Comparative analysis of urethral catheterization versus suprapubic cystostomy in management of neurogenic bladder in spinal injured patients.

BACKGROUND: The objective of this study was, to prospectively and retro respectively evaluate urethral catheterization (UC) versus supra-pubic cystostomy (SPC) in prevention of urinary tract infection (UTI) in patients with spinal cord injury lesion. METHODS: A total of 125 patients with neurogenic bladder and a mean age of 30 years had UC (n=80) and SPC (n=40) at the Jos University Teaching Hospital (JUTH) between January 1984 and June 2005. RESULTS: Episodes of UTI were significantly more; UC 65% versus 14% forS PC (P< O 0 5). Urinary tract infection occurred relatively late in the course of admission, in patient who had SPC. Patients in SPC group were significantly satisfied with this management option; 57% versus 8% for UC. Similarly, mortality at 1 year post admission was significantly less; 9% versus 36% for UC and death due to UTI related septicaemia was 33% versus 18% respectively. CONCLUSION: It was concluded that SPC was a better management option since it was associated with a low morbidity, better quality of life and a longer life expectancy than UC.

Clinicopathological features and molecular markers of breast cancer in Jos, Nigeria.

BACKGROUND: Several studies have suggested that breast cancer in black women is associated with aggressive features and poor survival. This study examines molecular markers along with clinical stage and pathological grade in breast cancer material from Jos, Nigeria. STUDY DESIGN: The histological diagnoses of 178 consecutive Nigerian patients with breast cancer were retrieved from their hospital records. A subset of 36 patients was staged and their tumours typed and graded. Immunohistochemical staining of sections from paraffin wax embedded tissues from these cases for the expression of oestrogen receptor (ER), progesterone receptor (PGR), Human ERBB2 (or HER2/neu), p53 and cyclin D1 (CCND1) was carried out using the avidin biotin complex (ABC) procedure. RESULTS: A majority of the cases were invasive ductal carcinoma (92.7%), high grade (grade 3, 70.6%) and of late clinical stage (stages III and IV, 58.3%). Only 25% and 27.8% of cases expressed ER and PGR respectively. The ERBB2 and CCND1 antigens were expressed in 25%, and 5.7% of cases respectively. The p53 protein was the most frequently expressed in this study (47.2% of cases). High grade tumours were significantly more likely to be ER and PGR negative (P = 0.006 and P = 0.002 respectively). CONLCLUSION: There is predominance of high grade, invasive ductal carcinomas which are likely to be ER and PGR negative but p53 positive. These features suggest a biologically aggressive form of breast cancer in Nigerian women with the possibility of poor response to both hormonal therapy and chemotherapy.

Lower limb amputation in Jos, Nigeria.

OBJECTIVE: To determine the pattern of lower limb amputation (LLA) and highlight preventable causes in our hospital. DESIGN: A retrospective study. SETTING: University Teaching Hospital, Jos, Nigeria. SUBJECTS: Eighty seven patients who had LLA over a five and a half year period. There were 62 males and 25 females aged between three and 83 years (mean+/-SD = 44.5+/-21.1). MAIN OUTCOME MEASURES: Indications, morbidity and mortality. RESULTS: A total of 94 LLA were performed in the 87 patients managed. Trauma, diabetic foot sepsis and malignant conditions of the limb were the main indications for LLA in 26(29.9%), 23(26.4%) and 20(23%) patients respectively. Others were peripheral vascular gangrene (PVG) in eight (9.2%) patients; chronic osteomyelitis, three (3.5%); chronic leg ulcers, three (3.5%); Ainhum, three (3.5%) and snake bite in one patient (1.1%). Above knee amputation (AKA) was the most common procedure performed (48.9%) followed by below knee amputation (BKA) in 37.2%. There were 11 deaths (12.6%), out of which eight were due to sepsis with multiple organ failure following diabetic foot sepsis, two cases of clostridial myonecrosis complicating compound fractures and a case of metastatic osteosarcoma in a child. CONCLUSION: Majority of the cases of LLA could have been avoided with early presentation and appropriate management. A case is made for community health education on the need for early presentation to hospital for limb lesions.

Prevalence of umbilical hernia in a private school admission-seeking Nigerian children.

