Predictors of recurrence of chronic subdural haematoma in a cohort study of patients presenting in a sub-Saharan African teaching hospital.

BACKGROUND: Chronic subdural haematoma (CSDH) is a common neurological condition affecting the elderly with decreased quality of life. Recurrence leads to increase in number of hospital admissions and surgical interventions. Several factors contribute to recurrence of chronic subdural haematoma, and determination of these factors will help institute measures to reduce recurrence of CSDH, cost of care and improved quality of life. The aim of this study was to determine the predictors of recurrence of chronic subdural haematoma in a cohort of patients presenting in a Sub-Saharan African Teaching Hospital. METHODS: A prospective hospital-based cohort study of 62 participants who presented with CSDH and underwent burr-hole and drainage at the Neuroscience unit of the Korle-bu Teaching Hospital. The primary outcome of this study was the recurrence of CSDH within 3 months after the surgery. Data was entered into Microsoft Excel 2016 and exported to International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Predictors of recurrence of CSDH were determined using logistic regression with odds ratio calculated at the 95% confidence level and a p-value less than 0.05 accepted as statistically significant. RESULTS: There was a male preponderance of 45 (72.6%), over females of 17 (27.4%). The mean age was 63.1 ± 13.6 years. The recurrence rate of CSDH was 21.0% whilst the mortality rate was 4.8%. Facial palsy and dysphasia were associated with the recurrence of CSDH (p = 0.045, 0.029). Hypertension and bilaterality were associated with recurrence of CSDH from a univariate analysis (p = 0.039, OR = 4.865, CI = 0.975-24.285; p = 0.005, OR = 5.979, CI = 1.585-22.557). In a multivariate logistic regression analysis, bilaterality was the only independent predictor of recurrence of CSDH (p = 0.030, AOR = 5.47, CI = 1.18-25.34). CONCLUSIONS: Both hypertension and bilaterality showed statistically significant association with recurrence of CSDH. However, only bilaterality proved to be an independent predictor of recurrence of CSDH in patient who underwent burr-hole and drainage.

Spontaneous extra-hepatic bile duct perforation postpartum.

Spontaneous bile duct perforation is an unusual cause of acute abdomen. It is an extremely rare condition and rarely suspected or correctly diagnosed pre-operatively. A case of a 29 year old adult female, presenting with peritonitis, 2 days post partum is presented. Exploratory laparotomy showed biliary peritonitis secondary to a perforated common bile duct. She had a cholecystectomy and closure of the perforation over a T-tube. She recovered well and was discharged home. Awareness of spontaneous common bile duct perforation as a rare cause of biliary peritonitis, avoids undue delay in the diagnosis and thus improve prognosis. Cholecystectomy and drainage of bile duct using a T-tube is emphasized.

Penetrating abdominal injuries in adults seen at two teaching hospitals in ghana.

BACKGROUND: The incidence of penetrating abdominal injuries (PAI) has increased in the West African sub-region. OBJECTIVE: To determine the pattern and management outcome of penetrating abdominal injuries (PAI) in the two main teaching hospitals in Ghana. STUDY DESIGN: A prospective and retrospective descriptive study. SETTING: Komfo Anokye Teaching Hospital (KATH), Kumasi and Korle-Bu Teaching Hospital (KBTH), Accra. METHODS: Relevant details of all adult patients admitted with penetrating abdominal injuries over a 11-year period were recorded at KATH and KBTH in Accra. The study in KATH was prospective pro forma based and that in the KBTH was a retrospective case review of all penetrating abdominal injuries. RESULTS: There were 411 patients, mostly men (M: F-8:1). The peak age of patients was 20-29 years, 164 patients (39.9%). Abdominal stab wound injuries accounted for 251 (61.1%). Three hundred and thirty - one patients (80.5%) had an emergency laparotomy. Twelve patients required 16 emergency thoracotomies. The small bowel (23.2%), stomach (12.9%), colon (10.2%), the liver (10.0%), were the most commonly injured organs. In 92 patients (29.0%) no significant intra-abdominal injury was detected at laparotomy CONCLUSION: Stab wounds are the main penetrating abdominal injuries seen mostly among young male adults in Ghana. Management was by a mandatory laparotomy after clinical assessment. The overall mortality was 4.4%. Selective non-operative management of abdominal stab wounds is possible.

