African Journals Online
Nigerian Journal of Surgical Research

Volume 4 Number 1 - 2 January - June 2002
CONTENTS

Benign breast lesions in Kano

Departments of Pathology and * Surgery, Aminu Kano Teaching Hospital, Kano and **Department of Pathology, National Hospital Abuja.

Reprint Requests to: Dr S. T. Edino, Department of Surgery, Aminu Kano Teaching Hospital, P. M. B. 3452, Kano. E- mail: [email protected]

Background: Non-malignant diseases of the breast have assumed increased importance in recent times because of public awareness of breast cancer. This study was carried out to look closely at benign breast lesions in Kano with a view to comparing with data from other centres in Nigeria and abroad.

Method: A five-year retrospective review of all histopathologically proven benign breast lesions in the two major hospitals in Kano was carried out. The data were analysed on the basis of the histopathological types, age and sex distribution.

Results: Benign breast lesions accounted for 160 (73%) of all breast biopsies seen, and 71.9% of breast diseases in women with a benign to malignant ratio of 2.6 to 1. The mean age at presentation was 26 years. Fibrocystic disease was the commonest histological lesion comprising 55 (34.3%) of all cases, with a mean age of 33 years. This was followed by fibroadenoma accounting for 28.8% with a mean age of 21 years, thus occurring a decade earlier than fibrocystic disease of the breast. Inflammatory breast diseases accounted for 8.1%.

Conclusion: This study has shown that benign diseases are common in our environment, and with few exceptions our data was comparable to other Nigerian series, but slightly at variance with the developed world.

University of Ilorin Teaching Hospital, Maternity Wing, Ilorin, Nigeria.

Objective: To determine the incidence, trends aetiological factors, clinical presentation and management of ectopic pregnancy at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Methods: Retrospective study of ectopic pregnancies at the University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Results: The incidence of ectopic pregnancy during the period was 1 in 69 deliveries or 1.4%. When compared with the incidence of 0.9% between 1987 and 1991, a one and a half increase is noted. Majority of the patients 139 (75.5%) were of low socio-economic status and of low parity 113 (61.4%). The common associated aetiological factors identified included previous induced abortion 105 (57.1%), previous pelvic inflammatory disease 39 (21.1%) and intrauterine contraceptive device 13 (7%). The recurrence rate was 26 (14.1%).

Conclusion: The incidence of ectopic pregnancy is on the increase. Measures to reduce the rising incidence include prompt and adequate treatment of pelvic inflammatory disease and sexually transmitted disease.

Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Reprint requests to: Dr Babatunde A. Solagberu, P. O. Box 4377, Ilorin Nigeria. E-mail: [email protected]

Background: Cardiopulmonary resuscitation (CPR), first described in 1960, is observed to be poorly applied in quality and quantum, hence, the need to ascertain its correct knowledge and practice among Nigerian doctors.

Methods: Questionnaires were distributed randomly to doctors in a Nigerian University Teaching Hospital. Respondents returned the unsigned questionnaires into a sealed box to protect their identity. There were 45 questions covering theories and practice of CPR.

Results: Fifty-six of 94 (59.6 %) doctors returned their questionnaires; comprising 16 Interns, 21 Registrars, 8 Senior Registrars, 7 Consultants and 4 others. Twenty of the 56 respondents (35.7 %) would do CPR for only 20 minutes, 25%-89% respondents (mean 61.6% ± 24%) did not know items absolutely essential for CPR, 37 (66.1%) could not use adrenaline effectively either by route of administration or dosage, 25 (44.6%) would use inappropriate venous access, and majority (41 of 56, 73.2 %) would not use blood gas analysis, urine output, ECG to monitor response to CPR. Thirty-nine (69.9%) listed lack of materials as the greatest problem faced in carrying out CPR. Thirty-eight (67.9%) believed other doctors’ knowledge of CPR was inadequate and 54 (96%) felt doctors needed to update their knowledge of CPR.

