Effect of routine preoperative fasting on residual gastric volume and acid in patients undergoing myomectomy.

BACKGROUND: Preoperative fasting of patients aims to reduce the residual gastric volume (RGV). The magnitude of this reduction is yet to be ascertained in the Nigerian population. AIM: To compare the RGV and pH of patients fasted for 6-12 h with those allowed oral intake of fluid up to 2 h preoperatively. SUBJECTS AND METHODS: This randomized study involved 90 American Society of Anesthesiologists physical status I-II patients booked for abdominal myomectomy under general anesthesia. The patients were randomized into three groups. Preoperative fasting from midnight (Group F, n = 30) was fasted from midnight to the operation time. Carbohydrate-rich drink group (Group C, n = 30) received 800 mL of oral carbohydrate solution in the evening before surgery (22:00 h). An additional 400 mL was given 2 h before anesthesia. Placebo drink group (Group P, n = 30) received water in the same protocol as Group C. The Student's t-test was used to analyze RGV and pH postoperative satisfaction and postoperative nausea and vomiting (PONV) were compared on a visual analog scale. RESULTS: The RGV and pH were similar for all groups (P = 0.45 and 0.90, respectively). Antiemetic consumption and PONV scores were lower in Group C compared with Groups F and P (P = 0.01). Patients' in Group C had higher satisfaction (P < 0.001). CONCLUSION: Preoperative carbohydrate or water intake up to 2 h before surgery is safe with better satisfaction when compared to overnight fasting.

Challenges and outcome of cranial neuroendoscopic surgery in a resource constrained developing African country.

BACKGROUND: Cranial neuroendoscopy has been safely applied to the surgical treatment of different lesions of the brain in our center since its introduction in September 2009. This article summarizes our experience with neuroendoscopy, highlighting the salient challenges and outcome. METHODS: A single institution, retrospective analysis of prospectively acquired cases over a 2.5-year period (September 2010 to February 2013). Challenges experienced during the course of patient care as well as complications and outcomes were recorded and analyzed using SPSS (SPSS Inc. Chicago IL, USA) version 17. Tests of statistical significance were set at 95% level. RESULTS: Of the 291 cranial procedures performed during the study period, 37 (12.7%) were neuroendoscopic interventions. Patients were between the ages of 0.25 years and 25 years with a mean of 5.7 ± 1.5 years (95% confidence interval (CI)). Aqueductal stenosis was the most common indication for endoscopic intervention in 22 (59.5%) patients. Endoscopic third ventriculostomy was the most commonly performed neuroendoscopic procedure in 21 patients (56.7%). Major challenges experienced were patient dependent in 28 ± 1.0 patients (95% CL), learning curve related in 21 ± 0.4 patients, and poor endoscopy support infrastructure in 15 ± 0.5 patients. Complications were significantly more common in the first 6 months of neuroendoscopy (χ2= 7.57, df = 1, P< 0.05). Overall, 30 (81.1%) patients in our study experienced a positive outcome. The permanent morbidity and mortality rates in our series were 2.7% and 8.5%, respectively. CONCLUSION: Highlighted are the myriad obstacles which interface the successful set up of neuroendoscopy service especially in resource-constrained settings. Endoscopic procedures become safer with experience and complications reduce significantly after a steep learning curve.

Disorders of sex development in a developing country: perspectives and outcome of surgical management of 39 cases.

OBJECTIVE: Improvements in diagnostic testing and genital repair have significantly advanced the management of disorders of sex development (DSD). Challenges however, still exist in the management of DSD. This study evaluated the types, challenges of surgical management, and outcome of DSD in south-east Nigeria. METHODS: Retrospective analysis of 39 children with DSD managed from January 2005 to December 2013 at the University of Nigeria Teaching Hospital, Enugu, Nigeria. RESULTS: Types of DSD were: 46, XX DSD in 17 (43.6 %) cases; 46, XY DSD 16 (41 %); Ovotesticular DSD 5 (12.8 %); and one (2.6 %) 46, XY Ovotesticular DSD. Median age at definitive gender assignment was 3 years (range 2 months-14 years). Gender assignment was female for 20 (51.3 %; all 46, XX DSD, one each of 46, XY DSD, Ovotesticular DSD and 46, XY Ovotesticular DSD), and male for 19 (48.7 %; 15 of 46, XY DSD, 4 of Ovotesticular DSD). Eight cases reared as male before presentation required gender reassignment after evaluation and counselling. Genital repair was undertaken at mean age of 4.1 years (range 6 months-14 years). After average follow-up of 22.5 months (range 1 month-7 years), a total of eleven (28.2 %) developed procedure-related complications. Challenges were delayed diagnosis, inadequate diagnostic facilities, and need for gender reassignment. CONCLUSION: There is a wide spectrum of DSD in our setting. Time to diagnosis, evaluation, and outcome may be improved by public enlightenment initiative, focused education of healthcare personnel and provision of relevant diagnostic facilities through enhanced funding and collaboration.

