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Outbreaks of infectious bursal disease (IBD), a highly contagious immunosuppressive disease of young chickens, are still reported globally despite vaccination efforts. This study investigated the genetic characteristics of infectious bursal disease virus (IBDV) from 26 reported outbreaks in 2019 in Nigeria. Nucleotide sequences of VP2 hypervariable (hvVP2) region (n=26) and VP1 (n=23) of Nigerian IBDVs were determined. Our results revealed the detection of reassortant strains with segment A related to very virulent IBDV (vvIBDV) having virulence marker (222A, 242I, 256I, 294I and 299S), whereas their segment B were closely related to previously detected IBDV strains having QEG substitution at positions 145-147. Phylogenetic analysis of the hvVP2 region revealed that all the Nigerian IBDV clustered with vvIBDV (genogroup 3) and were independent of the Asian/European lineage. Interestingly, in the hvVP2, all the viruses had a G-S substitution at residue 254. Additionally, one isolate had an A321T substitution at the PHI loop, which has been suggested to play a key role in antigenicity. Four of the viruses (Bauchi=3 and Plateau=1) had a unique A-T substitution at residue 144 on the VP1 region. We also observed a T174S substitution in nine of the Nigerian viruses from Bauchi and Plateau state that were not found in any outbreak viruses from Oyo and Akwa Ibom. This report demonstrates the circulation of reassortant strains in commercial and backyard poultry farms in Nigeria despite sustained vaccination efforts. Our data suggest that the Nigerian outbreak viruses have mutations that may affect antigenicity and contribute to antigenic drift.
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Infecciones por Birnaviridae , Virus de la Enfermedad Infecciosa de la Bolsa , Enfermedades de las Aves de Corral , Animales , Infecciones por Birnaviridae/epidemiología , Infecciones por Birnaviridae/veterinaria , Pollos , Virus de la Enfermedad Infecciosa de la Bolsa/genética , Nigeria/epidemiología , Filogenia , Enfermedades de las Aves de Corral/epidemiología , Virus Reordenados/genética , Proteínas Estructurales Virales/genéticaRESUMEN
Here, we describe the near-complete genome of an enterovirus F (EV-F) isolate from Nigeria. The obtained sequence was 7,378 nucleotides (nt) long and encodes 2 open reading frames (ORFs), an upstream ORF (uORF; 56 amino acids [aa]) and a polyprotein ORF (ppORF; 2,167 aa). Both ORFs overlap but are in different reading frames, with the uORF in a +1 reading frame relative to the ppORF.
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In 2018, a 26-month-old girl, fully vaccinated with Rotarix in 2016, presented with fever, diarrhea, and vomiting. A rapid test showed that her feces contained rotavirus A (RVA). VP7 reverse transcription-PCR (RT-PCR) and Illumina sequencing showed that a G1P[8] strain with a Wa-like genotype constellation was the etiologic agent. This is the first near-complete RVA genome sequence from Nigeria.
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BACKGROUND: Emergency abdominal operations carry significant risk of mortality and morbidity. The time of the day when such operations are performed has been suggested as a predictor of outcome. A retrospective comparison of outcomes of daytime and night-time emergency abdominal operations was conducted. METHODS: Clinical data of patients who had abdominal operations over a five-year period were obtained. Operations were classified as 'daytime' (group A) if performed between 8.00 am and 7.59 pm or 'night time' if performed between 8.00 pm and 7.59 am (group B). Post-operative outcomes were compared. RESULTS: A total of 267 emergency abdominal operations were analysed: 161 (60.3%) were performed in the daytime while 106 (39.7%) were performed at night. The case mix in both groups was similar with appendectomies, bowel resections and closure of bowel perforations accounting for the majority. Baseline characteristics and intra-operative parameters were similar except that 'daytime' operations had more consultant participation (p = 0.01). Mortality rates (13.7% in group A and 12.3% in group B, p = 0.2), re-operation rates (9.3% in group A and 10.4% in group B, p = 0.7) and duration of hospital stay (group A-11.1 days, group B-12.4 days p = 0.4) were similar. ASA status, re-operation and admission into the intensive care unit were identified as predictors of mortality. CONCLUSION: Timing of emergency abdominal operations did not influence outcomes. In resource-limited settings where access to the operating room is competitive, delaying operations till daytime may be counterproductive. Patients' clinical condition still remains the most important parameter guiding time of operation.
