African
Journals Online
Nigerian Journal of Surgical Research
Volume 3 Number 3 - 4 December 2001
Breast Cancer In Pregnancy: Management Approach
E. S. Garba, P. Uyanne, *A. O. Oguntayo, *S. Lafia and N.
O. Udezue
Departments of Surgery and *Obstetric and Gynaecology, Ahmadu
Bello University Teaching Hospital, Kaduna, Nigeria.
ABSTRACT
About 1-2% of breast cancers occur during pregnancy and
lactation, and 7% of fertile women have one or more pregnancies
after mastectomy for breast cancers. The high physiological
activity of the breast in pregnancy causes the breast to be
engorged. There is increased vascularity and lymphatic drainage
from the pregnant breast assisting the spread of metastatic
process to the regional lymph nodes. The clinical features of
cancers of the breast in pregnancy are the same as in the
non-pregnant patient. Pregnant patients tend to have a higher
incidence of positive lymph nodes, however. Early diagnoses is
made possible with awareness of this condition during pregnancy,
routine self examination, adequate history, meticulous
examination with liberal use of fine needle aspiration biopsy and
when necessary open biopsy under local anaesthesia. As in
non-pregnant patients all modalities of treatments are
intelligently employed in the treatment of breast cancer in
pregnancy. Radical mastectomy is well tolerated during pregnancy,
and the results of treatment during pregnancy are the same, stage
for stage as in the non-pregnant woman. The reported overall
survival rate for breast cancer in pregnancy is poor, reflecting
the more advanced stage of the disease at diagnosis. An approach
to the management of breast cancer in pregnancy is presented by a
case illustration and a review of literature. (Nig J Surg Res
2001; 3: 111 – 117)
KEY WORDS: Breast Cancer, Pregnancy, Management
Ketamine Hydrochloride: A Useful but Frequently Misused Drug
I. K. Kolawole
Department of Anaesthesia, University of Ilorin Teaching
Hospital, Ilorin, Nigeria.
ABSTRACT
Background: Ketamine hydrochloride remains the most
widely misused general anaesthetic agent in our environment
today. The misuse, which commonly involves non-anaesthetists,
often results in disastrous consequences.
Methods: A Medline literature search was performed to
identify articles concerning the pharmacology, clinical features,
uses and complications of ketamine hydrochloride. Standard
textbooks of anaethesia were also consulted and some local
scientific publications on the subject were reviewed.
Result: Ketamine is readily available and widely used
by both surgeons and general practitioners working in the
tropics. The drug has been found useful for superficial minor and
intermediate surgical procedures in regions where there is a
dearth of anesthetists. Its unique features, simplicity of
administration and relative safety, which has made it useful in
the hands of non-anaesthetists, have also led to widespread
abuse.
Conclusion: There is need for surgeons and other
“occasional anaesthetists” to be well informed on the
correct uses, limitations and dangers of ketamine anaesthesia to
enhance patients' safety. (Nig J Surg Res 2001; 3: 118 –
125)
KEY WORDS: Ketamine Hydrochloride, Useful, Misuse
Spectrum of Eye Injuries in Children in Guinness Eye
Hospital, Onitsha
L. O. Onyekwe
Guinness Eye Hospital, Nnamdi Azikiwe University Teaching
Hospital, Onitsha, Anambra State.
ABSTRACT
Background: This study aims at eliciting the epidemiologic
information on eye injuries in children seen in Guinness Eye
Hospital, Onitsha.
Methods: The records of all patients aged sixteen years
and below seen between August 1997 and July 1998 in Guinness Eye
Hospital, Onitsha were retrospectively reviewed.
Results: Ninety seventy children with eye injuries were
seen. Out of 216 patients with eye injuries seen 97(44.9%) were
children. The common activities resulting in eye injuries were
playing, fighting and flogging. The injuries were commonly
inflicted by self and playmates. Eighteen (18.5%) presented in
hospital within the first day of injury. Twenty-three (28.0%)
eyes were visually impaired, Visual Acuity (VA < 6/18) and
24(29.3%) were uniocularly blind (VA < 3/60) on presentation.
Final VA showed visual impairment in 18(30%) patients and
uniocular blindness in 13(21.7%) patients.
