Prolonged complete response after neoadjuvant capecitabine-gemcitabine for a locally advanced pancreatic adenocarcinoma: A case report.

Background: Pancreatic duct adenocarcinoma is increasing in incidence without appreciable decrease in overall survival despite decades of heightened research. Its mortality rate approaches its incidence rate. We report a case of carcinoma of the pancreas that had complete response from adjuvant chemotherapy. Case Presentation: A 39-year old male radiographer presented with a 3-month history of progressively worsening epigastric pain radiating to the back, associated with history of weight loss, anorexia, and jaundice. Abdominal CT scan showed a mass in the head of pancreas. A Whipple's operation was planned for the patient. However, intraoperatively, the head and body of the pancreas were found to have been taken over by the tumor, which encased the portal vein as well. Multiple core needle biopsies of the pancreas were taken. Cholecystojejunostomy, gastrojejunostomy, and jejunojejunostomy were then done. Histopathologic analysis of the specimen revealed a well-differentiated adenocarcinoma of the pancreas. He was commenced on 28-day cycle of gemcitabine 1000 mg/m2 on Days 1, 8, and 15 plus capecitabine 830 mg/m2 on Days 1-14. Repeat CT scan done after the 4th cycle showed no residual tumor in the pancreas. He has been in good health after 36 months follow-up, having received eight cycles of chemotherapy. He was counseled on resection of the pancreas, but he declined. Conclusion: Complete radiologic response may rarely occur after adjuvant chemotherapy for locally advanced adenocarcinoma of the pancreas. This does not, however, imply a cure of the disease.

Spontaneous Partial Percutaneous Extrusion of Swallowed Metallic long Spoon: A Case Report.

Foreign body ingestion is a commonly encountered clinical challenge. Most of these objects pass spontaneously, but long objects could be retained leading to uncommon complications. There seem to be no record of percutaneous extrusion of ingested spoon in literature. We report a case of 20 year old lady who swallowed a long metallic spoon. It got retained in the stomach for a month without obstructive symptoms, until the tail end of it eroded onto the skin. It was retrieved through an open gastrotomy. Patient had an uneventful postoperative recovery. Clinicians should be mindful that ingested large foreign bodies may be delayed in presentation. Whereas our index patient had open surgery, minimally invasive retrieval approaches could be considered when comparable cases are encountered.

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.

Ulcerative Colitis Prone to Delayed Diagnosis in a Nigerian Population: Case Series.

Inflammatory bowel disease is an emerging disease burden in the developing world. In Nigeria there is a persisting perception among physicians that it is a very rare disease, and publications on it are sparse. Early manifestations of ulcerative colitis (UC) are therefore likely to be missed at many health institutions. This publication aims to contribute to the growing literature on UC among Nigerians. We present 3 cases of UC that were diagnosed at very late stages. It took a range of 2-7 years for the diagnosis to be made from onset of symptoms. UC was confirmed in the first patient after bowel resection for massive gastrointestinal haemorrhage. The other two had colonoscopy and biopsy for confirmation. An increased awareness about UC is necessary in Nigerian population, because the condition may be commoner than hitherto thought. Provision of colonoscopy services to a wider population will assist in early discovery of this disease.

Isolated gallbladder perforation following blunt abdominal trauma: a missed diagnosis.

This is a case of a 21-year-old man who presented with history of abdominal pain following blunt abdominal trauma. Although the initial ultrasound scan showed mild free peritoneal fluid, the patient was managed conservatively as a probable case of splenic injury and was discharged in satisfactory condition after 6 days of admission. He presented again 7 days later with recurring epigastric pain and had exploratory laparotomy on the presumptive diagnosis of peritonitis, probably due to peptic ulcer perforation. Intraoperatively, he was then discovered to have an isolated gallbladder perforation. This is a rare condition in which the diagnosis is often delayed or missed as was the case in our patient. To the best of our knowledge, this is the first reported case of isolated gallbladder perforation in Nigeria, and it behooves the clinician to be aware of the likelihood of this condition in patients with blunt abdominal injury.