The Efficacy of Chewing Gum on Postoperative Ileus Following Cesarean Section in Enugu; South East Nigeria: A Randomized Controlled Clinical Trial

Background: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI.Aim: The aim was to evaluate the efficacy of gum­chewing in reducing POI following caesarean section in Enugu.Materials and Methods: One hundred and eighty women booked for elective caesarean section were randomized into gum­chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus.Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student's t­test and Pearson Chi­square test and multiple linear regression were used for statistical analysis.Results: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls.P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side­effect was recorded.Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect.Conclusion: Gum­chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol

The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial.

BACKGROUND: Postoperative ileus (POI) is a common complication following caesarean section. It impairs patients comfort; delays wound healing and prolong duration of hospital stay. Several methods have been used in the management of this condition with varying efficacy. Chewing gum postoperatively is a recent concept in the western world being advocated as a cost effective and comfortable management of POI. AIM: The aim was to evaluate the efficacy of gum-chewing in reducing POI following caesarean section in Enugu. MATERIALS AND METHODS: One hundred and eighty women booked for elective caesarean section were randomized into gum-chewing group (n = 90) or control group (n = 90) The subjects chewed sugarless gum three times daily from 6 h postoperatively until the first passage of flatus. Each chewing session lasted 30 min. Elective cesarean section was carried out with a Pfannenstiel incision. Groups were compared primarily for time to first bowel sound, and first flatus. Secondary endpoints of comparison were time of operation to first defecation, and patient satisfaction concerning postoperative gum chewing. The Student's t-test and Pearson Chi-square test and multiple linear regression were used for statistical analysis. RESULTS: The groups were comparable in age, body mass index (BMI) and duration of surgery. The mean time to first bowel sounds (21.9 ± 8.0 vs. 26.1 ± 10.0), mean time to first flatus (24.8 ± 6.4 vs. 30.0 ± 10.0) and mean time to defecation (30.7 ± 5.9 vs. 40.0 ± 9.0) were significantly reduced in patients that chewed gum compared with controls. P =0.02, 0.01, and 0.01, respectively. Patients were satisfied with gum chewing and no side-effect was recorded. Previous surgery and duration of surgery were predictors on duration of POI, while age, BMI and parity had no effect. CONCLUSION: Gum-chewing has a beneficial effect on early return of bowel function following cesarean section and should be included in the postoperative management protocol.

Forced Expiratory Volume in 6 s (FEV6) and FEV1/FEV6 Values as a Viable Alternative for Forced Vital Capacity (FVC) and FEV1/FVC Values During Pregnancy in South East Nigeria: A Preliminary Study.

BACKGROUND: Forced expiratory volume in 6 s (FEV6) and FEV1/FEV6 ratio have traditionally been used as a surrogate for forced vital capacity (FVC) and FEV1/FVC in the assessment of spirometric lung function in nonpregnant subjects. However, the existence of this relationship during pregnancy is yet to be ascertained. AIM: The aim of this study was to determine if FEV6 and FEV1/FEV6 can effectively be used instead of FVC and FEV1/FVC in the interpretation of lung function test during pregnancy. SUBJECTS AND METHODS: This study was a descriptive cross-sectional study carried out among 200 pregnant women who were recruited by using systematic random sampling during the period between April and October 2011. One hundred matched nonpregnant women served as control. A standard spirometer was used to determine the FVC, FEV6, FEV1/FVC, and FEV1/FEV6. Data analysis was done using SPSS version 11.0 (Chicago, IL, USA). Values were recorded as mean (standard deviation), and also median and interquartile ranges. The one-way analysis of variance, Mann-Whitey U and the Kruskal-Wallis were used to test for significance where applicable. P <0.05 were considered to be significant. RESULTS: All the values were within normal range, but the FVC and FEV6 decreased significantly while the FEV1/FVC and FEV1/FEV6 increased as pregnancy progressed. However, for first and last trimester, FVC differed significantly from FEV6. The values of the FVC were comparable to the values of FEV6. The FEV1/FVC and FEV1/FEV6 ratio were similar and well above the 0.7 cutoff for obstructive lung diseases. CONCLUSION: FEV6 requires a short exhalation time and can effectively be used in place of FVC in evaluation of lung function test during pregnancy. The FEV1/FEV6 may be applied as a proxy for FEV1/FVC in pregnant and nonpregnant women.