Conclusion: Eye injuries in children are preventable
and morbidity from such injuries can be reduced by early and
appropriate treatment. It is therefore necessary to institute
effective health education aimed at preventing eye injuries and
encouraging early treatment and improvement in childcare. (Nig
J Surg Res 2001; 3: 126 – 132)
KEY WORDS: Eye Injuries, Children
Repair of Extensive Composite Alar Defects with Single
Stage Nasolabial Turnover Flap and Auricular Composite Graft
O.M. Oluwatosin
Department of Surgery, University College Hospital, Ibadan.
ABSTRACT
Extensive and total (through and through) loss of ala or
lobule of the nose as seen in severe traumas and neglected
tumours should be replaced by the three anatomical layers of
skin, cartilage and vestibular lining. A technique of nasolabial
turnover flap transfer covered by a two layered auricular
chondrocutaneous graft is described for reconstructing such total
losses >1.5 cm. The method of survival of large volume
chondrocutaneous grafts is described as well as the advantages of
this technique over other alternatives. (Nig J Surg Res 2001;
3: 133 – 138)
KEY WORDS: Alar defects, Repair
Perception of Oral and Maxillofacial Surgery in a
University Community
O.N.Obuekwe and B.D.O Saheeb
Department of Oral And Maxillofacial Surgery and Pathology,
College of Medical Sciences, University of Benin, Benin City,
Nigeria.
ABSTRACT
Background: Oral and maxillofacial surgery is a
specialty that is expanding its frontiers of surgical anatomic
definition. There has been no study in Nigeria to ascertain the
level of knowledge of the specialty by the public.
Materials and Methods: The population of the University
of Benin Community is about 47,000 inhabitants. Students form the
bulk of the population. A questionnaire was designed to assess
the knowledge of the community of the specialties of Oral and
Maxillofacial Surgery, Ear, Nose and Throat (ENT), and plastic
Surgery. They were asked some questions on their choice of
surgeon to treat them if they or a member of their families had
an identified surgical problem. They were asked whether the title
of OMFS was suitable and its relevance in a developing country.
Results: Two hundred copies of the questionnaire were
collected which represented 80% of the sample. There were 48%
males and 52% females with an age range of 16 to 45 years. Less
than half (43.5%) of the respondents have heard of OMFS, 55% and
87.5% have heard of the ENT and Plastic Surgeon respectively.
Eighty nine percent of respondents think the specialty is
relevant in a developing country and 40.5% thought the name
should not be changed.
Conclusion: The results show a general lack of
awareness of OMFS. (Nig J Surg Res 2001; 3: 139 – 146)
KEYWORDS: Perception, Oral, Maxillofacial Surgery
Observing Precautions against Cutaneous Injuries by Theatre
Workers
S. A. Eguma and R. I. Mohammed
Department of Anaesthesia, Ahmadu Bello University Teaching
Hospital, Kaduna, Nigeria.
ABSTRACT
Background: Health care workers are at risk of
acquiring blood-borne viral infections from contact with infected
blood and body fluids. Operating room workers are at even greater
risk because of their greater exposure and the invasive
procedures they perform.
Method: A questionnaire was used to determine the type
and sites of injuries obtained at work by operating room workers
and how much precaution they took to avoid sustaining such
injuries. Knowledge of what to do following injury was also
tested.
Results: Seven peri-operative nurses,15 nurse
anaesthetists,23 resident doctors and 2 consultants responded to
the questionnaire. Most injuries occurred on the left index
finger. Injuries were sustained from needle sticks, broken
ampoules, surgical blades, needle holders and bolts used on bone
screws. Artery forceps, oxygen cylinder keys, bare hands, teeth
and files were used to open injection ampoules. Gloves were worn
while performing or assisting at surgery but not always for
procedures like setting up blood, passing naso-gastric or
endotracheal tubes, or opening injection ampoules. The risk of
acquiring injury from instruments in theatre was 4.49%. 59.5%
(28) of operating room workers took no measures to prevent
injuries. 14.8% (7) of workers still recapped needles after use.
Following injury, 78.7% (37) of operating room workers cleaned
the wound with antiseptic and covered with dressing. 8.5% (4)
cleaned the wound and left it open while10.6% (5) did nothing
about any injuries sustained.
