Intussusception in pregnancy--a rarely considered diagnosis.

Intussusception in pregnancy is rare and making a preoperative diagnosis is extremely difficult. The objective of this paper is to report a case of intussusception in a pregnant woman and to review the literature on the subject with a view to highlighting the peculiarities of this condition. The case file of a 26 year old Gravida 3, Para(0+2) lady who had appendectomy 5 years earlier and now presented at 33 weeks of gestation with features of intestinal obstruction was evaluated. Ultrasound scan showed dilated bowel loops suggestive of intestinal obstruction. At operation, an ileo-ileal intussusception was found without a lead point. Histology of the resected bowel segment showed haemorrhagic infarction without evidence of malignancy. Even though bands and adhesions are the commonest causes of intestinal obstruction in a patient that has had a previous abdominal surgery, possibility of other aetiological factors should always be considered.

Small bowel obstruction following perforation of the uterus at induced abortion.

BACKGROUND: Unsafe abortion is an important contributor to maternal morbidity and mortality. OBJECTIVE: To present a case of small bowel obstruction following perforation of the uterus at induced abortion. METHODS: A 36-year-old woman, presented at a private hospital, with abdominal pain and weight loss. She had full clinical assessment and laboratory investigations which indicated small bowel obstruction following perforation of the uterus at induced abortion, and was commenced on treatment. RESULTS: She was para 5+0. Her main complaints were abdominal and weight loss following induced abortion of a 12- week pregnancy, four months prior to presentation. At presentation the tools (ultrasound scan, plain abdominal radiograph and barium enema) used for diagnoses only suggested some form of intestinal obstruction and were unremarkable. Correct diagnoses indicating small bowel obstruction was only made at laparotomy. An exploratory laparotomy, adhesiolysis, small bowel resection, end to end anastomosis and bowel decompression was done after bowel preparation. CONCLUSION: Laparotomy has an enviable place in bowel injuries secondary to uterine perforation especially when there is a diagnostic dilemma. Nigerian female population requires continuous health education on widespread and effective use of contraception. Physicians need training and retraining on abortion techniques and management of abortion complications.

Analysis of five-year breast biopsies carried out in the University of Benin Teaching Hospital Benin City.

OBJECTIVE: To review the histology of breast biopsies carried out in our hospital with a view to designing management and preventive strategies. PATIENTS AND METHODS: 179 patients who had breast biopsies over a five year-period (January 1999 - December 2003) were included in the study. The patients were sorted out from the records in both the casualty and main theatres of the hospital. The medical records from their case files were analysed in terms of age, sex and the histology of the tissue obtained on biopsy. RESULTS: Benign breast lesions accounted for 73.2% with fibroadenoma constituting a greater percentage. Whereas benign breast lesions were most commonly encountered in the third decade of life, malignant lesions occurred most commonly in the fourth decade. After the age of 60, all the cases analysed were of the malignant variety. CONCLUSION: Young patients with breast lump should be encouraged to come for consultation as most of them are benign. However, any lump in a woman above 30 should be properly screened for cancer. Similarly, any patient who presents with a breast lesion after the age of 60 should be regarded as having breast cancer until proved otherwise.

Knowledge attitude and practice about breast cancer among civil servants in Benin City, Nigeria.

BACKGROUND: Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer, its complications and the management. METHODS: The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study, but only 385 respondents completed and returned the forms. RESULTS: Two hundred and seventy seven (72.0%) respondents had tertiary level of education. Sixty six (17.1%) respondents were in the 30-34-year age group. Three hundred and twelve (81.0%) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5%) respondents knew that a positive family history of breast cancer is a risk factor, while two hundred and seventy four (71.2%) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4%) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7%) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5%) respondents would visit the hospital as the first reaction if they were to detect a breast lump, while twenty three (6.0%) respondents would ignore the lump. While three hundred and twenty seven (85.0%) respondents have heard of breast self- examination, only one hundred (26.0%) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0%) respondents have heard of mammography, only twenty seven (7%) respondents go for yearly mammography screening. Three hundred and seventy two (96.6%) respondents know that mastectomy is done as part of the management of breast cancer, but only forty nine (12.7%) respondents have heard about conservative surgery. CONCLUSION: The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed, it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital.

Knowledge Attitude and Practice about Breast Cancer among Civil Servants in Benin City; Nigeria

Background: Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer; its complications and the management. Methods: The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study; but only 385 respondents completed and returned the forms. Results: Two hundred and seventy seven (72.0) respondents had tertiary level of education. Sixty six (17.1) respondents were in the 30-34-year age group. Three hundred and twelve (81.0) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5) respondents knew that a positive family history of breast cancer is a risk factor; while two hundred and seventy four (71.2) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5) respondents would visit the hospital as the first reaction if they were to detect a breast lump; while twenty three (6.0) respondents would ignore the lump. While three hundred and twenty seven (85.0) respondents have heard of breast self- examination; only one hundred (26.0) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0) respondents have heard of mammography; only twenty seven (7) respondents go for yearly mammography screening. Three hundred and seventy two (96.6) respondents know that mastectomy is done as part of the management of breast cancer; but only forty nine (12.7) respondents have heard about conservative surgery. Conclusion: The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed; it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital

Some malignant tumours in HIV -infected individuals in Benin City Nigeria.