Conclusion: Cardiopulmonary resuscitation is associated with problems of lack of materials, and demonstrable inadequate knowledge and application of its pathophysiology as more than two thirds of the respondents believed other doctors' knowledge of CPR was inadequate.

These three parameters may be responsible for the observed poor success rate in CPR. Efforts to correct these should improve CPR success rate among Nigerian doctors.

Departments of Haematology and *Surgery, University of Maiduguri Teaching Hospital, Maiduguri.

Background: Thirteen cases of priapism seen in adult patients with sickle cell disease (SCD) were treated by exchange blood transfusion (EBT) at the University of Maiduguri Teaching Hospital during a five-year period (1996-2000). Each patient was scheduled to receive a total of 12-unit exchange, but due to voluntary donor blood scarcity and differences in affordability of commercial donors only 1 (7.7%) patient could receive 10 units, 3 (23.1%) patients had 8 units each, and 9 (69.2%) patients received 7 units each.

Method: EBT was carried out manually in all cases and the mean number of units exchanged, the mean levels of Hb S and the mean levels of haematocrit were determined before the start of EBT (pre-EBT) and at the time of achieving complete detumescence.

Result: The exchange procedures were started with mean pre- EBT levels of 95% of Hb S and 0.24L/L of haematocrit; complete detumescence was achieved in all cases after an average of 6 units were exchanged by which time the mean Hb S level had fallen to 50.3% and the haematocrit had risen to a mean level of 0.28L/L.

Conclusion: EBT was successful in achieving complete detumescence and at much higher Hb S level (50.3%) than was earlier recommended. EBT is therefore effective in treating priapism in SCD and should be offered to such patients in order to avoid surgery, the risks of general anaesthesia in SCD and the possibility of postoperative impotence.

Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Nigeria.

Background: The rising cost of health care and dwindling economic resources necessitate the need to encourage cost-effectiveness in patient care. Cancellation of cases on the scheduled day of surgery leads to inefficient utilization of theatre space, waste of valuable manpower and scarce resources for patients and hospital. Avoidance of unnecessary cancellations of cases may therefore be an important way of ensuring efficient utilization of resources.

Methods: This is a prospective study. Record was taken of all patients whose names appeared on the routine elective surgical operation lists. The names of all those who could not have their surgery done were compiled. The age, sex, diagnosis, specialty of surgery, proposed surgery and reasons for cancellation were collated and analysed.

Results: Out of the 1,175 patients scheduled for surgery during the study period, 272(23.15%) were cancelled for various reasons. The highest incidence of cancellation 130(11.06%) was recorded in orthopaedic specialty, even though it ranked second to General Surgery in the total number of cases booked. Cardiothoracic unit recorded the lowest incidence of cancellations (1.84%), but it also had the lowest number of cases scheduled for surgery. The commonest cause of cancellations was time constraints (22.59%). Patients absconded from surgery for personal reasons not communicated to the Surgeons in 13.60% of cases, while unanticipated logistic problems accounted for another 9.93%. Other causes of cancellations included industrial action embarked upon by members of the hospital community staff auditing exercise, uncontrolled medical illness and unresolved laboratory abnormalities.

Conclusion: The incidence of cancellation of cases on the scheduled day of surgery is still high in our hospital. Most of the causes of the cancellations are preventable. In order to enhance cost-effectiveness, efforts should be made to prevent unnecessary cancellations through careful planning and closer interactions between surgeons and patients, and amongst members of the surgical team.

Urology Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.

Background: To present the clinical features and outcome of management of patients with prostate cancer in Port Harcourt, Nigeria.

Methods: A retrospective study of patients with prostate cancer managed in 14 years at the University of Port Harcourt Teaching Hospital.

Results: Of 154,594 men above 40 years old who attended the hospital, 177 were treated for prostate cancer, giving a hospital incidence of 114/100,000. Of these, the records of 47 had sufficient data to be included for analysis. Record keeping was poor. The ages ranged from 45 to 88 years with an average of 71.6 years. Forty-three patients (91.5%) presented late with features of advanced disease such as anaemia, spinal cord compression and urinary retention. The diagnosis was made from tissue biopsies, x-rays and biochemical results with clinical findings. The treatment was bilateral subcapsular orchidectomy with or without diethylstilbestrol. The response to treatment in most patients was satisfactory initially but relapse was common and fatal.

