Review of obstetrics genito-urinary fistulae in the University of Calabar Teaching Hospital Calabar, Nigeria.

BACKGROUND: Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. AIMS AND OBJECTIVES: To study the demographic and reproductive profiles as well as management of patients with obstetric fistulae in UCTH, Calabar, Nigeria. PATIENTS AND METHOD: A five-year retrospective study of case records of 37 patients managed in Maternity Annex of University of Calabar Teaching Hospital, Calabar Nigeria for obstetric genito-urinary fistulae was carried out. RESULTS: One in every 122 parturients during the period had fistula. Eleven (29.7%) were teenagers. Many patients were married (54.1%), nulliparous (59.4%), come from low socioeconomic class (72.9%) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4%) and 70.2% presented with total incontinence of urine. Eighteen (48.7%) were diagnosed within 6 month of delivery. The main types encountered included were vesico-vaginal (34.4%) or complex (10.8%) fistulae who were manage conservatively (21.6%) or with bladder repairs. Majority (29.7%) were referred for further treatment. CONCLUSION: Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention.

Review of Obstetrics Genito-urinary Fistulae in the University of Calabar Teaching Hospital Calabar; Nigeria

Obstetric fistulae with Urinary incontinence are one of the most distressing maternal morbidities. It is associated with physical and social deprivation such as wife abandonment and violent reactions against the victims particularly in the developing countries of the world. To study the demographic and reproductive profiles as well as management of patientswith obstetric fistulae inUCTH;Calabar;Nigeria. Afiver-year retrospective study of case records of 37 patients managed inMaternity Annex of University of Calabar Teaching Hospital; Calabar Nigeria for obstetric genito-urinary fistulae was carried out. One in every 122 parturients during the period had fistula. Eleven (29.7) were teenagers. Many patients weremarried (54.1); nulliparous (59.4); come from low socioeconomic class (72.9) and did not utilize modern obstetric facilities properly. Many cases resulted from prolonged obstructed labour (51.4) and 70.2presented with total incontinence of urine. Eighteen (48.7)were diagnosed within 6 month of delivery. Themain types encountered includedwere vesico-vaginal (34.4) or complex (10.8) fistulaewho were manage conservatively (21.6) or with bladder repairs. Majority (29.7) were referred for further treatment. Parturient in Calabar still suffer from this age long obstetric morbidity mainly due to poor utilization of modern obstetric care facilities. Results of treatment are largely unsatisfactory; therefore resources should be channeled towards prevention

Hinged Transpubic Approach to Delayed Repair of Posterior Urethral Distraction Defects Complicating Pelvic Fractures - Preliminary Experience

Objective: To present our experience with a transpubic approach to the management of one of the most challenging injuries of the lower urinary tract. Patients and Methods: Between January 2003 and December 2005; 7 patients presenting to our unit with complex urethral distraction defects due to type 2 or 3 posterior urethral disruption injuries complicating pelvic fracture were included in an ongoing evaluation of the transpubic approach to the repair of such defects. The patients had a mean age of 37.7 (range 22 - 56) years and were followed up for 1 - 4 years. Results: After the follow-up period 4 patients had a very successful outcome with trouble-free voiding. Three developed stric-tures; two of which were successfully managed with regular dilatation; while the third patient became catheter-dependent following dilatation and inadvertent creation of a false passage. This patient underwent a successful re-operation with full recovery. Conclusion: The transpubic approach to delayed repair of urethral distraction defects complicating pelvic fracture is feasible. It allows an effective dissection of the dense hematoma-fibrosis that commonly complicates these injuries at a later stage. The approach is particularly useful in complex long-standing defects where such dissection is made relatively easy by the ample working space provided. The successful outcome of treatment by this approach in 4 and ultimately 5 out of 7 patients offers a reasonable degree of salvage for patients with an otherwise poor prognosis. Further studies are warranted to confirm our positive results

Management Of Urethral Strictures In The UCTH Calabar.

Forty-five consecutive cases of urethral stricture seen in a single unit over a three-year period (May 2000-April 2003) were studied to determine mode of presentation, symptoms on presentation, cause of the stricture, course of the illness and the outcome of treatment. Thirty-nine patients were treated while 6 were lost to follow up before definitive therapy could be given. Most of the patients were adult males in their prime of life. Strictures were as a result of urethritis in 24 (53.3%) cases, trauma in 16 (35.6%) cases, indwelling catheter in 3 (6.6%) cases and of uncertain aetiology in 2 (4.4%) cases. Three of the post-traumatic cases were post prostatectomy. Definitive treatment was by urethroplasty in 28 (62.2%) patients, bouginage in 11 (24.4%) patients.. Results of treatment were classified as 'GOOD' or 'POOR' based on patients' judgement of improved flow, observed improvement of flow and comparison of urethrogram results, before and after treatment. Of the 28 patients treated by urethroplasty, 21 (75%) had 'GOOD' outcome while in 7 patients (25%) the outcome was 'POOR'. In the bouginage group, outcome was 'GOOD' in 63.6% (7/11) of patients, 'POOR' in 27.3% (3/11), while one patient died from septic complications. It is concluded that urethroplasty gives overall, better results in management of strictures, but dilatation remains a viable option in carefully selected cases and that urethritis is still a foremost aetiological factor for urethral strictures in Calabar.

