COVID-19 PANDEMIC: IMPACT ON GYNAECOLOGICAL ENDOSCOPY AT THE UNIVERSITY COLLEGE HOSPITAL IBADAN.

The impact of the COVID-19 pandemic on endoscopic services in a low resource economy is formidable. With the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there has been genuine concerns about the risk of transmission during gynaecological endoscopy via the diffusion of contaminated aerosols generated from CO2 leakage and smoke created by energy devices. A pragmatic step in mitigating transmission at the University College Hospital, Ibadan, resulted in the closure of the Endoscopic unit for 3 months whilst deploying increased hygienic methods coupled with social distancing. This however had its unintended consequences of delay and increased backlog of cases aside the economic losses. Developing a unit-based policy/protocol in response to any future unforeseen occurrence should take front stage in the planning and administration of the unit. Adopting global best practices and guidelines from researched evidence is not only imperative but desirable especially in the context of limited resources.

Daytime Versus Night-Time Emergency Abdominal Operations: Perspective from a Low-Middle-Income Country.

BACKGROUND: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. METHODS: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. RESULTS: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. CONCLUSION: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.

Comparing Lichtenstein with darning for inguinal hernia repair in an African population.

PURPOSE: Being a relatively new entrant into our practice, mesh repair has not been compared with previously existing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost. METHOD: Patients with uncomplicated, primary inguinal hernia were randomized to have their hernias repaired either by the Lichtenstein or darning technique. Details of their socio-demographic, hernia characteristics and intra-operative findings were recorded. Postoperatively patients were assessed for pain, wound site complications and recurrence. Both direct and indirect costs were calculated. Mean duration of follow-up was 7.5 months. RESULT: Sixty-seven patients were studied. Thirty-three had Lichtenstein repair while 34 had darning repair. Lichtenstein repair was associated with less post-operative pain, less analgesic requirement, and shorter time of return to work activities, these were all statistically significant (p < 0.05). Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest. There was no recurrence in any of the groups. Total cost was comparable between the two groups. CONCLUSION: Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are comparable in terms of frequency of early post-operative complications and total cost.

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study.

BACKGROUND: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR). MATERIALS AND METHODS: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps. RESULTS: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2-87 years with a median of 57 years. Forty-three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty-three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty-nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010). CONCLUSION: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.

Knowledge and use of emergency contraception by medical doctors on internship in a tertiary healthcare facility in Nigeria.

CONTEXT: Emergency contraception (EC) is widely used to prevent unwanted pregnancy and it is largely adopted in many countries as over the counter drug to improve access. AIMS: To determine and compare the correct knowledge, attitude and current use of EC among newly graduated medical doctors (MDs). SETTINGS AND DESIGN: A cross-sectional study conducted among 255 newly graduated MDs at the University College Hospital, Ibadan, Nigeria. MATERIALS AND METHODS: A pretested self-administered questionnaire was used to obtain data from consenting participants. STATISTICAL ANALYSIS USED: Descriptive, bivariate, and multivariable analyses were performed, and statistical significance was set at 0.05. Statistical Package for Social Science version 15.0 (Chicago, IL, USA) software was used. RESULTS: The mean age of the respondents was 27.2 years (standard deviation = 2.1). The commonest indication for emergency contraceptive use mentioned was rape-96.5%. About 70% support EC in Nigeria, while about a quarter (26.9%) routinely counsel women about ECP use. About 21% of respondents currently use EC. Logistic regression analysis revealed significant results for gender [odds ratio (OR) =3.64; 95% confidence interval (CI) OR = 1.31-10.01), religion (OR = 0.26; 95% CI OR = 0.11-0.630) and marital status (OR = 0.19; 95% CI = 0.07-0.56). CONCLUSION: The correct knowledge and professional disposition toward EC as a form of contraception is low. We recommend that in-service training should focus more on EC to improve the quality of their knowledge and attitude towards it.

Sublingual misoprostol to decrease blood loss after caesarean delivery: a randomised controlled trial.