Malaria Infection among Blood Donors in Onitsha Urban; Southeast Nigeria

Blood safety is a major issue of global concern in transfusion medicine especially in developing countries; where national blood transfusion policies and services as well as financial resources are lacking or inadequate. Transfusion-transmitted malaria is a potential health hazard but is often neglected in many malarious areas. Malaria infection among blood donors in Onitsha urban; Southeast Nigeria was studied between August and October 2008. Venous blood of donors was screened for malaria parasites using Giemsa-stained thick and thin blood films. The ABO and Rhesus phenotypes were classified using a haemaglutination standard test and demographic data of donors documented. Of the 410 blood donors analysed; 304 (74.1) were infected. Plasmodium falciparium was identified in all positive cases and mixed infection with P. malariae was seen in 5(1.6) cases. Infection significantly varied with age and not with sex and occupation (p0.05). People with blood group O+ showed significantly higher rate of infection (p0.05). Since there is scarcity of voluntary donors in Nigeria; donor deferral done in non-malarial endemic regions cannot be practiced in Nigeria. The high prevalence of asymptomatic malaria in this area; suggests the need for careful screening of blood samples for malaria parasites. Positive samples should be indicated on the blood packs and transfusion of malaria positive blood requires the administration of curative dose of antimalarials to the patient. Commercial donors should be freely given mosquito treated bed nets and be encouraged to sleep under them

Parasites associated with sachet drinking water (Pure Water) in Awka; South-Eastern; Nigeria

A study to ascertain the parasites associated with sachet drinking water, (popularly called "Pure Water" in Nigeria), in Awka, capital of Anambra State, southeast Nigeria was conducted. This was in order to determine the safety and suitability of such water for human consumption. Sachet water is a major source of drinking water for low and middle class Nigerians. The increase in demand of this water has led to the proliferation of industries in this sector, because of the economic benefits derivable from the sale. Samples of differently packaged sachet drinking water were purchased from producers, distributors, marketers and hawkers. Samples were observed macroscopically and pH tested. Using a sterile syringe, 10mls of water was taken from each sample and centrifuged at 2,500rpm per minute. Sediments observed were placed on a glass slide and observed microscopically using x10 and x40 objective lens for a possible parasite ova or cyst. The surface of each sachet of the packaged drinking water was also washed thoroughly and the resulting water was centrifuged and observed microscopically. All the tested water samples met the W.H.O. recommended standard, of being colorless, tasteless, odourless with average pH of 6.93. No parasites were found in the water in the sachets but some parasites were found on the surfaces of the sachets. The surface of the sachets of the packaged water purchased from hawkers had the highest number of parasites {15 (41.7%)}. Identified parasites include cysts of Ascaris lumbricoides (5.6%), Entamoeba histolytica (4.6%), hookworm (2.8), Trichuris trichuria (2.8%) and Giardia lamblia cysts (1.9%). Hawkers possibly play a very significant role (χ2 = 20.21, df =2, p<0.05) in the transmission of parasitic infection from the outside of the sachets through improper handling. It is advocated among others that cleaning and washing of sachets of packaged drinking water before use will aid in breaking the transmission circle

Tube thoracostomy in the management of pleural fluid collections.

