Medical education impact assessment: knowledge of final year medical students of Obafemi Awolowo University about male urethral catheterization.

BACKGROUND: Urethral catheterization is one of the commonest procedures performed by doctors either for prophylactic, diagnostic or therapeutic purposes. The medical education impact of this procedure on graduating medical students was assessed using a structured questionnaire. METHOD: This is a questionnaire--based study and the respondents were final year medical students who have completed their final examinations. RESULTS: There were 86 respondents with M:F ratio of 1. About a third of the respondents have not done urethral catheterization during their training while only 7% have done the procedure more than 5 times. All the students know that urethral catheterization is a sterile procedure and 96% knew that sterile gloves should be donned during the procedure. 92.4% of the respondents knew that skin preparation was necessary during the procedure with 75% of them responding that cetriomide and chlorhexidine solution was appropriate. 54% of the students used xylocaine as lubricant while 46% used KY Jelly. On the quantity of the lubricant for catheterization, only 2.7% of the respondents felt that 11-15 mls should be injected into the urethra. On the maximum amount of fluid to retain the balloon, only 36% of the students responded that it should be according to the specified capacity of the balloon. Majority of the students (88%) know that the catheter should get to the Y-junction before it is inflated. CONCLUSION: Most of the students in this study were taught appropriately the procedure of urethral catheterization; however about a third had not performed the procedure as a medical student.

Digital rectal examination for prostate and rectal tumour: knowledge and experience of final year medical students.

BACKGROUND: It is most pertinent that medical students are taught the necessary skills for digital rectal examination (DRE) before they become doctors. OBJECTIVE: The study is to assess the knowledge and experience of final year medical students regarding DRE for prostate and rectal tumours. METHODS: Well-structured questionnaire were administered to each of the final year medical students of Ladoke Akintola University of Technology a week to their final examinations. RESULTS: Response was received from 127 (60%) of the students, 124 (97.6%) agreed that they have been taught DRE. Most of the students, 102 (80.3%), have done one to five DRE, three (2.4%) and have never performed DRE while none of the students have done more than ten DRE. Only in 49 (38.6%) of cases were the findings of the students on DRE always confirmed by a doctor. Nine students (7.1%) have never felt a clinical BPH and none had felt it more than five times. Sixty-six (52.0%) have never felt a malignant prostate and none of the students have felt it up to three times. Most of the students, 106 (83.5%), have never felt a rectal tumour on DRE Only five (3.9%) felt very confident of their ability to give an opinion based on their findings on DRE while 105 (82.7%) felt reasonably confident CONCLUSIONS: The students have been taught DRE and a good number of them have performed it. Few of the DRE done by the students were cross-checked by a doctor. Most of the students have problems differentiating BPH from cancer of the prostate and many of them were not very confident of their findings on DRE.

Plasma lipid peroxidation and totalantioxidant status among dyslipidaemic and hypertensive Nigerians with high risk of coronary heart disease.

BACKGROUND: The oxidative modification hypothesis of atherosclerosis predicts that low density lipoprotein-cholesterol (LDL-C) oxidation is an early event in atherosclerosis and that oxidized LDL-C contributes to atherogenesis OBJECTIVE: To determine a link, if any, between the plasma lipid peroxidation and total antioxidant status (TAS) among dyslipidemic and hypertensive Nigerian patients with high risk of coronary heart disease. METHODS: The study groups comprised 58 hypertensive adult Nigerians whose fasting plasma total cholesterol (TC) levels were > 5.5 mmol/L and with high risk coronary heart disease (CHD) lipid fraction i.e. 'the ratio of high density lipoprotein cholesterol to total cholesterol' (HDL-C/TC) < 0.13 were selected for the study. The control groups comprised 58 non hypertensive adult Nigerians with (HDL-C/TC) > 0.30. RESULTS: The mean +/- SD TAS level (1.02 +/- 0.15 mmol/L trolox) for males and (0.99 +/- 0.17 mmol/L) for females were significantly reduced (p < 0.05) compared to the controls; however (MDA) level (5.15 +/- 0.82 mmol/ml) for males and (5.06 +/- 0.73 mmol/ml) for females were significantly increased (p < 0.01) compared to the controls. The mean +/- SD plasma TC and LDL-C malonyl level (5.87 +/- 0.23 mmol/L and 4.65 +/- 0.34 mmol/L) were significantly increased (p < 0.01) in males hypertensive compared to the control. An inverse correlation between the TAS/TC(r = -0.53, p < 0.001) and TAS/LDL-C (r = -0.50, p < 0.001), however a direct correlation between the MDA/TC(r = 0.51, p < 0.001) and MDA/LDL-C (r = 0.48, p < 0.01) for males hypertensive were found. In female subjects the mean +/- SD plasma TC (5.95 +/- 0.13 mmol/L) and LDL-C (4.45 +/- 1.04 mmol/L) were significantly increased (p < 0.05) and (p < 0.01) respectively compared to the controls. Also in hypertensive females inverse correlation between the TAS/TC (r = -0.59, p < 0.001) and TAS/LDL-C (r = -.41, p < 0.01), and a direct correlation between the MDA/TC ( r= .48, p < 0.01) and MDA/LDL-C (r = 0.31, p < 0.05) were found. CONCLUSION: Since dyslipidaemia, hypertension and lipid peroxidation were directly relate to the severity of atherosclerosis, elimination of free radicals in the plasma before the peripheral tissues can take them up might reduce atherosclerosis. In view of our present findings, a management strategy aimed at simultaneously reducing lipid peroxidation and increasing total antioxidant status in dyslipidemic patients may be of benefit.