The aim of the study was to compare the efficacy of sublingual misoprostol in addition to intravenous oxytocin, with oxytocin alone, in reducing blood loss during and following caesarean section. A total of 120 women undergoing caesarean delivery at the University College Hospital, Ibadan, were randomised into two equal groups. In Group A, 20 IU of intravenous oxytocin was given after umbilical cord clamping, while in Group B, the women received 400 µg misoprostol sublingually and 20 IU oxytocin intravenously. The outcome measures were blood loss, additional uterotonics, change in packed cell volume and side-effect profile. Associations between variables were determined by the χ(2) and Student's t-test. Relative risks were calculated for side-effects; the level of significance was p < 0.05. Intraoperative and postoperative blood loss were significantly lower in Group B (451.3 ml vs 551.2 ml, p = 0.007; 22.7 vs 42.2 ml, p < 0.001, respectively). In Group B, women were 7.4 (p < 0.001) and 9.0 (p = 0.008) times more likely to experience shivering and fever, respectively. The need for additional uterotonics was greater in the oxytocin group (66.7% vs 27.6%, p < 0.001). The addition of sublingual misoprostol to intravenous oxytocin reduces postpartum blood loss and the need for additional uterotonics. There is however, an increased risk of shivering and fever with this combination.

Bilateral tubal gestation associated with schistosomiasis in an african woman.

Background. The incidence of tubal ectopic gestation caused by schistosomiasis induced tubal pathology is undocumented in this environment, which may be due to rarity of this pathology. Bilateral tubal gestation is common in patients that have undergone in vitro fertilization. We report a hitherto undocumented case of spontaneous bilateral ectopic gestation following tubal schistosomiasis. Case Report. Mrs. OB was a 32-year-old G4P3(+0) (3 alive) woman who complained of abdominal pain and bleeding per vaginam of 4 and 2 days' duration respectively following 8 weeks of amenorrhea. A clinical impression of ruptured ectopic gestation was confirmed by ultrasound scanning. She had bilateral salpingectomy with histology of specimens showing bilateral ectopic gestation with Schistosoma haematobium induced salpingitis (findings of Schistosoma haematobium ova noted on slide). Conclusion. Schistosoma induced salpingitis is a rare but possible cause of bilateral tubal gestation.

Selenium levels in neoplastic breast lesions.

AIMS AND OBJECTIVES: The aim of this prospective case controlled study was to evaluate the tissue levels of selenium in patients with cases of fibroadenoma, cancer of the breast and in the controls in order to relate them to the occurrence of breast diseases. SUBJECTS AND METHODS: Consecutive consenting patients who had histologically confirmed breast cancer and fibroadenoma attending the General surgical outpatients departments of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, were recruited for the study. One gram of core disease breast tissues was taken for Selenium level estimation. RESULTS: There were 127 female subjects;. 95 (74.8%) cases of fibroadenoma and 32 (25.2%) of breast cancer. While breast cancer was common on the left, fibroadenoma was more common on the right breast (? = 8.994; p=0.011). The median tissue level of selenium in patients with fibroadenoma was 0.0272 mg/g with a range of 0.0124 to 0.0576 mg/g and that of the cancer patients was 0.0178 mg/g with a range 0.0072 to 0.0436 mg/g. These were statistically significantly different ( p=0.001). Factors affecting tissue selenium level include age (p<0.001), overall stage of breast cancer (p<0.001), maximum length of breast mass (p=0.023), previous delivery (p=0.004), age at last confinement (p=0.007), parity (p<0.001), oestrogen receptor (ER) status (p<0.001) and progesterone receptor (PR) status (p=0.021). CONCLUSION: Tissue selenium was lower in breast cancer than in fibroadenoma; Tissue selenium inhibits carcinogenesis; low tissue level of selenium therefore may be a factor in the development of breast cancer.

Presentation, distribution pattern, and management of diverticular disease in a Nigerian tertiary hospital.

BACKGROUND: Colonic diverticular disease is one of the most common and costly gastrointestinal disorders among industrialized societies, which have recently been described among Africans. Presentations and distribution pattern of the disease among Africans appeared to be different from that described among the Western population. We embark on this study aimed at evaluating the presentation, distribution pattern, and the management of diverticulosis in our tertiary health facility. MATERIALS AND METHODS: A prospective descriptive study of the cases of diverticular disease seen between January 2007 and December 2011 at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. RESULTS: During the 5-year study period, 40 cases were seen. The patients were aged 41-85 years with a median age of 64 years. There were 29 (72.5%) male and 11 (27.5%) female with an average male to female ratio of 3:1. The most common presentation was bleeding per rectum in 28 (70%) patients, which mostly needed transfusion. Ten (25%) patients presented with recurring abdominal pain, whereas one (2.5%) patient presented with abdominal mass and features of intestinal obstruction. Thirty patients were diagnosed on colonoscopy, eight on barium enema, and two on computerized tomography scan. Thirty-four (85%) patients had a pancolonic disease. All the patients were placed on high fiber diet and antibiotics namely ciprofloxacin and metronidazole. Five patients had recurrence within 6 months of follow up, of which one had emergency colectomy. CONCLUSION: Diverticular disease is no longer a rare disease in Nigeria. It is a common cause of lower gastrointestinal bleeding in elderly patients. High index of suspicion for diverticular disease of the colon and its complications should increase in the country.

