Management of a severe thoracoabdominal injury from motorized sawing machine in a temporary semi-urban university teaching hospital: a case report.

BACKGROUND: Report of our experience and outcome of a case of severe thoracoabdominal injuries by motorized sawing machine (a rare cause) in a Semi-Urban temporary University Teaching Hospital. METHOD: Literature review on the topic was done using Pubmed. Relevant journals and topics were also reviewed. Textbooks on relevant topics were also searched. RESULTS: A 25 year old male timber-cutter was traumatized by motorized sawing machine injuring the left half of the chest, upper abdomen, the left shoulder and left hand. It is an unusual presentation of penetrating thoracoabdominal injury. There was open pneumotharax, 3th-8th ribs fractures, diaphragmatic laceration, and eviscerations of abdominal contents without affecting other thoraco-abdominal organs. Urgent surgical intervention done was the only option. CONCLUSIONS: The challenges posed by severe motorized sawing machine thoraco-abdominal injuries in a Semi-Urban temporary University Teaching Hospital were successfully managed due to rapid pre-hospital transfer and co-ordinated team effort.

Prospective evaluation of the Bengezi and Al-Fallouji modified Alvarado score for presumptive accurate diagnosis of acute appendicitis in University of Port Harcourt Teaching Hospital, Port Harcourt.

BACKGROUND: The accurate diagnosis of acute appendicitis (AP) in a patient is valuable to the busy clinician. Decision making in cases of AP poses a clinical challenge especially in developing countries where advanced radiological investigations are not readily available and do not appear cost effective, clinical parameters remain the mainstay of diagnosis. Time and resources wasted on surgical intervention, with the added risks of surgery and anaesthesia, only to discover that this was unnecessary remains a big challenge. This prospective study was carried out to assess the accuracy of the Bengezi and Al-Fallouji modified Alvarado score in presumptive diagnosis of AP and its effect on the negative appendicectomy rate (NAR) at the University of Port Harcourt Teaching Hospital. METHODS: A retrospective study of the NAR of this hospital between June 2000 and May 2002 was carried out. All consecutive patients (128) who presented with presumptive diagnosis of AP between June 2003 and May 2004 were scored using the Bengezi and Al-Fallouji modified Alvarado scoring system and correlated with histological diagnosis. Patients discharged without surgery based on score, were reviewed in the outpatient's clinic for one month to ascertain that they did not need surgical intervention. The NAR for all appendicectomies performed by surgeons for presumptive diagnosis of AP without scoring between June 2004 and May 2005 was determined as control. Validity of the scoring system was assessed by calculating sensitivity, specificity, positive and negative predictive values. RESULTS: A total of 128 patients were scored. Forty patients with scores less than 4 after eight hours observations and re-evaluation at the Accident and Emergency were discharged without surgery. Eighty eight patients had appendicectomies as treatment for scores 5-10. There were 39 males and 49 females. In eighty patients, the appendix was histologically inflammed and 8 were normal, giving a NAR of 9.09%. High sensitivity of 92.93% and specificity of 92.93% were recorded in the study. The NAR of the retrospective study was 26.4% and 19.05% for the control group operated without scoring. CONCLUSION: The Bengezi and Al-Fallouji modified Alvarado score is a simple, safe and cost effective aid in diagnosis of acute appendicitis and decreases NAR.

A simple lithotomy device for children.

BACKGROUND: The position of the patient is important for good access during surgery. The aim of this paper is to present a simple lithotomy device for children. METHOD: We present a simple easy-to-construct and affordable lithotomy device utilizing locally available materials for paediatricpatients. RESULTS: A simple, cheap and easy-to-construct lithotomy device for children has been used in our centre. It is also easy to sterilize and very durable. No complication has been noticed so far that is attributable to the lithotomy device. It has been used for Swenson's procedure for Hirschsprung's disease, and rectal biopsy. CONCLUSION: The affordability of the device will save hospital administrators and the country great cost while still being effective. The device is being recommended for use in developing countries where paediatric operating tables are not available.

Choroidal vascular abnormality in Purtscher's retinopathy shown by indocyanine green angiography.

PURPOSE: To report choroidal vascular abnormality in unilateral Purtscher's retinopathy. METHODS: Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were used to examine a 19-year-old man four days, three months, and five months after sustaining an injury in a car accident. RESULTS: Indocyanine green angiography showed an area of choroidal hypofluorescence that continued to be present up to five months after the accident. CONCLUSIONS: Choroidal vasculature may be affected in Purtscher's retinopathy. Disorder in the choroidal microcirculation could be an additional cause of the resulting poor vision observed in some patients with Purtscher's retinopathy.

Epidemiology and treatment outcome of head injury in children: A prospective study.

SUMMARY: Head injury in children is a major concern all over the world. The increasing level of poverty in the world is exposing more children to trauma situations. The future consequences of trauma in these children are enormous, hence prevention they say, is better than cure. AIM OF THE STUDY: The study was designed to determine the etiological pattern, age group affectation and treatment outcome in children managed for head injury in our center. METHODS: It was a prospective, descriptive and cross-sectional study of children with head injuries managed in our center from July 2010 to December 2013. Data were collected using structured proforma that was part of our prospective Data Bank approved by our hospital Research and Ethics Committee. Data were collected in accident and emergency unit, Intensive Care Unit, wards and out-patient clinic. The data was analyzed using Epi Info 7 software. RESULTS: Total of 76 children managed by the unit and followed-up to a minimum of 3 months qualified for the study. There were 42 males. The age ranged from 7 months to 18 years with a mean of 8.66 years. There were 30 adolescent/teenagers. Road traffic accident formed 63.15%. Pedestrian accident was more among preschool and school children. Thirty-seven patients had mild head injury. Sixty-six patients were managed conservatively. The commonest posttraumatic effect was seizure (15.79%). Good functional outcome (≥4) was seen in 92.1%. Mode of accident and severity of injury affected the outcome. CONCLUSIONS: The etiologies of traumatic brain injury, from our study, were age dependent with falls commonest in toddlers and pedestrian accident commonest in pre-school and school ages. The outcome of treatment was related to severity of injury.