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Abdomen/cirugía , Atención Posterior/estadística & datos numéricos , Adulto , Apendicectomía/estadística & datos numéricos , Urgencias Médicas , Servicio de Urgencia en Hospital , Femenino , Investigación sobre Servicios de Salud/métodos , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nigeria , Cuidados Nocturnos/estadística & datos numéricos , Quirófanos/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
We describe the draft genome of a bovine enterovirus (EV) isolate recovered from sewage in Nigeria. This isolate replicates on both RD and L20B cell lines but is negative for all EV screens in use by the Global Poliovirus Eradication Initiative (GPEI). It contains 7,368 nucleotides (nt) with 50.2% G+C content and an open reading frame (ORF) with 6,525 nt (2,174 amino acids).
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We present the draft genome of Mycoplasma arginini strain NGR_2017. This strain was recovered in Nigeria from cell culture in 2017. The assembly contains 620,555 bp in 12 contigs. It contains 561 coding sequences, 34 RNAs (29 tRNAs, 4 rRNAs, and 1 transfer-messenger RNA [tmRNA]), and a >26-kb integrative and conjugative element.
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Riedel's thyroiditis is a rare cause of the enlargement of the thyroid gland. The etiology is not fully known. There has been no report of Riedel thyroiditis in our country. We report a case of a 61-year-old man with the disease as well as review the literature. We present the case of 61-year-old carpenter seen in our clinic with 2½ years history of painless anterior neck swelling associated with hoarseness of voice. He had multiple hard nodules on the left lobe of the thyroid gland with multiple cervical lymph nodes enlargement. No feature of hypothyroidism or thyroiditis. Clinical diagnosis of malignant goiter was made although Fine-needle aspiration for cytology did not suggest malignancy. He had surgery, findings included nonresectable hard multinodular left thyroid lobe from which a wedge biopsy was taken, Histology of the specimen revealed Riedel's thyroiditis. He was managed with oral Prednisolone and Tamoxifen with remarkable improvement in his clinical symptoms. Riedel's thyroiditis is a rare disease. It can easily mimic malignant goiter hence proper histological diagnosis will be necessary to differentiate. Review of medical literature showed that Riedel thyroiditis has not been reported in a black African patient inhabiting the sub-Sahara Africa. This was a report of Riedel thyroiditis in a black Nigerian patient that was successfully managed on oral glucocorticoid, tamoxifen and L-thyroxine.
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PURPOSE: Being a relatively new entrant into our practice, mesh repair has not been compared with previously existing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost. METHOD: Patients with uncomplicated, primary inguinal hernia were randomized to have their hernias repaired either by the Lichtenstein or darning technique. Details of their socio-demographic, hernia characteristics and intra-operative findings were recorded. Postoperatively patients were assessed for pain, wound site complications and recurrence. Both direct and indirect costs were calculated. Mean duration of follow-up was 7.5 months. RESULT: Sixty-seven patients were studied. Thirty-three had Lichtenstein repair while 34 had darning repair. Lichtenstein repair was associated with less post-operative pain, less analgesic requirement, and shorter time of return to work activities, these were all statistically significant (p < 0.05). Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest. There was no recurrence in any of the groups. Total cost was comparable between the two groups. CONCLUSION: Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are comparable in terms of frequency of early post-operative complications and total cost.
