African
Journals Online
Nigerian Journal of Surgical Research
Volume
4 Number 3 – 4 July – December 2002
Abstracts
Management of massive
haemoptysis
V.
O. Adegboye and A. O. Adebo
Cardiothoracic
Unit, Department of Surgery, University College, Hospital, Ibadan and
the University of Ibadan, Nigeria.
Reprint requests to:
Dr. V. O. Adegboye, Department Of Surgery, University College
Hospital, Ibadan, Nigeria. [email protected]
ABSTRACT
Background:
This study compares two management techniques in the treatment of
massive haemotysis.
Method:
All patients with massive haemoptysis treated between January 1969 and
December 1980 (group 1) were retrospectively reviewed and those
prospectively treated between January 1981 and August 1999 (group II)
were analysed. Group I
patients had emergency bronchoscopy and surgery while group II
patients had interval conservative care before bronchoscopy and
definitive surgical management.
Results:
Both groups have comparative age and sex distribution and infective
pulmonary diseases dominated as causes of massive haemoptysis.
Recurrent haemoptysis occurred in 15 patients (22.7%) of group II
during preoperative waiting period. In group I, bronchoscopy was
abandoned in 5 patients and was immediately fatal in 1 patient. No
such experiences in group II. The number of pneumonectomies were 12
out of 18 procedures (66.7%) for group I and 19 out of 68 procedures
(27.9%) in group II. There were 5 lobectomies (27.8%) in group I and
49 (72.5%) in group II. Operative mortality was 72.2% for group I and
7.4% for group II.
Conclusion:
Initial unduly prolonged, conservative therapy followed by
appropriately timed operative intervention produced the best outcome.
Keywords:
Massive haemoptysis, treatment.
Skin-test reactions in
chronic allergic rhinitis in Benin
F. O. Ogisi
ENT Unit, Department
of Surgery, University of Benin Teaching Hospital, Benin City,
Nigeria.
Reprint requests
to: Dr. F. O. Ogisi, Department of Surgery, U. B. T. H., P. M. B.
1111, Benin City, Nigeria.
ABSTRACT
Background:
Skin testing is an established mode of investigation of atopic
allergic conditions, to determine the allergen or allergens
responsible for clinical symptoms as well as the degree of reactivity
in individual cases. However over the years little has been reported
on the pattern of reactions in the common condition of allergic
rhinitis in this part of the world.
Method:
Seventy-five (75)
patients with symptomatic chronic allergic rhinitis attending the Ear,
Nose, and Throat Clinic of the University of Benin Teaching Hospital
and forty -two (42)
control subjects had skin prick tests performed on them for 11
different allergens.
Results:
There were a significantly higher proportion of positive reactions in
the rhinitis group (81%) than in the controls (36%). The commonest
allergen detected was the House Dust mite (Dermatophagoides
pterronysinnus) to which more than half of the rhinitis patients
reacted as compared to less than a fifth of the control group. A
positive reaction to multiple allergens was also common.
Conclusion:
The skin test reaction is a valuable diagnostic index of the presence
as well as the degree of allergic diathesis in allergic rhinitis in
our environment. Although multiple reactions have been demonstrated,
the house dust mite is the most common allergen incriminated in our
patients.
Key
Words: Skin test, rhinitis, allergy,
sensitivity
Urethroplasty
for strictures in Nigerian children
O.
B. Shittu
Urology Division, Department of Surgery, College
of Medicine, University of Ibadan and University College Hospital,
Ibadan, Nigeria
Reprint
requests to:Mr. O. B. Shittu, Department of Surgery, University
College Hospital, P. M. B. 5116, Ibadan, Nigeria. E-mail: [email protected]
ABSTRACT
Background/Objective:
To review the outcome of urethroplasty performed for urethral
strictures in children at the University College Hospital, Ibadan,
Nigeria, highlighting the difficulties that may hamper successful
outcome of reconstruction and suggesting factors that may enhance
successful reconstruction.
Method:
A retrospective study of 16 children who had urethroplasty performed
for urethral strictures over a 5-year period.
