Effect of Perioperative Tranexamic Acid on Blood Loss following Open Simple Prostatectomy: A Prospective Review in Nigerian Men.

BACKGROUND: Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement. METHODOLOGY: This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented. RESULTS: Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups. CONCLUSION: The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.

CONTEXTE: L'hémorragie est une complication courante après une prostatectomie simple ouverte et les patients doivent parfois recevoir une transfusion sanguine. Il a été démontré que l'acide tranexamique réduit la perte de sang après une résection transurétrale de la prostate et une prostatectomie radicale ouverte. Cette étude a évalué l'effet de l'administration intraveineuse périopératoire d'acide tranexamique sur les pertes sanguines et les taux de transfusion sanguine chez des patients ayant subi une PSO pour hypertrophie bénigne de la prostate. MÉTHODOLOGIE: Il s'agissait d'une étude comparative de patients dont la prostate de 60 g et plus était documentée et qui devaient subir une PSO. L'hématocrite de base a été effectué un jour avant la chirurgie. Les patients ont été répartis aléatoirement dans le groupe acide tranexamique, qui a reçu de l'acide tranexamique periopératoire par voie intraveineuse, et dans le groupe sans TXA, qui a reçu un placebo. Tous les patients ont subi une prostatectomie rétropubienne simple ouverte. L'hématocrite postopératoire a été évalué, et la perte de sang calculée à l'aide de la formule de Gross modifiée. Le taux de transfusion a été documenté. RÉSULTATS: Cinquante-six patients ont participé à cette étude et ont été randomisés entre le groupe avec acide tranexamique et le groupe sans acide tranexamique. L'âge moyen des patients du groupe acide tranexamique était de 66,07 ±7,08 ans et était comparable à celui du groupe sans acide tranexamique qui était de 66,50 ± 8,80 ans (P =0,842). La perte sanguine totale médiane était plus faible dans le groupe avec acide tranexamique (502 ml, IQR 613) que dans le groupe sans acide tranexamique (801 ml, IQR 1069). La différence de la perte de sang médiane entre les deux groupes était de 299 ml (U 275, P 0,055). Le taux de transfusion sanguine était inférieur dans le groupe acide tranexamique (6 patients, 21%) par rapport au groupe sans acide tranexamique (11 patients, 39%), (P =0,146). Il n'y avait pas de différence dans les taux de complication entre les deux groupes. CONCLUSION: L'utilisation de l'acide tranexamique chez les patients subissant une prostatectomie simple ouverte a montré une tendance à la réduction de la perte de sang peropératoire et un besoin moindre de transfusion sanguine. Mots clés: Hypertrophie bénigne de la prostate, Prostatectomie simple ouverte, Hémorragie, Acide tranexamique.

Simple Prostatectomy for Giant Benign Prostatic Hyperplasia in Sub-Saharan Africa: Case Series and Literature Review.

INTRODUCTION: Benign prostatic hyperplasia (BPH) is a common cause of bladder outlet obstruction in men worldwide. African men are known to have larger mean prostate volumes than other races. Giant benign prostatic hyperplasia (GBPH) is defined as prostate size greater than 200 grams. Management of GBPH is associated with several challenges which have been under-reported from the African sub-region. OBJECTIVE: To highlight the peculiarities of clinical presentation, surgical management and outcome of GBPH. PATIENTS AND METHODS: Men with BPH and trans-rectal ultrasound estimated prostate volume > 200 grams who were scheduled for open simple prostatectomy between January and December 2016 in our hospital were prospectively studied. RESULTS: Four patients with GBPH had simple prostatectomy during the period under review. Their ages ranged from 68 to 78 years with a mean age of 73.7 years.Three patients (75.0%) had transvesical prostatectomy while one (25.0%) had retropubic prostatectomy. The enucleated prostate specimen were found to weigh 312.1g, 396.4g, 420.8g and 450.0g respectively with mean weight of 394.8 ±50.2g and mean operation time of 111.7 ±19.7 minutes. They all had blood transfusion post-operatively with mean transfusion of 3±1.5 pints of blood per patient with relatively longer hospital stay (mean 10 days). CONCLUSION: The surgical management of GBPH can be quite challenging. Recalcitrant gross haematuria, chronic urinary retention and renal impairment are possible modes of presentation. Open simple prostatectomy is the best option for treatment in our environment. It is associated with improved quality of life and minimal morbidity in expert hands.