Surgical challenges in the treatment of advanced cases of ameloblastoma in the developing world: The authors' experience.

Total mandibulectomy was carried out in 32 patients with extensive oro-facial lesions histologically diagnosed as ameloblastoma in four specialist centres in south-eastern Nigeria from January 2001 to December 2006. All the patients presented at an advanced stage with the whole mandible affected so the treatment of choice was total mandibulectomy. The patients gave informed consent for surgery. The standard surgical procedure was the same in all cases and was performed by the same surgeons. Of the 32 mandibles removed, there were 13 male (41%) and 19 female (59%) patients, giving a male-to-female ratio of 1:1.6. Three (9%) patients died due to problems relating to anaesthesia while five (16%) had postsurgical-related psychosomatic problems. Generally, the postoperative recovery was characterized by reduction in the quality of life of these patients because immediate jaw reconstruction was not feasible. This article highlights the challenges in the surgical management of advanced cases of ameloblastoma in the developing world and proposes a middle ground for professional interactions and exchange programmes among oral and maxillofacial surgeons across the world to assist poorer countries in the management of these advanced cases of oro-facial tumours.

Critical incidents during anesthesia in a developing country: A retrospective audit.

BACKGROUND: Critical incidents occur inadvertently where ever humans work. Reporting these incidents and near misses is important in learning and prevention of future mishaps. The aim of our study was to identify the incidence, outcome and potential risk factors leading to critical incidents during anaesthesia in a tertiary care teaching hospital and attempt to suggest preventive strategies that will improve patient care. MATERIALS AND METHODS: A retrospective audit of all anaesthesia charts for documented critical incidents over a 12 month period was carried out. Age and ASA classification of patient, urgency of surgery, timing of the incident, body system involved and the grade of the anaesthetists were noted. The data collected was analysed using the SPSS software. RESULTS: Fourteen incidents were documented in 54 patients, giving a frequency of 0.071. More females suffered critical incidents. Patients in the 4(th) and 5(th) decades of life were noted to be more susceptible. Airway and cardiovascular incidents were the commonest. Anaesthetists with less than 6 years experience were involved in more mishaps. CONCLUSION: We conclude that airway mishaps and cardiovascular instability were the commonest incidents especially in the hands of junior anaesthetists.

Giant Seminoma following ipsilateral orchidectomy: a rare finding. Case report.

Giant intrascrotal recurrent seminomas are rare in the surgical literature, probably due to widespread information about self-detection. A recent European study has reported a reduction in the primary tumour size at presentation. These findings are at variance with the situation in sub-Saharan Africa. We present a 32-year-old patient who presented with an 8-month history of progressive, painless left hemiscrotal swelling, no lower urinary tract symptoms and no evidence of metastatic disease. The patient had undergone a left inguinal orchidectomy 2 years prior to the onset of the current swelling, on account of a suspected testicular tumour. Histology was, however, returned as 'sections of testis showing haemorrhagic necrosis with areas of fibrosis. No malignancy seen. Diagnosis consistent with long standing torsion'. The patient had excision of the mass via an inguinoscrotal incision, with primary wound closure and drainage, and had good post-operative recovery. Histopathology subsequently reported seminoma. We discuss a rare case of giant intrascrotal recurrent seminoma in a young African patient and comment on the surprising absence of metastatic symptoms and the management in the absence of new imaging techniques. We emphasize the value of extirpation in such cases and the need for thorough sectioning of histopathological specimens. We also note that seminoma should be considered in the differential diagnosis of scrotal swelling even in the absence of the testes (after orchidectomy).