Pyocolpos with imperforate hymen during early childhood presented with urine retention and bouts of intestinal obstruction

An imperforate hymen is not a rare condition in female newborns, but is often ignored in a genital examination by doctors. We report an unusual case of a 2 years old Sudanese girl with an imperforate hymen and pyocolpos presented with urine retention and intermittent bouts of intestinal obstruction. To our knowledge, this is a first case of female child with pyocolpos to be documented in Sudan literature

Spontaneous achilles tendon rupture in alkaptonuria

Spontaneous Achilles tendon ruptures are uncommon. We present a 46-year-old man with spontaneous Achilles tendon rupture due to ochronosis. To our knowledge, this has not been previously reported in Sudan literature. The tendon of the reported patient healed well after debridement and primary repairs

relation between the presence of intestinal bacteria in the perianal abscess and the anticipated perianal fistula

Perianal abscess and fistulas are frequently encountered in our surgical practice; however, very little has been written about them. The clinical effectiveness of pus swabs for microbiological analysis during incision and drainage of perianal abscess is controversial. Its cost implication is often overlooked. To assess whether the culture of pus swab following incision and drainage of perianal abscess has any significant impact on surgical outcome and on early anticipation of development of fistula in-ano in our local population. A non-probability sample, total coverage multicenteric cross-sectional study. All consecutive cases of incision and drainage of perianal abscess between November 2008 and June 2011 were enrolled into our study after acceptance of a pre-given informed consent. Out of 76 patients with perianal abscess included in the study only 62 patients were available for the final assessment [9 F: 53 M; age range: 18-63 years; mean +/- SD: 37.66 +/- 10.67]. Median follow-up was 2 months irrespective to culture result. The mean hospital stay was 1.44 days, and is affected by the presence of associated illness [p=0.02]. Skin flora organisms, heavy mixed growth of both skin flora and intestinal organisms, and no bacterial growth were isolated from 75.8%, 12.9% and 11. 3% respectively. Fistula in-ano developed in 16.7%, 83.3% and 0% respectively. 83.3% of fistula developed in the group of patient who presented >/= 10 days, which is statistically found to be significant p=0.003.Fistula was developed in 7.1% [4/56] of patients who were treated under general anaesthesia, and in 33. 3% [2/6] of patients who were treated under local anaesthesia. The preliminary findings suggest that microbiological results have correlation with presence of fistula in-ano. The result warranted us to submit pus swabs from perianal abscess for assessment as it affect clinical effectiveness of treatment, and that culture of pus in perianal abscess is an essential part of its management

Case report and systematic review of blunt abdominal trauma as a cause of acute appendicitis

Acute appendicitis commonly presents as an acute abdomen. Cases of acute appendicitis caused by blunt abdominal trauma are rare. The aetiology and pathphysiology of appendicitis have been well investigated. However, the occasional cases of co-existent appendicitis and blunt abdominal trauma raise questions regarding a possible cause/effect relationship. We present a case and review of appendicitis following blunt abdominal trauma. The aim of this study is to collate and report the clinical presentations and experience of such case by internet search using PubMed and the keywords 'appendicitis', 'abdominal' and 'trauma' a literature review was carried out. The initial search returned 382 papers, of which 18 articles were included. We found 29 cases of acute appendicitis secondary to blunt abdominal trauma reported in the literature between 1991 and 2010. Mechanisms of injury included road traffic accidents, falls, assaults and accidents. Presenting symptoms invariably included abdominal pain, also nausea, vomiting and anorexia. Only 13 patients had computed tomography scans and 10 patients had ultrasonography. All reported treatment was surgical and positive for appendicitis. Although rare, the diagnosis of acute appendicitis must be considered following direct abdominal trama especially if the patient complains of abdominal right lower quadrant pain, nausea and anorexia. Haemodynamically stable patients who present shortly after blunt abdominal trauma with right lower quadrant pain and tenderness should undergo urgent imaging with a plan to proceed to appendicectomy if the imaging suggested an inflammatory process within the right iliac fossa