INTRODUCTION: L'hyperplasie bénigne de la prostate (HBP) est une cause fréquente d'obstruction de la vessie chez les hommes du monde entier. Les hommes africains sont connus pour avoir des volumes de prostate moyens plus importants que les autres races. L'hyperplasie bénigne géante de la prostate (GBPH) est définie comme une taille de la prostate supérieure à 200 grammes. La gestion du GBPH est associée à plusieurs défis qui ont été sous-déclarés dans la sous-région africaine. OBJECTIF: Mettre en évidence les particularités de la présentation clinique, de la prise en charge chirurgicale et du résultat de la GBPH. PATIENTS ET MÉTHODES: Les hommes atteints d'HBP et d'une échographie trans-rectale d'un volume prostatique estimé> 200 grammes qui devaient subir une prostatectomie simple ouverte entre janvier et décembre 2016 dans notre hôpital ont été étudiés de manière prospective. RÉSULTATS: Quatre patients atteints de GBPH ont eu une prostatectomie simple au cours de la période sous revue. Leur âge variait de 68 à 78 ans avec un âge moyen de 73,7 ans). Trois patients (75,0%) ont eu une prostatectomie transvésicale et un (25,0%) une prostatectomie rétropubienne. L'échantillon de prostate énucléé pesait respectivement 312,1 g, 396,4 g, 420,8 g et 450,0 g avec un poids moyen de 394,8 ± 50,2 g et une durée opératoire moyenne de 111,7 ±19,7 minutes. Ils ont tous eu une transfusion sanguine postopératoire avec une transfusion moyenne de 3 ± 1,5 pintes de sang par patient avec un séjour à l'hôpital relativement plus long (10 jours en moyenne). CONCLUSION: La prise en charge chirurgicale de la GBPH peut être assez difficile. Une hématurie macroscopique récalcitrante, une rétention urinaire chronique et une insuffisance rénale sont des modes de présentation possibles. La prostatectomie simple ouverte est la meilleure option de traitement dans notre environnement. Elle est associée à une meilleure qualité de vie et à une morbidité minimale entre des mains expertes. MOTS CLÉS: Hyperplasie bénigne géante de la prostate, prostatectomie simple, Afrique subsaharienne.

HISTOMORPHOLOGICAL PATTERN OF UROLOGIC MALIGNANCIES IN ILE-IFE, SOUTH-WESTERN NIGERIA.

INTRODUCTION: The last decade witnessed a remarkable rise in the prevalence of several malignant diseases in Nigeria. Whether Urologic malignancies (UM) have followed the same trend remains to be studied. The pattern of UM diagnosed in a Nigerian tertiary hospital is hereby presented. Our aim was to determine the pattern and prevalence of histologically diagnosed UM in Obafemi Awolowo University Teaching Hospitals Complex. Ile-Ife, Nigeria. MATERIALS AND METHODS: A 10-year retrospective review of all patients diagnosed with UM was carried out between January 2005 and December 2014. Data was obtained from the patients' case files and the Ife-Ijesha Cancer registry. Information obtained included demographic characteristics, site of origin and histology. Data was analysed with Statistical package for Social sciences (SPSS) Version 20. RESULTS: A total of 4675 malignancies were histologically confirmed during the study period. UM accounted for 420 (8.9%) of total malignancies. Prostate cancer was the commonest UM with 315 (75%) cases. Others include renal tumours 62(14.8%), bladder tumours 29 (6.9%), testicular tumours 13(3.1%) and scrotal tumour 1(0.2%). UM were commoner in males (348, 88.8%) than females (47, 11.2%) and accounted for 13.8% and 2.18% of all tumours in males and females respectively. CONCLUSION: This study revealed a rising prevalence of UM most especially Prostate and Renal Cancers among other malignancies in Ile-Ife.

SCROTAL SQUAMOUS CELL CARCINOMA AND ASSOCIATED BLINDNESS: A CASE REPORT AND LITERATURE REVIEW.

