Development and practice of laparoscopic surgery in a Nigerian tertiary hospital.

BACKGROUND: For the benefits of less postoperative pain, early recovery and discharge, and better cosmesis, laparoscopic surgery is rapidly gaining acceptance amongst surgeons as a better alternative to traditional open procedures. In January 2015, bookings for laparoscopic surgery became a more regular feature on our operation list. AIMS: We reported the indications, management outcome, and challenges in patients who had laparoscopic surgery in our institution. This is to document the trends in our surgical practice. METHODOLOGY: This is a descriptive study of 137 patients who had laparoscopic surgery for general surgical indications in our institution over a period of 5 years. Patients data as collected from the records department were evaluated for demographic characteristics, medical comorbidities, type of procedures done, and perioperative outcome. Data analysis was performed using Statistical Package for Social Sciences (SPSS). RESULTS: A total of 137 Patients had laparoscopic general surgery between January 2015 and December 2019. There were 48 males and 89 females with a male-to-female ratio of 1:1.9. The mean age of the patients was 38.8 ± 3.4 years (range 16-87 years). Laparoscopic cholecystectomy (35%) and laparoscopic appendicectomy (29.9%) were the most common procedures performed. Five (3.7%) cases were converted to open surgery. Superficial surgical site infection (5.8%) following laparoscopic appendicectomy was the most common postoperative complication. There was no 30-day postoperative mortality. CONCLUSION: Laparoscopic surgery is safe and can be applied to wide variety of general surgical conditions in developing countries. Minimal postoperative morbidity of laparoscopy is a major benefit to the patients.

Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria.

BACKGROUND: Breast cancer is the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement. PATIENTS AND METHODS: All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2-year period. Self-administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS. RESULTS: Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke's R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke's R2 = 0.126. CONCLUSION: The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.

Unstimulated thyroid function indices of Nigerians with secondary amenorrhea.

The unstimulated plasma thyroid indices of triiodothyronine uptake (T(3)U), thyroxine (T(4)), free thyroxine index (FTI), thyroid-stimulating hormone (TSH), and prolactin levels were measured in 56 patients who were complaining of secondary amenorrhea, and in 40 control patients. No significant differences were noted in the plasma indices between the two groups. Mean ± standard error plasma prolactin levels in patients with secondary amenorrhea and in the control patients were 21.8 ± 2 ng/mL and 10.5 ng/mL, respectively. Twenty-two (39 percent) patients who were complaining of amenorrhea had hyperprolactinemia and galactorrhea. The thyroid indices of these patients did not differ significantly from the control group.

The accuracy of ultrasonography in the diagnosis of breast pathology in symptomatic women.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of total cancer cases and 14% of cancer deaths worldwide. The developing countries are catching up with this trend. Breast ultrasound when properly performed and interpreted, is an indispensable tool in breast imaging. The early diagnosis and treatment of breast masses reduces the morbidity and mortality associated with delayed diagnosis of breast carcinoma. The use of breast ultrasound is gaining ground in recent time, this is due to current advances in ultrasound technology which permit greater spatial and contrast resolution and shortened scan time. OBJECTIVE: To determine the sensitivity, specificity and positive predictive value of ultrasound in the detection of palpable breast masses and to correlate the findings of ultrasound with the findings of fine needle aspiration cytology, or histopathology. METHODS: Breast ultrasound scanning was done in 100 patients with signs and symptoms of breast lesion referred from the Surgical out Patient Clinic to the Radiodiagnosis Department of Lagos University Teaching Hospital (LUTH). Histology reports were collected from either the case note or Morbid Anatomy department to correlate the findings with ultrasound diagnosis. RESULTS: The mean age was 41.7 +/- 11.34 (18-59) years. Symptoms of breast lesion were highest in the age group 41-50 years 38 (38%), and least in 18-20 years 4 (4%). When the use of ultrasonography was compared with the histopathology report in the diagnosis of breast lesion in the studied population, the sensitivity was 100%, specificity (96.6%), accuracy (97%), posting predictive value (PPV) 81.3%, and negative predictive value (NPV) 100%. The accuracy, specificity and PPV however decreased with increasing age. CONCLUSION: Ultrasonography of the breast is useful in the diagnosis of breast lesions, because of the high sensitivity, specificity and diagnostic value it exhibited with histopathologic findings.