Colorectal cancer during pregnancy in a Sudanese female

We report a new case of uncommon but not rare condition of colorectal cancer during pregnancy in 33 years old Sudanese female at her 16th weeks of gestation presented with bloody diarrhea and intermittent left side abdominal pain. Initially she was diagnosed as a case of dysentery which was treated by antibiotics. Condition was diagnosed by colonoscopy and histopathology as colonic cancer, located in the sigmoid colon 50 cm from anal verge. A review of literature found that 276 cases of colon cancer associated with pregnancy have been reported. Pregnancy affects the clinical presentation, evaluation, therapy, and prognosis of colon cancer. Patients usually present with misdiagnosed symptoms. Diagnostic delays often lead to the tragic demise of a young woman from a potentially curable disease and of an otherwise viable fetus. This delay in diagnosis is a major contributing factor to the poor prognosis associated with this disease. Synchronous colon cancer during pregnancy presents a diagnostic and therapeutic challenge for clinicians because there are no generally accepted guideline regarding diagnosis or treatment. This article reviews this uncommon condition with a focus on the features of colon cancer in pregnancy to facilitate earlier diagnosis, to modify investigations, to optimize the therapy, and to improve the maternal and fetal outcomes

Why do people prefer traditional bonesetters in Sudan?

In Sudan as in other developing nations, traditional bonesetters play a significant role in primary fracture care. There is widespread belief in our society that TBS are better at fracture treatment than orthodox practitioners. Significant numbers of patients with fractures present first to the traditional bonesetters before coming to the hospital and therefore this mode of care delivery cannot be overlooked in Sudan. A prospective study designed to determine the reasons of why a considerable number of people prefer to go to the traditional bonesetters in Sudan. Patients and methods: This prospective two stages study was carried out in two different stages, 1st stage in 2006 targeted general population, and the 2nd stage in the period from May 2009 to September 2009 targeted traditional bonesetters and their patients. In the 1st stage of the study we distributed a predesigned questionnaire to general population, while in the 2nd stage of the study we visited different traditional bonesetter in order to interview them and their visitors and completing the early prepared Performa. We excluded the too elderly patients and children who have no decisions to choose TBS. In the 1st stage of study the participants were 199 of them, 192 participants responded well to the questionnaire. The reasons why they went to traditional bonesetters were; in 71 participants [37%] was their beliefs, in 27 [14.06%] was due to the low cost, and in 27 [14.06%] was due to fear of plaster. In the 2nd stage of the study 276 participants fulfilled the criteria of the research. The reason why they went to traditional bonesetters; in 63 candidates [22.8%] was their beliefs [P value < 0.003], in 53 [19.2%] was low cost [P value < 0.05], and in 46 [16.7%] was due to fear of cast or amputation. Study included sixteen traditional bonesetters, of them 14 were males and 2 were females. One of them has a bachelor graduation from faculty of sciences. 11 [68.8%] traditional bonesetters accepted the idea of regular training under medical supervision. Despite an adequate number of physicians practising in the region, traditional bonesetters continue to be consulted. Study showed that a belief is the most leading cause of consulting traditional bonesetters, other causes including fear of plaster or amputation and less cost. We recommend that the efficacy of their treatments have to be further assessed