BACKGROUND: Carcinoma of the scrotum is a rare disease which has been linked with occupational exposure to certain industrial carcinogens. Scanty reports of scrotal carcinoma exist in literature but in very few places worldwide. To our knowledge, there has been one documented report of scrotal carcinoma in our country and this is the first report of scrotal carcinoma in over 45years existence of our tertiary Health institution. We present the clinical evaluation, investigations and surgical intervention of a blind elderly welder with squamous cell carcinoma of the scrotum at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. CASE PRESENTATION AND MANAGEMENT: A 65 year-old blind welder presented to us with a painless fungating scrotal mass of two years' duration. He had prior incision and drainage of the swelling in a primary health centre but this failed to heal, with copious purulent discharge. The mass measured 20cm x 15cm x 8cm and was inseparable from the right testis and cord structures, with infiltration of the root of the penis. The inguinal lymph nodes were not enlarged. CT scan confirmed localized scrotal tumour and biopsy confirmed squamous cell carcinoma.He subsequently had wide local excision of the scrotal tumour (with at least 2cm free margins), right total orchidectomy and advancement flap closure of scrotal defect. Histopathological reports corroborated the earlier findings and confirmed tumour free margins. He has remained well 18 months after surgery. CONCLUSION: Squamous cell carcinoma of the scrotum, though rare, is the commonest malignancy affecting the scrotum worldwide. Surgery still remains the mainstay of treatment and early intervention improves the chances of a favourable outcome.

Radiographic chest findings and immunological status in HIV-positive patients with tuberculosis coinfection in a sub-urban Nigerian tertiary hospital.

INTRODUCTION: The study was undertaken to assess chest radiographic features and lymphocyte counts among HIV-positive patients with TB coinfection. MATERIALS AND METHOD: We reviewed the chest radiographs of all newly diagnosed, treatment-naïve HIV-positive patients attending the Treatment Centre at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria. The radiographs were examined for presence or absence of features of tuberculosis and pneumonia. Those with tuberculosis were further evaluated for presence of cavities and milliary appearance. The demographic characteristics of the patients were recorded. RESULTS: Two hundred and ninety-five radiographs were reviewed, consisting of 192 females, 103 males with mean ages of 33.6±11.65 and 37.85±13.54 years, respectively. Normal radiographs were found in 68.5% patients, features of tuberculosis in 27.8%, and pneumonia in 2.7%. The percentages of males and females with tuberculosis were 35% and 25%, respectively. Patients with milliary TB were from the youngest age group and those with cavities had CD4 cell count below 200cells/mm(3). Cavities occurred most frequently in the lower zones. WBC and counts were highest in patients with pneumonia. CONCLUSION: Normal chest radiographs were associated with mild clinical course. Males were more frequently involved in TB coinfection. Cavities were associated with lowest CD4 cell count and occurred more in lower zones. Patients with HIV/PTB coinfection had the most severe weight loss. There was no statistically significant difference in absolute lymphocyte count between patients with or without tuberculosis. Chest radiograph remains a veritable tool for identifying HIV/AIDS patients with tuberculosis whether sputum is positive or negative.

Are there differences in disease progression and mortality among male and female HIV patients on antiretroviral therapy? A meta-analysis of observational cohorts.

Studies examining the sex differences in morbidity and mortality among HIV/AIDS patients have yielded inconsistent results. We conducted a meta-analysis of sex differences in disease progression and mortality among HIV/AIDS patients. Medical literature databases from inception to August 2014 were searched for published observational studies assessing sex differences in immunologic and virologic response, disease progression and mortality among HIV-infected patients. Random effects meta-analyses of 115 eligible studies were conducted to obtain pooled estimates of outcomes and heterogeneity was explored in sub-group analyses. Pooled estimates showed an increased risk of progression to AIDS (relative risk [RR]=1.11,95% CI=1.02-1.21) and all-cause mortality (RR=1.23, 95% CI=1.17-1.29) among males compared to females. All-cause mortality differed by sex only in low and middle income countries. The risk of AIDS-related mortality (RR=1.03, 95% CI=0.82-1.30), immunologic failure (RR=1.19,95% CI: 0.97-1.47), virologic suppression (RR=0.98, 95% CI=0.84-1.14), virologic failure (RR=1.26, 95% CI=0.99-1.61) and the change in CD4 cell count (Weighted mean difference [WMD] = -5.15, 95% CI= -13.57 to 3.28) did not differ by sex. These findings were modified by disease severity, adherence and use of highly active antiretroviral therapy. We conclude that HIV-related disease progression and survival outcomes are poorer in males.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria.

