Violence in the emergency department: a multicentre survey of nurses' perceptions in Nigeria.

BACKGROUND: Emergency department (ED) violence is common and widespread. ED staff receive both verbal and physical abuse, with ED nurses bearing the brunt of this violence. The violence is becoming increasingly common and lethal and many institutions are still improperly prepared to deal with it. METHODS: A questionnaire based survey of the perception of violence among nurses working in six tertiary hospitals' EDs across five states in Nigeria was conducted. RESULTS: 81 nurses were interviewed with a male to female ratio of 1:4. Most were right about the definition of violence. About 88.6% of respondents have witnessed ED violence while 65.0% had been direct victims before. Nurses followed by doctors were the usual victims. The acts were carried out mostly by visitors to the ED. Men were usually responsible for the violence, which usually occurred in the evenings. Weapons were not commonly utilised: only 15.8% of the nurses had been threatened with a weapon over a 1-year period. The main perceived reasons for violence were overcrowded emergency rooms, long waiting time and inadequate system of security. All the institutions were lacking in basic strategies for prevention. While most of the nurses were not satisfied with the EDs that were considered not safe, few would wish for redeployment to other departments/units. CONCLUSIONS: There is a need to make the EDs safer for all users. This can be achieved by a deliberate management policy of 'zero' tolerance to workplace violence, effective reporting systems, adequate security and staff training on prevention of violence.

Fulminant necrotizing fasciitis following the use of herbal concoction: a case report.

INTRODUCTION: Necrotizing fasciitis is a rare and life-threatening rapidly progressive soft tissue infection. A fulminant case could involve muscle and bone. Necrotizing fasciitis after corticosteroid therapy and intramuscular injection of non-steroidal anti-inflammatory drugs has been reported. We present a case of fulminant necrotizing fasciitis occurring in a patient who used a herbal concoction to treat a chronic leg ulcer. CASE PRESENTATION: A 20-year-old Ibo woman from Nigeria presented with a three-year history of recurrent chronic ulcer of the right leg. She started applying a herbal concoction to dress the wound two weeks prior to presentation. This resulted in rapidly progressive soft tissue necrosis that spread from the soft tissue to the bone, despite aggressive emergency debridement. As a result she underwent above-knee amputation. CONCLUSION: The herbal concoction used is toxic, and can initiate and exacerbate necrotizing fasciitis. Its use for wound dressing should be discouraged.

Soft tissue sarcoma of the thigh: need for angiography in the developing countries.

BACKGROUND: Soft tissue sarcomas (STS) are relatively rare tumors that are seldom seen in many surgical practices. In the developing countries, most patients present lately to the tertiary center either because of poverty, ignorance, or poor management by the primary health workers that first come into contact with these patients. METHODS: We bring you five patients with large STS thighs that were managed by unity between the years 2005 and 2007. RESULTS: Three of these patients are deceased, and one of the two surviving patients has amputation below the knee. The two surviving patients lost view after 3 months. CONCLUSION: Although angiography has been relegated to the background by the advent of modern techniques such as tomography imaging by computer (CT) and imaging by magnetic mirroring (IRM), in the developing countries angiography remains important as one pri-opiratoire of surgical guide in the thigh STS.

Management dilemma of a recurrent huge fibrosarcoma in a 25-year-old African: a case report.

INTRODUCTION: Soft tissue sarcomas are rare tumours that are infrequently seen in most surgical practices. They can occur in any anatomic region of the body. The size of a soft tissue sarcoma is an important prognostic variable and so affects the quality of tumour resection. CASE PRESENTATION: A 25-year-old Nigerian African presented with recurrent huge fibrosarcoma measuring about 55 x 40 x 10 cm at his posterior trunk. The patient's clinical condition was poor; the tumour seemed unresectable and the patient looked inoperable. He had an extensive excision of the tumour but could not afford adjuvant therapies. He was discharged home against medical advice but may succumb to metastases. CONCLUSION: Sarcomas in black people can present as extremely large masses; the dilemma in management is not only limited to the delay in presentation but also the poor socio-economic status of the patients and the frequent non-availability of supporting services. Treatment grants or subsidies from government may go a long way to ensuring that patients receive appropriate care.

Giant scrotal lymphedema of unclear etiology: a case report.