BACKGROUND: Despite the claims that umbilical hernia (UH) is common among Nigerian children, the socio-economic class-related prevalence or incidence rate of UH in the Nigerian children is not known. We therefore undertook this study to determine the prevalence of UHs among Nigerian children of high socio-economic class. PATIENTS AND METHODS: This 7- years prospective study assessment of the prevalence of primary umbilical hernias among a private school admission seeking Nigerian children. Clinical evaluations of the umbilicus were conducted on 7,968 Nigerian children, attending interview into Nigerian Airforce Military schools from across the country. RESULTS: Umbilical hernia was present in 102 (1.3% ) out of 7968 children, giving a prevalence of 12.8 per 1,000. Fifty-three (52.% ) were boys and 49 (48% ) were girls; their ages ranged from 6 to 9 years (mean 6.5 years). Umbilical hernia was 1.4 times as common in the girls as in the boys, with a prevalence of 15.3 per 1,000 and 11.1 per 1,000, respectively. The overall prevalence in this study is comparatively lower than those previously reported. CONCLUSION: Our study suggests that there is a low prevalence rate of UH among the children of high socio-economic class in Nigeria.

A 10-year review of venous thrombo-embolism in surgical patients seen in Jos, Nigeria.

A retrospective study was carried out on 42 clinically diagnosed cases of venous thrombo-embolism (VTE) seen over a 10 year period. The mean age at presentation was 41 years with a sex ratio M:F of 2.5:1. The three commonest primary surgical conditions in patients with VTE were spinal trauma (16 percent), benign prostatic hypertrophy (12 percent) and head injury (10 percent). Prostatectomy was performed in 18 percent, ventral hernia repair in 12 percent and splenectomy in 9 percent. Sudden severe dyspnoea was the clinical presentation in 60 percent of patients. Central chest pain occurred in 43 percent, loss of consciousness (38 percent), haemoptysis (7 percent), mental confusion (19 percent) and lower limb swelling (14 percent). Fifty-two percent of patients presented within 10-15 days. Oral warfarin and intravenous heparin were employed in management in 45 percent. Hospital mortality from massive pulmonary embolism was 64 percent while post thrombotic syndrome occurred in 5 percent of patients.

Diagnosis and management of brain tumours at Jos University Teaching Hospital, Nigeria.

OBJECTIVE: To report on the incidence of brain tumours in Jos Plateau of Nigeria and to highlight areas of interest regarding diagnosis, management and outcome. DESIGN: A retrospective study. SETTING: Jos University Teaching Hospital (JUTH), Jos, Nigeria. SUBJECTS: Thirty patients with brain tumours. INTERVENTIONS: Specific management of primary lesions was carried out in cases of metastatic brain tumours. Steroids were administered in one case of cerebellar oligodendroma. Craniotomy and excision was achieved in two cases of meningioma and two of sarcoma. Palliative excision was employed in another two cases of meningioma. Two cases each of pituitary adenomas were managed by craniotomy and excision and trans-nasal transsphenoidal excision. RESULTS: Brain tumours ranked third in frequency relative to other tumours. The relative frequency of different histological types in percentages were: metastatic (30%), anterior pituitary (21%), meningeal (18%), neuroepithelial (15%) and nerve-sheath (6%). The mean age of presentation was 33 years. The three commonest clinical features in percentages included headaches (43%), cranial masses (39%) and visual defects (26%). Eighty three per cent of the total number of patients died within three weeks to one year irrespective of management modality employed. Two patients who had transnasal excision of pituitary tumours abroad are, however, well and alive at one and two years post-operation respectively. CONCLUSION: In this study, roentgenograms of the skull had a diagnostic value of 76% for tumours of meningeal origin and pituitary adenomas. CT scan is the mainstay for diagnosis of brain tumours. The outcome was poor with a mortality of 83%.

Surgical experience with management of vascular injuries.

UNLABELLED: To highlight the problems that are associated with the causes, diagnosis and management of vascular injuries. MATERIALS AND METHODS: A retrospective study of 52 cases of vascular injuries managed at the Jos University Teaching Hospital (JUTH) during a ten year period. RESULTS: The sex ratio M:F was 6:1 and the mean age at presentation was 23 years. The most common causes of vascular injuries were road traffic accidents in 44 per cent, iatrogenic 27 per cent and industrial in 13 per cent. These resulted in 50 cases (96 percent) of penetrating vascular injuries and 2 (4 percent) of blunt injury to vessels. Fifty-four percent of patients presented in shock. Active bleeding was recorded in 81 percent, pulse deficit in 65 percent and frank gangrene in 16 per cent. Aneurysms of various types occurred in 14 percent. Associated injuries were fractures in 60 percent, soft tissue injuries in 56 per cent and peripheral nerve injuries in 10 per cent. Overall, 52 arteries and 51 veins were injured, resulting in 15 lacerations, 74 complete transactions and 2 vascular blunt injuries with intimal tears and intraluminal thrombosis. Direct lateral suture of vessels was employed in 13 vessels, anastomosis in 12 vessels, graft interposition in 4 cases, ligation in 49 cases and aneurysmectomy in 3 cases. Three primary amputations were performed versus 7 secondary amputations. Hospital mortality was 16 percent and was mainly due to hypovolaemic shock, acute renal failure and sepsis.