PURPOSE: To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography. MATERIALS AND METHODS: 60 adult subjects with suspected obstructive uropathy and 60 asymptomatic apparently healthy controls with normal renal ultrasound features were evaluated. B-mode sonography of the kidneys and spectral Doppler examination of the renal interlobar arteries of all the participants were performed. The mean resistive indices (mRI) of both interlobar arteries were obtained and compared to that of the controls. The mRI of bilaterally obstructed kidneys were also compared with the mRI of unilaterally obstructed kidneys. RESULTS: The mRI of the right and left kidneys of subjects were 0.72±0.04 and 0.69±0.06 while those of the controls were 0.64±0.04 and 0.63±0.03 respectively. The mRI for the grades of caliectasis increased from grade I (0.72±0.03) to grade II (0.73±0.03) and grade III (0.73±0.02) but fell within the most severe levels of obstruction (0.69±0.07). There was no statistically significant relationship between the grades of caliectasis and unilateral or bilateral obstruction for both kidneys. The results show a sensitivity and specificity of 86.7% and 90% respectively when mRI≥0.7 was used to determine presence of obstruction. CONCLUSION: Renal duplex sonography is highly sensitive and specific for diagnosis of obstructive uropathy. Increased resistive index of the obstructed kidney may be a useful diagnostic tool in situations where intravenous urography cannot be done or is contraindicated.

Ultrasound evaluation of obstructive uropathy and its hemodynamic responses in southwest Nigeria

To determine the renal arterial hemodynamic changes induced by obstructive uropathy using Doppler ultrasonography.

Overflow urinary incontinence due to bladder stones.

Overflow urinary incontinence is rare in women. We report a case of overflow incontinence due to bladder stones in a 40-year-old widow (para 2) who presented with a 5-month history of involuntary loss of urine aggravated by postural change, and associated with recurrent painful ineffectual urge to urinate. Her intravenous urogram revealed multiple bladder stones, for which she underwent cystolithotomy. However, following catheter removal on the fifth postoperative day, she developed urge incontinence due to urinary tract infection. She responded well to the choice of antibiotics dictated by the sensitivity result of her postoperative urinary culture, and she was discharged home on the ninth postoperative day. This case highlights the uncommon occurrence of bladder stones as a cause of urinary incontinence, as well as the potential value of intravenous urography in incontinence evaluation.

Public-private mix for TB and TB-HIV care in Lagos, Nigeria.

SETTING: Private and public tuberculosis (TB) treatment centres in Lagos State, Nigeria. OBJECTIVE: To assess the contribution of private health care providers to TB and TB-HIV (human immunodeficiency virus) case finding in Lagos State. DESIGN: A retrospective review of programme data submitted to the Lagos State TB and Leprosy Control Programme in 2011 by public, private for-profit (PFP) and private not-for-profit (PNFP) health care providers. RESULTS: A total of 8425 TB cases were notified by 31 private (11 PFP and 20 PNFP) and 99 public health facilities in Lagos State. Overall, the private facilities were responsible for 10.3% (866/8425) of the total TB cases notified. The proportion of TB patients tested for HIV was respectively 86.2%, 53.1% and 96.5% among public, PFP and PNFP facilities. Overall, 22.4% of the TB patients were HIV-positive. The HIV positivity rate among public, PFP and PNFP facilities was respectively 23.8%, 7.8% and 9.9%. Uptake of cotrimoxazole preventive therapy was respectively 69.6%, 25% and 38.2% among public, PFP and PNFP facilities, while that of antiretroviral therapy was respectively 23.8%, 8.3% and 9.1% in public, PFP and PNFP facilities. CONCLUSION: There is a need to scale up collaboration with the private sector, and particularly PNFP health providers.

Characteristics of clients accessing HIV counseling and testing services in a tertiary hospital in Sagamu, Southwestern Nigeria.

