Evaluation of spinous process wiring techniques for accidental canal penetration.

BACKGROUND AND OBJECTIVE: Accidental canal penetration with attendant complications constitutes one of the reasons for abandoning the use of wires for posterior spinal fusion techniques. However, there is dearth of information on this risk when the wire is introduced through the base of spinous process as against sublaminar passage. This study was designed to evaluate hardware-related postoperative complications, especially canal penetration, in our patients who had spinal process wiring in two types of posterior wiring techniques. MATERIALS AND METHODS: Patients who had either of two spinous process wiring techniques formed the population for the study. The clinical records were reviewed and the following data were extracted: Age, sex, diagnosis, operation (fusion type), preoperative neurological status, postoperative neurologic deterioration, other postoperative complication and radiologic evidence of canal encroachment. RESULTS: One hundred and seventy four spinous processes were instrumented in 42 patients. The age of the patients ranged from 11 to 78 years while male to female ratio was 2.5:1. Majority of the spinal wiring were for trauma (29 patients; 69.0) while the remaining were tumor (6; 14.3%), degenerative diseases (4; 9.5%) and infections (3; 7.1%). The Rogers technique was performed in 16 (38.1%) patients while 26 (61.9%) underwent Adeolu et al. technique. One patient (2.3%) had neurologic deterioration while 5 patients (11.1%) had varying type of complications from wound infection to fracture of spinous processes. There was no patient with radiological or clinical evidence of canal compromise. CONCLUSION: Spinous process wiring techniques for posterior spinal stabilization appears to be safe as demonstrated in this study.

Population-based prevalence of hepatitis B and C virus, HIV, syphilis, gonorrhoea and chlamydia in male injection drug users in Lagos, Nigeria.

There is little research on injecting drug use in Nigeria. We investigated the prevalence of HIV, hepatitis B and C, and sexually transmitted infections (STIs) among male injection drug users (IDUs) in Lagos. Male IDUs (N = 328) were recruited through respondent-driven sampling. Participants completed an interview about their sexual and injecting risk behaviours and were tested for hepatitis B surface antigen (HBV), hepatitis C antibody (HCV), HIV and syphilis, as well as genital chlamydia and gonorrhoea infections. Three-quarters of IDUs (74%) reported injecting drugs in the past one month although most did not share needles (92%) and the majority obtained sterile needles from pharmacists (87%). Estimated HBV, HCV, HIV, syphilis, gonorrhoea and chlamydia prevalences were 7.8%, 7.7%, 0.9%, 1.9%, 0.0%, and 3.7%, respectively. The burden of HIV is presently low among IDUs in Lagos. Changes in accessibility to sterile needles at pharmacists would likely have a deleterious effect on IDUs' health. HBV vaccination and HCV prevention programmes for IDUs are urgently needed.

Fatal tetanus complicating an untreated mild open head injury: a case-illustrated review of cephalic tetanus.

BACKGROUND: Tetanus is now a rare disease in the Western world, but not so in developing countries. Cephalic tetanus, unlike some other local forms of the disease, is likely to be fatal. METHODS: We describe the clinical presentation of a case of fatal cephalic tetanus complicating an unattended open non-severe head injury with a review of the literature on the disease. RESULTS: Few cases of cephalic tetanus complicating head injury are found in the world literature, and many were diagnosed late. Cephalic tetanus from open or compound depressed skull fracture is even more rare. Our patient was a young male with an uncertain tetanus immunization history who sustained mild head injury (scalp laceration) and an unattended open depressed skull fracture in a motorcycle crash. He developed cephalic tetanus seven days later, presented late to our service, and died while being prepared for surgical debridement of his cranial wounds. At the immediate post-trauma medical contact, in an across-the-street "clinic," he had received suboptimal care for his head wound and inadequate tetanus prophylaxis. CONCLUSION: Cephalic tetanus is a rare form of the disease. Although it is preventable easily by well-established medical and surgical treatment paradigms, it continues to catch many clinicians disastrously unaware.