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Hernia Inguinal/cirugía , Herniorrafia/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Población Negra , Femenino , Herniorrafia/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Mallas Quirúrgicas , Técnicas de Sutura , Cicatrización de Heridas , Adulto JovenRESUMEN
BACKGROUND: Hand-sewn gastrointestinal anastomoses has been the traditional approach to gastrointestinal anastomosis in Nigeria while stapled anastomoses are infrequently performed in few centers. OBJECTIVES: To describe the outcome of our initial experience with stapled gastrointestinal anastomoses in a semi-urban patient population. PATIENTS AND METHODS: Consecutive patients who had stapled gastrointestinal anastomoses between January 2011 and June 2014 in a Nigerian tertiary hospital were prospectively evaluated. Indications for operation, procedures performed and anastomoses constructed and postoperative outcome of each patient were documented. RESULTS: Nineteen patients including seven males and 12 females had stapled anastomoses within the period. Their ages ranged between 41 and 68 (mean 52.5) years. Six (31.6%) Roux-en-Y gastrojejunostomies, 6 (31.6%) ileo-colic, 3 (15.8%) ileo-ileal, 2 (10.5%) colo-colic, and 2 (10.5%) colo-anal anastomoses were performed. Indications include antral gastric cancer in 4 (21.1%), right colon cancer 4 (21.1%), ileal perforations in 3 (15.8%) while 2 (10.5%) each had left colon cancer, common bile duct obstruction, rectal cancer and ruptured appendix. Mean duration of operation was 108 ± 46 min and mean duration of postoperative stay was 5 ± 2.6 days. No intraoperative complications were recorded and no anastomotic leakage occurred. At a median follow-up of 5 months no staple related stricture had occurred. CONCLUSIONS: Stapled gastrointestinal anastomoses are associated with a good outcome in our center. We propose a prospective, large-population randomized comparison of the technique with hand-sewn anastomoses.
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BACKGROUND: Giant fibroadenoma of the breast is a rare benign breast tumour which seldom grows to a giant size, it is even rarer for this benign tumour to grow rapidly, ulcerate spontaneously and present like a fungating breast tumour in a way mimicking breast cancer. CASE PRESENTATION: This is a presentation of a 14 year old premenarchal girl with a massive ulcerating and fungating left breast mass that was initially thought to be a fungating locally advanced breast carcinoma on clinical examination. Further examination of the morphology of the resected surgical specimen and histological examination confirmed it to be giant fibroadenoma of the breast. It was successfully managed by partial mastectomy and breast reconstruction with an excellent result and a high degree of patient satisfaction was achieved. CONCLUSION: Though a rare clinical entity benign breast tumour can present like a fungating breast cancer and this must be bore in mind especially in young adolescent patients presenting with ulcerating breast tumour.
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Neoplasias de la Mama/cirugía , Fibroadenoma/cirugía , Adolescente , Neoplasias de la Mama/patología , Diagnóstico Diferencial , Femenino , Fibroadenoma/patología , Humanos , Mamoplastia , Mastectomía Segmentaria , Resultado del Tratamiento , Úlcera/complicacionesRESUMEN
OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics in our immediate black community. PATIENTS, MATERIALS AND METHOD: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded, prostate volumes determined with ultrasound, body mass index (bmi) calculated, and correlations determined between the prostate volume and the age, and anthropometrics. RESULTS: 105 patients aged 43-88 yrs (mean=64.4, 8.88 SD) managed for BPH were studied with 93 asymptomatic men aged 43-80 yrs (mean=56.15, 9.89 SD). The mean (SD) prostate volume, height, weight and bmi were 83.8 (37.7) ml, 1.67 (0.07) m, 63.6 (9.32) kg and 22.8 (3.03) kg/m2, and 24.5 (9.2) ml, 1.69 (0.06) m, 68.9 (10.6) kg and 24.2 (3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and bmi (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p=0.394), and bmi (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43- 88 years with 83.79 (37.66) ml mean (SD) volume in symptomatic patients and 24.45 (9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH in our community.