Results:
All the strictures were post- traumatic. There were no
post-inflammatory
strictures. Fourteen of the patients had patent anastomosis as
demonstrated by the pericatheter urethrogram, and they were able to
void satisfactorily thereafter. Two patients developed recurrent
strictures that required surgical intervention.
Conclusion:
Urethroplasty should be performed for urethral strictures in children
as soon
as
they present in order to prevent complications such as urinary tract
infections, urinary calculi and epididymoorchitis, which may
complicate prolonged catheterization. The outcome of urethroplasty in
children can be satisfactory if appropriate fine instruments and fine
sutures are used.
Key
words: Urethral strictures, Nigerian
children
Computed tomography features
of head injury in Ghanaian children
M. O. Obajimi1, K. B. Jumah1,
W. O. Brakohuapa1, W. Iddrisu2
Departments of Radiology1 and Surgery2,
Korle-Bu Teaching Hospital, Accra, Ghana.
Reprint requests to: Dr. (Mrs.) M. O. Obajimi,
Department of Radiology, University College Hospital, Ibadan, Nigeria.
ABSTRACT
Background: Injuries to the head are common in
children. There are several reports in literature of head injury and
evaluation with computed tomography scan (CT scan) but only a few
focus on children.
Method: A retrospective review of films and
reports of the CT scans of 41 children with head injury.
Results:
Positive CT findings were noted in 19 (46.3%). Road traffic accident
was found to be the commonest cause of injury with the highest
incidence in the 5 – 9 year age group. Cranial fractures were the
commonest (73.68%) CT findings especially in the frontal and parietal
bones. Intracranial haemorrgage was outlined in 47.37%. In classifying
the extent of head injury type 3 with intracranial injury alone
occurred most (58.8%). Extraparenchymal haemorrages occurred more in
69.2% than the intracerebral variety (30.8%) Hydrocaphalus and
cerebral oedema were also reported.
Conclusion:
CT scan provides accurate non-invasive diagnosis of fractures,
intracranial haemorrhages and other sequale of head injury. However,
it should be done only when clinically indicated to reduce cost and
avoid unnecessary irradiation
Key
words: Head
injury, computed tomography children
Clinico-pathological
presentation of primary cervical cancer seen in Ilorin, Nigeria
M. A. Ijaiya, A.P. Aboyeji, A.W.O. Olatinwo and
* M. O. Buhari
Departments of Obstetrics and Gynaecology and *morbid
anatomy and
Histopathology
University of Ilorin Teaching Hospital, Ilorin,
Nigeria.
Reprint requests to:
Dr. Munir-deen Ijaiya, Department of Obstetrics and Gynaecology,
University of Ilorin Teaching Hospital, P.M.B. 1339, Ilorin, Nigeria.
ABSTRACT
Background:
Invasive cervical cancer remains the most common cancer in the
developing countries and the second leading cause of cancer mortality
in women worldwide.
Methods:
a 10-year retrospective review of
histologically confirmed primary cervical cancers seen at the
department of obstetrics and gynaecology of the university of ilorin
teaching hospital, ilorin in 10 years.
Results:
Of the 236 confirmed gynaecological cancers, 147 (62.3%) cases were
histologically confirmed primary cervical cancers. One hundred and thirty two patients (89.8%) were of low
socio-economic status and 145 (98.6%) were married. Majority of the patients 102 (69.4%) were in the age range 40
– 69 years with highest frequency in 40 – 49 years. The study also revealed a steady rise in the incidence of the
disease with increase in parity.
Grandmultiparous women had the highest incidence 119 (80.9%).
Most of the patients had multiple symptoms.
The common symptoms include irregular vaginal bleeding 108
(73.5%), vaginal discharge 58 (39.5%) and post coital bleeding 31
(21.1%). Only 18 (12.3%)
reported at the hospital within one month of onset of symptoms.
About three-quarters of the patients had advanced disease
(stage IIb to IVb) and Stage III was the most common 74 (50.3%). Squamous cell carcinoma accounted for 126 (85.7%) of the
cases while Adenosquamous carcinoma and Adenocarcinoma were
responsible for 13 (8.9%) and 8 (5.4%) cases respectively.
