Severe Chest Injury Revisited - An Analysis of The Jos University Teaching Hospital Trauma Registry.

BACKGROUND: Chest injury remains a major source of morbidity and mortality in trauma as approximately two-thirds of all severe traumas involve the chest. OBJECTIVE: To determine the changes in the profile management and outcome of severe chest injury in Jos University Teaching Hospital, Jos, Nigeria. MATERIALS AND METHODS: This is an analysis of the Trauma Registry of Jos University Teaching Hospital-a prospectively gathered database. Patients' entries with severe chest injuries for 7 years, from January 2012 to December 2018, were entered into a database and analyzed using the Epi Info Statistical Software, using simple statistics. RESULTS: In all, 162 patients presented with severe chest injury over a 7-year period, of whom 78 (48.1%) had polytrauma, while 84 (51.9%) had isolated chest injury. There were 139 males and 23 females, giving male: female ratio of 6:1. Over 95 (58.6%) of them were between 20 and 39 years. Blunt injury was predominant, constituting 66.7%. Motor vehicular crash was the most common mechanism of injury constituting 87 (53.7%), while gunshot injuries were responsible for 34 (21%). In managing these severe chest injuries, 146 (90%) of the patients had closed-chest tube thoracostomy as the definitive treatment, while 16 (9.9%) had thoracotomy. The mean and median duration of hospital stay was 13.3 and 10 days, respectively. The commonest complication was wound infection in 8 (4.9%) patients and a mortality of 5.9%. CONCLUSION: Blunt chest injury remains the commonest mechanism of chest injury but with an increasing proportion of penetrating injuries affecting predominantly young males. Most severe chest injury patients survive with simple interventions of resuscitation, and closed-chest tube thoracostomy for definitive treatment.

DISTAL ILEAL STENOSING SUBSEROSAL LIPOMA: A CASE REPORT.

Lipoma is the commonest soft tissue tumour and ubiquitous in distribution. The gastrointestinal tract is a rare site for this neoplasm. This 38 years old patient presented to the surgical emergency unit of the Jos University Teaching Hospital with features of intestinal obstruction which was confirmed by plain abdominal X-ray. Patient was resuscitated and had exploratory laparotomy. At surgery, a dilated, oedematous, and pale segment of ileum was seen measuring 56 cm in length and 10 cm short of the ileo-caecal junction, where an obstruction had occurred.The distal segment was collapsed. A limited right hemi-colectomy was done with ileocolic anastomosis. Specimen received atthe Histopathology Laboratory consisted of 45 cm of the ileum, the caecum, appendix, and proximal 25 cm of the colon in continuity. There was stenosis affecting the distal 30 cm of the ileum. The wall of the stenosed part of ileum had intramural fat at the sub-serosal locale. Histology confirmed the presence of sheets of matured adipocytes between the muscularispropria and serosa. Patient condition improved and was discharged seven days after surgery. This case is reported five months after surgery. We recommend that lipoma be at all times considered in the differential diagnosis of intestinal obstruction.

Management of the mass casualty from the 2001 Jos crisis.

BACKGROUND: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001. MATERIALS AND METHODS: A retrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care. RESULTS: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients. Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside. CONCLUSION: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.

Experience with rubber band ligation of hemorrhoids in northern Nigeria.

BACKGROUND: Treatment of hemorrhoids in Nigeria is usually done by the traditional open method that requires hospital admission; anesthesia and is associated with high morbidity. Rubber band ligation is a suitable alternative to open hemorrhoidectomy and has the potential to reduce the need for hospital admission. PATIENTS AND METHODS: This was a prospective analysis of consecutive patients presenting with hemorrhoids that were suitable for surgical treatment to the Jos University Teaching Hospital and the Federal Medical Centre Gombe from January 2008 to December 2010 (24 months). RESULTS: A total of 232 rubber band ligations were performed on 40 patients whose ages ranged from 20 to 54 years with a mean age of 37.1 ± 12.2 years. There were 24 males and 16 females (M:F::2:3). Thirty-nine patients (97.5%) were cured of their symptoms following the procedure, and 1 patient (2.5%) had severe pain as complication of the treatment. Another patient had recurrence that was treated by repeat rubber band ligation. CONCLUSION: We conclude that rubber band ligation is a safe and reliable way for outpatient treatment of hemorrhoids in Nigeria.