Prolactin and insulin estimates in pregnancy with glucose intolerance

To show the relation of prolactin with the incidence of glucose intolerance in pregnancy. This study was carried out on thirty Sudanese pregnant ladies suffering from gestational diabetes mellitus, 30 ones with impaired glucose tolerance and 30 control ones with normal glucose tolerance. All subjects overnight fasted before the test. A fasting blood sample was drawn at 6.00 a.m. Thereafter, 75g oral glucose dissolved in 200 cc water was given for each, waiting for two hours and then another blood sample was drawn. Fasting and 2-h, after 75g glucose load, plasma glucose concentrations [FBS and 2h-BS] were estimated by glucose oxidase method. The concentrations of serum insulin in the fasting sample [0 min.] and in the 2 hour after 75g glucose load sample [120 min.] were measured with a specific immunoradiometric assay. The concentrations of serum prolactin [120 min.] were measured with a specific radioimmunoassay. There were no significant differences among levels of fasting serum insulin of the three studied groups [p>0.05] while, the mean level of 2h- serum insulin of the GDM group was significantly lower than that of the IGT and control groups [p <0.005]. Results of serum prolactin of the control group in the first, second and third trimester showed that prolactin increases progressively as pregnancy advances [p <0.0001]. Results of serum prolactin of the GDM, IGT and control groups in the third trimester showed that no two groups were significantly different [p>0.05] although the control group recorded the highest mean level of serum prolactin. Prolactin increases progressively as pregnancy advances, reaching a peak in the third trimester when many pregnant ladies may develop gestational diabetes due to the state of insulin resistance which may occur although there is no evidence that prolactin may be directly incorporated with the pathogenesis of glucose intolerance in pregnancy. A decline in insulin secretion may lead to a decline in prolactin since insulin stimulates both acute secretion and de novo synthesis of decidual prolactin

Chronic pain after inguinal hernia repair

Hernia repair is one of the most common surgical procedures, and some patients suffer from chronic pain after hernia surgery. Chronic pain was believed to be a recognized but infrequent complication after inguinal hernia repair. Although it is usually mild, its exact cause and lack of evidence-based treatment path present problems in the effective management of this surgical complication. It has significant variable degrees of effects on work and social activities. The aim of the present study was to evaluate chronic post-herniorrhaphy pain in patients who underwent Darn or modified Bassinis' repair. We evaluated the patients over the subsequent 3 months, using a telephone filled questionnaire. The questionnaire included the chronic pain grading scale [CPG] questionnaire to focus on chronic pain and its limitations to their quality of life. The results show that the majority of patients were successfully treated by therapeutic injection into the point of maximal tenderness. It was concluded that chronic pain following open inguinal hernia repair can be disabling, sometimes seriously affecting quality of life. It is, therefore, very important to discuss the possibility of resulting chronic severe pain when obtaining preoperative informed consent. This paper highlights the importance of education of junior trainees about the appropriate issues and skills needed to get informed consent. We believe that each patient must be informed about the possibility of chronic, severe pain and its impact on their quality of life should it occur. The present findings indicate that identification and preservation of nerves during open inguinal hernia repair reduce chronic incapacitating groin pain and that, in the majority of patients with chronic pain at 6 months, the pain at 1 year is resolved only with conservative or medical treatment

Auditing the use of percutaneous pinning as a technique of fixation of unstable humeral supracondylar fractures in Sudanese children

Supracondylar fractures of the humerus in children are commonly treated with closed reduction and percutaneous pin fixation. There has been controversy regarding the optimal pin configuration in the management of supracondylar humeral fractures in children. The objectives of this work are to evaluate the effectiveness closed percutaneous pinning [P.C.P.] as a treatment modality of supracondylar fractures of humerus in Sudanese children; To overall improve the strategy of treatment technique local experience in treating displaced supracondylar fracture of the humerus in children and; to assess the results of treatment by closed reduction and percutaneous pin fixation of humeral supracondylar fractures in children. Hospital based prospective analytical observational study conducted in Khartoum teaching hospital during the period from July 2006 to March 2007. Included all children less than 14 years of age, with closed type III supracondylar humeral fracture, extension variant, who treated by closed reduction and percutaneous cross pinning. The results show that 34 patients were available for the final assessments at nineth weeks. Their age ranged between 4-12 years, with mean +/- SD of 7.68 +/- 2.34 years. Twenty-four [70.6%] fractures were fixed with crossed pins whereas ten [29.4%] fractures with two lateral pins. The two lateral pins fixation was found to be significantly associated with loss of reduction [p=0.004]. It was concluded that PCP is safe and effective with good functional outcome in treatment of unstable supracondylar fractures. The best wires configuration is that give ability to extend elbow with much stability

reliability of modified Alvarado score as a tool for diagnosis of acute appendicitis in Sudanese adults