Conclusions: Record keeping requires urgent attention. Prostate cancer screening should be adopted in line with trends in industrialised countries. Mortality in our patients was mainly from direct complications of prostate cancer.

Department of Otorhinolaryngology, University College Hospital, Ibadan.

Background: The goal of ear surgery is to eradicate active disease, prevent recurrence or complications and restore functional hearing. The aim of this paper is to review the indications, complications and benefits derived by the patient from otologic surgery.

Methods: A retrospective study of patients seen in the Department of Otorhinolaryngology, University College Hospital, Ibadan, in fifteen years.

Results: Ninety-six ear surgeries (46 males and 40 males) were performed during the period. Fifty of these were done within the last five years out of the 1,207 patients (4%) seen in the Outpatient clinic. The mean age was twelve years (SD = 15 years) with a range of 3 — 66 years. Mastoiditis and mastoid abscesses accounted for 49% and 35% respectively of the indications for surgery. The most common postoperative complication encountered was persistence of mastoidectomy cavity with chronic infection. Fifty-seven (95%) of mastoidectomy was done by the Consultant staff and three (5%)by the senior residents. Three (5%) out of the sixty patients who had mastoidectomy recovered functional hearing postoperatively while the rest were discharged with a dry or infected ear.

Conclusion: the otologic surgeries done were few and the exposure of the residents was inadequate thus recommended that there is urgent need for improvement in the skill of the surgeon through post-fellowship training in tympanoplasty or an increased exposure of the residents coupled with provision of adequate operating facilities.

Veterinary Surgery and Medicine, *Veterinary Teaching Hospital **Division of Agricultural Colleges, Ahmadu Bello University, Zaria.

Reprint Requests To: Dr A.Z Hassan, Veterinary Surgery And Medicine Department, Ahmadu Bello University, Zaria. E-mail: [email protected]

Background: Untreated aural haematoma may result in deformity of the pinna.

Methods: Retrospective study of 55 cases of aural haematoma (AH) managed in 18 years.

Results: AH was categorized based on the severity of the condition and the management protocol employed. AH fluid aspiration, AH fluid aspiration and dexamethasone infusion, AH incision plus bandaging, AH incision plus ablation suturing and AH stab incision plus placement of measured indwelling polyethylene infusion tubes were employed in the management of this disorder.

Conclusion: AH stab incision plus placement of measured indwelling polyethylene infusion tubes proved to be the most successful of these protocols.

Where there is no t-tube: operative management of 2 patients with choledocholithiasis

D. O. Irabor, I.O. Oyegbile, J. K. Ladipo and P. A. Adegoke

Gastrointestinal Surgical Unit, University College Hospital, Ibadan, Nigeria.

Reprint requests to: Dr. D.O. Irabor, Department of Surgery, University College Hospital, P.M.B. 5116, Ibadan, Oyo State, Nigeria. E — mail: [email protected]

The T — tube is invaluable following choledochotomy. Unavailability has prompted improvisation using size 18 nasogastric tube as a T — tube in 2 patients. The improvised tube was effective. In the absence of a conventional T — tube, the nasogastric tube could serve as a useful alternative.

Departments of Radiology and *Surgery, University College Hospital, Ibadan, Nigeria.

This is a report of 2 males aged 48 years and 50 years respectively presenting with persistent cough. Computed tomography showed posterior and anterior mediastinal masses respectively. Needle aspiration and cytology confirmed teratoma, with sarcomatous change in the first patient. Due to advanced disease only radiotherapy was offered but the patient died after a few courses. The other patient had excision of the mass, confirmed to be a benign teratoma. Computed tomography is invaluable in the diagnosis of mediastinal teratomas.