MICA, HLA-B haplotypic variation in five population groups of sub-Saharan African ancestry.

The human major histocompatibility complex (MHC) class I chain-related gene A (MICA), located 46 kb centromeric to HLA-B, encodes a stress-inducible protein, which is a ligand for the NKG2D receptor. In addition to its primary role in immune surveillance, data suggest that MICA is involved in the immune response to transplants and in susceptibility to some diseases. In this study, 152 subjects from the Yoruba (n=74), Efik (n=32), and Igbo (n=46) tribes of southern Nigeria, 39 nationwide African-American stem cell donors, and 60 African-American individuals residing in the metropolitan Boston area were studied for MICA, HLA-B allelic variation, haplotypic diversity, and linkage disequilibrium (LD). MICA and HLA-B exhibited a high degree of genetic diversity among the populations studied. In particular, MICA allele and HLA-B-MICA haplotype frequencies and LD in the Efik and Igbo tribes were significantly different from the other study groups. HLA-B and MICA loci demonstrated significant global LD in all five populations (P-values &<0.00001). LD also varied in a haplotype-specific manner. A novel MICA allele was detected in the Boston population. These findings are important from an anthropologic perspective, and will inform future HLA-linked disease association studies in related ethnic groups of African-derived ancestry.

Surgical management of large bowel cancer 1983-1988, University of Calabar Teaching Hospital audit.

Thirty one consecutive patients with histologically confirmed colorectal carcinoma were treated at the University of Calabar Teaching Hospital (UCTH), Calabar between January 1983 and December 1988 inclusive. On presentation the disease was advanced in 15 patients, and in 13 of these it was complicated by obstruction (10), fistulation (two), and penetration (three). In the colonic group, curative resection was feasible in eight (66,7 pc) as opposed to 10(52,6 pc) in the rectal group. Overall resectability and operative mortality rates were 58 pc and 10 pc respectively. Definitive surgery was not feasible in, or refused by a total of nine (24 pc) patients because of poverty (four), religious objection to blood transfusion (one), fear of colostomy (three) and for very advanced disease (one). We consider that public education on the disease, colostomy and its management as well as a greater striving to perform restorative operations on suitably selected cases of rectal carcinoma could improve our results in the surgical management of the disease.

Hyperpyrexia in spinal injury patients.

We studied 13 spinal injury patients who had hyperpyrexia during an 18 month period (September 1984-March 1986) to discover if differences existed in the core temperature of patients with tetraplegia and those with paraplegia, and the contribution of these differences to the final outcome. Children were excluded from this study as well as patients with any sign of infection on first admission, patients with multiple injuries, and those referred from peripheral hospitals more than one week after injury. Patients with tetraplegia (C3-C7) had persistently high and uncontrollable core temperatures (average 39.5 degrees C) while those with paraplegia (T4-L5) showed lower core temperatures which were still high (average 38.1 degrees C). The difference in the average high core temperature (1.4 degrees C) is statistically significant. The lowest average core temperatures were about the same in tetraplegics and paraplegics (just over 35 degrees C). Four patients died: 3 tetraplegics and one paraplegic. Antipyretic analgesics were ineffective in reducing the high core temperatures.

Emergency large-bowel surgery in a tropical environment: approach and outcome.

In 87 of 90 consecutive patients aged between 24 hours and 72 years operated upon for large bowel emergencies, 79.3% were for acute obstruction and 20.7% for perforation. Following a management policy of safety first, 46 (52.9%) patients had primary colonic resection with 25 (54.3%) of these primarily anastomosed (treatment group I), and 21 (45.7%) exteriorized (treatment group II). Twenty one (24.1%) patients with simple obstruction had reduction (treatment group III) and 27 others (31.0%) had colostomy alone after laparotomy (treatment group IV). In treatment group I, the mean hospital stay was 21 days, and the clinical leak rate was 8%. The mean hospital stay for treatment groups II-IV were, respectively, 36, 13, 69 days. There were nine (10%) deaths in hospital, six (6.9%) of these postoperatively, 11 (12.6%) septic complications and three (3.4%) wound failures in the series. The hazards of large bowel surgical emergencies can usually be minimised by primary resection, anastomotic integrity, avoidance of primary anastomosis or closure of laceration when hazardous and a judicious use of systemic and topical antibiotics in a well resuscitated patient.

Irreducible dislocation of the metacarpophalangeal joint of the thumb due to tendon interposition.

Two cases of irreducible dorsal dislocation of the metacarpophalangeal joint of the thumb are reported. In both cases, there was interposition of the tendon of flexor pollicis longus. Open reduction was required to achieve successful reduction.

Cement burns of the heels.

Two artisans working on machinery sustained thermal burns (9 per cent and 5 per cent, respectively) of both heels and lower legs from hot cement powder. The burned areas took 4-6 weeks to heal following intensive treatment and the workers only returned to work after 10 weeks.