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Próstata/patología , Hiperplasia Prostática/patología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estatura , Índice de Masa Corporal , Peso Corporal , Estudios de Casos y Controles , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Tamaño de los Órganos , Hiperplasia Prostática/complicaciones , Prostatismo/etiologíaRESUMEN
BACKGROUND: Hirschsprung's disease in adulthood is very rare and is often misdiagnosed. We present four cases of adulthood Hirschsprung's disease seen in the last two decades to illustrate challenges accompanying its diagnosis and management. METHOD: This descriptive case series included cases of histologically proven Hirschsprung's seen in adulthood at the Obafemi Awolowo University Teaching Hospitals Complex in the last two decades (1991-2011). The clinical data, radiological investigations, details of surgical treatment, histological diagnosis, outcomes and complications were analyzed. RESULT: There were 4 adult patients, 3 males and 1 female with age ranging from 17 to 74 years (mean 23 years). Each patient presented with sub acute intestinal obstruction needing two staged procedures of initial colostomy followed by definitive procedure of low anterior resection (State procedure) in 3 patients and Swenson-Bill procedure in one. There was one mortality and good long term outcome in the remaining three. CONCLUSION: This review presented the oldest patient presenting with adult Hirschsprung's and the highest mean age of any case series. Four patients with adulthood Hirschsprung's disease managed by two operative procedures enabled comparison of operative outcome with respect to complications and functional outcomes. Mortality seems to correlate with presentation at old age, which is usually due to life long self-management of chronic constipation. Though very rare, a high index of suspicion of adulthood Hirschprung's disease should be maintained in adult patients with recurrent chronic constipation needing lifelong laxative, enema or mechanical wash-out.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Enfermedad de Hirschsprung/cirugía , Adolescente , Adulto , Anciano , Colon/patología , Diagnóstico Diferencial , Femenino , Enfermedad de Hirschsprung/diagnóstico , Humanos , Masculino , Nigeria , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
Scrapie, a disease of sheep and goats with a progressive course and fatal outcome, has not been identified in Nigeria. Anecdotal scrapie reports by livestock workers abound. Livestock diseases like scrapie form huddles in livestock economics of countries. For 8 months we surveyed for scrapie targeting emergency/casualty slaughter sheep and goats in Jos, Nigeria. We clinically examined 510 sheep and 608 goats of local breeds, aged from 12 months to 5 years. In total 31 (5.10%) goats and no sheep were clinically suspicious for scrapie. Caudal brainstem tissues of suspect animals collected postmortem were analyzed for the disease specific form of the prion protein, PrP(Sc), using Bio-Rad's TeSeE ELISA rapid test kit. No sample was positive for scrapie. Fluorescent antibody test for rabies and H&E staining on samples were carried out for differential diagnosis. These showed no pathological lesions indicative for neurological disease. While our findings do not exclude the presence of scrapie in Jos, we demonstrate that targeted sampling of small ruminants for neuroinfectious disease is feasible in developing countries, pointing to the possibility of implementing such a monitoring scheme in Nigeria to prevent economic losses in small ruminant livestock as scrapie caveats from endemic countries have shown.
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AIMS AND OBJECTIVES: To determine the prevalent age of symptomatic benign prostate hyperplasia (BPH), the average BPH volume, and the association between BPH volumes and the age, and anthropometrics. PATIENTS, MATERIALS AND METHODS: Selected patients with lower urinary tract symptoms (LUTS) due to BPH with tissue diagnosis, and adult men of similar age group with no irritative or obstructive LUTS were prospectively studied from July 2003 to June 2009. The age, height and weight were recorded; prostate volumes determined with ultrasound, body mass index (BMI) calculated, and correlations determined between the prostate volume, the age and anthropometrics. RESULTS: One hundred and five patients aged 43-88years (mean=64.4, 8.88SD) managed for BPH were studied with 93 asymptomatic men aged 43-80years (mean=56.15, 9.89SD). The mean (SD) prostate volume, height, weight and BMI were 83.8(37.7) ml, 1.67(0.07) m, 63.6(9.32) kg and 22.8(3.03) kg/m2, and 24.5(9.2) ml, 1.69(0.06) m, 68.9(10.6) kg and 24.2(3.44) kg/m2 respectively for symptomatic and asymptomatic groups. In the symptomatic group, BPH volume showed significant positive correlation with the age (p=0.030), but no correlation with the weight (p=0.550), height (p=0.375) and BMI (p=0.840). In the asymptomatic group, prostate volume also showed significant positive correlation with the age (p=0.041), but no correlation with the weight (p=0.434), height (p= 0.394), and BMI (p=0.203). CONCLUSION: The prevalent age of symptomatic BPH in our community is 43-88years with 83.79(37.66) ml mean (SD) volume in symptomatic patients and 24.45(9.21) ml in asymptomatic men. BPH volume correlates with age but not with anthropometrics. Lack of correlation with BPH volume suggests that anthropometrics may not be risk factors for development of BPH.
