The Trend of Cholecystectomies After the Introduction of Laparoscopic Surgery in a District Hospital in Abuja, North Central Nigeria.

Background Laparoscopic cholecystectomy is not readily available in secondary care hospitals in Nigeria, even though it is now the gold standard for the treatment of cholelithiasis and other gallbladder diseases worldwide. Thus, many hospitals in Nigeria still offer open cholecystectomies. This retrospective study investigated the trend of cholecystectomies performed in the general surgery unit of a district hospital in Abuja before and after the commencement of laparoscopic surgery services in 2016. Methodology This retrospective study was conducted in Asokoro District Hospital, Abuja, Nigeria The records of all patients who underwent a cholecystectomy from January 2000 to December 2019 were retrieved and analyzed for the number, types, and rate of cholecystectomies performed per year. All open cholecystectomies were performed via a right subcostal incision, whereas all laparoscopic cholecystectomies were performed via the standard four-port incisions approach. Results A total of 96 patients underwent cholecystectomies from January 2000 to December 2019. In total, 50 (52.08%) open cholecystectomies were performed in 20 years with a yearly average of 2.5, and 46 (47.92%) laparoscopic cholecystectomies were performed in four years with a yearly average of 11.5. The trend of open cholecystectomies in four years dropped from three (30%) in 2016 to one (5.26%) in 2019, whereas laparoscopic cholecystectomies increased from seven (70%) to 18 (94.74%) within the same period. Conclusions There is a drop in the trend of open cholecystectomies and an increase in both laparoscopic and total cholecystectomies in our hospital. We recommend adequate capacity and subsidized laparoscopic cholecystectomy for secondary healthcare facilities in Nigeria.

Pattern of Mammography Utilization by Women Attending Asokoro District Hospital, Abuja, Nigeria.

Introduction: Mammography is a major tool for the screening and diagnosis of breast cancer globally. Poor funding and lack of good public health education for mammography in resource-limited countries limit access to mammographic services. In these settings, patients bear the cost of breast cancer screening from out-of-pocket expenses. The aim of this study was to interrogate the pattern of utilization of mammography by women of childbearing age, who attended Asokoro District Hospital (ADH) for Healthcare, with the view to increase uptake. Materials and Methods: This was a 4-year retrospective, cross-sectional study of 534 women who attended ADH from July 2015 to June 2019 for screening or diagnostic mammography. Data were extracted from completed questionnaire by women who had mammography during the period under review. The data were entered into Statistical Package for the Social Sciences version 27 by IBM for analysis. Results: The mean age of the women was 47.8 years ± 7.7 with a range of 30-82 years. Most of the women, 525 (94.9%), were referred for mammography by health workers; only nine (5.1%) had mammography on self-referral. In all, 71% of the women paid for their mammography from their pockets, whereas 28.1% made payments through the National Health Insurance Scheme (NHIS). A total of 100% of women who reported for mammography on self-referral paid for the services from their pockets. The association between the funding options and mode of referral was statistically significant, P = 0.049. Conclusion: This study showed that referral for mammography by health workers was responsible for not only most of the mammograms conducted but also all the women who utilized NHIS to pay for this service. Resources should therefore be directed towards creating awareness among health workers, especially with the present level of NHIS coverage in the population, in order to increase the uptake of screening mammography in the population.

Demonstration of the high collection efficiency of a broadband Mo/Si multilayer mirror with a graded multilayer coating on an ellipsoidal substrate.

A graded and broadband Mo/Si multilayer mirror for EUV spectroscopy is demonstrated. This mirror has an average reflectivity profile of 16% in the wavelength region from 15 nm to 17 nm and an effective area of 1100-1500 mm(2). This reflectivity is about 4 times larger than that of a standard Mo/Si multilayer mirror on a 1 in. diameter substrate, showing that the mirror can be used for measuring EUV fluorescence at wavelengths in the region around 15 nm to 17 nm.

Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria.

BACKGROUND: Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness. METHODS: We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis. RESULTS: The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 - 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 - 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 - 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening. CONCLUSION: The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report.

INTRODUCTION: Intracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement. CASE PRESENTATION: We present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment. CONCLUSION: The clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.

Endothelium removal augments endothelium-independent vasodilatation in rat mesenteric vascular bed.

