Post-operative surgical-site infection from skin bleaching: a case report.

BACKGROUND: Prolonged application of steroid containing cream can pose a serious challenge to users. Apart from making the skin lighter it creates a spectrum of diseases in those that use them as the adrenal glands are suppressed and are unable to secrete more steroids when required. OBJECTIVE: The objective is to report on a patient who presented with severe sepsis after a long period of application of steroids to the skin. METHODS: A patient who has applied steroids to the skin over a prolonged period was followed up during treatment to ascertain the complications that the patient sustained during the period of treatment. CONCLUSION: The patient was found to have developed a pelvic induration without abscess. She also had a large anterior abdominal wall abscess superficial to the external oblique muscle extending towards the left flank.

Profile of breast diseases at a self-referral clinic in Ghana.

BACKGROUND: Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. OBJECTIVE: To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. METHODS: A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. RESULTS: Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses were: Normal breasts 192 (27.7%), mastalgia 135 (18.1%), fibroadenosis 114 (15.2%), fibroadenomas 84 (11.2%), breast cancer 58 (7.8%), suspected breast cancer 25 (3.3%), galactorrhea 9 (1.2%), mastitis 8 (1.1%), musculoskeletal pain 8 (1.1%), duct ectasia 8 (1.1%), mondor's disease 7 (0.94%) and recurrent breast cancer 6 (0.8%). In patients with breast cancer, 42 (66%) had advanced disease, 6 (9.4%) had recurrent disease and 4 (63%) had metastatic disease. CONCLUSION: The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.

Surgically correctable adrenal-dependent hypertension: a report of five cases.

SummaryAlthough endocrine causes of secondary hypertension are relatively uncommon, medical practitioners must maintain a high index of suspicion for them in certain categories of patients. Such patients include young individuals, those with difficult-to-treat hypertension and those presenting with symptoms, clinical signs and/or laboratory parameters well-known to be associated with Cushing's syndrome, Conn's syndrome or phaeochromocytoma.This paper reports on 5 patients identified over a 2-year period with various hormonally-active adrenal adenomas causing hypertension in an environment where, hitherto, the occurrence of these conditions was generally thought to be rare. Aspects of the patients' histories, examination and laboratory findings that drew attention to the possibility of the diagnosis in each case are highlighted, as are the confirmatory investigations and management methods used by a multidisciplinary team of medical practitioners. The clinical outcome with appropriate treatment of adrenal-related hypertension is good and can result in significant cost savings in the long term.

Upper gastrointestinal endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana

Objectives: To study the indications for endo-scopy, the endoscopic diagnosis and other lessons learnt.. Methods: A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results: A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 + 0.5 and females 43.7 + 0.6 years. Epi-gastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duo-denal ulcer (19.6%), acute gastritis (12.7%), duo-denitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion: The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ul-cer is usually associated with H. pylori infection and is the commonest cause of upper gastrointesti-nal bleeding

Deep venous thrombosis of the lower limb in young ambulant Ghanaians

Background: Deep venous thrombosis (DVT) usually affects patients who are over 40 years old; obese; bed ridden or have had major operations or have hypercoagulable states. Healthy and ambu-lant young people are usually not affected.Objectives: To report the observation of DVT in young patients below the age of 40 yearsMethods: A study of all healthy and ambulatory patients below the age of forty years with a diag-nosis of DVT seen on one surgical unit at the Korle Bu Teaching Hospital; Accra was performed from 1st January 2000 to 30th June 2003.Results: Eleven patients; eight (8) females and three (3) males aged between 20 and 40 years with a median age of 32 years were treated. All the pa-tients had deep venous thrombosis of the lower limb confirmed with Doppler studies and duplex scan of the lower limb. Swollen lower limb was the commonest presenting symptom and sign. Pro-longed sitting was the main factor in 9 out of eleven patients.Conclusions: Deep venous thrombosis may not be a rare condition in the young ambulant Ghanaian and may be related mainly to a sedentary life style. Diagnosis should be suspected in patients who present with unilateral swollen and oedematous leg. There is the need to study the ailment in greater detail

Extensive groin and perineal hidradenitis suppurativa complicated by high fistula in ano

Anal fistula is a common cause of perianal sepsis in surgical practice. We share our experience in the management of a high fistula in ano caused by hidradenitis suppurativa an uncommon condition in Ghana

Peripheral Vascular Injuries and their Management in Accra

Background: The true incidence of vascular injuries in Ghana is not known on account of low reporting. Objective: We performed a study aimed at reviewing the pattern of injuries to peripheral vessels; and also the pattern of referral; presentation and management of these injuries at the Korle-Bu Teaching Hospital; Accra. Method: The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion. Results: Fifty two (52) patients with aged between 13- 50 years were reviewed. Penetrating trauma (82.7) and blunt trauma (11.5) were the commonest modes of injury. Arterial injuries (63.5) and combined arterial and venous injuries (23.1) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25 of patients most of whom also had brachial artery injuries. Late presentations of false aneurysms and arteriovenous fistulae were seen in 40.4patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0 of patients. Vascular reconstruction was successful in 84.6patients and 7.7of patients required major limb amputation and an equal number of patients died from other injuries. Conclusion: There is undue delay in referring patientswith vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations; which are usually expensive

Anal pain secondary to swallowed bone.

SummarySwallowed foreign bodies can be a source of morbidity or rarely mortality since they can impact in the pharynx and the oesophagus and cause discomfort or even perforate to cause mediastinitis. Most (80% to 90%)1 foreign bodies including swallowed bone pass into the stomach, proceed through the intestines and are passed in stool without problems. Swallowed bone has been documented to cause intestinal perforation2, enterovesical fistula3 and perianal abscesses4. Two cases of swallowed bones, which passed through the alimentary tract to finally cause anal pain and anal fistula, are presented. Doctors should be aware of the possibility of sharp objects being the cause of anal pain and must therefore be careful when performing digital rectal examinations to prevent injuries from these foreign objects.