Comparative Study of Use of Reusable Skin Staples and Vertical Mattress Sutures in the Closure of Midline Laparotomy Wounds.

Background: There is an increasing tendency to close midline abdominal wounds with staples because of the speed of closure. The aim of this study was to compare the use of skin staples and vertical mattress sutures in the closure of midline abdominal wounds. Materials and Methods: Patients who met inclusion criteria and were booked for laparotomy in our teaching hospital were counseled on the two methods of skin closure using vertical mattress sutures or the use of staples (35 W Surustap, Suru International PVT Ltd, India). Alternating post-laparotomy wounds were closed using skin staples and with a vertical mattress, using nylon 2(0) (3 metric) sutures. The parameters assessed were speed of closure, cost of closure using the different methods, wound infection rate, and short-term cosmetic appearance of wounds. Data were analyzed using SPSS version 21 (IBM, SPSS, Chicago, Illinois). Results: Sixty patients met the inclusion criteria and were recruited for the study. The speed of closure of midline laparotomy skin wound was significantly higher in "the staple group" than in "the suture group" (0.14 vs. 0.034 cm/s), P < 0.05, while the cost of use of staples was significantly more than the cost for closure with sutures (184 vs. 26 Naira/cm), P < 0.05. The mean operative time was significantly less in "the staple group" than in "the suture group" (128.9 minutes versus 157.6 min), P < 0.05. There was no significant difference in the infection rates and cosmetic appearance between the two groups (P > 0.05). Conclusion: Midline abdominal wound closure with staples is faster. There was no difference in wound complication rates and scar appearance when compared with skin closures using the vertical mattress technique. Wound closure with staples is, however, more costly.

Correlation of Clinical, Endoscopic, and Pathological Findings among Suspected Peptic Ulcer Disease Patients in Abuja, Nigeria.

BACKGROUND: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and has been linked to Helicobacter pylori (H. pylori) infection. This condition may be suspected on clinical grounds, but diagnosis is established using upper gastrointestinal endoscopy. AIMS: To determine the correlation between the endoscopic and pathological findings among suspected PUD patients who have been referred for diagnostic upper gastrointestinal endoscopy in National Hospital Abuja. METHODS: This is a hospital-based prospective study conducted among suspected PUD patients at National Hospital Abuja over a one-year period. Clinical, endoscopic, and histological findings were ascertained and documented. Data obtained were analyzed using SPSS version 21.0. Tests of significance were done using the chi-square test and Student t-test at 95% confidence intervals. RESULTS: One hundred and thirty-two patients were included in the study. The ages ranged from 15 to 87 years, mean age 43.30 ± 11.94 years. Seventy-seven (58.3%) patients had abnormal endoscopic findings, of whom 37 (28.0%) had PUD. Prevalence of H. pylori infection was 42.2% and was found in 81.1% of PUD patients. H. pylori was significantly associated with confirmed PUD (p < 0.001) and abnormal endoscopic findings (p < 0.001). No association was found between normal endoscopic findings and histological findings (p = 0.924). CONCLUSION: There is a poor correlation between clinical and endoscopic diagnoses of PUD. H. pylori was found to be significantly associated with PUD and abnormal endoscopic findings. Endoscopic facilities should therefore be made available and accessible for proper PUD diagnosis. Empirical treatment of H. pylori in patients with diagnosed PUD is strongly recommended.

Problems and prospects of managing thoracic aortic aneurysm at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

The objective of this report is to highlight the problems encountered in managing thoracic aortic aneurysm in a third-generation teaching hospital serving a purely rural community in the heartland of Anambra State, in the southeastern part of Nigeria. This report also proffers solutions aimed at assisting in providing better care for patients afflicted with this condition. From time to time, patients present with vascular diseases, including aneurysm, but the condition is only occasionally suspected and sparingly investigated. This is a report of two cases within the setting of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Nigeria. After the death of these two patients, one of whom was a member of the staff of the hospital, post mortem examinations revealed that they had died of ruptured thoracic aortic aneurysm. Their medical records were retrieved from the Medical Records Department and reviewed with the aim of analyzing their clinical features and management in the light of the unexpected post-mortem examination results. The survey of the patient records revealed that the diagnosis of thoracic aortic aneurysm was not suspected in either patient even though both had symptoms pointing to this condition. The staff member was a 55-year old man and the other patient was a 31-year old woman in her 30th week of pregnancy. We conclude by drawing the attention of medical practitioners in our community to the fact that thoracic aortic aneurysms are probably more common than we thought. Only a high index of suspicion will lead to clinical diagnosis and treatment.