Does preoperative chemical depilation make any difference in postoperative wound infection?

BACKGROUND: Preparation for surgery has traditionally included the removal of body hair from the intended surgical wound site. The effect of this practice on postoperative wound infection is yet to be fully elucidated. AIMS: This study sought to determine if preoperative chemical depilation reduces the risk of surgical site infection (SSI). METHODOLOGY: Two methods of preoperative hair removal: razor shaving and depilatory cream were compared. The eligible patients were randomized into two groups and the presence of postoperative wound infection was evaluated using the Southampton wound grading system. Data were analyzed using SPSS version 21 Chicago-Illinois, statistical significance was inferred at Pvalue ≤ 0.05. RESULTS: In total 100 patients were analyzed with 20 patients excluded due to co-morbidities and noncompletion of the study. The overall prevalence of SSI was 18.0% (7 (14.0%) and 11 (22.0%) in the depilatory cream and razor shaving groups, respectively). The difference in the rate of SSI was not statistically significant (P = 0.436). Hair was completely removed in 47 (94.0%) compared to 38 (76.0%) patients in the razor shaving group (P = 0.012) while skin injuries were noted in 21 (42.0%) vs 1 (2.0%) patients who had razor shaving and chemical depilation(P = <0.0001), respectively. CONCLUSION: There was no significant difference in SSI rates in patients that had preoperative chemical depilation when compared with razor shaving.

Sub-classification of Breast Masses by Fine Needle Aspiration Cytology.

OBJECTIVE: The aim of this study is to evaluate the accuracy of sub-classification of breast diseases using Fine Needle Aspiration cytology (FNAC). MATERIALS AND METHODS: A one-year prospective study of 180 consecutive patients with palpable breast lesions who underwent FNAC and subsequently open surgical biopsy for histological confirmation. FNAC was used to sub-classify breast lesions and then correlated with histological diagnosis. RESULTS: A total of 180 patients were enrolled into the study but only 110 patients with histology report were used for test validity. Seventeen (15.5%) smears were C1; while 46 (41.8%), 5 (4.5%), 4 (3.6%) and 38 (34.6%) were C2, C3, C4 and C5, respectively. FNAC achieved sensitivity of 90.0%, specificity of 95.5%, false positive rate of 5.3%, false negative rate of 8.7%, positive predictive value of 94.7%, negative predictive value of 91.3% and overall diagnostic accuracy of 92.9%. Only 86 (78.2%) of the 110 smears could be sub-classified into different disease conditions of the breast on cytology. FNAC accurately sub-classified 25(78.1%) of fibroadenoma and 28(87.5%) of invasive ductal carcinoma. CONCLUSION: FNAC can reasonably sub-classify fibroadenoma, invasive ductal carcinoma and mastitis but there is still a challenge with lobular carcinomas, metaplastic carcinomas, papillary carcinomas and fibrocystic changes.

MISSILE AND BLAST INJURIES IN NIGERIA - THE SOUTHEAST EXPERIENCE.

BACKGROUND: Missile injuries occupy a large segment of injuries treated in Southeast Nigeria, accounting for a significant proportion of morbidity and mortality. However, blast injuries are uncommon in this region. This study became necessary as a result of the rising spate of violence in various parts of Nigeria, particularly in the Northeast and in the Niger Delta regions, as well as the ever-present fear of kidnappers, armed robbers and occasionally, trigger-happy security agents. AIM: To determine the types of missile and blast injuries in Southeast region, the circumstances that led to them, the management of the patients, and the outcome. DESIGN OF THIS STUDY: This is a collaborative, retrospective multi-centre study. Setting: 1. Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. 2. Imo State University Teaching Hospital, Orlu, Imo State 3. Abia State University Teaching Hospital Aba, Abia State. 4. Federal Medical Centre, Owerri, Imo State. 5. University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, all in the Southeast of Nigeria. METHODOLOGY: Patients who were treated for missile or blast injuries in the last five years in each of the collaborating institutions were studied to determine the pattern of such injuries, causes, management options and outcome. RESULTS: Four thousand, two hundred and sixteen (4,216) patients were admitted with missile and blast injuries in the collaborating Institutions in a period of five years. Majority of the injuries (4,177{99.1%}) were from gunshots, mainly to the limbs. The 39 (0.9%) cases of blast injuries were from land mines, hand grenades, and the Biafran type of improvised explosive device, popularly known as "Ogbunigwe". Seven hundred and seventy-two (18.3%) of the patients signed against medical advice and went to traditional bone-setters. Of the remaining 3,444 patients, 3,432 (99.7%) had good outcome. However, there were a total of 12 (0.4%) deaths, four from fulminant sepsis; eight from unknown causes. CONCLUSION: Missile injuries account for a significant proportion of injuries treated in the Southeast of Nigeria; only a few were blast injuries. The outcome of management of the affected patients was satisfactory.

Fibroadenoma: Accuracy of clinical diagnosis in females aged 25 years or less.