Predictive indices in traumatic intracranial haematomas.

OBJECTIVE: To identify factors of predictive value in the early diagnosis of traumatic intra-cranial haematomas (ICH). DESIGN: A retrospective study of patients with positive exploratory burr hole findings of ICH. SETTING: Jos University Teaching Hospital, Nigeria between January 1988 and December 1998. PATIENTS: Two hundred and six patients. MAIN OUTCOME MEASURES: The demographic data of patients, duration of presentation, Glasgow Coma Scale (GCS), causes, clinical features and mortality characteristics of patients were analysed. RESULTS: There was a bi-modal age distribution with a mean of 26 years. Male:female ratio was 2:1. Vehicular accidents accounted for 72% of ICH and falls for 22%. Sixty seven per cent recorded a GCS of 14-15 out of a total of 175 GCS recorded. A brief history of loss of consciousness was obtained in 33%, headaches 49%, deterioration in conscious level 91%, seizures 53%, cranial nerve deficits 11% and hemiplegia in 22%. Significant lateralising signs occurred within 72 hours. Extra-dural haematomas constituted 37% and were associated with cranial vault fractures in all cases. Subdural haematomas constituted 60%, with skull fractures in eight per cent and intracerebral haematomas occurred in three per cent. A mortality of seven per cent was recorded for all patients with ICH. CONCLUSION: Traumatic ICH is associated with raised intracranial pressure in many patients.

Rectus abdominis myocutaneous flap in reconstruction for advanced male breast cancer: case report.

A case of advanced male breast cancer which masqueraded as recurrent abscess of the right breast is presented to highlight the role of contra-lateral rectus abdominis pedicled myocutaneous flap in providing adequate skin and soft tissue cover in male breast reconstruction. This was carried out for this patient following a modified radical mastectomy for stage III (T2b, N2, M0) intraductal carcinoma of the breast. The patient has remained well without clinical features of distant metastasis at a follow up period of two years despite periodic excision of locally recurrent cancer nodules from the affected breast.

Spinal injuries in the Plateau State, Nigeria.

OBJECTIVE: To highlight the epidemiology, management and outcome of spinal cord injuries (SCI) in the Plateau State of Nigeria. DESIGN: A retrospective study involving case note analysis of all patients with SCI admitted into the hospital. SETTING: The study was carried out at the Jos University Teaching Hospital to cover January 1984 and December, 1997. SUBJECTS: Sixty eight cases of SCI were studied. INTERVENTIONS: Patients were managed by conservative and operative interventions especially in cervical subluxations involving C5 on C6. MAIN OUTCOME MEASURES: Neurological function was assessed employing Frankel scale. RESULTS: There was an increased hospital incidence for SCI between 1994 and 1997. Means age of presentation was 30 years and sex ratio M:F was 10:1. Vehicular accidents accounting for 49 per cent of SCIs and collapsed tunnels (26 per cent) were the two common causes. Fracture dislocation of the spine (unstable) occurred in 52 per cent and flexion wedge fractures (stable) in 14 per cent. Ten per cent of patients had no neural deficits at presentation, 21 per cent had partial cord lesions and 69 per cent complete cord lesions. Hospital mortality was 26 per cent. The four patients subjected to posterior spinal fusion, (Frankel A to E) including 8 other patients that were conservatively managed. CONCLUSION: Centres for spinal injuries should be established incorporating hospital wards, theatres, gymnasia, nursing units, occupational therapy units, activity centres and workshops. These centres will generate comprehensive data on morbidity and morality needed for future planning.

Comparative study of conservative resection and radical operation for thyroid carcinomas.

