A 10-year audit of gynaecological surgeries performed in the paediatric age group at the Jos University Teaching Hospital.

BACKGROUND: Surgeries performed for gynaecological conditions in children and adolescents are not common in our environment. Adequate facilities and the skill to perform the required procedures may also be lacking. We were interested in reviewing the practice of paediatric gynaecological surgery in our facility. PATIENTS AND METHODS: A retrospective study of case files and theatre records of children below the age of 16 years who had surgeries at the Jos University Teaching Hospital over a 10 year period was undertaken. RESULTS: A total of 89 surgeries were performed in this age group during the period under review. Twenty-eight (33.4%) of the patients were below the age of 11. The most common surgical procedure was for the management of septic abortion (21.3%). Correction of congenital malformations of the genital tract accounted for 21.4% (19) of the surgeries performed. Fourteen (15.7%) laparotomies were performed for ovarian cysts. CONCLUSION: Though the number of surgeries performed on children for gynaecologic reasons may appear small, the skills required to manage them should be enhanced and the requisite facilities provided.

Underutilization of vaginal hysterectomy and its impact on residency training.

BACKGROUND: The advantages of vaginal hysterectomy over abdominal hysterectomy include lower morbidity, shorter hospital stay, and reduced cost to the patient. It is, therefore, important to pass the required skill for vaginal hysterectomy unto trainees. OBJECTIVE: To determine the proportion of vaginal hysterectomies done in a residency training institution in Nigeria and its possible impact on the proficiency of future gynaecologists in performing the procedure. METHODS: A chart review was done on all documented cases of hysterectomies for benign gynaecological conditions done in Jos University Teaching Hospital, over a four-year period (January 2002 to December 2005). Case files of patients who had hysterectomy during the study period were retrieved and the relevant information obtained for analysis of frequencies and percentages. RESULTS: A total of 94 hysterectomies for benign gynaecological conditions were done during the study period. Nine (10%) vaginal hysterectomies were done. All the vaginal hysterectomies performed were for uterovaginal prolapse by consultants. However, 45 (53%) of the abdominal hysterectomies were performed by consultants and 40 (47%) by residents. CONCLUSION: This study suggests that residents exposure and training on the act of vaginal hysterectomy is inadequate. This has potential implications on future gynaecologist proficiency to perform this method of surgery that has documented advantages and better outcome for patients.

The impact of HIV/AIDS epidemic on the choice of specialties among medical students and house officers in Jos, Nigeria.

BACKGROUND: HIV/AIDS is a scourge that has seriously compromised the lives of millions of people, especially those living in sub-Saharan Africa. With continued high prevalence, there is a high risk of healthcare workers, especially those in the surgical specialties, acquiring the infection. This study was done to investigate the impact of HIV on the choice of surgical specialties in a training institution located in Jos, north-central Nigeria. We hypothesized that the awareness of the risk of acquiring infections associated with surgical practice has no significant impact on the choice of surgical specialties among final-year medical students and house officers at our institution. METHOD: A cross-sectional questionnaire based survey was conducted on final-year medical students and house officers during their training in Jos University Teaching Hospital (JUTH), Jos. Two hundred questionnaires were randomly distributed to final year medical students and house officers who volunteered to participate in the survey. The completed questionnaires were returned to the researchers and information obtained was analyzed using Epi info 3.3. RESULTS: Of the 200 questionnaires distributed, 135 with relevant information were returned for analysis, giving a response rate of 67.5%. Of these respondents, 96.3% said they planned to specialize after their basic medical training and the majority of these (97.8%) were aware of the increased risk associated with surgical specialties, with 83.7% acknowledging the transmission of HIV and hepatitis B as being the greatest risk. About 53.0% of the respondents said they planned to pursue surgical specialties. Fifty three percent (53.3%) and sixteen percent (16.3%) based their choice of specialty on job satisfaction and favourable work schedule respectively. The knowledge of the risk of acquiring HIV/AIDS affected choice of specialty in only 21% of the respondents. CONCLUSION: The awareness of most recently graduated medical doctors and final-year medical students of the risk of acquiring HIV in surgical specialties seems to have not deterred them from wanting to pursue surgical specialties. We recommend improvements in the work environment and adherence to universal precautions to reduce the risk of transmission of HIV and other infections to surgeons practicing in the region.

Meigs' syndrome presenting as haemorrhagic pleural effusion.

BACKGROUND: The association of a benign ovarian tumor with ascites and hydrothorax that resolve after tumor resection, known as Meigs syndrome is a rare clinical entity. Rarer still is the haemorrhagic form of the syndrome OBJECTIVE: To describe a case of benign ovarian tumour associated with ascites and bloody pleural effusion. METHODS: A thirty-seven year old woman was referred for the further management of a pleural effusion. A detailed clinical evaluation was carried out, including pleural fluid cytology, chest CT scan and laparatomy. Treatment included antituberculous therapy and finally ovariectomy. RESULTS: The physical examination and a pelvic ultrasonographic scan revealed ascites in addition to a right sided ovarian mass. A chest CT-scan did not show any intrathoracic mass. Repeated pleural fluid cytology showed mesothelial cells but was negative for malignancy. An ovariectomy was performed and histological examination revealed a thecoma fibroma. The pleural effusion and ascites resolved spontaneously thus confirming the diagnosis of Meigs' syndrome. CONCLUSION: Meigs' syndrome should be considered in the differential diagnosis in female patients with hemorrhagic pleural effusion.

