Pilot study on one-stage colonic resection without lavage in obstructed left colon in children in an emergency setting.

Classically, left-sided colon obstruction is managed by a multi-staged resection and defunctioning colostomy. The purpose of this study was to examine the feasibility of single-stage resection and anastomosis without intraoperative colonic lavage for acute left-sided colonic obstruction in children. Between October 2000 and May 2006, nine consecutive patients who had a one-stage left-sided colon resection without preceding colonic lavage were evaluated. The main outcome measures were anastomotic leakage, wound infection and death. There were nine patients: six were males and three were females (M:F = 2:1). Their ages ranged from 2-10 years (mean age 6 years). The obstruction was due to irreducible colo-colic intussusceptions in two patients and colo-colic intussusceptions with colonic perforation in four patients, and colo-colic intussusceptions with gangrene in three. All the patients had resection and primary anastomosis without on-table colonic lavage. There were no anastomotic leakages or deaths. Postoperative complications included superficial wound infections in two patients and dry cough in four other patients. Three patients were lost to follow up after 3 years of follow up, but the remaining six are presently doing well. Primary anastomosis without colonic lavage is safe for resection of the left colon in children in an emergency setting.

The scope and utilisation of day case surgery in a developing country.

BACKGROUND: The practice of day case surgery is today an attractive and an appealing one with increase spread to many specialties and many regions of the world. However, there is a great variability in its use and application. OBJECTIVE: To determine the scope and degree of utilisation of day case surgery in a developing country. DESIGN: A prospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria between January and December 2004. SUBJECTS: One thousand and twenty four patients had elective surgical procedures carried out during the study period out of which, three hundred and twenty procedures were done as day cases. MAIN OUTCOME MEASURES: There is a changing trend with a great prospect for the practice of day case surgery in the developing world. CONCLUSION: There is the need to harness all resources and keep abreast with relevant technological drive to realise the full potentials of this practice in this part of the world.

Posterior urethral valves in childhood : experience in a center with scarce facilities

Objective: Posterior urethral valves (PUV) are the most common congenital causes of lower urinary tract obstruction in male children; but few cases have been reported from Nigeria. In this study we describe our 7-year experience of management of PUV in children in order to increase the awareness of this condition in our environment. Patients and Methods : This is a report of 41 consecutive children with PUV who were managed at the Jos University Teaching Hospitals (JUTH); Jos; Nigeria; from June 2000 to April 2006. Their age at presentation ranged from 2 days to 15 years (mean: 2.5 years). The relevant clinical; laboratory and radiological data were entered into a database and analyzed.Results: Twenty-eight patients presented with a condition highly suspicious of PUV; while 7 patients presented with other urological conditions. Six patients presented with non-urological symptoms which caused a delay in diagnosis and institution of treatment. Voiding cystourethrography was diagnostic in all cases. In the majority of patients (n=31); management consisted of transurethral balloon avulsion of the valves yielding a satisfactory outcome in over 80. Conclusion : Although this study was restricted to one hospital; there appears to be a high incidence of PUV in children in North Central Nigeria. An increased awareness of varied clinical features; a high index of suspicion and simple conservative treatment by balloon avulsion of PUV would improve the outcome.of the patients. Urethral stricture was the main complication (which responded to serial dilatation) and occurred in 3 patients. The postoperative mortality rate was 2.6

Management of Conjoined Twins : a Report of Two Sets

Background: Conjoined twinning is a rare congenital anomaly. We present here; our experience in the management of two sets of conjoined twins at a Teaching Hospital in north central Nigeria. Method: Data of conjoined twins managed at the Jos University Teaching Hospital in 1987 and 2004 were retrospectively collated and analyzed. Result: Two sets of pyopagus tetrapus conjoined twins were managed within the period; one was a set of triplets. The conjoined pairs in both sets of twins were females. None of the twins was diagnosed prenatally. Both sets of conjoined twins were delivered spontaneously by vaginal route. Emergency surgical separation was undertaken in both sets be- cause of deteriorating anencephaly in one twin in the first set and anorectal malformation and intestinal obstruction in one twin in the second set. Both sets of twins died after separation. Conclusion: Our experience showed that separation of conjoined twins may be associated with high mortality. Sepsis and electrolyte imbalance appear to be the major causes of morbidity and mortality; particularly when the resultant skin defects are large

Appraisal on fluid and electrolyte management in paediatric surgical patient.