Laparoscopic paediatric surgery: a potential for paradigm shift in developing countries.

BACKGROUND: Until recently, surgical conditions in children requiring operation were managed by the traditional open method. The introduction of the laparoscopic surgical technique seems to be reversing this trend in many centres. We are pioneering some laparoscopic surgery procedures in our environment and the aim of this study was to document our experience with laparoscopic paediatric surgical procedures in a developing country. MATERIALS AND METHODS: This was a prospective analysis of all consecutive children that had laparoscopic surgery at 5 hospitals in Northern Nigeria from June 2008 to February 2011. RESULTS: Twenty-one patients had laparoscopic surgeries during the study period with a mean age of 12.5 ± 2.6 years and age range of 10-16 years. There were 14 females and 7 males with a M:F ratio of 1:2. Seven patients (33.3%) had cholecystectomies and 13 (61.9%) had appendicectomies and the remaining one patient (4.8%) had adhesiolysis for partial adhesive intestinal obstruction following previous open appendicectomy. The mean operating time was 89 min with a range of 45-110 min for appendicectomies, 55-150 min for cholecystectomies and the adhesiolysis took 50 min. The mean hospital stay was 2 days except for the conversions that stayed up to 7 days. There were 2 (9.5%) conversions with no mortality. CONCLUSION: We solicit a paradigm shift in our approach to surgical management and implore other centres to embrace laparoscopic surgery in the management of surgical conditions in children since it confers obvious advantages over open surgery.

Pattern of urological malignancies seen at Federal Medical Centre Gombe North Eastern Nigeria.

BACKGROUND: The incidence of urological malignancies is on the increase globally like most other malignant tumours. There is generally poor documentation of urological malignancies in Nigeria attested to by the paucity of literature on this subject matter. This study was carried out to document the pattern and distribution of urological malignancies seen at Federal Medical Centre, Gombe, North Eastern Nigeria. MATERIALS AND METHODS: This was a retrospective analysis of all pathologically proven urological malignancies seen at this centre from January 2000 to December 2007. All records of patients with the diagnosis of urological malignancies were retrieved from the histopathology registers, operation registers and patients' case notes. The patients' biodata including their ages, sex and tumour site were extracted and analysed. RESULTS: A total of 118 cases of urological malignancies were recorded during the 8 years under review. Ninety-nine (83.9%) ocurred in males while the remaining 19 (16.1%) were in females giving a male: female ratio of 5:1. Children comprised of nine 9 (7.6%) and adults 109 (92.4%) of the population. The organ specific frequency of occurrence of the tumour in descending order comprised of prostate 63 (53.4%) bladder 33 (28.0%), kidney 17 (14.4%), testes 3 (2.5.%) penis 2 (1.7%) ureter and urethra (0%). CONCLUSION: We concluded that prostate, urinary bladder and renal carcinomas are the three most common urological malignancies in North Eastern Nigeria.

Histopathological types of breast cancer in Gombe, North Eastern Nigeria: a seven-year review.

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7 (4%) were in males while the remaining 165 (96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases.

Histopathological types of breast cancer in Gombe, North Eastern Nigeria: a seven-year review

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7(4%) were in males while the remaining 165(96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases (Afr J Reprod Health 2011; 15[1]: 107-109)

Laparoscopic general surgery--the journey so far.

BACKGROUND: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: Laparoscopic surgery has developed rapidly, initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline.

Inguinal hernia: the quest for the best repair.

BACKGROUND: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current mesh-based techniques is presented. METHODS: The PubMed database was searched for all English language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. CONCLUSION: The history of inguinal hernia is a rich one, from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure.