Uterine aspiration using the Karman cannula and syringe.

PIP: A research project took place at the Department of Obstetrics and Gynaecology of Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria, between April 1987 and May 1988 to determine the efficacy, safety, and acceptability of the manual vacuum aspiration (MVA) procedure using the Karman cannula in an outpatient facility without anesthesia to manage incomplete abortions and to determine the suitability of endometrial biopsy specimens obtained with MVA. All patients who arrived in the daytime for evacuation and all patients requiring endometrial biopsy were included in the study. 375 cases were recorded; there were 272 endometrial biopsies, 89 nonseptic abortions, 10 missed abortions, and 4 septic abortions. These subjects were interviewed for their history, treated with MVA, observed, given the contraceptive of their choice, and then discharged. The mean duration of the procedure was 3.5 minutes, with evacuation taking as long as 5-7 minutes and endometrial biopsies taking approximately 1 minute or less. Most patients spent 10-15 minutes in the hospital before discharge; no patient required hospitalization. There were very few complications (n = 6), none of them serious. Over 98% of the endometrial biopsy specimens were deemed suitable. Fewer than 5% of the patients had mild to moderate discomfort, usually during the endometrial biopsy procedures; the evacuations were virtually without discomfort. The author concluded that MVA using the Karman cannula and syringe is effective, safe, reliable, convenient, and economical for use in an outpatient setting. In addition, this procedure reduced the waiting list for dilation and curettage procedures.^ieng

Carcinoma of the cervix uteri in Zaria: etiological factors.

The study conducted at Ahmadu Bello University Teaching Hospital, Zaria from January to December, 1984 showed that carcinoma of the cervix uteri occurred in 4.18% of new gynecological attendances; 68.9% of the cases occurred in the age range 40-55 years. Early age at marriage (80.0%), and at first pregnancy (77.8%) as well as multiple marriages (48.9%) and low contraceptive usage were identifiable associated factors. The parity of the patient did not seem to be of significance. The earliest presenting symptom was post-coital bleeding occurring 10.8 months prior to attendance for medical advice. However, late presentation (in Stages IIb-IV) in 86.7% of cases was due to illiteracy, shyness, male dominance and non-recognition of the importance of early warning symptoms.

Anaemia and iron status of pregnant and non-pregnant women in the guinea savanna of Nigeria.

Haemoglobin concentration, serum iron, iron binding capacity, transferrin saturation, free erythrocyte protoporphyrin and serum ferritin (SF) were measured in 66 elite non-pregnant and 95 pregnant (27 elite and 68 non-elite) Nigerian women at Zaria, in the guinea savanna. Anaemia (as defined) was observed in 46% non-pregnant, 37% pregnant elite and 52% pregnant non-elite women. Iron deficiency (as defined) was diagnosed in 54, 30 and 25%, respectively. The mean SF in pregnant elite (28.9 micrograms l-1 was lower, but not significantly, than in pregnant non-elite women (33.6 micrograms l-1, either because of less inflammatory disease or because of more iron deficiency. The prevalence of anaemia tended to fall with increasing parity, being 52% in primigravidae and 40% in grande-multigravidae; this was probably due to greater risk of malaria-induced anaemia in primigravidae. In contrast, prevalence of iron deficiency increased with parity, being 18 and 35%, respectively, in primigravidae and grande-multigravidae. Anaemia and iron deficiency were seen most frequently in the third trimester. Pregnant women in the north of Nigeria require iron supplements irrespective of socioeconomic status or maternal parity.

Pregnancy-specific beta-glycoprotein (SP1) in normal pregnancy in Nigeria.

The circulating levels of pregnancy-specific beta 1-glycoproteins (SP1) were measured in 71 normal pregnant women in Northern Nigeria by immunoelectrophoresis. The levels showed a steady rise up to 34 weeks as in Caucasians and then plateaued with a slight fall just before term. The mean individual values were lower than those found in Caucasians at comparable gestation periods. This was thought to be related to the lower mean fetal weight in the Nigerian women.

Postoperative morbidity of eclamptic patients delivered by cesarean section.

Postoperative morbidity was investigated in 32 eclamptic patients and 12 normal well-matched controls who had been delivered by cesarean section. The incidence of wound and chest infection, genital sepsis and puerperal psychosis was higher among the eclamptics than the controls. The former also harbored more pathogens in the throat, rectum, abdominal wound and cervix than the controls. It is concluded that eclamptic patients are more prone to sepsis after surgery and should be nursed with special care.

Endometriosis among the Hausa/Fulani population of Nigeria.

In three and half years at the Ahmadu Bello University Hospital, Zaria, Nigeria, endometriosis was found in 27 Nigerians (all negroid) and one Caucasian. Age and parity distribution were similar to what has been found in patients elsewhere. In other respects, there were striking differences. The frequency (8.2 percent) is one of the highest reported in the negro. Two fifths were menopausal, majority had associated pelvic inflammatory disease, and nearly all were in women of the lowest socio-economic status. The lesions were rare in the pouch of Douglas and were totally absent from the rectovaginal septum and in the extra peritoneal space.