Adulthood hirschprung's disease: a report of 4 cases in Ile-Ife. Nigeria.

BACKGROUND: Hirschsprung's disease in adulthood is very rare and is often misdiagnosed. We present four cases of adulthood Hirschsprung's disease seen in the last two decades to illustrate challenges accompanying its diagnosis and management. METHOD: This descriptive case series included cases of histologically proven Hirschsprung's seen in adulthood at the Obafemi Awolowo University Teaching Hospitals Complex in the last two decades (1991-2011). The clinical data, radiological investigations, details of surgical treatment, histological diagnosis, outcomes and complications were analyzed. RESULT: There were 4 adult patients, 3 males and 1 female with age ranging from 17 to 74 years (mean 23 years). Each patient presented with sub acute intestinal obstruction needing two staged procedures of initial colostomy followed by definitive procedure of low anterior resection (State procedure) in 3 patients and Swenson-Bill procedure in one. There was one mortality and good long term outcome in the remaining three. CONCLUSION: This review presented the oldest patient presenting with adult Hirschsprung's and the highest mean age of any case series. Four patients with adulthood Hirschsprung's disease managed by two operative procedures enabled comparison of operative outcome with respect to complications and functional outcomes. Mortality seems to correlate with presentation at old age, which is usually due to life long self-management of chronic constipation. Though very rare, a high index of suspicion of adulthood Hirschprung's disease should be maintained in adult patients with recurrent chronic constipation needing lifelong laxative, enema or mechanical wash-out.

Imatinib (Glivec) and gastrointestinal stromal tumours in Nigerians.

BACKGROUND: To assess the response and the impact on the overall survival (OS) on c-KIT-positive (CD117+) gastrointestinal stromal tumours (GISTs) patients treated with imatinib mesylate. METHODS: Between July 2003 and December 2012, consenting patients with advanced c-kit-positive GISTs were enrolled to receive imatinib mesylate therapy at a dose of 400mg - 800mg daily, supplied gratis by Novartis Pharma (Basel, Switzerland) under its GIPAP initiative. Disease severity was based on tumour site, size and mitotic index at diagnosis. Clinical features together with drug toxicity, haematological and biochemical parameters were monitored. Overall survival (OS) reviewed at 12 months intervals over 5 years was computed using Kaplan-Meier RESULTS: There were 27 patients in all (17 males and 10 females with a median age of 52 years (range 26 - 83). Twenty three patients, 15 males and 8 females that have been followed up for at least 6 months were evaluated, aged 26-83 years (median = 56). There were 17 (73.9%) gastric tumours and 6 extragastric including 3 cases of peritoneum and 1 each of small gut, colon and rectum. At diagnosis, 21 (91.3%) cases were high risk, and 1 each fell into the intermediate and low risks, respectively. Ten patients (43.4%) including 5 with metastases presented with unresectable lesions. Five patients (21.7%) had complete tumour resection, 5 (3 with metastases) had partial resections and 3 others with non-bulky, nonmetastatic diseases underwent no surgery. Imatinib was used as the primary therapy for all patients, except the 5 patients that underwent complete tumour resection. Nine (39.1%) patients were lost to disease progression with a median survival of 16.7 +/- 10.7 (+/- SE) (95% CI = 0-37.6) months. The overall survival at 2 years for all patients was 71.9%, which dropped to 65.9% at 4 years. CONCLUSIONS: Although a small number of GISTs, imatinib induced an extended remission in patients with advanced disease, most of whom would have been dead within a few months of diagnosis.

Characteristics of inflammatory bowel disease in three tertiary health centers in southern Nigeria.

