adolescents: Is there a Place for Non-operative Management by Pediatric Surgeons.

Background: The treatment of breast masses in female children and adolescents is controversial. While some advocate for early surgical removal others prefer the conservative non operative approach. The aim of this study is ascertain the evidence for the current protocol of early surgical removal in our centre. Materials and Methods: Retrospective observational study to highlight the epidemiology of discrete breast masses in female children and adolescents <18years seen at the Lagos University Teaching Hospital, Nigeria. Main outcome measure was to find out if there is a malignancy in excised tissue specimens. Results: Fifty three girls with 76 breast masses were evaluated. Median age at presentation was 16years (4 –17 years). Mean size of lumps was 3.6 cm (±2.1). All the breast masses had benign clinical characteristics and were confirmed histologically to be benign. There was no case of primary or secondary malignancy in any of the histological specimens. Family history, nipple discharge or ingestion of oral contraceptives did not affect presentation, diagnosis and outcome (p>0.05). Conclusion: This series show that breast masses in children and adolescents are almost always benign. It is advocated that conservative non-operative management (with close follow up with imaging such as breast ultrasound and/or MRI) should be adopted by paediatric surgeons in cases of breast masses in children except when surgery is specifically indicated. These indications which should be individualized include: cosmesis, bloody nipple discharge, persistent history of pain in the mass, rapid growth of the mass and malignancies with predilection for the breasts.

Medical education impact assessment: knowledge of final year medical students of Obafemi Awolowo University about male urethral catheterization

Urethral catheterization is one of the commonest procedures performed by doctors either for prophylactic; diagnostic or therapeutic purposes. The medical education impact of this procedure on graduating medical students was assessed using a structured questionnaire. This is a questionnaire - based study and the respondents were final year medical students who have completed their final examinations. There were 86 respondents with M:F ratio of 1. About a third of the respondents have not done urethral catheterization during their training while only 7have done the procedure more than 5 times. All the students know that urethral catheterization is a sterile procedure and 96knew that sterile gloves should be donned during the procedure. 92.4of the respondents knew that skin preparation was necessary during the procedure with 75of them responding that cetriomide and chlorhexidine solution was appropriate. 54of the students used xylocaine as lubricant while 46used KY Jelly. On the quantity of the lubricant for catheterization; only 2.7of the respondents felt that 11-15mls should be injected into the urethra. On the maximum amount of fluid to retain the balloon; only 36of the students responded that it should be according to the specified capacity of the balloon. Majority of the students (88) know that the catheter should get to theY-junction before it is inflated. Most of the students in this study were taught appropriately the procedure of urethral catheterization; however; about a third had not performed the procedure as a medical student

Digital Rectal Examination for Prostate and Rectal Tumour: Knowledge and Experience of Final Year Medical Students

BACKGROUND: It is most pertinent that medical students are taught the necessary skills for digital rectal examination (DRE) before they become doctors. OBJECTIVE: The study is to assess the knowledge and experience of final year medical students regarding DRE for prostate and rectal tumours. METHODS: Well-structured questionnaire were administered to each of the final year medical students of Ladoke Akintola University of Technology a week to their final examinations. RESULTS: Response was received from 127 (60) of the students; 124 (97.6) agreed that they have been taught DRE. Most of the students; 102 (80.3); have done one to five DRE; three (2.4) and have never performed DRE while none of the students have done more than ten DRE. Only in 49 (38.6) of cases were the findings of the students on DRE always confirmed by a doctor. Nine students (7.1) have never felt a clinical BPH and none had felt it more than five times. Sixtysix (52.0) have never felt a malignant prostate and none of the students have felt it up to three times. Most of the students; 106 (83.5); have never felt a rectal tumour on DRE Only five (3.9) felt very confident of their ability to give an opinion based on their findings on DRE while 105 (82.7) felt reasonably confident CONCLUSIONS: The students have been taught DRE and a good number of them have performed it. Few of the DRE done by the students were cross-checked by a doctor. Most of the students have problems differentiating BPH from cancer of the prostate and many of them were not very confident of their findings on DRE

Day Case Surgery in Nigerian Children: Influence of Social Circumstances of Patients

Background: In order to achieve good results in day surgery and avoid pitfalls; selection of appropriate procedures and patients is required with attention given to the social circumstances among other considerations. The aim of this prospective study therefore was to evaluate the influence of the social circumstances of the patients on the performance of day surgery practice in our environment. Method: This was a prospective study carried out between April; 2004 and December; 2004; during which time 88 children aged 15 years and below with uncomplicated inguinal hernias were treated at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). The parents of the patients were interviewed about their social circumstances to determine the possibility of compliance with postoperative instructions. The data generated were then analyzed. Results: More than half (54.6) of the patients were from Ile-Ife. A few came from towns varying in distances from 65 to 80 km and spent an average time of 75 to 90 minutes to reach the hospital. Majority of the patients used public vehicles as a means of transport to and from the hospital in escort of their mothers. Despite the long distances and difficult traveling conditions; the parents still preferred day case surgery and were willing to obey postoperative instructions. Conclusion: From the findings in this study; day case surgery in children in our environment is feasible; despite the poor social circumstances of most of them. There is; however a compelling need to raise the standard of living of the people to enable them benefit maximally from day case surgery

Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria

Background: Neonatal intestinal obstruction (NIO) is a common cause of mortality. This study determined the causes of mortality in patients with NIO at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC); Ile Ife. Patients and Methods: Records of all cases of NIO managed at OAUTHC between January 1996 and December 2005 were retrospectively reviewed and the possible factors that may result in mortality were analysed. Results: Sixty-three neonates with intestinal obstruction were managed; representing 24.3of the neonatal admissions during the study period. Forty-two were males and 21 were females (M:F = 2:1). The majority (71.4) of the patients presented within the first week of life. Anorectal malformation constituted 57.1of the causes of NIO. Other causes included Hirschsprung's disease; duodenal atresia; intestinal malrotation with midgut volvulus and jejunal atresia. There were 18 deaths; with a mortality rate of 28.6. Reoperation; postoperative bleeding and peroperative sepsis were significant determinants of mortality. Conclusion: NIO is associated with significant mortality in our centre. Repeat surgery; postoperative bleeding and sepsis were the significant factors that contributed to mortality in NIO

Outcome of primary closure of abdominal wounds following typhoid perforation in children in Ile-Ife, Nigeria

Background: Abdominal wounds following surgery for typhoid perforation are classified as dirty; with an infection rate of over 40. To date; the optimal method for closure of these wounds remains controversial. Delayed primary closure which was conventionally recommended as standard practice; is now considered to be of no value in preventing surgical site infection (SSI). This study evaluates the outcome of primary closure of this class of wounds in children in Ile-Ife; Nigeria; and advocates a multidisciplinary wound management protocol. Patients and Methods: This is a retrospective study of children aged 1-15 years who had had surgery for typhoid perforation in a teaching hospital in south western Nigeria; over a period of ten years. Results: Thirty-two patients; 18 males and 14 females; in the ratio of 1.3:1 were managed for typhoid perforation during the ten year period. All 32 patients had primary closure of their abdominal wounds. There was primary wound healing in six (18.8) patients; while 19 (59.4) patients had surgical site infections. Wound dehiscence; intraabdominal abscess; and faecal fistulas were the other complications documented in the study. Conclusion: Abdominal wounds of typhoid perforation; though classified as being dirty; can be closed primarily with good healing outcomes. A multidisciplinary approach to wound management will reduce the incidence of wound sepsis and its associated morbidity and costs