Histopathological Pattern of Breast Carcinoma in Different Age Groups

Background: Breast cancers tend to be more aggressive in younger patients and some histopathological types like medullary; mucinous and tubular variants have a better prognosis. This study describes the histopathologic pattern and tumour grade of breast carcinoma in younger patients. Methods: This was a retrospective analysis of all consecutive breast cancer specimens submitted to the histopathology department of Federal Medical Centre Gombe during the study period. The data was analyzed with EPI Info 2002 using simple means and percentages. Results: A total of 167 cases of breast carcinoma in 164 females were reviewed with three patients having bilateral disease. The age range of the study population was 22-75 years with a mean age of 44 +/-11.7 years. One hundred and twenty seven patients (76) were aged less than 50 years while the rest were above 50 years. A total of 133 tumours were invasive ductal carcinomas; 107(80.45) of which were in the premenopausal age group and 26(19.55) in post menopausal age. One hundred and six patients (63.5) had low grade tumours (grades 1 and 2) while 61(36.5) had high grade tumours (Grades III and IV tumours). Forty three (70.5) of these high grade tumours were seen in premenopausal age group. Eleven patients had invasive lobular carcinoma of which 4(36.4) were premenopausal while 7(63.6) were post menopausal. Conclusion: It is concluded that younger patients tended to frequently have aggressive and high grade disease

Laparoscopic General Surgery - The Journey So Far

Background: Laparoscopic surgery has evolved in a relatively short time to become a popular and integral part of the surgical armamentarium. An overview of developments which have taken place since its inception is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: Laparoscopic surgery has developed rapidly; initially from a basically diagnostic procedure to a therapeutic one which is currently challenging time-honoured traditional methods of surgery. Technological advancements and enthusiasm as well as the desire for scar less surgery appear to be poised to push even further the frontiers of this discipline

Inguinal Hernia:The Quest for the Best Repair

Background: Inguinal hernia repair may be the most common procedure in general surgery. Many repairs have been described but none appears completely satisfactory. A brief look at the popular methods of repair from the traditional tissue approximation to the current meshbased techniques is presented. Methods: The PubMed database was searched for all eng language literature. Further references were obtained through cross-referencing the bibliography cited in each work and using books from the authors' collection. Conclusion: The history of inguinal hernia is a rich one; from the traditional tissue approximation techniques to the current mesh-based repairs which are now performed as open or laparoscopic procedures. Recurrent rates have reduced but are still a problem. Perhaps the perfect repair remains elusive because the problem may also be with patients' collagen not just the surgical procedure

Pattern of duplex doppler ultrasound scans in Jos University Teaching Hospital.

INTRODUCTION: Doppler ultrasound scan is a non invasive diagnostic tool used in the evaluation of vascular and perivascular lesions. It is gaining a wider acceptance over other methods of vascular evaluation which are expensive and invasive. We aimed at evaluating the indications and findings of duplex doppler ultrasound scans performed in this centre. METHODOLOGY: This was a retrospective study of all consecutive patients that had doppler ultrasound scans from January 2000 to December 2004. RESULTS: One Hundred and sixty five (165) Doppler ultra sound scans were performed on 115 patients. Thirty nine patients had a double scan while 19 had repeated scans. The study population was aged between 2-90 years with a mean age of 44.5 +/- 17.5 years. There were 86 (52.1%) males and 79 (47.9%) females giving a male to female ratio of 1:1.67 (41%) of the doppler scans were for deep vein thrombosis while peripheral vascular disease and vascular aneurysm accounted for 24 (14.5%) and 23 (13.9%) respectively, see Table 1. Reduction in vascular blood flow was the most common doppler finding seen in 34 (20.6%) patients followed by visible thrombi in 14 (8.5%) patients. CONCLUSION: Deep vein thrombosis is the most common indication for doppler ultrasound scan in our practice.