BACKGROUND: Inflammatory bowel disease (IBD) refers to two chronic inflammatory disorders of the gastrointestinal tract which is generally believed to be rare in most African countries. The objectives of the current study were to present the experience of three tertiary gastroenterology centers in southern part of Nigeria on IBD, highlighting the age distribution of the patients seen, management and the impact on the quality of their life in university-based community-type practices in Nigeria. METHODS: This was a retrospective review of charts of inflammatory bowel disease seen between January 2007 and June 2010 at three teaching hospitals in Southern Nigeria. Diagnosis of IBD was made from clinical manifestations, colonoscopic and histopathological findings. RESULTS: During the study period, 12 patients presented with clinical features consistent with inflammatory bowel disease. There were 8 (66.7%) males and 4 (33.3%) females and had ages ranged from 18 years to 80 years with a median of 26.5 years. Eight (66.7%) patients had ulcerative colitis while 4(33.3%) had Crohn's disease. Ten (83.3%) patients had severe disease with main clinical features being recurrent diarrhoea and passage of mucoid bloody stools. All the patients had treatments with sulphasalazine or mesalazine, steroids and antibiotics with good responses. One patient died following the occurrence of toxic megacolon. CONCLUSION: Although IBD is uncommon in Nigeria, high index of suspicion is necessary by attending physicians managing patients with recurrent passage of mucoid bloody stools. Prompt gastroenterological referral and judicious use of colonoscopy and biopsy will assist in making the diagnosis.

Spectrum of colonoscopy findings in Ile-Ife Nigeria.

AIMS AND OBJECTIVES: Lower gastrointestinal (LGI) diseases are the leading causes of morbidity and mortality worldwide. Colonoscopy holds an important place in screening, diagnosing and treatment of these conditions. In Nigeria, as in many other developing countries, the facility for performing colonoscopy is rarely available. This prospective report seeks to evaluate the demographic data of patients presenting for colonoscopy, the pattern and validity of referral diagnosis versus colonoscopy findings in Ile-Ife, Nigeria. SUBJECTS AND METHODS: All patients who had colonoscopy procedure done in the Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex between January 2007 and December 2011 were included in the study. RESULTS: During the study period, colonoscopy was carried out in 320 patients. One hundred and eighty two (56.9%) were males, while 138 (43.1%) were females. The median age was 59.5 years. Their ages ranged from 2-87 years. The most common indications were lower gastrointestinal bleeding and change in bowel habit which together accounted for 79.0%. No abnormality was seen in 93(29.1%) patients. Abnormal endoscopic findings included 66(20.6%) patients who had haemorrhoids, 50(15.6%) cases colorectal cancer, 33 (10.3%) patients had benign polyps and (30 (9.4%) patients had diverticular disease. Other findings were colitis, inflammatory bowel disease, rectovaginal fistula, vascular ectasia and extra luminal compression. Haemorrhoids, diverticulosis and polyps were the most common findings in patients presenting with lower gastrointestinal bleeding. CONCLUSION: This present report showed that colonoscopy is a cheap, safe and effective method of investigating lower gastrointestinal disease in Ile-Ife, Nigeria. When the indication is based on symptoms, the diagnostic yield could be as high as 90%. The common causes of lower gastrointestinal bleeding in Ile-Ife, Nigeria include haemorrhoids, diverticulosis and polyps.

Audit of management of gallbladder cancer in a Nigerian tertiary health facility.

BACKGROUND: Gallbladder cancer is a rare malignancy with a variable incidence worldwide. It ranks number eight among all gastrointestinal cancer seen in Nigeria. It is associated with high mortality and morbidity because it is usually diagnosed very late. Adequate surgical resection is the only modality with hope of cure. This requires advanced surgical skills which is quite rare in most developing countries like Nigeria. In this current work, we audit the management and outcome of gallbladder cancer in our hospital, highlighting peculiarity associated with our setting. PATIENTS AND METHOD: Consecutive patients managed as cases of gallbladder cancer at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1990 and December 2010 were studied retrospectively. Patient demographics, disease and treatment-related variables, and outcomes were analyzed by SPSS version 16.0. RESULTS: Thirty-one cases of gallbladder cancer were diagnosed over the 21-year period, and this accounts for about 0.3% of all cancer cases seen in our hospital. The median age of this patient cohort was 58 years (range 28 to 79 years). Seventeen (54.8%) patients were age below 60 while 14 (45.2%) were age 60 and above. Twenty-seven patients (87.1%) were female and four (12.9%) were male, with a male to female ratio approximately 1:7. Over 80% of the patients presented with a triad of upper abdominal pain, weight loss, and jaundice. Majority (67.7%) of the patients were diagnosed intraoperatively. Only four patients underwent complete resection as they had radical cholecystectomy including regional lymph node dissection and wedge resection of the gallbladder fossa of the liver. The stages of the resected patients were T3 in three patients and T2 in one. Overall 1- and 5-year survival rates for our entire patient cohort were 32% and 10%, respectively. CONCLUSION: In conclusion, this study showed that preoperative diagnosis of gallbladder cancer could be challenging in our environment. A triad of upper abdominal pain, jaundice, and weight loss with judicious use of available radiological modality will increase the chances of making the preoperative diagnosis of the cancer. It also showed that good outcome can be obtained when radical surgery is offered to these few patients within the limitation of resources in few patients with resectable tumor.