Colorectal Carcinoma: an Update of Current Trends in Accra

BACKGROUND: Clinical experience and earlier studies indicate that the number of colorectal cancer cases seen annually in the Accra metropolis is increasing. OBJECTIVE: This study was aimed at providing a current update on colorectal cancer in Accra; Ghana. METHODS: A prospective study of confirmed cases of colorectal cancer diagnosed from January 1997 - December 2007. RESULTS: Three hundred and fifty-nine colorectal cancer cases were studied. Males were 192(53.5) and females 167(46.5) with an annual incidence of 32.6 new cases. The crude incidence rates were 12.53; 9.87 and 11.18 per 100;000 population for males; females and overall respectively. Rectal bleeding 185(51.1); abdominal mass 76(21.1); intestinal obstruction 62(17.3); intestinal perforation nine (2.5) and iron deficiency anaemia nine (2.5) cases were the main presentations. There were 168 (46.8) rectal and 191(53.2) colon tumours. Two hundred and thirty-one patients had laparotomy with 225 resections; and 128 patients for various reasons did not undergo surgery. The Astler Coller stages of the tumours at diagnosis were C2 84(36.7); C1 53(22.1); B2 49(21.4); D 17(7.4); B1 14(6.1) and A 12(5.1) cases. Adenocarcinoma was the commonest histological type 321(89.4); with the majority either well-differentiated (62.5) or moderately well-differentiated (25.6) carcinomas. Poorly differentiated carcinomas accounted for 28 cases (7.8). Post-operative mortality was 6.1. Long term survival could not be assessed as the majority of patients were lost to follow up. CONCLUSION: The incidence of colorectal cancer has increased over the last four decades in tandem with an aging population of Accra with adenocarcinoma as the predominant histological type

Gastro-duodenal peptic ulcer perforation.

OBJECTIVES: To determine the epidemiology of, and define the morbidity and mortality factors following emergency surgery for patients with perforated peptic ulcer disease in Accra, Ghana. DESIGN: A retrospective and prospective hospital-based study. SETTING: The general and paediatric surgical wards of the Korle-Bu Teaching Hospital. MAIN OUTCOME MEASURES: Demography, the systolic BP, pulse rate and haemoglobin on admission at ER, co-morbid conditions, site of perforation, surgical method and treatment outcome. SUBJECTS: A total of 326 cases treated for peptic ulcer perforation, 267 males and 59 females; ratio 4.5:1, with mean age of 40.9, SD 16.4 and range 4-87 years, were studied. RESULTS: The incidence of peptic ulcer perforation rose from 1.6% in 1998 to 5.3% in 2002 and stabilised at 5%, and overall accounted for 4.6% of acute abdomen. Co-morbid conditions were present in 48 (18.2%) of cases. Ulcerogenic substance intake was in 177 (67%) patients. One hundred and twenty two (46.2%) patients reported to hospital within 24 hours of perforation. There were 287 (88%) duodenal, 22 (7.1%) prepyloric, and 19(4.9%) type 1 gastric ulcer perforations. Simple closure with omental patch was performed in 299 (94.3%), truncal vagotomy and drainage in 10 (3.2%), and Billroth II partial gastrectomy in seven (2.2%). Post-operative complications occurred in 62 (19%); overall mortality was 36 (11%). Logistic regression analysis of the patients clinical variables showed that age less that 60 years (p-value, OR and 95% CI; 0.002, 3.964 and 1.668-9.420), duration of perforation of more than 24 hours before admission (p-value, OR and 95% CI; 0.011, 2.471 and 1.228-4.971), alcohol intake (p-value, OR and 95% CI; 0.009, 2.543 and 1.259-5.135) and resectional surgery (p-value, OR and 95% CI; 0.000, 8.25E and 74204908.138-9162648048.1) were statistically significant in determining postoperative complications. Age 60 years and above (p-value, OR and 95% CI; 0.018,4.359 and 1.284-14.802), alcohol intake (p-value, OR and 95% CI; 0.042, 3.238 and 1.046-10.021) and resectional surgery (p-value, OR and 95% CI; 0.000, 1.20E and 938112920.94-1.54E+ 11) were the factors that showed statistical significance in determining post-operative mortality. CONCLUSION: Perforated peptic ulcer disease is emerging as a frequent cause of acute abdomen in our centre and affects the youth commonly. Age 60 years and above, duration of perforation for more than 24 hours before admission, alcohol intake and resectional surgery were the variables that showed statistical significance in predicting post-operative morbidity and/or mortality.