INTRODUCTION: Scrotal lymphedema is common in the tropics and subtropics. The giant variants can cause a lot of physical disability and psychological disturbances. CASE PRESENTATION: We present a 25-year-old Nigerian male with giant scrotal lymphedema with severe debilitating symptoms, immobility and emotional disturbance. He benefited from a modified Charles' procedure and reconstruction of the penile shaft using a split-thickness skin graft. CONCLUSION: Giant scrotal lymphedema related to poverty, ignorance and neglect, is amenable to surgery. Surgery provides a cosmetically acceptable and functionally satisfying outcome.

Ulnar Hemimelia with Oilgodactyly: Report of Two Cases.

We present two sporadic cases of complete ulnar hemimelia, a rare congenital defect. In one case, ulnar hemimelia was associated with tridactyly and elbow malrotation with radiohumeral synostosis; in the second case, ulnar hemimelia was assciated with mono-metacarpal bidactyly and anterior cubital webbing of the elbow with fixed flexion. To the best of our knowledge, there is dearth of information on these combinations of anomalies in the literature and their management remains a challenge.

Economic burden of drug use in patients with acute burns: experience in a developing country.

Background/Objective. Burn injury is a devastating injury. The economic drain on the patient's purse is equally devastating. Few studies have examined the cost of managing burn patients particularly the drug component. Methods. The financial implication of drug use in the management of 69 consecutive patients admitted by the burn unit over a period of two years was retrospectively analysed. Results. Thirty-six (52.2%) patients were males and 33 (47.8%) females with a mean age of 17.9 years (SD = 18.4). The patients spent an average sum of $91.21 to procure drugs; 84.3% of the costs were for antibiotics, 11.1% for analgesics, and 4.6% for others. Conclusion. Significant amount of money is spent on the procurement of drugs. Most of the money is spent on prescribed antibiotics. Measures that reduce antibiotics use in burn management might relief patients of the huge economic burden associated with its use.

Pattern of rhabdomyosarcoma in Nigerian children.

BACKGROUND: Soft-tissue sarcomas are uncommon tumors that are infrequently seen in most surgical practices. They represent 6.5% of all cancers in children < 15 years of age and are the fifth leading cause of cancer death in that age group. This study was conducted to show the prevalence and pattern of distribution of rhabdomyosarcoma among children in a black African population. METHODS: We retrospectively reviewed 232 cases of soft-tissue sarcomas that were managed for a period of 22 years (1985-2006). Materials were obtained from the clinical records, operation notes and histopathology reports of the patients. The records of patients with rhabdomyosarcoma were analyzed in details. RESULTS: The result showed the age peak incidence for the total soft-tissue sarcomas occurring between the third and sixth decades of life. Rhabdomyosarcoma constitutes 9.5% of the total number of patients managed, and 54.5% of these patients are age < 20 years. CONCLUSION: We conclude that parents must be educated about the need to look out for any mass on their children that persists for > 4 weeks so as to reduce the delayed and advanced stage of presentation.

Soft-tissue sarcoma in black Africans: pattern, distribution and management dilemma.

BACKGROUND: Soft-tissue sarcomas (STS) are a heterogeneous group of rare tumors that arise predominantly from the embryonic mesoderm. Currently, >70 different histologic types of STS have been identified. There is no identifiable etiology in most cases of STS even though a variety of predisposing or associated factors have been identified. The American Cancer Society estimated that approximately 8,680 new cases were expected to be diagnosed, and 3,660 deaths in the United States were a result of STS in 2004. This study shows the pattern, distribution and problems of STS in a black African population. METHODS: We retrospectively reviewed 209 patients that were managed for STS between the periods of January 1985 to December 2004. Materials for the study were obtained from the case notes as well as the histopathology reports of the patients. RESULTS: Two-hundred-nine patients were treated for STS during the 20-year study period. The peak incidence of age occurred between the third and sixth decades of life with a slightly male preponderance. Fibrosarcoma was the commonest STS, followed by malignant fibrous histocytoma, liposarcoma and rhabdomyosarcoma. Fibrosarcoma, malignant fibrous histocytoma and liposarcoma are more common in the extremities while leiomyosarcoma is more common in the intra-abdominal region. CONCLUSION: The treatment of STS is a multidisciplinary approach, and patients have benefited from multimodality treatment. In the western countries, STS most commonly present as asymptomatic masses with tumors in the distal extremities, often small in size when discovered. In our own environment, delayed and advanced stages of the disease are the rule. Modern imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRIJ and magnetic resonance angiography (MRA) are not commonly available-and where they are available, they are usually not affordable for the majority of our patients. We need to establish good interdisciplinary relationships among the managing physicians and educate our patients on early presentation to the hospital.