Bowel habits of urban and rural populations on the Jos, Plateau, Nigeria.

BACKGROUND: Constipation and diarrhoea are frequent complaints amongst patients attending Gastroenterology Clinics. The normal bowel habits may vary among populations. OBJECTIVE: To characterise and compare the bowel habits of rural and urban dwellers in a Nigerian population. METHODS: Questionnaires were administered to 1236 adults aged 16 years and above recruited from two communities (rural and urban) using a two stage cluster sampling scheme based on existing administrative set up in a cross-sectional study. Information sought included socio-demographics, alcohol consumption, bowel habits and level of physical activity. RESULTS: Adequate data for analysis were available in 1017 subjects giving a response rate of 509(93.1%) and 508(87.7%) for rural and urban populations respectively. The mean weekly bowel frequencies for the rural and urban populations were 10.8 ± 5.1 and 9.7 ± 4.9 (p=0.09) respectively. Four hundred and ninety-four (97%) subjects from the rural community and 493 (97%) from the urban opened their bowels between three times per day to three times per week. Constipation as identified by the passage of three or less motions per week was present in 14 (2.8%) of urban dwellers compared to 4 (0.8%) of the rural (p = 0.01). Bowel motions were more frequent in males than in females. CONCLUSION: Bowel opening appears slightly more frequent among rural plateaus inhabitants than in urban dwellers. Constipation is more common in the urban than in the rural area.

Evaluation of tension-free mesh inguinal hernia repair in Nigeria: a preliminary report.

BACKGROUND: Tension-free mesh inguinal hernia repair is becoming increasingly popular worldwide. However, reports are sparse in Nigeria. OBJECTIVE: To evaluate the impact, outcome and cost implication of tension free inguinal hernia repair in a Nigerian setting. METHODS: A prospective study of all consecutive adults patients with uncomplicated inguinal hernia who had mesh repair over a period of 12 months was undertaken. A large sheet of 900cm2 polyproylene mesh material was used for all the patients in the study. All wounds were opened on the third postoperative day while sutures were removed on the eight day. Patients were followed up for one year. RESULTS: A total number of 30 patients had tension-free mesh ingunal hernia repair. Their ages ranged from 21 to 78 years (mean 47.2±15.5) years with a female to male ratio of 1:15. Complete inguinoscrotal hernia was the commonest type of groin hernia accounting for 40% of the cases. The repair of posterior wall which entailed placement of mesh was completed at a median time of 15 minutes. While two (6.7%) and one (3.3%) had wound oedema and groin pain respectively at one month, none of the patients had these complications or recurrence at a median of five months follow-up period. CONCLUSION: Tension-free mesh inguinal hernia repair was well tolerated and affordable to our patients. Pain and infections, reported to be the common complications of this procedure were infrequent in this study. A larger study is recommended to help confirm these findings.

Metastatic breast cancer in a Nigerian tertiary hospital.

BACKGROUND: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. OBJECTIVE: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. METHOD: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed. RESULTS: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81 years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Two-thirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%. CONCLUSION: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation.

Bowel preparation for colonoscopy: enema versus sodium phosphate.

