Thyroidectomy under ketamine anaesthesia in a semi urban hospital in Nigeria

To evaluate the efficacy and safety of ketamine hydrochloride anaesthesia without endotracheal intubation in thyroidectomy. Patients with goitres fulfilling selected criteria had thyroidectomy under ketamine over an 11 year period. The data was pooled and analyzed. Fifty five patients all females were included in the study. The average gland weight was 80 +/- 19g. Emergence response was the commonest complication. One patient developed respiratory obstruction for which she had tracheostomy. There was no mortality. Thyroidectomy in selected cases under ketamine anaesthesia is safe and economical with minimal morbidity and mortality. We recommend the technique in our sub region where there is a dearth of anaesthetic machines and equipment

Spontaneous enterocutaneous fistula in an HIV positive patient

A 35 years old woman presented with a periumbilical abscess that later developed into an enterocutaneous fistula. She was found to be HIV positive and responded promptly to antibiotics and antiretroviral drugs. We conclude that in situations where there is enterocutaneous fistula of unknown aetiology, HIV screening should be strongly recommended

Outcome of management of gunshot injuries by Nigerian traditional doctors

Four patients with gunshot injuries who were managed by Nigerian traditional doctors are presented. They finally presented to us with some avoidable complications which was successfully managed in three of these patients while one of them died. The first patient with abdominal gunshot injury died of septicaemia after being managed conservatively by the traditional doctor. The second patient had Pneumothorax as a result of gunshot injury to the chest. The conservative management by the traditional doctor failed so we had to insert chest tube and underwater seal drainage. The third patient had tetanus from gunshot injury while being managed by traditional doctor. He responded favourably to orthodox management. The fourth patient had embedded pellets following a gunshot injury which were removed by us. He was earlier deceived by the traditional doctor who claimed that he had removed the pellets diabolically.The morbidity and mortality of the management of gunshot injury by traditional doctors in Nigeria is quite high. We therefore recommend strict regulation of their activities

Comparative study of single dose and five days dose of gentamicin as prophylaxis in appendicectomy

One hundred patients who had appendicectomy for uncomplicated acute appendicitis over 1 year were randomly allocated to two groups of 50 patients each. Patients in group 1 had a single prophylactic injection of gentamicin while those in group 2 had a five days course with the first dose given just before the operation. There was no wound infection in any of the patients in either groups. There was also no statistically significant difference in the incidence of other postoperative complications. These findings suggest that a single prophylactic dose of gentamicin was as effective as a five days course in preventing postoperative complications, like wound infection