Fluid and electrolyte disorders are common occurrences in Paediatric surgical practice. Despite this, the management of fluid and electrolyte imbalance in the paediatric surgical patients remains problematic. This is partly because authorities vary considerably in their recommendations for therapy, despite the great advances being attained in the understanding of the fluid and electrolyte homeostasis in the Paediatric age group. This has, in no doubt, resulted in a number of morbidity and mortality that could have been prevented based upon rational and acceptable recommendations for fluid and electrolyte therapy in children. In this review, the normal homeostasis, disorders and management of fluid and electrolyte and corrections of metabolic disorders in children are highlighted, with the aim to update the practice of fluid and electrolyte therapy in children.

Outcome of primary closure of incised acute soft-tissue abscesses.

One hundred and six patients with acute soft tissue abscesses were involved in the study at the Accident and Emergency unit of Jos University Teaching Hospital (JUTH) from June, 1996 to April, 1997. The objective of the study was to assess the outcome of primary closure in the treatment of acute soft tissue abscesses using the healing rate, cost effectiveness, quality of scars and postoperative complications as parameters. The patients were divided into two groups: group A for primary closure, and group B for the conventional method. There was a statistically significant difference (P<0.05) in the healing time for study group A (6.96 +/-123.56) compared with control group B. Similarly group A was more cost effective (Total cost = N406 +/-123.56) compared with control group B (Total cost = N580.47 +/- 174.24). The difference was statistically significant (P

Open haemorrhoidectomy revisited.

The open method of haemorrhoidectomy has been criticized because of slow wound healing, severe pain and prolonged post operative care. This has led to a shift of interest to other methods of haemorrhoidectomy. These grounds of criticism need to be re-appraised for a rational conclusion and recommendation. Thirty nine consecutive patients who had open haemorrhoidectomy between 2nd and 3rd degree haemorrhoids from May, 1998 to April, 1999 were prospectively assessed for wound healing rate and complication rate. There were 26 males and 13 females (ratio 2:1). The average length of hospital stay was 3 days. Post operative pain and acute retention of urine were the commonest complications. The mean wound healing rate was 5 weeks, with a peak (30.8%) in the 5th post operative week. The mean cost of management was thirty eight U.S. Dollars ($38.00) or four thousand, five hundred and ninety three Naira. (N4,593.00). Open haemorrhoidectomy remains a safe and simple surgical technique that should not be discarded in complete preference to newer innovative methods.

Tru-cut biopsy of palpable breast lesions: a practical option for pre-operative diagnosis in developing countries.

OBJECTIVES: To establish the role of Tru-cut needle biopsy in the pre-operative diagnosis of breast lesions in a developing country. DESIGN: Prospective cross sectional study. SUBJECTS: 112 consecutive patients with palpable breast lesions who had both Tru-cut and excision biopsy as a pre-operative diagnostic procedure. RESULTS: Four (3.6%) patients had specimens that were inadequate for histological diagnosis. Tru-cut biopsy diagnosed 42 of the remaining 108 as malignant and 66 as benign, but only 40 and 61 respectively were confirmed to be correctly so by excision biopsy. Tru-cut biopsy, therefore, achieved a sensitivity of 88.9% (95% CI 79.7 to 98.1) specificity of 96.8% (95% CI 92.5 to 100) and an over all diagnostic accuracy of 93.5% (95% CI 88.9 to 98.2). There was a false positive rate of 4.8%, a false negative rate of 7.6% and a positive predictive value of 95.2%. The pathologist was able to make a correct specific histological diagnosis in 76.2% of all the adequate Tru-cut samples. CONCLUSION: If Tru-cut biopsy is done instead of excision biopsy, it will sufficiently reduce waiting time and reduce cost (four fold). It is well tolerated by patients. We regard the procedure as a useful adjunct and indeed a practical option for accurate pre-operative diagnosis of palpable breast lesions.

Traditional bone setter's gangrene.

Traditional bone setter's gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5-50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.

Dyspepsias among the highlanders of Nigeria: an epidemiological survey.

