The value of international prostate symptom scoring system in the management of BPH in Jos, Nigeria.

OBJECTIVE: To determine the value of international prostate symptom scoring (IPSS) system in management of patients with benign prostatic hyperplasia (BPH) in Jos, Nigeria. MATERIALS AND METHODS: This was a prospective study of 104 newly diagnosed patients with BPH from June 2006 to July 2007. Patients' symptoms were initially evaluated by administering a pretreatment IPSS/Quality of Life Score (QOLS). This categorized patients into mild, moderate, and severe symptom groups. The mild symptom group had watchful waiting as mode of management. The moderate symptom group received doxazosin, an alpha blocker, while the severe symptom group had prostatectomy. A post-treatment IPSS/QOLS was administered 3 months after. Mean changes in IPSS/QOLS was calculated and subjected to paired student's t- test for significance in changes. Spearman's correlation coefficient was used to test significance between correlations. RESULTS: Mean age of patients was 64.3 years. 3 patients (2.9%), 53 patients (51.0%), and 48 patients (46.1%) fell into the minor, moderate, and severe symptom categories, respectively. The QOLS correlated with IPSS. There was a mean change in symptom scores of +2.3 for the minor symptom category, -8.1 (P < 0.001) for IPSS and -1.7 (P < 0.001) for QOLS in the moderate symptom category, and -24.6 (P < 0.001) for IPSS and -4.0 (P < 0.05) for QOLS in the severe symptom category. CONCLUSION: The study has shown that IPSS is a valuable tool in management of patients with BPH.

Ileal perforation due to typhoid fever - review of operative management and outcome in an urban centre in Nigeria.

BACKGROUND: The management of ileal typhoid perforation is a challenging task in our environment. Lack of incidence data base and poor financial resources preclude adequate prevention of this public health menace. OBJECTIVES: For now the focus will remain the effective and strategic management of this complication to reduce the morbidity and mortality. METHODS: 86 cases of ileal typhoid perforation were seen over a two year period. Most were male children and male young adults. Data collection was by retrieving information from the medical records of Enugu State University of Science and Technology Teaching Hospital (ESUTH). All were resuscitated with 1v fluids, iv antibiotics, nasogastric tube suction and where indicated blood transfusions. Majority had bacteriological, biochemical, haematological and radiological investigations. Laparotomy was undertaken after adequate resuscitation. RESULTS: Most had been febrile for 2-6weeks prior to admission, with the majority having been labelled resistant malaria cases. Most presented more than 24 h after onset of peritonitis and were therefore explored late, some as late at 96 h. At laparotomy 97% had large volumes of pus and small bowel contents in the peritoneal cavity and 3% had localized intraabdominal abscesses. No attempt at healing or omental localization of the perforation was observed. Fifty two (60.5%) patient underwent simple closure, 18(21%) had ileal resection and enteroanastomosis, 7(8.1%) had tube ileostomy, 5(5.8%) had primary suture and proximal ileo-transverse anastomosis and 4(4.7%) limited right hemicolectomy. All had liberal peritoneal lavage with normal saline. The group that presented relatively early, with minimal pathological changes, had primary suture and mortality in this groups was 11.5%. The group with gross pathological changes seen mainly in patients that presented late had higher mortality rates, even as high as 50%. However our overall mortality rate was 18.6%. CONCLUSION: The authors affirm that typhoid ileal perforation must be treated surgically. Early presentation and diagnosis, adequate resuscitation, prompt surgery and vigorous post-operative management improved mortality rates. Clearly delays in presentation necessitating prolonged resuscitation and therefore delayed surgery affected mortality.

Acute perforated peptic ulcer: on clinical experience in an urban tertiary hospital in south east Nigeria.