Conclusion: This
study has shown a high incidence of primary cervical cancer in our
centre. The common
presenting symptoms were irregular vaginal bleeding, vaginal discharge
and postcoital bleeding in that order.
Majority of the patients presented in advanced stage (stage IIb
– IVb) of the disease.
Key words:
Cervical cancer, Clinico-pathological presentation
Site
of trabeculectomy and control of intraocular pressure: a preliminary
report
C.
D. Mpyet, S. K. Alli and N. E. Zaure
Department
of Ophthalmology, Jos University Teaching Hospital, Jos, Nigeria.
Reprint
requests to: Dr Caleb Mpyet, Department of Ophthalmology, Jos
University Teaching Hospital, P. .M. B. 2076, Jos, Nigeria. E-mail: [email protected]
ABSTRACT
Background/Objective:
To determine the extent to which the site of trabeculectomy affects
the extent of drop in intraocular pressure in an African population.
Methods: A
prospective study involving 54 eyes randomly allocated to a nasal,
central and temporal trabeculectomy group and followed up for a period
of six months.
Results:
The nasal group had consistently lower intraocular pressures though
there was no statistically significant difference between the groups.
A good number of patients were lost to follow up.
Conclusion:
Surgeons performing primary trabeculectomy should consider the nasal
site leaving the easily accessible temporal and central sites for
repeat trabeculectomies when the need arises.
Key
Words: Trabeculectomy, intraocular pressure, site, control
Trauma
deaths in children: a preliminary report
Babatunde
A. Solagberu
Department
of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria.
Reprint
requests to: Dr. B. A. Solagberu, P. O. Box 4377, Ilorin, Nigeria.
E-mail:
[email protected]
*Paper presented at
the 40th Scientific Conference of the Nigerian Surgical
Research Society, Ilorin, Nigeria. 30th November to 2nd
December 2000.
ABSTRACT
Background/Objectives:
Childhood trauma data, in developing countries, requires updating to
highlight problems in childhood trauma care. This study was done to
examine childhood trauma deaths in the Accident and Emergency room (A
and E).
Methods:
A prospective trauma analysis of children aged 15 years and below
attending the surgical A and E was done from September 1999 to August
2000. Data collected included age (0-4 years, >4-9 years, >9-15
years), sex, causes of trauma, injury-arrival time, the quality and
outcome of care and the circumstances of death.
Results:
Out of 543 children seen, 327 were boys and 216 were girls. Most of
the children were in the age group >9-15 years (215, 39.6 %).
Trauma occurred in 391 children (72.0 %) due to road traffic accidents
(RTA, 169 children, 31.1 %), falls (75, 13.8 %), burns and scalds (37,
6.8 %), other domestic accidents (35, 6.5 %), foreign body (FB) in the
orifices (37, 6.8 %), assaults (20, 3.7 %), occupational injuries (10,
1.8 %) and gunshot injuries (8, 1.5 %). There were seven deaths
(mortality 1.3 %); three each from burns (38 %-60 % burns, 2 of whom
reported 1-2 weeks after burns) and pedestrian RTA (all with head
injury, 2 of whom had other injuries) while one child had airway
obstruction from a FB. All the deaths were on day 1 of admission.
Conclusion:
Trauma is the commonest surgical problem seen in childhood in
the A and E and largely preventable. Children have good outcome from
trauma with low mortality, but this can be further decreased. Evidence
from the preventable nature of the deaths presents strong arguments in
favour of better organization of trauma care and reinforcing public
health education especially concerning care of children of working
parents.
Key words: Trauma
deaths, children
Anomalous patterns of
formation and distribution of the brachial plexus in Nigerians and the
implication for brachial plexus block
S. S. Adebisi
and S. P. Singh
Department of Human Anatomy, Ahmadu Bello
University, Zaria, Nigeria.
Reprint requests to: Dr. S. S. Adebisi,
Department of Human Anatomy, Ahmadu Bello University, Zaria, Nigeria.
E-mail: [email protected]
ABSTRACT
Background:
Structural variations in the patterns of formation and distribution of
the brachial plexus have drawn attentions both in anatomy and
anaesthesia.