Decision making in cases of acute appendicitis may be difficult especially for junior surgeons as diagnosis of that condition is sometimes difficult. In conditions like acute appendicitis, it is not possible to have definitive diagnosis by gold standard test [histopathology] before surgery, so various diagnostic modalities are introduced to establish accurate diagnosis. Modified Alvarado score [MAS] system is one of the examples. This work was carried out to evaluate the reliability and sensitivity of modified Alvarado scoring system in Sudanese adult patients with suspected diagnosis of acute appendicitis This prospective study included 866 [452 males and 414 females] who underwent appendicectomy in different centers in Khartoum, Sudan in the period from January 2006 to August 2007. It included all adult patients above 16 years with clinical diagnosis of acute appendicitis. Modified Alvarado score system was calculated for all patients; however decision to operate was clinical.The results showed that the overall sensitivity, specificity and accuracy were 87.78%, 24.78% and 79e.56% respectively. Our data suggested that the modified Alvarado scoring system had little applicability to the local adult population. Its sensitivity was high but the specificity was too low. So, we conclude that the modified Alvarado scoring system is not accurate in the diagnosis of suspected cases of acute appendicitis in Sudanese adult patients

Importance of fine needle aspiration in evaluation of single nodular goiter

Improvements in the sensitivity and specificity of biochemical thyroid tests, as well as the development of fine needle aspiration biopsy [FNA] and improved cytological techniques, have dramatically impacted clinical strategies for detecting and treating thyroid disorders. Fine needle aspiration is a safe and relatively painless procedure where a hypodermic needle passed into the lump and samples of tissue taken out. This procedure will provide us with more information about the nature of the lump, and especially differentiate between a benign and malignant mass. The current prospective study designed to evaluate the sensitivity, specificity and accuracy of FNA. The study was performed in the regional major hospital, Khartoum, Sudan. A thousand and three hundred thirty one patients who underwent thyroid surgery between January 2004 to June 2007 were enrolled. 247 [18.3%] had single nodular goiter. The incidence of benign and malignant lesions in single nodular goiter were 204 [87.6%] and 29 [12.4%] respectively. The overall sensitivity, specificity and accuracy of FNA were 95.5%, 99.5% and 99.4% respectively. Also there is correlation between the nodule size and the result of FNA, as the nodular size increase there is increase of the probability of malignant changes. So, solitary or dominant nodules 1cm in diameter might be evaluated by FNA

Patterns of pelvic and acetabular injury among Sudanese patients

Most of major pelvic fractures result from very high energy trauma and require urgent hospital treatment. However more minor, stable fractures may only require a period of rest and analgesia followed by gradual mobilization. Extended civil development and increased means of transportation in Sudan during the last two decades led to an increase in the number of highly potentiated traumatic accidents including isolated or combined pelvic and acetabular injuries. For this reason a unit for pelvic surgery has been established in Khartoum north teaching hospital in 2006. A prospective study designed to evaluate the various patterns of pelvic and acetabular injuries in Khartoum North Teaching Hospital. Patients with pelvic ring and acetabular injuries treated in Khartoum North Teaching Hospital, Khartoum, Sudan, between August 2006 and September 2009 were enrolled in the study. The collected data had been managed statistically using the appropriate SPSS computer package. Hundred ten patients were included in the study. There were eighty one males. The mean age [ +/- SEM] was 36.6 +/- 1.61 years. The cause of injury was a road traffic accident in 89 patients, a fall from height in ten patients, a fall at home in three patients and in eight patients due to miscellaneous cause. Forty four [40%] patients presented directly to our hospital, whereas, 66 [60%] patients referred from other various hospitals from different region of Sudan. The average hospital stay [ +/- SEM] was 16.12 +/- 1.09 days. Regarding pattern of fractures; pelvis only was 59.1%, acetabulum only was 25.5%, and combined pelvic and acetabular fracture was 15.5%. According to Tile's classification of pelvic and acetabular injuries there were 25 [22.7%] patients with type Cl pelvis, 18 [16.4%] with type A2 pelvis, 15 [13.6%] with type Al acetabulum, three 2.7% with type A2 pelvis and Al acetabulum, and three 2.7% with type Cl pelvis and A3 acetabulum injuries. Thirty seven patients had associated skeletal fractures and 12 patients had extra-skeletal injuries. Pelvic and acetabular injuries remain relatively uncommon in Sudan when compared with other musculoskeletal injuries. But our study showed that there is a continuous increase in the number of pelvic and acetabular injuries. So, many pelvic surgery units are needed to be established to cover many areas in Sudan to overcome the delay factor which may affect management outcome