Thyroidectomy under local anaesthesia: how safe?

BACKGROUND: In order to compliment the inadequate health facilities in the rural areas in Nigeria, nongovernmental organisations provide adhoc outreach health camps that offer treatment in various medical specialties including surgery. SETTING: Rural outreach health camps. OBJECTIVE: To evaluate the safety of thyroidectomy under local anaesthesia at rural outreach setting with inadequate facilities for general anaesthesia. PATIENTS AND METHODS: This was a prospective descriptive study of 33 consecutive cases of thyroidectomy performed using field block with 1% lignocaine and adrenaline 1: 200,000 dilution during two free medical outreaches that held at Jos, Nigeria in March and October 2005 respectively, lasting two weeks each. RESULTS: A total of 33 primary thyroid operations were performed consisting of 30 subtotal thyroidectomies (91%), 2 lobectomies (6%) and one total thyroidectomy (3%), The patients were aged between 23 and 62 years with a mean age of 45.8 years. There were 3 males and 30 females with a male: female ratio of 1:10. There was no mortality but morbidity was 2/33 (6%) Two complications were recorded in 2 patients and were superficial surgical site infection (3%) and reactionary haemorrhage (3%). CONCLUSION: We conclude that thyroidectomy under local anaesthesia is a safe procedure in experienced hands at rural settings with inadequate facilities for general anaesthesia.

Endoscopic Dilatation of Severe Oesophageal Stricture in Pregnancy: Case Report

In this paper; we present a case report of a severe oesophageal stricture in a pregnant woman that was successfully dilated endoscopically with improved maternal and foetal outcomes

Uterine rupture in a primigravida presenting as an acute abdomen post delivery: a case report.

BACKGROUND: Spontaneous rupture of the uterus in primigravida is a rare event reported in the literature. Rupture of the uterus usually presents as an acute life-threatening condition with symptoms and signs that makes diagnosis relatively easy particularly when there is history of obstructed labour and other risk factors. A case of uterine rupture in a primigravida with clinical signs evolving insidiously post delivery is being reported. METHOD: A review of the case record of a primigravida who developed acute abdomen post delivery and the relevant literature search was done with pubmed using, uterus, rupture, primigravida, oxytocin use, and vaginal delivery as key words. RESULT: A 22-year old primigravida who had spontaneous vaginal delivery developed acute abdomen post delivery subsequently had a laparotomy for suspected intra abdominal abscess and was found to have ruptured uterus. Repair of the uterus was done and post operative recovery was uneventful. Subsequent history from the patient revealed previous termination of a 5 month pregnancy 3 years before. CONCLUSION: This report highlights the need to suspect the possibility of uterine rupture as a differential diagnosis of acute abdomen post delivery particularly if there is past history of manipulations involving the uterus.

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.

A 5-year prospective study on chest trauma in children

Chest trauma is an important cause of mortality in children worldwide. In this study we present our experience with childhood chest trauma within a five years period. This was a 5-year prospective study of consecutive patients with chest trauma. Data entered into a pre-planned proforma included demographic information, type of injury, mechanism of injury, associated injuries, type of treatment given, outcome of management and duration of hospital stay. There were 36 children aged between 2 and 16 years (mean age: of= 10.5 ± 6.2 years). There were 24 males and 12 females (m:f 2:1). Twenty seven (75%) of the 36 patients had blunt trauma while nine (25%) had penetrating chest injury. Road traffic accident was responsible for chest trauma in 26 (72.2%) children, but 6 (16.7%) other children were victims of civil unrest while 4 (11.1%) fell from heights. Haemo-pneumothorax was common in 10 (27.8%) patients. Twenty five out of the 36(69.4%) patients had associated injuries, 10 (40%) were head injuries, followed closely by abdominal injury in 8 (32%). Chest trauma in children is common in our environment. Majority of the children suffered blunt trauma following road traffic accidents. Prompt recognition and treatment of affected children is needful for a successful outcome