INTRODUCTION: Client-initiated HIV testing and counseling has helped millions of people learn their HIV status. Nevertheless, global coverage of HIV testing and counseling programs remains low. This study describes the characteristics of clients who accessed HIV counseling and testing (HCT) services in Olabisi Onabanjo University Teaching Hospital, (OOUTH) Sagamu. MATERIALS AND METHODS: A retrospective study of the clients accessing HCT services in OOUTH. Data was collected from clients using a client intake form. Pre-test counseling, HIV screening and post-test counseling were carried out. Informed consent and confidentiality were ensured. Data obtained were analyzed using SPSS 10.0. RESULTS: A total of 2607 clients accessed our HCT services between May 1 st 2008 and April 30 th 2010. The clients were between the ages of 1 year and 90 years. The mean age was 33.3 ± 15.26. The median age was found to be 32.0 years, with the modal age being 30.0 years. 73.7% (1828) were non-reactive (negative result), 25.9% (643) were reactive (positive result), while 0.3% (8) were indeterminate. Among the reactive results, 9.3% (242) were males while 15.1% (394) were females. CONCLUSION: A fair uptake of HCT services was noted. More females accessed services than males. More positive results were seen among females than males (P<0.05). RECOMMENDATIONS: Upscale of HCT services to involve Sexually transmitted infections clinics and free-standing, client-initiated testing centers is necessary. Continuous AIDS education and risk reduction should be promoted.

Effects of Ficus exasperata vahl. (moraceae) leaf aqueous extract on the renal function of streptozotocin-treated rats.

The present study was undertaken to evaluate the possible reno-protective effect of Ficus exasperata leaf aqueous extract (FEE) in a rat experimental paradigm of diabetes mellitus. Forty Wistar rats (weighing 200-230 g) were divided into four (A, B, C, and D) groups, each group consisting of 10 rats. Group A rats served as 'control' animals and received citrate buffer (pH 6.3) solution in quantities equivalent to intraperitoneally-administered volumes of streptozotocin (STZ) and FEE. Diabetes mellitus was induced in Groups B and C rats by intraperitoneal injections of STZ (75 mg/kg). Group C rats were additionally treated with FEE (100 mg/kg/day, p.o.) 4 weeks post STZ injections, for 4 consecutive weeks. Group D rats received FEE (100 mg/kg/day p.o.) only for 4 weeks. Post-euthanisation, kidney tissues were excised for histopathological evaluation and processed for light microscopy. Plasma malondialdehyde and tissue nitric oxide were determined. Serum creatinine, blood urea nitrogen, nitrite, and albumin concentrations were measured for the evaluation of renal function. The diabetic rats significantly lost more weight and their blood glucose levels were significantly elevated as compared to the 'control' group of animals. Renal dysfunction was evidenced by kidney hypertrophy, decreased renal blood flow, and increased serum creatinine and nitrite concentrations. Furthermore, vascular dysfunction, as evidenced by decreased carotid blood flow, was observed in the diabetic rats. FEE treatment positively ameliorated the alterations in the biochemical variables in the STZ + FEE-treated rats. In conclusion, our findings suggest that FEE treatment ameliorates STZ-induced nephrotoxicity.

Examination malpractice in our medical schools: prevalence and import on tomorrow's doctors.

UNLABELLED: AIMS AND OBJECTIVES. The objective of this paper is to estimate the prevalence of examination malpractice among medical students; its import on medical education and future doctors. MATERIALS AND METHODS: Structured questionnaires were administered to consenting medical students of participating four medical colleges in Nigeria. Data was collated and analysed using SPSS version 11. RESULTS: Three hundred and eighty two students responded. There were 210 males and 172 females (M: F-1.2:1); age range 19-45 years, mean 24.86 ± SD. Majority 304(79.6%) were in the 5th and final years. At secondary and tertiary levels, 67(18.1%) and 79(22.2%) were respectively involved in cheating. Mode of cheating included seeking examination materials, 10(2.6%); copying answers between examination rooms, 18(4.8%); copying assignments, 290(77.7%) and copying laboratory results 206(56.6%). Clinical examinations not performed were described as "normal" by 206(56.6%). Motivation for cheating included previous failures and escape punishment in 6(3.3%) and 31(10.4%) respectively. While 46(12.8%) tried to induce lecturers to change grades, 97(25.8%) would not inform the authority if they suspected that examination leaked. CONCLUSION: Examination malpractice in High schools and Tertiary institutions also includes the medical students. Educating pupils from the elementary schools on effects of cheating, inclusion of this practice in the medical curriculum as part of Medical Ethics and Institutional culture of Integrity among doctors are recommended. Stiffer punishment for offenders would reduce the practice among the students.