BACKGROUND: Colonoscopy is considered to be the gold standard investigation for assessing the colonic mucosa. Good bowel preparation is essential in order to achieve optimal visualisation of the mucosa. Traditionally water enema is used for bowel preparation in most centres in Nigeria. This prospective study was performed at the Gastrointestinal Endoscopy Unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria between July 2008 and June 2009. AIMS AND OBJECTIVES: This study compared patients' tolerability, adverse effects, efficacy and mean duration of colonoscopy of water enema and sodium phosphate (NaP) for bowel preparation toward colonoscopy. PATIENTS AND METHODS: Standard structured questionnaire was completed by 64 patients and the colonoscopist assessing tolerability, adverse effect, efficacy and mean duration of the procedure. RESULTS: There were sixty four patients aged between 22 to 86 years. The mean age was 58.16 ± 15.790. Thirty eight (59.4%) patients were in patients and 26 (40.6%) were out patients. Forty one (64.1%) patients had water enema while 23 (35.9%) patients were included in the NaP group. The median age for patients in both groups was 62.0 years. Patients in NaP group rated their bowel preparation as more tolerable and found the dietary restriction much easier than those in water enema group (p < 0.0001). Better colon cleansing score was found in patient in NaP group as compared with those in water enema group in all region of the colon. The procedure took significantly longer time in patients in water enema group as compared with those in NaP group (p < 0.0001). CONCLUSION: NaP has a better bowel cleansing score for colonoscopy than water. It has better tolerability, side effect profile, efficacy and gives a shorter mean duration for the procedure.

An audit of laparoscopic surgeries in Ile-Ife, Nigeria.

BACKGROUND: After several years of lagging behind due to several constraints, many general surgeons across Nigeria are now performing laparoscopic surgery. An audit of the procedure in our setting is required. OBJECTIVE: To describe the outcome of consecutive laparoscopic general surgical procedures performed at the Obafemi Awolowo University Teaching Hospital, South-western Nigeria. METHODS: All patients with general surgical conditions who had laparoscopic surgery from January 2009 through May 2010 in our hospital were prospectively studied and type of pre, intra and postoperative data including sex, age, indication for surgery, and outcome of the procedure were obtained and analysed. RESULTS: Sixty-two patients (ages 18 to 72 years) had laparoscopic surgeries within the study period. Eighteen (29%) patients had laparoscopic cholecystectomy, 13 (21%) had laparoscopic appendicectomy, 10 (16.1%) had laparoscopic adhesiolysis, 7 (11.3%) laparoscopic biopsies of intraabdominal masses while 14(22.6%) others had diagnostic laparoscopies for a range of suspected abdominal conditions. All diagnostic procedures were performed as day cases while the duration of hospital stay was one to two days for the therapeutic procedures. Two(3%) procedures, including a biopsy of hepatic mass and a cholecystectomy were converted to open surgery due to significant haemorrhage. A minor bile duct injury was recorded in one patient who had cholecystectomy and superficial port site wound infections were noticed in two patients who had appendectomy. No mortality was recorded. CONCLUSION: Our results show the feasibility of laparoscopic surgery in Nigeria. We advocate local adaptation and improvisations to increase the use of laparoscopic surgery in Nigerian hospitals.

Laparoscopic cholecystectomy in Ile-Ife, Nigeria.

BACKGROUND: Laparoscopic cholecystectomy is not yet routinely performed in most public tertiary hospitals in Nigeria. OBJECTIVES: To assess the feasibility and early outcoe of laparoscopic cholecystectoy in Ile-ife, Nigeria. METHOD: Consecutive patients who were selected for the procedure from June 2009 through December 2010 at the Ife State Hospital of the ObafemiAwolowo University Teaching Hospitals Complex, Ile-Ife were prospectively studied. RESULTS: Eighteen female (75%) and six male patients had laparoscopic cholecystectomy within the study period. They were aged 19-83 years with a mean age of 33.4 years. Six (25%) patients had acute calculous cholecystitis while the rest presented with chronic calculous cholecystitis. Their Body Mass Indices ranged from 21 to 32kg/m2. Operation time ranged from 65 to 105 minutes. One procedure (4%) was converted to open due to bleeding from the gallbladder bed. Another patient who had a minor common bile duct injury presented with generalized dull abdominal pain on the sixth postoperative day. She had open repair of the injury over a T-tube. Three patients (12.5%) were discharged on the first postoperative day while 15 (62.5%) others were discharged on the second postoperative day. No mortality was recorded. CONCLUSION: Laparoscopic cholecystectomy is feasible in our setting with outcome comparable to previous pioneering experiences in other African countries centre in spite of resource limitations.