BACKGROUND AND PURPOSE: The vascular endothelium regulates vascular tone by releasing various endothelium-derived vasoactive substances to counteract excess vascular response. We investigated whether the vascular endothelium regulates vasodilatation via released endothelium-derived contracting factors (EDCFs), by examining the effect of endothelium removal on responses to periarterial nerve stimulation (PNS) and various vasodilator agents. EXPERIMENTAL APPROACH: The rat mesenteric vascular bed was perfused with Krebs solution. Vasodilator responses to PNS and 5 min perfusion of vasodilator agents in preparations with endothelium were compared with those in the same preparations without endothelium. The endothelium was removed by 30 s perfusion with sodium deoxycholate. KEY RESULTS: Endothelium removal significantly augmented vasodilator responses to PNS and calcitonin gene-related peptide (CGRP), isoprenaline (beta-adrenoceptor agonist), SNP and 8-bromo-cGMP (8-Br-cGMP; cGMP analogue) but not BAY41-2272 (soluble guanylate cyclase activator). The augmentation of SNP-induced vasodilatation after denudation was much greater than that of CGRP- or isoprenaline-induced vasodilatation. In the preparations with an intact endothelium, L-NAME (nitric oxide synthase inhibitor) significantly augmented vasodilator responses to PNS and CGRP, isoprenaline, SNP and 8-Br-cGMP, but not BAY41-2272. Indomethacin (cyclooxygenase inhibitor) and seratrodast (thromboxane A(2) receptor antagonist), but not phosphoramidon (endothelin-1-converting enzyme inhibitor) or BQ-123 (selective endothelin type A receptor antagonists), significantly augmented vasodilator responses to PNS and CGRP, isoprenaline, SNP and BAY41-2272. CONCLUSION AND IMPLICATION: These results suggest that the endothelium in rat mesenteric arteries regulates and maintains vascular tone via counteracting not only vasoconstriction through releasing endothelium-derived relaxing factors, but also vasodilatation, in part by releasing an EDCF, thromboxane A(2).

Development of ET, primary myelofibrosis and PV in mice expressing JAK2 V617F.

An acquired JAK2 V617F mutation is found in most patients with polycythemia vera (PV), and about half of patients with essential thrombocythemia (ET) or primary myelofibrosis (PMF). Mice transplanted with bone marrow cells in which JAK2 V617F was retrovirally expressed developed PV-like features, but not ET or PMF. To address the contribution of this mutation to the pathogenesis of these three MPDs, we generated two lines of JAK2 V617F transgenic mice. One line showed granulocytosis after 4 months of age. Among 43 mice, 8 (19%) showed polycythemia and 15 (35%) showed thrombocythemia. The second line showed extreme leukocytosis and thromobocytosis. They showed anemia that means Hb value from 9 to 10 g per 100 ml when 1 month old. Myeloid cells and megakaryocytes were predominant in the bone marrow of these animals, and splenomegaly was observed. The expression of JAK2 V617F mRNA in bone marrow cells was 0.45 and 1.35 that of endogenous wild-type JAK2 in the two lines, respectively. In vitro analysis of bone marrow cells from both lines showed constitutive activation of ERK1/2, STAT5 and AKT, and augmentation of their phosphorylations by cytokine stimulation. We conclude that in vivo expression of JAK2 V617F results in ET-, PMF- and PV-like disease.

Overexpression of cyclooxygenase-2 in high-grade human transitional cell carcinoma of the upper urinary tract.

OBJECTIVE: To examine cyclooxygenase (COX)-2 expression (a key enzyme in the synthesis of prostaglandins, and involved in carcinogenesis of human epithelial tumours) in human transitional cell carcinomas (TCCs) of the renal pelvis and ureter, and to determine whether COX-2 expression correlates with the clinicopathological characteristics of the disease. MATERIALS AND METHODS: Specimens from 144 patients with TCC of the upper urinary tract who had undergone nephroureterectomy were analysed immunohistochemically, and 23 were also analysed by immunoblotting. RESULTS: Immunoblot analysis showed COX-2 immunoreactivity in 17 (74%) of 23 tumours, but not in normal transitional epithelium. COX-2 was localized to the cytoplasm of cancer cells and expressed in 108 (75%) of 144 tumours, as assessed by immunohistochemical analysis. COX-2 expression correlated with tumour grade (P < 0.008), being detected in one of nine grade 1, 77 (79%) of 97 grade 2 and 30 (79%) of 38 grade 3 tumours. Other variables including tumour stage were not associated with COX-2 expression. CONCLUSIONS: We show for the first time that COX-2 is frequently expressed in TCC of the upper urinary tract and is associated with the degree of tumour cell differentiation, indicating that COX-2 may be involved in TCC carcinogenesis at an early and/or late stage, and could be a useful target for chemoprevention of this type of cancer.