An epidemiological survey of the dyspepsias in a Nigerian Community drawn from five different local government areas, is described. Analysis of the data obtained from 1,151 respondents (684 males and 467 females) showed that 45.0% of this population had complaints of dyspepsia within the immediate six months period preceeding this study. The relevance of the independent variables as age, sex, marital status, family size, place of abode, number of meals per day, type of staple food consumed, self-medication and presence of melaena stool to the prevalence of dyspepsia was statistically analysed using the Chi-square test method. The family size (P < 0.05), occupational scatter (P < 0.001), type of staple food consumed (P < 0.05), presence of melaena stool (P < 0.01) and indulgence in self-medication (P < 0.001) were found to be the most significant variables. Since the vast majority of subjects with complaints of dyspepsia are to be encountered by general practitioners at the Primary Health Care level, it is hoped that the findings will go a long way towards evolving a more meaningful management strategy for this subset of subjects.

Thyroid function profile and differential serum lipid and lipoproteins in Africans with endemic goitre.

Serum total thyroxine (TT4), total triiodothyronine (TT3), thyrotrophine (TSH), thyroxine binding globulin (TBG), total lipids, triglycerides, total cholesterol, beta lipoprotein and beta lipoprotein cholesterol level were measured in 68 goitrous subjects and 4 agoitrous cretins by the techniques based on enzyme immunoassay (ELISA) (for thyroid parameters) and enzyme substrate principle (for lipid and lipoproteins) using commercial test kits (Boehringer Mannheim, W. Germany) and the results were matched with those derived from 59 clinically normal control subjects. The mean values of serum TT3, TBG, TSH and T3/T4 ratio showed positive correlations with the goitre size (r > 0.8, P < 0.005) while mean serum TT4 was negatively correlated (r > -0.9, P < 0.005). Typical biochemical features of hypothyroidism on serum lipid and lipoprotein profile were seen throughout, the changes being more marked in cretins. However, the serum lipid and lipoproteins were also, to some extent, found to be positively related to the thyroid size. In addition, a number of patients also showed variations in the serum lipid and lipoprotein levels appropriate to their compensated thyroid functional status in endemic goitre (as reflected by low TT4, raised TT3 and raised T3/T4 quotients).

Surgical correction of Hirschprung's disease: 7 years' experience with the Rehbein technique.

Twenty-seven children with Hirschsprung's disease underwent surgery using a modified Rehbein procedure. All the patients were admitted under one unit at the Jos University Teaching Hospital, Nigeria, over a 7-year period from April 1985 to March 1992. There was a male:female ratio of 3:1 with an average age at presentation of 21 months. Skin excoriation (19.0%) following initial colostomy was the commonest postoperative complication, while wound infection (18.5%) featured most often after definitIve surgery. There were no deaths following this procedure. The modified Rehbein technique is a safe and efficacious definitive method of surgical correction of Hirschsprung's disease.

Another look at acute appendicitis in tropical Africa: and the value of laparoscopy in diagnosis.

Acute appendicitis is believed to be one of the commonest causes of the acute abdomen in tropical Africa. Negative appendicectomy rates are usually above 20%, which is now considered unacceptably high because of increased risk to patients and the availability of diagnostic facilities to aid clinical decision-making. Our negative appendicectomy rate over a 4-year retrospective period was 29.7% in males, and 47% in females. These reduced to 11% and 10%, respectively, after the introduction of laparoscopy for doubtful cases of acute abdominal pain.

Male breast carcinoma in eastern Nigeria--a 13 year study.

A 13 year review of carcinoma of the male breast in an African Population is presented. Its incidence, Clinical presentation, diagnosis and modalities of treatment are critically analysed. The literature is reviewed and such topical issues as risk factors, prognostic indices and modern concepts on the possible aetiological mechanisms of development of human breast cancer are discussed. Finally suggestions are offered on possible strategies to improve the bleak survival rate.

Influence of variety of Nigerian rice on experimental peptic ulceration

The susceptibility of rats prefed with five varieties of rice to indomethacin - induced gastric ulceration was studied. The degree of ulceration was significantly higher (P0.001) in rats fed with white polished rice than in any of the two local rice varieties (Tapa and Ofada). Ulceration was significantly lower (P 0.001) in the brown rice-fed rats than with the polished rice-fed rats. This study indicates that the modern milling processes which improve the palatability and digestibility of rice remove most of the required vitamins along with the bran. Lack of these vitamins makes animals susceptible to gastric ulceration