Upper gastrointestinal endoscopy at the korle bu teaching hospital, accra, ghana.

SUMMARY OBJECTIVES: To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. METHODS: A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. RESULTS: A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 +/- 0.5 and females 43.7 +/- 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. CONCLUSION: The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.

Deep venous thrombosis of the lower limb in young ambulant ghanaians.

SUMMARY BACKGROUND: Deep venous thrombosis (DVT) usually affects patients who are over 40 years old, obese, bed ridden or have had major operations or have hypercoagulable states. Healthy and ambulant young people are usually not affected. OBJECTIVES: To report the observation of DVT in young patients below the age of 40 years METHODS: A study of all healthy and ambulatory patients below the age of forty years with a diagnosis of DVT seen on one surgical unit at the Korle Bu Teaching Hospital, Accra was performed from 1(st) January 2000 to 30(th) June 2003. RESULTS: Eleven patients, eight (8) females and three (3) males aged between 20 and 40 years with a median age of 32 years were treated. All the patients had deep venous thrombosis of the lower limb confirmed with Doppler studies and duplex scan of the lower limb. Swollen lower limb was the commonest presenting symptom and sign. Prolonged sitting was the main factor in 9 out of eleven patients. CONCLUSIONS: Deep venous thrombosis may not be a rare condition in the young ambulant Ghanaian and may be related mainly to a sedentary life style. Diagnosis should be suspected in patients who present with unilateral swollen and oedematous leg. There is the need to study the ailment in greater detail.

Extensive groin and perineal hidradenitis suppurativa complicated by high fistula in ano.

SummaryAnal fistula is a common cause of perianal sepsis in surgical practice. We share our experience in the management of a high fistula in ano caused by hidradenitis suppurativa an uncommon condition in Ghana.

Peripheral vascular injuries and their management in accra.

SUMMARY BACKGROUND: The true incidence of vascular injuries in Ghana is not known on account of low reporting. OBJECTIVE: We performed a study aimed at reviewing the pattern of injuries to peripheral vessels, and also the pattern of referral, presentation and management of these injuries at the Korle-Bu Teaching Hospital, Accra. METHOD: The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion. RESULTS: Fifty two (52) patients with aged between 13-50 years were reviewed. Penetrating trauma (82.7%) and blunt trauma (11.5%) were the commonest modes of injury. Arterial injuries (63.5%) and combined arterial and venous injuries (23.1%) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25% of patients most of whom also had brachial artery injuries. Late presentations of false aneurysms and arteriovenous fistulae were seen in 40.4% patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0% of patients. Vascular reconstruction was successful in 84.6% patients and 7.7% of patients required major limb amputation and an equal number of patients died from other injuries. CONCLUSION: There is undue delay in referring patients with vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations, which are usually expensive.