Testicular and para-testicular tumors in south western Nigeria.

BACKGROUND: Tumors of the testis and paratesticular tissues are rare, especially in men of African descent. In recent reviews however, the incidence is rising among the Caucasians and black Americans. We set out to determine the incidence in South-Western Nigeria and to examine the histopathologic variants. METHODS: A retrospective study of patients who had histopathologically confirmed testicular and para-testicular tumours between 1989 and 2005 (17 years). Their records were documented at the Ife-Ijesha cancer registry which serves 4.7 million men residing in three states of South-Western Nigeria. RESULTS: There were 26 cases of testicular and para-testicular tumors with an average incidence of 1.5 cases per year. The incidence of testicular cancer in our study was 0.55 per 100,000 population (95% CI, 0.52-0.57) and accounted for 1.1% of all male cancers. Rhabdomyosarcomas were the most common variety (70% of the paratesticular tumors and 26.8% of all tumors of the testis). Seminomas comprised 50% of the germ cell tumors and 15.4% of all testicular tumors in this series. CONCLUSION: There still remains a low incidence of testis cancer in the South Western Nigeria. The reduction in the incidence of seminomas makes rhabdomyosarcomas the most predominant tumor in South Western Nigeria.

Penile fracture at LAUTECH Teaching Hospital, Osogbo.

BACKGROUND/OBJECTIVE: We have seen three cases of penile fracture presenting in diverse ways in our teaching hospital. We want to highlight the difficulties of management when patients present late. PATIENTS AND METHODS: Three case reports of young men whose ages range between 22-32 years and who presented at 1 year 6 months, four weeks, and 3 hours respectively, following penile fracture. RESULTS: The patient that presented within 3 hours had immediate exploration and primary repair with good results while the one that presented after four weeks is still being followed up. The patient that presented very late has been lost to follow up after he was told that he would require surgery. CONCLUSION: Early surgical intervention in penile trauma still gives the best result and is hereby advocated. Decision to operate or not should also be based on the empirical finding of size of tear if there is no associated urethra injury.

Relations of the neck of groin hernias to pubic tubercle.

OBJECTIVE: The traditional anatomical and surgical teaching is that any hernia with the neck above and medial to the pubic tubercle are inguinal. Present day surgical authors and teachers mostly adhere to this teaching but observe a difference in this relationship in clinical demonstrations. This confuses most medical students and surgical residents. This all-important clinical teaching should hence be revisited. Hence this study was to ascertain and validate clinically the true relationship of pubic tubercle and the neck of groins hernia. DESIGN: Aprospective observational study. SETTING: Surgical Outpatient Clinic of Wesley Guild Hospital, Ilesa Unit of the Obafemi Awolowo University Teaching Hospital Complex, Nigeria. SUBJECTS AND MEASUREMENTS: Consecutive patients seen in the clinic with uncomplicated groin hernias were studied from January 1993 to December 2004. Examinations were done to ascertain the relationship of the groin hernias to the pubic tubercle. RESULTS: 96.8% of inguinal hernias have their necks above and lateral to pubic tubercle while all femoral hernia had their necks below and lateral to the pubic tubercle. CONCLUSION: Location above or below the pubic tubercle should be used as the sole difference between femoral and inguinal hernias in clinical demonstrations. More observations and inguinal dissections will be necessary for further clarification.

Experience with transverse preputial island flap for repair of hypospadias in Ile-Ife, Nigeria.

OBJECTIVE: To review our experience with the use of transverse preputial island flap in the repair of hypospadias in the paediatric surgical unit of our University Teaching Hospital, Nigeria. PATIENTS AND METHODS: We reviewed the cases of hypospadias managed by transverse preputial island flap repair over a ten year period (1996 and 2006) in the paediatric surgical unit of our institution. Data was retrieved from the case notes and analysed. RESULTS: Fifty-one patients had hypospadias repair during the period, 22 of whom were by transverse preputial island flap repair. Hypospadisas were in penile shaft in 16 (72.7%), penoscrotal in 5 (22.7%) and perineal in 1 (4.55%). All the patients had intact prepuce at presentation and chordee was present in 18 (81.8%). The commonest complication was urethrocutaneous fistula in five patients, which closed spontaneously in three leaving 2 patients (9.1%) with persistent urethrocutaneous fistular. CONCLUSION: Transverse preputial island flap urethroplasty remains a viable option in the management of hypospadias especially when the meatal opening is proximal, with associated chordee limiting the options in the repair.