sensitivity and specificity of the conventional symptoms and signs in making a diagnosis of acute appendicitis

Simple appendicitis can progress to perforation, which is associated with a much higher morbidity and mortality. So, surgeons have therefore been inclined to operate when the diagnosis is probable rather than wait until it is certain. This study is designed to evaluate the sensitivity and specificity of clinical examination in the diagnosis of acute appendicitis. The study included 866 patients of acute appendicitis who had undergone appendicectomy with preoperative diagnosis of acute appendicitis. They were analyzed retrospectively. The parameters evaluated were age/gender, clinical presentation [signs and symptoms] and total white blood cell counts. The operative findings were recorded and the inflammation of the appendix was graded into normal, acutely inflamed and gangrenous. Clinical diagnosis was made correctly in 807 [93.2%] of the patients. White blood cells count ranged from 3.70 to 45.30 /mm[3] [mean 17.5353 /mm[3]]. It was <10.000/mm[3] in 133 [15.4%] patients. Clinical assessment is the best criterion to reach a confident diagnosis. Investigations may supplement the diagnosis but are never a substitute for it

Neurotransmitters - a biochemical view

The neurotransmission at most if not all synapses is chemical and is of great biochemical, physiological and pharmacological importance. Neurons communicate with each other at synapses by a process called synaptic transmission which is the release of small quantities of chemical messengers, called neurotransmitters that alter the electrical activity of neurons after they interact with receptors on post-synaptic cell surfaces. This review gives a biochemical view on the nature of neurotransmitters and presents the biochemical chart and the medical relevance of the most important neurotransmitters

Life style and outcome following open cholecystectomy

Gallstone disease remains one of the most common medical problems leading to surgical intervention. The Increasing number of cholecystectomy has increased the need to assess the effects of the surgery on presenting symptoms. Cholecystectomy is intended to relieve symptoms of gallstones, but unfortunately some patients will experience post-cholecystectomy symptoms, including pain. There is limited information in the literature on gallstone-related pain and its influence on quality of life. The aim of this study is to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery. Eighty three patients had open cholecystectomy in charity teaching hospital during the period between March 2007 and March 2008. Preoperative data on pain, symptoms, and history was recorded, and the questionnaire on pain and symptoms was filled 1 year postoperatively. Preoperative sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without post-cholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. The results show that sixty eight patients completed all questionnaires. 54 of patients [80%] had documented gallstones preoperatively, 44 [64.7%] had biliary pain and 49 [72%] had both biliary pain and documented gallstones prior to surgery. Twenty three patients had some pain postoperatively. Of these thirteen patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an Introverted personality and by the absence of 'agonizing' pain and of symptoms coinciding with pain [P < 0.003]. In a constructed logistic regression model 8 of 11 predicted patients had postoperative pain [PV pos = 0.73]. Of 57 patients predicted as having no pain postoperatively, 52 were pain-free [PV neg = 0.91]. The cure rate for biliary colic was 85% if stones were documented preoperatively, and 49% when they were not [P< 0.05]. It was concluded that most patients [81%] with biliary colic and gallstones have complete relief of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculus cholecystitis was only 52%. Non-pain symptoms were common preoperatively [82%] and were relieved in 44% of patients