BACKGROUND: Acute perforated peptic ulcer is a leading cause of generalized peritonitis and its management has continued to be a challenging task in our environment. OBJECTIVE: There is a paucity of published reports on acute perforated peptic ulcers in our environment. This study was conducted to evaluate the different pattern of risk factors clinical presentations, management and clinical outcome of patients with acute perforated peptic ulcer in our setting and to highlight the factors that continue to account for the high mortality and morbidity as seen here. METHOD: A retrospective study where data of seventy-six (76) patients managed for generalized peritonitis due to acute peptic ulcer perforation over a five year period (January 2006-December 2010) were retrieved from medical records of Enugu State University of Science and Technology Hospital (ESUTH). The patients' biodata, clinical and operative findings and treatment outcome were extracted and analysed, after institutional ethical approval was secured. All other cases of generalized peritonitis not traceable to acute peptic ulcer perforation were excluded from the study. RESULTS: There were76 patients; 58 males and 18 females (M:F = 3.2:1) Their ages ranged from 20 to 80years with a mean of 39.5yr and SD ± 13.10years. Majority of the patients 49(64.4%) were 40years of age and below and only 24 (31.6%) had a previous history suggestive of chronic peptic ulcer disease. Twenty five (32.9%) patients presented within 24 h of onset of symptoms of perforation with a mortality of 8.0%. Slightly more than half of our patients 39(51.3%) presented between 24 and 48 h with mortality of 17.9%. Twelve patients (15.8%) presented between 48 and 72 h and the mortality in this group was 58.3%. The latter two groups accounted for most of the mortality in our series. All perforations were anterior perforations within the first 2.5 cm of the duodenum and all had simple closure with pedicled omental patch and peritoneal toilet with copious volumes of warm normal saline. Postoperatively all received Helicobacter pylori eradication therapy and proton pump inhibitors for at least two months. CONCLUSION: Patient groups who presented early had low mortality rates, but patient groups who presented late had higher mortality rates. Overall mortality was 21%.

Body size and adiposity indicators and their relationship with blood pressure levels in Ibos of Nigeria.

BACKGROUND: Racial Predisposition to Hypertension, obesity and other cardiovascular diseases (CVD) have been the subject of some recent researches. The various anthropometric and obesity indicators and their relationship with blood pressure parameters in the Ibos of Nigeria were studied. METHOD: Using the simple random design, 569 males and females Nigerians of Ibo ethnicity, ages 20 to 80 years were enrolled for this study. Systolic and diastolic blood pressure (SBP & DBP), body mass index (BMI), waist hip ratio (WHR), waist height ratio (WHTR), waist circumference (We), triceps, subscapular, calf and sum of three skin fold thicknesses (TSF, SSF, eSF,& STS respectively) and other anthropometric parameters were measured. RESULT: The mean SBP for the study was 119.6 +/- 23 mmHg and DBP 79.8 +/- 13mmhg. Males showed higher mean values of 5mmHg in SBP and 3mmHg in DBP than the females. we was 3cm larger in the females than the males. BMI, WHTR, and STS were all larger in the females than in the males. The highest level of association noted in the study was between we and WHTR (r = 0.926, P < 0.01). The levels of correlations of the blood pressure parameters with the obesity indices were higher with DBP than SBP. For both sexes; we was the highest predictor of DBP, followed by WHTR. Age gave the highest prediction of SBP. CONCLUSION: This work notes WHTR as the best predictor of central obesity and also a better index for screening CVD risk factors in the Ibos.

Traumatic ruptured diaphragm: a clinical diagnostic dilemma

Sequel to a car crash; Chief A; a 52-year old bankerpresented in the Orthopaedic Unit of University of Nigeria Teaching Hospital Enugu with fracture right forearm bones and minor bruises in the abdomen and buttocks. His fractured right forearm was treated surgically and patient was dischharged. A month later; Chief A developed breathlessness and was therefore re-admitted in same hospital where radiological survey including plain chest radiography and tailored barium meal revealed a hitherto clinically Occult rupture left hemi-diaphragm with mediastimal shift to the contra-lateral side. We present this case to highlight the pleomophism of traumatic rupture of diaphragm with emphasis on the causes; clinical presentation; complications and model of progression and different treatment options

Intraperitoneal low-pressure suction drainage following splenectomy.

A consecutive series of 282 patients undergoing splenectomy on one surgical unit has been studied to ascertain the incidence of postoperative subphrenic abscess. Only two atypical subphrenic abscesses occurred (0.17 per cent), a rate of abscess formation much lower than that reported in other series. We believe that the use of low-pressure closed suction drainage to the splenic bed accounts for this low rate.