Captopril renography in Bartter's syndrome.

We describe a 19-year-old man who developed muscle weakness due to hypokalemia. His blood pressure on admission was considered to be relatively high, and we performed captopril renography. His baseline renogram was normal, while the results of captopril renography showed delayed patterns similar to those of renovascular hypertension. However, his blood pressure level decreased and returned to the normal range without medication 2 weeks after admission. Our final diagnosis in this patient was Barter's syndrome. We speculate that the delayed pattern of captopril renography was due to an imbalance between the prostaglandin and the renin-angiotensin systems. The blockade of the renin-angiotensin system by captopril may cause dominant prostaglandins, produce systemic vasodilatory effects, and lead to hypoperfusion of the kidneys in patients with Bartter's syndrome.

Pharmacological actions of AH-9700 on micturition reflex in anesthetized rats.

In radioligand binding assays, AH-9700 (1-[2-(3,4-dihydro-6,7-dimethyl-2-naphthalenyl)ethyl]pyrrolidine fumarate) had high affinity for sigma receptors and moderate affinity for muscarinic receptors. The affinity of AH-9700 for sigma(1) receptors was significantly reduced in the presence of 5'-guanylyl-imidodiphosphate (GppNHp). In isolated bladder strips of rats, AH-9700 inhibited carbachol-induced contractions. In anesthetized rats, i.v. administration of AH-9700 and typical sigma receptor ligands, (+)-pentazocine and 1,3-di-o-tolylguanidine (DTG), but not oxybutynin, dose-dependently inhibited rhythmic isovolumetric reflex bladder contractions. AH-9700 and oxybutynin suppressed the amplitude of rhythmic bladder contractions. On the other hand, at doses lower than used i.v., the i.c.v. administration of AH-9700 or the sigma receptor ligands inhibited rhythmic bladder contractions without suppressing the amplitude. This inhibitory effect of AH-9700 was markedly reduced by pretreatment with i.c.v. pertussis toxin. These results suggest that AH-9700 exerts a marked anti-micturition reflex effect through central sigma receptors possibly related to pertussis toxin-sensitive Gi/o-proteins and a moderate spasmolytic effect based on its peripheral anti-muscarinic activity.

Interactions among protein molecules in freeze-gel of soymilk and protein structures in heated soymilk during cooling.

To estimate the interactions forming in soymilk freeze-gel, lyophilized gel was extracted successively with various solvents. A mixture of urea, sodium dodecyl sulfate (SDS), and 2-mercaptoethanol (2-ME) dissolved the proteins effectively. The thiol-disulfide exchange reactions and hydrophobic interactions were shown to have a complex relation with a three-dimensional network. The addition of SDS or 2-ME resulted in an incomplete gel or no precipitation of soymilk. In our previous paper (Shimoyamada et al. Food Sci. Technol. Res. 1999, 5, 284-288), the significance of precooling to form small, homogeneously distributed ice crystals in soymilk was reported. In this study, precooling was shown to maintain the partially denatured structures of soybean proteins in soymilk that had unfolded due to heat treatment. These phenomena were considered to be other important functions of precooling in freeze-gelation.

Comparison of the in vitro caffeine-halothane contracture test with the Ca-induced Ca release rate test in patients suspected of having malignant hyperthermia susceptibility.

PURPOSE: We compared the results of the in vitro caffeine-halothane contracture test (CHCT) according to the protocols of the North American Malignant Hyperthermia Group (NAMHG) and the European Malignant Hyperthermia Group (EMHG) with the Ca-induced Ca release (CICR) rate test in the same patients with suspected malignant hyperthermia (MH). METHODS: Five normal controls and 16 patients suspected of having MH susceptibility were studied. Muscle biopsies were usually obtained from the musculus vastus lateralis. Diagnostic cutoff points and procedures for CHCT protocols were as described in the original and renewal versions of NAMHG and EMHGs. The CICR rate test was performed according to the protocol reported by Endo et al. RESULTS: All five normal controls and two patients with abortive MH, two with postoperative hyperthermia, and three with high serum creatine kinase levels were normal in the three tests. Three patients with MH reactions and one patient with a history of masseter spasm were classified as MH positive according to NAMHG criteria and MH susceptible and MH equivocal according to EMHG criteria. There were five cases with discordant results between the CHCT and CICR rate tests. CONCLUSION: We propose that muscle biopsy for diagnosis of MH susceptibility should combine the CHCT with the CICR rate test, which may identify the defective site of Ca release channels.