OBJECTIVE: To determine the demographic pattern, indications and complications associated with tube thoracostomy in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. PATIENTS AND METHODS: A 5-year review of case records of patients who underwent tube thoracostomy at NAUTH Nnewi between January 1999 and December 2003. Demographic data, clinical features, duration of drainage, complications and outcomes were analyzed. RESULTS: A total of 65 cases were studied, male: female ratio was 2.4:1. Eighteen patients (27.7%) were below 10 years of age. Infective cases accounted for 63.1% (41) of the cases that had tube thoracostomy. Forty-one patients (63.1%) had tube drainage for 10 days or less. Complication rate was 41.5% (27), mostly mild, with dislodgement of the tube accounting for about half. Failure rate of 13.7% (9) was recorded for the procedure. A mortality of 6.2% (4) was recorded but there was no procedure related death. Seven patients (10.8%) required further surgery. CONCLUSION: Tube thoracostomy is a simple and efficacious procedure for the treatment of pleural space collections. The safety of the procedure can be improved upon by adequate training in the insertion procedure, while proper selection of cases will reduce failure rate and unnecessary morbidity. Early resort to thoracoscopic or open surgery when tube thoracostomy is considered inappropriate or has failed will improve the success rate in the overall management of pleural fluid collections.

Use of prophylactic antibiotics in a paediatric day-case surgery at NAUTH, Nnewi, Nigeria: a randomized double-blinded study.

This was a randomized double-blinded study to assess the need for prophylactic antibiotics in paediatric day-case surgery, as well as the cost implication. Group A received preoperative intravenous ampiclox and vitamin B complex in doses appropriate for weight and age, while group B received only vitamin B complex as a placebo. The study was completed by 138 (95.2%) patients in group A, and by 140 (97.2%) patients in group B. Wound infection was seen in seven (5%) patients in group A and six (4.3%) patients in group B. The average cost of hernia repair in group A was US 43 dollars and US 31.1 dollars in group B.

Skin closure after groin hernia repair in children : a comparative study of three suture materials and two suture techniques

Objective The surgical scar is of great importance both to the patient and surgeon. For the patient an ugly scar may not only present a cosmetic problem but in some cases it may also impair function; and the surgeon is always confronted with the problem of possible litigation. This study was undertaken to evaluate the effect of different suture materials and skin suture techniques on surgical scars. Patients and Methods Three suture materials (chromic catgut 3/0; silk 3/0 and nylon 3/0) and two skin closure techniques (transcutaneous interrupted mattress and subcuticular continuous running sutures) were compared in a randomized partially blinded fashion using a groin skin crease incision. The resulting scars were graded after two years using a conceived three-level scale. Results Subcuticular nylon sutures gave the best cosmetic results followed by subcuticular chromic catgut. Transcutaneous interrupted mattress silk sutures left the worst scars followed by subcuticular continuous running silk sutures. Conclusion The use of suture materials for skin closure is still the norm in developing countries. We therefore suggest that for any particular suture material; the subcuticular continuous running technique should be used and whenever possible the suture material of choice should be nylon

Paediatric day-case surgery at NAUTH, Nnewi, Nigeria.

Day-care surgery is strongly advocated in well-selected paediatric cases when the complications are within acceptable limits because it is very cost effective.

Paediatric urological trauma at Nwewi; South Eastern Nigeria : a two-year experience

Objectives: To evaluate the factors implicated in paediatric urologic trauma at Nnamdi Azikiwe University Teaching Hospital (NAUTH); Nnewi; and to determine how these factors could influence the management. Patients and Methods: All medical cases of paediatric urological trauma managed at NAUTH between January 1st; 2000 and December 31st; 2001 were analyzed retrospectively on the basis of the patient records. The patient group included neonates up to children aged 15 years. Apart from the biodata; the cause of the trauma; the organ(s) injured; the treatment given and its outcome were critically analyzed. Results: In the two years under review; 257 cases of paediatric trauma were managed. Out of these; urological trauma was found in 18 patients (7) with a male/female ratio of 5:1 (15 males and 3 females). The commonest causes of paediatric urological trauma in our environment were found to be circumcision mishaps followed by road traffic accidents (RTA) caused by commercial motorcyclists. Treatment was mainly surgical. There was no mortality but we recorded morbidity in four cases (22.2). Conclusion: Our study shows that most of our paediatric urological trauma is preventable. We conclude that paediatric urological trauma in our environment would be drastically reduced if there were laws stipulating that circumcisions should only be done by qualified personnel and if the existing traffic laws of the country were strictly enforced