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

Symptomatic empty sella syndrome - a case report and review of the literature

The pituitary gland is a hormone-responsive gland and is known to vary in size depending on the hormonal status of the patient and the multifaceted positive and negative hypothalamic-pituitary-gonadal axis. We are reporting on a case of symptomatic empty sella syndrome occurring in 68 years old Sudanese woman with a long history of hypothyroidism. Concepts and definitions of the empty-sella [ESS] syndrome, origins of primary and secondary empty-sella syndrome [ESS] including defect of the Turkish saddle diaphragm, pituitary abnormality, and disease states [development frequency, symptom, and test result] are reviewed. In addition, preventive strategies of late diagnosis are suggested

study of the hospital stay in laparoscopic cholecystectomy versus open cholecystectomy

Each year, large numbers of Sudanese have gallbladder surgery. Surgery options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy. While elective cholecystectomy now carries extremely low morbidity and mortality rates, the operation does incur sizable expense in terms of hospitalization and time lost from work. The advantages of hospital stay in laparoscopic cholecystectomy versus open cholecystectomy were questioned because the recovery from open cholecystectomy is brief

Comparison between usages of a single preoperative metronidazole dose with other antibiotic regimens in nonperforated acute appendicitis

In this study, the safety and efficacy of a single dose of metronidazole in preoperative prophylaxis in nonperforated appendicitis were evaluated. Records of 866 patients underwent appendectomy were evaluated and 11.43% [99] of these patients received 500 mg of metronidazole only before undergoing operation on induction for anaesthesia. Factors known to affect the incidence of wound infection, such as abdominal or wound drains, and the inclusion of patients with perforated or ruptured appendicitis, were eliminated. The patients were divided into three groups: patients with a normal appendix, patients with an acutely inflamed appendix, and patients with a gangrenous appendix. The study showed for each group a significant reduction of the incidence of wound infection in patients receiving prophylaxis. Routine preoperative prophylaxis is recommended before appendectomy. The findings demonstrated that more than ninety-four percent of the wound infections were detected after discharge from the hospital strongly indicate the need for follow-up

Outcomes and complications of thyroid surgery among the Sudanese patients

To reveal the outcomes and complications of post-thyroidectomy, a study was carried out on 1351 patients aged between 18 and and 76 years [mean, 43.9 years] of whom 945 were female [69.95%] and 406 [30.05%] were male patients [female to male ratio was 2.3:1]. The most common Indications for total thyroidectomy were diffuse goiter and multlnodular goiter [45.7% and 36.04%of cases respectively]. Incidence of malignancy was 41 cases [2.7%]. Of those patients with malignancy, thirty cases [73.2%] underwent an associated nodal dissection along with total thyroidectomy. The Incidence of postoperative wound haematoma was 0.6% [8 cases], wound infection was 0.4% [5 cases], and mortality rate was 0.0%. The Incidence of postoperative hypocalcaemia was 8.4% [113 cases]. Younger age was statistically associated with an Increased Incidence of hypocalcaemia [P<0.002], whereas sex [P=0.31], Indication for surgery [P=0.16], and associated neck dissection [P=0.13] were not. The Incidence of hyperthyroidism was 0.148% [2 cases]. The mean duration of hospital stay was 4.2 days and was unaffected by occurrence of postoperative hypocalcaemia. The Incidence of unilateral and bilateral vocal cord paralyses was 1.1% [23 cases] and 0.22% [3 cases], respectively. The study showed that there is an Increase of the Incidence of complications when the operation performed for carcinoma. This Increase may be due to the extent of disease found at operation or the less experienced surgeons. Postoperative hypocalcaemia is the most common immediate surgical complication of total thyroidectomy. Other complications, including recurrent laryngeal nerve paralysis, hypothyroidism, hyperthyroidism, and haematoma formation