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Índice de Masa Corporal , Próstata/patología , Hiperplasia Prostática/patología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Estatura , Peso Corporal , Estudios de Casos y Controles , Humanos , Síntomas del Sistema Urinario Inferior/diagnóstico por imagen , Síntomas del Sistema Urinario Inferior/patología , Masculino , Persona de Mediana Edad , Nigeria , Tamaño de los Órganos , Estudios Prospectivos , Próstata/diagnóstico por imagen , Hiperplasia Prostática/diagnóstico por imagen , UltrasonografíaRESUMEN
BACKGROUND: Giant fibroadenoma of the breast is a type of rare benign breast tumour which can grow to a giant size, It is even rarer for this benign tumour to grow rapidly, ulcerate spontaneously and present like a fungating breast tumour in a way mimicking breast cancer. Carcinoma of the breast on the other hand has been on the increase so much that it has assumed an epidemiological dimension. In developing country such as Nigeria late presentation of breast cancer has remained a rule rather than exception and it is very common for patient to present with fungating breast lesion. STUDY DESIGN: This is a case presentation of a 14 year old premenarchal girl presenting with a massive ulcerating and fungating left breast mass that was initially thought to be a fungating locally advanced breast carcinoma on clinical examination. Further examination of the morphology of the resected surgical specimen and histological examination confirmed it to be giant fibroadenoma of the breast. RESULTS: The giant fungating breast tumour successfully managed by partial mastectomy and breast reconstruction with an excellent result and a high degree of patient satisfaction was achieved. CONCLUSION: Though a rare clinical entity benign breast tumour can present like a fungating breast cancer and this must be bore in mind especially in young adolescent patients presenting with ulcerating breast tumour.
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Neoplasias de la Mama/patología , Fibroadenoma/patología , Adolescente , Neoplasias de la Mama/cirugía , Femenino , Fibroadenoma/cirugía , Humanos , Mamoplastia , Mastectomía Segmentaria , Menarquia , Pezones/patología , Úlcera Cutánea/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Gallbladder cancer is a rare malignancy with a variable incidence worldwide. It ranks number eight among all gastrointestinal cancer seen in Nigeria. It is associated with high mortality and morbidity because it is usually diagnosed very late. Adequate surgical resection is the only modality with hope of cure. This requires advanced surgical skills which is quite rare in most developing countries like Nigeria. In this current work, we audit the management and outcome of gallbladder cancer in our hospital, highlighting peculiarity associated with our setting. PATIENTS AND METHOD: Consecutive patients managed as cases of gallbladder cancer at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1990 and December 2010 were studied retrospectively. Patient demographics, disease and treatment-related variables, and outcomes were analyzed by SPSS version 16.0. RESULTS: Thirty-one cases of gallbladder cancer were diagnosed over the 21-year period, and this accounts for about 0.3% of all cancer cases seen in our hospital. The median age of this patient cohort was 58 years (range 28 to 79 years). Seventeen (54.8%) patients were age below 60 while 14 (45.2%) were age 60 and above. Twenty-seven patients (87.1%) were female and four (12.9%) were male, with a male to female ratio approximately 1:7. Over 80% of the patients presented with a triad of upper abdominal pain, weight loss, and jaundice. Majority (67.7%) of the patients were diagnosed intraoperatively. Only four patients underwent complete resection as they had radical cholecystectomy including regional lymph node dissection and wedge resection of the gallbladder fossa of the liver. The stages of the resected patients were T3 in three patients and T2 in one. Overall 1- and 5-year survival rates for our entire patient cohort were 32% and 10%, respectively. CONCLUSION: In conclusion, this study showed that preoperative diagnosis of gallbladder cancer could be challenging in our environment. A triad of upper abdominal pain, jaundice, and weight loss with judicious use of available radiological modality will increase the chances of making the preoperative diagnosis of the cancer. It also showed that good outcome can be obtained when radical surgery is offered to these few patients within the limitation of resources in few patients with resectable tumor.
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Colecistectomía/mortalidad , Neoplasias de la Vesícula Biliar/cirugía , Auditoría Médica , Adulto , Anciano , Femenino , Estudios de Seguimiento , Neoplasias de la Vesícula Biliar/epidemiología , Neoplasias de la Vesícula Biliar/mortalidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Nigeria/epidemiología , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Centros de Atención TerciariaRESUMEN
BACKGROUND: Tension-free mesh inguinal hernia repair is becoming increasingly popular worldwide. However, reports are sparse in Nigeria. OBJECTIVE: To evaluate the impact, outcome and cost implication of tension free inguinal hernia repair in a Nigerian setting. METHODS: A prospective study of all consecutive adults patients with uncomplicated inguinal hernia who had mesh repair over a period of 12 months was undertaken. A large sheet of 900cm2 polyproylene mesh material was used for all the patients in the study. All wounds were opened on the third postoperative day while sutures were removed on the eight day. Patients were followed up for one year. RESULTS: A total number of 30 patients had tension-free mesh ingunal hernia repair. Their ages ranged from 21 to 78 years (mean 47.2±15.5) years with a female to male ratio of 1:15. Complete inguinoscrotal hernia was the commonest type of groin hernia accounting for 40% of the cases. The repair of posterior wall which entailed placement of mesh was completed at a median time of 15 minutes. While two (6.7%) and one (3.3%) had wound oedema and groin pain respectively at one month, none of the patients had these complications or recurrence at a median of five months follow-up period. CONCLUSION: Tension-free mesh inguinal hernia repair was well tolerated and affordable to our patients. Pain and infections, reported to be the common complications of this procedure were infrequent in this study. A larger study is recommended to help confirm these findings.