Method: An
observational study.
Results: The
brachial plexus was carefully inspected in both the right and left
arms in 90 Nigerian cadavers, comprising of 74 males and 16 females.
Four anomalous patterns of formation and distribution of the plexus
were observed in 65(72%) of the subjects. These include an additional
4th trunk formed by C5 in 20(22.2%) and the anticlockwise
displacement of the cords with respect to the axillary artery in
12(13.3%) cases; such patterns had hitherto not been reported.
Conclusion:
These findings have important clinical implications for brachial
plexus block.
Key words:
Brachial plexus, anomalous patterns, brachial plexus block
Acute intestinal obstruction
in Nnewi Nigeria: a five-year review
A. N. Osuigwe
and S. N. C. Anyanwu
Department of
Surgery, College of Health Science, Nnamdi Azikiwe University, Nnewi
n Campus, Nigeria.
Reprint requests to: Dr. A. N. Osuigwe,
Department of Surgery, N. A. U. T. H.,
P. M. B. 5025, Nnewi, Nigeria.
ABSTRACT
Background:
Acute intestinal obstruction is still one of the commonest causes of
acute abdomen in the country and the patterns and causes have kept
changing over time within various parts of the country. We undertook
this study to determine data on presentation and management in
our environment as well as highlight these changing patterns.
Methods:
A retrospective study of all patients managed for acute
intestinal obstruction from 1993 to 1997.
Results:
Seventy-six patients fulfilled the inclusion criteria; 51 males and 25
females. Peak age incidence was in the first decade of life while the
major complaint was abdominal pain. Commonest clinical finding was
abdominal tenderness. Seventy-five (98.68%) had surgery and 42(55.26^)
had resection. The commonest causes were; strangulated hernia (18)
intussusception (18) and adhesion (15). The commonest postoperative
complication was burst abdomen (4%) and mortality was (9.2%).
Conclusion:
High clinical acumen, aggressive resuscitation and prompt surgical
intervention are the key to achieving good results in both pediatric
and adult acute intestinal, obstruction.
Key words:
Intestinal obstruction
Penile gangrene following
cavernoglandular shunt for priapism: case report
O. O. Olaomi
Royal Victoria Hospital, Banjul, The Gambia.
Reprint requests to: Dr. Oluwole Olayemi
Olaomi, Department of Surgery, National Hospital, Plot 132,
Central District (Phase II), P. M. B. 425, Garki – Abuja, Nigeria.
ABSTRACT
A 35-year-old man presented with priapism for 24
hours. Cavernoglandular
shunt was performed under general anaesthesia. There was bleeding from
the operation site necessitatig application of a pressure dressing.
Penile skin developed, progressing from the glans to complete gangrene
of the distal half of the penis. The patient had amputation of the
gangrenous distal half of the penis, debridement of the skin necrosis
of proximal half and skin grafting. Penile gangrene is a rare
complication following cavernoglandular shunt for priapism and has
been reported in all invasive treatment for priapism. Good
intraoperative haemostasis, avoidance of urethral catheterisation,
local infection and pressure dressing should prevent this
complication.
Key words:
Penis, gangrene, cavernoglandular shunt
Yellow
nail syndrome and bronchiectasis
V. O.
Adegboye, *J. K. Ladipo and O. A. Adebo
Cardiothoracic and *General
Surgery Units, Department of Surgery, College of Medicine, University
of Ibadan, Ibadan, Nigeria.
Reprint requests to: Dr. V. O. Adegboye,
Department of Surgery, University College Hospital, P. M. B. 5116,
Ibadan, Nigeria. E-mail: [email protected];
[email protected]
ABSTRACT
The Yellow Nail Syndrome includes slow growing,
opaque yellow nails with exaggerated lateral curvature, associated
with lymphoedema and chronic respiratory disorders. The nail changes
may precede the lymphoedema by a number of years. Bronchiectasis may
be the only chronic respiratory disorder; others include chronic
bronchitis, pleural effusions and chronic sinusitis. Two illustrative
cases show the combinations of some of these clinical features in two
black Africans.
Key words:
Yellow nail, bronchiectasis
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