Conclusion: Theatre workers need
to change their present casual attitude towards taking preventive
measures against injury at work. (Nig J Surg Res 2001; 3: 147
– 153)
KEY WORDS: Cutaneous injuries,
Theatre staff, Awareness
Day Case Transurethral Prostatectomy without Post-Operative
Catheterisation: A Preliminary Study
L. I. Okeke
Department of Surgery, University College Hospital, Ibadan,
Nigeria.
ABSTRACT
Background: The pain fibers from the pelvic viscera
including the prostate gland, the urinary bladder, and the entire
perineum are mostly carried by the sacral parasympathetic outflow
via the anterior divisions of the sacral nerve roots 2, 3, and 4.
Caudal anesthesia has been used over the years for out-patient
procedures. It was considered that if the usual indications for
postoperative admission in patients who have undergone
transurethral resection of the prostate could be removed, then
they too can be managed as day cases.
Method: Ten selected patients with obstructing benign
prostatic enlargement on urethral catheter drainage with prostate
glands weighing 60g or less on ultrasound assessment, were
subjected to transurethral resection of the prostate gland (TURP)
as day-cases under caudal block regional anesthesia using 2%
xylocaine with 1 in 80,000 adrenaline. Hemostasis was secured
until effluent of the irrigation fluid from the bladder was
totally free of any visible trace of blood. A catheter was not
inserted postoperatively.
Results: These patients resumed spontaneous voiding
postoperatively before discharge. Their discharge on the same day
did not in any way lead to any adverse events.
Conclusion: With a better understanding of the anatomy
of the innervations and blood supply of the prostate gland, and
proper patient selection, day-case TURP without postoperative
catheterization can safely be added to the list of day case
procedures. If a larger study further confirms the safety of
these preliminary findings, the cost and inconvenience associated
with hospitalization on the part of the patient would be reduced.
(Nig J Surg Res 2001; 3: 154 – 158)
KEY WORDS: TURP, Day case, Catheterisation
Transrectal Biopsy of the Prostate Gland in Ibadan
O. B. Shittu and T. B. Kamara
Urology Division, Department of Surgery, College of Medicine,
University of Ibadan and University College Hospital, Ibadan,
Nigeria.
ABSTRACT
Background: Transrectal needle biopsy of the prostate
gland is considered to be more accurate than the transperineal
approach.
Method: A review of the problems associated with
transrectal biopsy of the prostate gland in our institution over
a 5year period.
Results: A total of 230 patients had transrectal
biopsies of the prostate performed. The procedure was associated
with complications in sixty patients.The infective complications
seen were bacteraemia, manifesting as fever and rigors, and
urinary tract infection. The traumatic complications manifested
mainly as rectal bleeding and haematuria. Most of the
complications were self- limiting and responded adequately to
conservative management.
Conclusion: Complications are common and could be
fatal. Infective complications could be reduced, by administering
antibiotics before and after the procedure. (Nig J Surg Res
2001; 3: 159 – 164)
KEY WORDS: Prostate, Transrectal biopsy, Complications
Menetrier's Disease: Case Report
S.T Edino, S.U Alhassan and *O. Ochicha
Department of Surgery, and *Pathology, Aminu Kano Teaching
Hospital, Kano, Nigeria.
ABSTRACT
A 25 year old man presented with epigastric pain ,
postprandial vomiting which was non projectile and non bilous,
progressive weight loss, and body swelling for 2 years. The only
remarkable findings were wasting and epigastric tenedreness and
positive succussion splash. A gastroduodenoscopy revealed
polypoid gastric mucosa involving the fundus and body of the
stomach but sparing the antrum; there was no ulceration.
Histology os endoscopic biopsy specimen showed features
suggestive of Menetrier's disease. Treatment with oral cimetidine
was continued along with high protein and calorie diet but the
symptoms persisted . Subsequently, an exploratory laparotomy was
done and the findings at surgery were a hypertrophied stomach
with polypoid mucosa involving the fundus and body. The
antroduodenal region was grossly normalTotal gastrectomy with
direct esophagoduodenostomy was done The second histology report
confirmed Menetrier's disease. Menetrier's disease is a rare form
of hypertrophic gastropathy. It is a premalignant disorder of the
stomach. Cytomegalovirus and Helicobacter pylori infections, and
transforming growth factor alpha , have been implicated in the
aetiopathogenesis of the disease. Conservative treatment by
aggressive eradication of H.pylori improves patients' symptoms,
and abrogates the protein losing enteropathy characteristic of
the disease. Surgery by total gastrectomy offers the best
definitive treatment as it removes the risk of gastric cancer in
a gastric remnant. (Nig J Surg Res 2001; 3: 165 – 169)
KEY WORDS: Menetrier's Disease, Helicobacter Pylori, Total
Gastrectomy
Giant Anal Condyloma Acuminatum in Childhood: A Case Report
K. Attipou, K. Yawovi, N. James, *G. A. Napo-Koura, **A.
Tchangaï-Walla and K James
Visceral Surgery Department, *Cytology and Pathological
Anatomy Laboratory and **Dermatology and Venereology. UTH-Tokoin.