Psychosocial aspects of breast cancer treatment in Accra, Ghana.

OBJECTIVES: To evaluate psychosocial influences and effects of breast cancer treatment. DESIGN: Cohort questionnaire survey. SETTING: Surgical Outpatient Department, Korle Bu Teaching Hospital (KBTH), Accra, Ghana. SUBJECTS: Women previously treated for breast cancer, including those still on hormonal therapy. MAIN OUTCOME MEASURES: Perception of quality of treatment and psychosocial support; and patients' felt needs for alternative treatment. RESULTS: Eighty nine women treated one to 22 years previously were interviewed. The majority (86%) had mastectomy. Chemotherapy was the most unpleasant aspect of treatment in 58 (65.2%), and 27 (30.3%) were not warned about complications of treatment. Thirty eight (42.7%) reported being afraid (frightened or terrified) at the diagnosis; other reactions were shock, devastation, weeping and depression. Twenty two (24.7%) received no counselling and 15 (18.5%) did not have opportunity to express their fears of death 55 (61.8%), mastectomy/deformity 27 (30.3%) and financial incapability 23 (25.8%). Forty four (49.4%) used alternate 'treatment', mainly prayer camps (25 cases) and herbs (22 cases), before and during hospital treatment. Use of alternate treatment led to delays in treatment in 23 women. They had complaints about the care they received: lack of sympathy and emotional support (16 cases), lack of information and communication (13 cases), lack of counselling (9 cases) and slow processes (8 cases). CONCLUSIONS: Many patients utilise prayer camps and herbs leading to delays in treatment. Breast cancer patients in Ghana (West Africa) are not receiving satisfactory emotional support, communication and counseling. Adequate psychosocial interventions need to be implemented.

Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana.

OBJECTIVES: To determine the optimum period for passive post-mastectomy drainage in Accra, Ghana, comparing early (day 4) to late (day 10) drain removal. DESIGN: Randomised prospective clinical study. SETTING: Surgical Department, Korle Bu Teaching Hospital, Accra, Ghana SUBJECTS: Patients with breast cancer scheduled for total mastectomy and level 11 axillary clearance. INTERVENTIONS: Patients were randomised to one of the two groups: early (day 4) and late (day 10) passive drainage. MAIN OUTCOME MEASURES: Duration of hospital stay, seroma formation and postoperative wound infection. RESULTS: Forty five patients had 4-day drainage and 42 had 10-day drainage. Late removal of drains (Day 10) was associated with a significantly higher drainage (1123ml) than those with early (4-day) drain removal (571 ml); p=0.0019. Late removal, however, had fewer seromas (28.6% vs. 46.7%; p=0.2), smaller aspirate volumes (435ml vs. 563ml) and fewer number of aspirations (2.1 vs. 3.2). Early removal had a shorter hospital stay of 6.2 (+/-1.52) days compared to 11.07 (+/- 0.76) days for late removal, and a lower wound infection rate (2.2% vs. 9.5%). There was a low incidence of seromas when drainage was <30 ml/day at the time of drain removal. CONCLUSIONS: Post-mastectomy passive drains may be removed when drainage is <30 ml in 24 hours. When there is a persistent large volume of axillary drainage, patients should be counselled about the relative risks of early and late drain removal. For patients who do not find seroma aspiration unacceptable, early (day 4) removal appears preferable to late (day 10) removal of drains.

Human pentastomiasis: a case report.

We report a case of human pentastomiasis in a 55-year-old farmer whose diagnosis was made incidentally during laparotomy on account of a mechanical small intestinal obstruction caused by adhesions. Encysted parasites and degenerative granulomas were found in the omentum and in the subserosal layer of the small intestine. These parasites were diagnosed as Armillifer armillatus larvae. The patient made an uneventful recovery after the operation and was discharged. He is being followed up.