A case of Marfan syndrome in an adolescent with aortic dissection: should the recommendation for surgical intervention be changed?

We present a 15-year-old male patient with Marfan syndrome who died suddenly of aortic dissection and rupture. The commonly used criteria for elective aortic root replacement are an aortic root dimension >50 mm or an aortic dimension more than twice the normal predicted value. He did not fulfill these criteria. His ascending aortic dimension 17 days prior to his death was 48 mm and the aortic dimension to the predicted value was 1.8, although he showed progressive dilatation of the aortic root. A ratio of the ascending aortic dimension of more than 1.5 times that predicted, as proposed by Pyeritz, and a considerable increase in aortic dilatation beyond previous observations may lead to timely surgical repair.

[Anesthetic and perioperative management of 1000 cases of congenital heart surgery--massive vasodilator therapy and early extubation].

We report our anesthetic and perioperative management of 1000 cases of congenital heart surgery in Okayama University Medical School over the last six and a half years. Most of these patients were anesthetized by fentanyl and all patients were managed in our ICU postoperatively. Although hospital death rate in all patients was 4.5%, almost half of dead patients were patients with hypoplastic left heart syndrome. Neonatal mortality rate has been still high, 18.9%, which has been our main problem. We tried to extubate patients with complex congenital heart diseases earlier postoperatively for the last three years, using massive dose of vasodilators without nitric oxide.

[Analysis of cerebral blood flow SPECT imaging on standard brain atlas in patients with dementia of Alzheimer type].

Statistical parametric map (SPM) has been developed by Friston et al. to analyze focal changes in rCBF induced by brain activation. This automated and objective approach has the potential of being applied to SPECT image data sets. This study evaluated an automated analysis of brain SPECT imaging in patients with dementia of Alzheimer type (DAT) using SPM95. Seventeen patients with clinically diagnosed moderate to severe DAT and nine normal control subjects were studied. The SPECT device used was a triple-headed rotation gamma camera GCA9300A/HG. All images were transformed into the standard anatomical space of the stereotactic brain atlas of Talairach and Tournoux, and then smoothed. Statistical analysis was made between DAT and normal control groups. SPM analysis of SPECT images revealed that the parieto-temporal areas and posterior cingulate gyrus of both cerebral hemispheres were significantly decreased in DAT patients compared to normal controls. In conclusion, SPM analysis of SPECT images proved to be useful in the evaluation of abnormal perfusion areas of demented patients.

Twenty-five types of T-cell receptor Vbeta family repertoire in patients with Kawasaki syndrome.

UNLABELLED: Recently, a possible relationship between Kawasaki syndrome (KS) and superantigen has been discussed since the report of selective expansion of specific Vbeta family in the acute phase of KS. To further investigate the relationship between KS and superantigens, we examined 25 types of T-cell receptor Vbeta family repertoire in patients with KS using the reverse transcription polymerase chain reaction. This is the first attempt to examine all of 25 Vbeta families in KS. A non radioisotope method was used to quantify mRNA so that the experiment was safer, simpler, and faster. An expression index (EI) for each Vbeta was defined as: (the amount of each Vbeta mRNA)/(the sum of all Vbeta mRNA) x 100. Ten patients with KS and ten normal children were studied. The Vbeta9 and Vbeta15 of acute phase of KS showed both significantly lower mean EI and significantly higher frequency of a decreased EI value as compared with control children. Selective expansion of the Vbeta family in the patients with KS was not observed. Although highly increased EIs were observed in various Vbetas, their frequency was not statistically significant. The pattern of increased Vbetas did not show the specific pattern that indicates a particular superantigen. CONCLUSION: In Kawasaki syndrome non-radioisotope method for analysing Vbeta mRNA is useful in cases where many samples have to be handled. The depletion of Vbeta9 and Vbeta15 or highly increased expression index in the acute phase of Kawasaki syndrome might suggest a relationship to superantigens.