Lomé-Togo.
ABSTRACT
The authors report a case of anal giant condyloma acuminatum
present for 10 years in a 14 year old. The giant tumor was
responsible for difficulty in the sitting and difficulty with
defecation. Surgical excision was a little limited in order to
conserve the anal sphincter. Cauterization with diathermy was
done on the remaining small sized lesions at the level of the
perineum and at the level of anal canal mucosa. Post-operative
follow-up was marked by the recurrence of the tumor after 3
months. Giant ano-rectal condylomas are very rare. The treatment
is surgical excision and chemotherapy. (Nig J Surg Res 2001;
3: 170 – 174)
KEY WORDS: Giant Condyloma, Anus
Misuse of Ketamine: Report of two Cases
I. K. Kolawole
Department of Anaesthesia, University of Ilorin Teaching
Hospital, Ilorin.Nigeria.
ABSTRACT
Two patients were referred to our hospital from different
private hospitals, within a period of 2-months, following
complications arising from ketamine anaesthesia. Our assessment
revealed obvious cases of misuse of ketamine hydrochloride as a
sole anaesthetic. The cases are presented to highlight various
forms of misuse of ketamine in the hands of non-anaesthetists. (Nig
J Surg Res 2001; 3: 175 – 180)
KEY WORDS: Ketamine, Misuse
Renal Angiomyolipoma Presenting as Acute Abdominal
Emergency: A Case Report
L.I. Okeke and *R. A. O. Ogunseyinde
Departments of Surgery and *Radiology, University of Ibadan
and University College Hospital, Ibadan, Nigeria.
ABSTRACT
A 47-year-old woman presented as an acute abdominal emergency
with rapid progression to shock following spontaneous rupture of
a left renal angiomyolipoma. The diagnosis was missed clinically
and on computerized tomographic scan. At different stages of
management based on her pattern of symptoms, signs and radiologic
appearances of her lesion, she was thought to have ruptured
ectopic pregnancy, torsion of a left ovarian cyst, acute
salpingitis, spontaneous rupture of the spleen, leaking abdominal
aortic aneurysm and eventually left renal cell carcinoma until
the histology of her left nephroureterectomy specimen became
available. Even though a rare entity, with a high index of
suspicion and a good knowledge of the pathognomonic features on
ultrasound and computerized tomographic scanning, the diagnosis
should be more easily made to facilitate quicker decisions on
management. (Nig J Surg Res 2001; 3: 181 – 184)
KEY WORDS: Renal Angiomyolipoma, Acute Abdomen
Chondrolipoma of the Breast: A Case Report
A.Z. Mohammed, *S.T. Edino and O. Ochicha
Department of Pathology and*Surgery, Aminu Kano Teaching
Hospital, Kano, Nigeria.
ABSTRACT
Chondrolipoma of the breast is a rare mesenchymal tumour of
unclear histogenesis. In this report, we present a case in an
elderly female highlighting the clinical features, gross and
microscopic findings and a review of the literature. (Nig J
Surg Res 2001; 3: 185 – 187)
KEY WORDS: Breast, Chondrolipoma
Giant Osteoma of the Frontoethmoidal Sinus: A Case Report
B.B. Shehu and J.N. Zaman
Neurosurgical Unit, Department of Surgery, Ahmadu Bello
University Teaching Hospital, Zaria, Nigeria.
ABSTRACT
Giant or large osteomas of the skull are uncommon. This is a
report of a 14-year old girl presenting with a giant osteoma of
the frontoethmoidal sinus. The osteoma was completely excised at
limited craniectomy. There has been no recurrence at 2 years of
follow up. (Nig J Surg Res 2001; 3: 188 – 190)
KEW WORDS: Skull, Giant Osteoma
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