OBJECTIVE: To compare mortality and morbidity in management of thyroid cancers by total lobectomy (C-R) and near-total thyroidectomy (R-O) and to relate pathological subtype to prognosis. DESIGN: A retrospective study of patients with thyroid cancers that were managed during an eleven-year period. SETTING: Jos University Teaching Hospital, Nigeria. SUBJECTS: A total of 44 patients who underwent C-R (n = 26) and R-O (n = 18) were studied. INTERVENTION: A total of 509 goitrous specimens including the excised thyroid cancers were histopathologically studied. MAIN OUTCOME MEASURES: Cases were analysed for mortality and morbidity data in the two groups during a partial follow-up period of two years. RESULTS: Mortality figures for C-R was 4% versus 11 for R-O. Postoperative haemorrhage occurred in 14% for C-R versus six for R-O. Similarly, bilateral vocal cord paralysis occurred in 11% versus 22; voice changes in 11% versus 33, transitory hypoparathyroidism 8% versus 50, local recurrence in 18% versus eleven. Hypothyroidism occurred in all patients undergoing R-O and stitch granuloma in 11% of patients in C-R group versus six for R-O. Follicular carcinoma constituted 59% of the total number thyroid cancers with papillary cancer constituting 35%. CONCLUSION: C-R is recommended as the operation of choice for thyroid cancers.

Peutz-Jeghers syndrome: case report.

A case of Peutz-Jeghers syndrome (PJS) in an African girl is presented to document the clinical presentation, management and follow up of this condition. The patient who presented with black buccal mucosal hyperpigmentation and clinical features of jejuno-jejunal intussusception was successfully managed by operative reduction of the intussusception and polypectomy. She is being followed up for evidence of malignant transformation in associated intestinal polyps and development of extra-intestinal malignancies at other sites. The management of PJS in light of recent trends is discussed, especially with reference to suggested protocols for screening and surveillance of sites at supposed risk of tumour development.

The diagnostive evaluation and surgical management of soft tissue sarcomas.

A retrospective case note study of 40 patients presenting with soft tissue sarcomas at different sites was carried out covering the period between January 1985 and December 1995 at the University Teaching Hospital, Jos Nigeria. The hospital incidence was 4 cases a year males are afflicted more often than females in a ratio of 2:1. The mean age at presentation was 30 years with a range of (4-65) years. The main modes of presentation were tumefaction 95% and ulceration 50%; the mean duration of symptoms before presentation was about 6 months. Lesions were distributed mainly in the lower limbs in 65% of cases; thirty-four percent of the total number of cases were low grade while 48% were high grade malignant lesions. Incisional biopsy was the most favoured method of confirming the diagnosis in these lesions while surgery was the mainstay of treatment in stages 1 and 2 lesions. Radical excision especially in the lower limb is advocated for curative purposes. The results of palliative surgery are no doubt gratifying to patients with advanced lesions but the relative place of surgery, radiotherapy and chemotherapy in the 5-year survival of these patients continued to be conjectural. Prospective studies are badly needed in this respect.

Experience in managing splenic trauma on the Jos Plateau.

We studied retrospectively, fifty eight (58) patients with splenic injury admitted to Jos University Teaching Hospital between October 1988 and September, 1995. Forty-nine were males while nine were females (M:F = 5.4:1). The age ranged from 5 to 50 years with a mean of 24.5 years. The highest incidence was recorded in the third decade of life. Road Traffic Accident (RTA) was the commonest (75.8%) cause of splenic injury; others were fall from heights 7 (12.1%), blows to the abdomen 5 (8.6%) and stab wounds to the abdomen 2 (3.5%). Of the 58 cases, 56 (96.5%) were blunt abdominal injuries while 2 (3.5%) were penetrating stab injuries. All had laparotomy. 13 (22.4%) sustained Upadhyaya and Simpson's type 1 injury, 18 (31.0%) type II, 12 (20.7%) type III and 15 (25.9%) type IV injuries. Of the 58 patients, 29 (50%) had total splenectomy without heterotopic autotransplantation (HAT); 21 (36.2%) had splenectomy with HAT, while 8 (13.8%) had splenorrhaphy with omentoplasty. The average number of units of blood transfused was 2.3 units per patient. There were four (6.9%) deaths--two as a result of shock and multiple organ failure and another two died as a result of pulmonary embolism. However the commonest post operative complications were chest and wound infections. The rate of splenic salvage in this study was low despite the fact that most of these patients sustained types I and II injuries. We believe a greater salvage rate could be achieved and the trend in our centre now is toward splenic conservation.