Chemopreventive and remediation effect of Hydrocotyl bonariensis Comm. Ex Lam (Apiaceae) leave extract in galactose-induced cataract.

ETHNOPHARMACOLOGICAL RELEVANCE: Hydrocotyl bonariensis Comm. Ex Lam (Apiaceae) is being widely used in Western Nigeria in treating various symptoms of ophthalmic diseases; however scientific data in support of this medicinal use have not been reported. AIM OF THE STUDY: This study, investigated the efficacy of Hydrocotyl bonariensis leave extract in offering protection against experimental cataract and also examined its remediation effect when administered after cataract onset. MATERIALS AND METHODS: Weanling albino rats fed with 30% galactose diet were used in the study. Mechanisms of action of the extract were investigated by measuring the degree of lens peroxidation, lens antioxidant status and lens protein concentration. Severity of cataract was determined by measuring the cataract index. RESULTS: The extract at 500 mg kg(-1) reduced cataract index significantly and also reduced cataract progression when administered after cataract onset. Administration of this dosage also significantly reduced the degree of lens peroxidation, increased the level of reduced glutathione (GSH) and the lens catalase and superoxide dismutase activity. The extract also prevents protein insolubilization. Administration of the extract at 1000 mg kg(-1) reduced cataract index and lens peroxidation but did not increase the antioxidant status significantly. Administration of the extract after cataract onset reduced cataract index, moderately increased percentage soluble protein above the value prior to the arrest of hypergalactosemia but did not increase the antioxidant status. CONCLUSION: Our study suggests that Hydrocotyl bonariensis protects against galactose-induced cataract, and that administration of the extract after cataract onset reduced cataract progression but did not reverse cataractogenesis.

Preliminary experience with laparoscopic surgery in Ile-Ife, Nigeria.

This study presents a pioneer experience with laparoscopic operations in a General Surgical unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Consecutive patients who had laparoscopic operations from April through December 2008 were prospectively studied. Following clinical diagnosis, initial diagnostic laparoscopy was undertaken in all patients, followed by therapeutic open or laparoscopic procedures. All procedures were done under general anaesthesia. Duration of operation and outcome including complications were recorded. In all, there were 12 patients (8 males, 4 females), aged 15 to 50 years. Eight patients had clinical diagnoses of acute appendicitis, one each had undetermined right lower abdominal pain suspected ectopic gestation, adhesive intestinal obstruction and metastatic liver disease. The first 4 patients with inflammed appendix confirmed at laparoscopy had open appendicectomy. Of the next cohort of 5 patients, laparoscopic appendicectomy was completed in four but converted to open procedure in one. Normal findings were noted in the lady with suspected ectopic gestation. Laparoscopic adhesiolysis was done for adhesive intestinal obstruction while a laparoscopic liver biopsy was done for the patient with metastatic liver disease. Operative time ranged from 55-105 minutes with marked reduction in operation time as confidence and experience grew. No intraoperative complication was observed but one patient had superficial port site infection postoperatively. We conclude that with good patient selection and some improvisation, laparoscopic general surgical operations are feasible with acceptable outcome even in a poor resource setting.

Prune belly syndrome in an adult Nigerian: case report.

Prune Belly Syndrome is a rare congenital anomaly characterized by deficient anterior abdominal wall musculature, bilateral cryptorchidism, bilateral megaureters and often unilateral or bilateral vesico-ureteric junction obstruction. The report of prune belly syndrome in the adult is scanty. We report a case of prune belly syndrome in a 24 year old Nigerian who presented with 3 year history of recurrent right loin pain. Examination showed wrinkled abdominal skin, bilateral undescended testes and an hypoplastic rectus abdominis, below the umbilicus. Further evaluation revealed enlarged bladder, bilateral megaureters and right intra-abdominal testis. A diagnosis of Prune Belly Syndrome was made. The challenges in the diagnosis and management of this rare condition are highlighted in this presentation.