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.

Mirizzi syndrome caused by a bile pseudocyst.

BACKGROUND: Mirizzi syndrome caused by bile pseudo cyst presents diagnostic and management challenges to the surgeon. OBJECTIVE: To emphasize to clinicians the need to always recognize and correct associated liver derangements before surgery so as to prevent the usual accompanying high morbidity/mortality associated with Mirizzi syndrome. CASE REPORT: We report an unusual and previously unreported pathology of post-cholecystectomy Mirizzi syndrome in a 35 year old female who developed a bile pseudo-cyst and which may possibly qualify for Mirizzi syndrome type 5--highlighting the need for maximum pre, -intra, and post-operative challenges for improved prognosis. The patient was lost from reactionary haemorrhage due to limited facilities. CONCLUSION: There is a crying need in developing countries to have Critical Care centers and for Clinicians to recognize the necessity for adequate pre, intra and post-operative care of these high risk patients.

Giant renal oncocytoma masquerading as infiltrating renal cell carcinoma: case report and literature review.

Renal oncocytomas (RO) are tumours containing a population of cells with highly differentiated eosinophilic granular cytoplasm, extremely rich in mitochondria. It is estimated they account for about 3 to 7% of all solid renocortical tumours that were previously regarded as renal cell carcinoma. Based on their clinical behaviour and distinct pathologic features they are now regarded as benign renal tumours, often less than 5cm in diameter. We present a case of giant renal oncocytoma in a patient with synchronous bladder tumour, with pre-operative clinical, urographic and ultrasound features of locally advanced renal cell carcinoma (RCC). Findings at surgery included huge right renal tumour with infiltration to the duodenum; hepatic colic flexure; gall bladder; liver capsule and the greater omentum with small indurations at the base of the bladder. There was no tumour extension to the renal vein, no peritoneal seedling, no nodal metastasis and no ascites. Radical nephrectomy was carried out with good prognosis and without recurrence 52months post nephrectomy. This presentation, besides highlighting the possible giant nature of RO, also illustrates the malignant potential of RO to infiltrate contiguous structures and mimics infiltrating RCC. In view of the difficulties at establishing pre-operative diagnosis in this disease and because nephron-sparing surgery is curative, especially for the well-circumscribed tumours, RO should be considered in the management of patients with features of infiltrating RCC. A review of literature is also presented.

Hydrocelectomy under local anaesthesia in a Nigerian adult population.

BACKGROUND: Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or a patent processus vaginalis. It is commonly encountered in our practice and often requires surgical treatment. However in our setting and in many underdeveloped countries, availability of general anaesthetic service is poor due to lack of trained personnel and equipment. OBJECTIVES: To ascertain the practicability and acceptability of hydrocelectomy under sedation and local anaesthesia in Nigerian adults with hydrocele PATIENTS AND METHODS: A prospective study was carried out over a two year period on patients that had hydrocelectomy at the surgery unit of the Obafemi Awolowo University Teaching Hospitals Complex, Wesley Guild Hospital, Ilesa. Consecutive patients with diagnosis of hydrocele who consented had hydrocelectomy using intramuscular diazepam sedation and spermatic-cord block with 0.5% plane xylocaine and the scrotum infiltrated with same along the line of incision. RESULTS: Fifty adult patients were studied: age range 15-94 years. Eighty percent of the patients had unilateral hydrocele and the commonest type was vaginal hydrocele (94%). All patients had hydrocelectomy, 96% were under local anaesthesia while 4% were converted to general anaesthesia. All patients except one prefer to have future surgery under such local anaesthesia and sedation. CONCLUSION: Hydrocelectomy under local anaesthesia and sedation is practicable and was tolerated and accepted by the adults patients studied.