BACKGROUND: Accurate clinical diagnosis of fibroadenoma in young females is desirable because of the possibility of nonoperative treatment for those desiring it. OBJECTIVES: To determine the accuracy of the clinical diagnosis of fibroadenoma in patients aged ≤ 25 years. PATIENTS AND METHODS: A prospective study of all patients with breast disease presenting to the breast clinic was conducted from January 2004 to December 2008. RESULTS: During the study period, 145 patients aged ≤25 years presented with breast lumps. In this group, a clinical diagnosis of fibroadenoma was made in 100 (69.0%), fibrocystic disease in 32 (22.1%), breast cancer in 4 (0.03%) patients, the remaining were benign lesions. Excision biopsy was done for 81 (55.9%) patients. Of these 81 patients, only 62 (76.5%) returned with histology report. The histological diagnosis was fibroadenoma in 45 (72.5%) patients with a mean age of 21.4 years. Their ages range from 18 to 25 years. The histological diagnosis was fibrocystic disease in 9 (14.5%) and malignant phyllodes in 1 (1.6%) patient. The remaining 7 (11.3%) patients had other types of benign lesions. For fibroadenoma, true positive cases were 42, false positive 7 and false negative 3, and true negative 10. Therefore, the sensitivity of clinical diagnosis of fibroadenoma was 93.3%, while specificity was 58.8%. CONCLUSION: The sensitivity of clinical diagnosis of fibroadenoma in patients aged ≤25 years was good, though specificity is low.

Primary papillary transitional cell carcinoma of the breast: a case report.

BACKGROUND: Primary papillary transitional cell carcinoma of the breast is a rare occurrence worldwide and few cases ever have been reported. It may be mistaken for the benign intraductal papillary lesions or papillary adnexal neoplasms. CASE REPORT: A 66 year old woman who presented with a recurrent right breast mass. Histopathologic studies confirmed a diagnosis of Primary Papillary Transitional cell carcinoma. CONCLUSION: The need for a high index of suspicion of primary papillary transitional cell carcinoma of the breast must be considered, especially in suspected benign intraductal papillary lesions to facilitate adequate and timely diagnosis and management of this lesion.

Urological injuries following gynecological operations--our experience in a teaching hospital in Nigeria.

BACKGROUND: Various grades of urological injuries occur following gynecological operations. Some are recognized during or after surgery but others pass unnoticed. AIMS AND OBJECTIVES: To study the urological injuries that follow gynecological operations in our centre. DESIGN: Retrospective study. SETTING: Nnamdi Azikiwe University Teaching Hospital, Nnewi Nigeria, a third generation tertiary institution serving rural, semi-urban, and urban communities. PATIENTS AND METHODS: Searching through the records, all the gynecological operations performed in our centre from 1st July 1998 to 30th June 2003 were reviewed. Those patients in whom there were documented evidences of urological injuries were noted. Similarly, all the urological injuries treated in our institution during the same period but resulting from gynecological operations carried out in peripheral hospitals were also noted. From the relevant medical records, the following data were extracted: type of gynecological operation, nature of urological injury, time when injury was detected, status of the surgeon, management modalities, and outcome. RESULTS: A total of 37 urological injuries occurred but, because of incomplete records in five, only 32 patients were included in this study. Ligation of the ureters following hysterectomy was the most common injury and occurred in 28 (87.5%) of the patients. CONCLUSIONS: Ureteric ligation is a common urological injury following gynecological operations in our centre.

Carcinoma of the gallbladder at the Nnamdi Azikiwe University Teaching Hospital--a 5-year retrospective study.

BACKGROUND: Carcinoma of the gallbladder is often missed because of the low index of suspicion. AIMS AND OBJECTIVES: To review the incidence, pattern and outcome of carcinoma of the gallbladder in our center and to highlight the need for early diagnosis. DESIGN: Retrospective survey of all cases of carcinoma of the gallbladder. SETTING: Nnamdi Azikiwe University Teaching Hospital serving rural, semi-urban and urban communities. PATIENTS AND METHODS: Patients who had histologically confirmed carcinoma in the general surgical units of the Nnamdi Azikiwe University Teaching Hospital over a 5-year period were reviewed and, from their case notes, the following information on sex, age, mode of presentation, time of diagnosis, stage of disease, treatment given and outcome were extracted. RESULTS: Twenty-one cases of gallbladder carcinoma were seen out of a total of 692 cases of different types of cancers seen in the general surgical units, giving an incidence of 3.04%. Six were males and 15 were females, age ranged between 39 and 72 years, a mean of 55; with the peak age in the 7th decade of life. Eleven patients (52.4%) presented with features of chronic cholecystitis and had cholecystectomy. Ten patients presented with obstructive jaundice in a stage too advanced for any form of palliative surgical treatment. The outcome was good in patients who presented with features of cholecystitis but who turned out to be cases of early carcinoma of the gallbladder because after five years of follow-up, none of them has shown any features of recurrence. There was no mortality in this group and the patients have remained in good health. However, the prognosis was poor in those patients who presented with obstructive jaundice. They remained very ill, with worsening general condition. They were discharged home on request of their relations and were lost to follow-up. CONCLUSIONS: Carcinoma of the gallbladder may present as cholecystitis. It is advisable for clinicians to have this in mind before, during and after cholecystectomy. Early presentation to hospital by patients would avert delay and improve early diagnosis, early treatment, and better outcome.