AIM AND OBJECTIVES: The aim of the study was to report the cases of some malignancies seen in Human Immune Deficiency Virus (HIV) - positive patients seen at the UBTH between January 1999 and December 2003. PATIENTS AND METHODS: All patients that presented to the medical and surgical units of the UBTH within the period of the study and who had histologically confirmed malignant conditions and also tested to HIV were included in the study. RESULTS: The male: female ratio of HIV-seropositivity within the period of study was 1:1.2. The highest incidence of HIV-seropositivity was in 2003 (65.1%). Of the patients that tested positive for HIV, Hodgkin's lymphoma was the commonest form of malignancy while leukaemia was the least common. CONCLUSION: We conclude that Kaposi's sarcoma is not now so common in HIV-positive patients as previously reported by other studies, while Hodgkin's lymphoma has become rather more prevalent.

Urethral fibrosis with pyonephrosis in a patient with situs inversus totalis: a case report.

BACKGROUND: Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed. OBJECTIVE: To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity. PATIENT AND METHOD: The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea. RESULTS: Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure. CONCLUSION: Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.

Paediatric intussusception in Benin city, Nigeria

Intussusception is one of the leading causes of intestinal obstruction in children. This study reports our experience in the management of intussusception in Benin City; Nigeria. This was a 10-year retrospective review of intussusception in children at the University of Benin Teaching Hospital from January; 1997 to December; 2006. Twenty four children were admitted with intussusception (M: F = 1:1.4) within the period. Only three patients (12.5) presented within 24 hours of onset of illness. Ten (41.6) presented between one and four days; seven (29.2) between five and 10 days; while four (16.6) presented between 11and14 days. Abdominal pain; irritability; blood in stools; vomiting; abdominal distension and palpablemass in various combinations were the clinical features. All the patients; except one (4); were below the age of one year. There was much delay before presentation of infantswith intussusception; with high attendant mortality

Pneumothorax in a 16-year-old Nigerian Male with Asthma

Background: Asthma is a commonly occurring disease but the combination of asthma with pneumothorax is not as common. Aim : To outline the diagnostic features and management of this disorder. Case Report : A 16-year-old male student presented with history of marked dyspnoea; tachycardia and chest findings of bilateral polyphonic rhonchi. Drugs which are used for acute severe asthma were administered. The response was not satisfactory . A chest radiograph showed left pneumothorax. A chest tube was inserted and connected to an under-water seal drainage. Conclusion : A detailed history and physical examination aided by a chest radiograph are important in patients who present with acute severe asthma to rule out possible complications; such as pneumothorax

Pattern and outcome of management of fractures in a Nigerian community

"Background: There has been increasing incidence of road traffic accidents and gun shot injuries in Benin City in the recent past. A major complication of these events is fracture of the bones. Various patterns of fractures are reported from different communities.Aim: To determine the pattern and outcome of fractures in Ikpoba Hill; a sub-urban community in Edo State.Methods: A retrospective study of all cases of fractures that presented to ""Our Medical Centre"" in Ikpoba Hill; a sub-urban community in Edo State between January 1998 and December 2004 was carried out. Parameters analysed included age; sex; and occupation; cause of fracture; site of fracture; associated injuries; treatment offered and outcome of management.Results: A total of 285 cases of fractures were seen over the period of study. There was a steady increase in the number of cases of fractures over the period of study. The 20 -29 years age group was more commonly affected (25.61). The male: female ratio was 1.9: 1. Civil servants and business people were most commonly affected (36.49and 24.56respectively). The humerus was the bone most commonly affected (24.32). Road traffic accident was the commonest aetiological factor accounting for 80. Some 69.47of the cases discharged themselves against medical advice to seek help with a traditional bonesetter. Head injury was the commonest cause of death (44.44). The average duration of hospital stay was 21 days.Conclusion: Road traffic accident was a common cause of fracture. The humerus was the bone most commonly fractured. Most patients with fracture prefer to patronize the traditional bone setters. Public enlightenment campaign should be mounted to discourage the attitude of most patients with fracture seeking help in traditional bonesetters' place."

Pneumothorax in a 16-year-old Nigerian male with asthma

Background: Asthma is a commonly occurring disease but the combination of asthma with pneumothorax is not as common. Aim: To outline the diagnostic features and management of this disorder. Case Report: A 16-year-old male student presented with history of marked dyspnoea; tachycardia and chest findings of bilateral polyphonic rhonchi. Drugs which are used for acute severe asthma were administered. The response was not satisfactory . A chest radiograph showed left pneumothorax. A chest tube was inserted and connected to an under- water seal drainage. Conclusion: A detailed history and physical examination aided by a chest radiograph are important in patients who present with acute severe asthma to rule out possible complications; such as pneumothorax

Current practices and medico-legal aspects of pre-operative consent.

BACKGROUND: Written informed consent is a pre requisite for surgical intervention as it provides the forum for the patient to appreciate implications of the procedure and the doctor to explain details and effects of the surgery. OBJECTIVES: To evaluate the practice of obtaining informed consent pre-operatively by surgeons in Benin City and proffer solutions that would enhance its practice. DESIGN: Cross-sectional study involving surgical patients or their relations or gurdian (in cases involving minors and unconscious patients) who were interviewed with structured ended questionnaires. SETTING: Study was carried out at the University of Benin Teaching Hospital, Benin City, between 5th July and 6th September 2002. RESULTS: One hundred and thirty-three respondents; 53(39.2%) males and 80(60.2%) females were interviewed. Documentations regarding consent were noted in 118(88.7%) cases. Of these, 74.6% felt they had enough time to reflect on the consent obtained while 48(36.1%) respondents were meeting the individual who obtained their consent for the first time. The content of information offered patients prior to obtaining consent was found to be significantly related to the levels of education (X2= 31.44; P<0.001). Over a hundred respondents were not informed of risk of procedure. Nonetheless over 50% of respondents felt satisfied with information supplied. CONCLUSION: The quality of consent obtained from the average patient fell below expected standard. There is need for greater awareness amongst administrators of consent on the essence of improving quality of information given and mode of obtaining consent from patients.