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Hernia Inguinal/cirugía , Mallas Quirúrgicas , Adolescente , Adulto , Anciano de 80 o más Años , Análisis Costo-Beneficio , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Nigeria , Polipropilenos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. OBJECTIVE: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. METHOD: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria were reviewed. RESULTS: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81 years with a mean age of 45.9 years. Only 3% (6 of 202) were males. Two-thirds had more than one secondary site on initial evaluation and the commonest sites were liver (63%), lung parenchyma (51%), pleura (26%) and contralateral breast in 25%. On immunohistochemistry, basal like tumours were found in 46.1%. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27%. CONCLUSION: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation.
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Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Terapia Combinada , Neoplasias Basocelulares/patología , Neoplasias Basocelulares/terapia , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/clasificación , Neoplasias de la Mama/epidemiología , Diagnóstico Tardío , Femenino , Estudios de Seguimiento , Hospitales de Enseñanza , Humanos , Masculino , Mastectomía , Persona de Mediana Edad , Estadificación de Neoplasias , Neoplasias Basocelulares/clasificación , Neoplasias Basocelulares/epidemiología , Nigeria/epidemiología , Radioterapia , Distribución por Sexo , Factores Socioeconómicos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Laparoscopic cholecystectomy is not yet routinely performed in most public tertiary hospitals in Nigeria. OBJECTIVES: To assess the feasibility and early outcoe of laparoscopic cholecystectoy in Ile-ife, Nigeria. METHOD: Consecutive patients who were selected for the procedure from June 2009 through December 2010 at the Ife State Hospital of the ObafemiAwolowo University Teaching Hospitals Complex, Ile-Ife were prospectively studied. RESULTS: Eighteen female (75%) and six male patients had laparoscopic cholecystectomy within the study period. They were aged 19-83 years with a mean age of 33.4 years. Six (25%) patients had acute calculous cholecystitis while the rest presented with chronic calculous cholecystitis. Their Body Mass Indices ranged from 21 to 32kg/m2. Operation time ranged from 65 to 105 minutes. One procedure (4%) was converted to open due to bleeding from the gallbladder bed. Another patient who had a minor common bile duct injury presented with generalized dull abdominal pain on the sixth postoperative day. She had open repair of the injury over a T-tube. Three patients (12.5%) were discharged on the first postoperative day while 15 (62.5%) others were discharged on the second postoperative day. No mortality was recorded. CONCLUSION: Laparoscopic cholecystectomy is feasible in our setting with outcome comparable to previous pioneering experiences in other African countries centre in spite of resource limitations.
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Colecistectomía Laparoscópica/métodos , Colelitiasis/cirugía , Enfermedades de la Vesícula Biliar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Colecistectomía Laparoscópica/estadística & datos numéricos , Colelitiasis/diagnóstico por imagen , Colelitiasis/epidemiología , Femenino , Enfermedades de la Vesícula Biliar/epidemiología , Hospitales de Enseñanza , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Complicaciones Posoperatorias/epidemiología , Factores de Tiempo , Resultado del Tratamiento , UltrasonografíaRESUMEN
INTRODUCTION: The management of splenic injuries has shifted from splenectomy to splenic preservation owing to the risk of overwhelming post-splenectomy infection (OPSI). This study aimed to identify the factors that determine splenectomy in patients with isolated splenic injuries, with a view to increasing the rate of splenic preservation. PATIENTS AND METHODS: Files of 55 patients managed for isolated splenic injuries from blunt abdominal trauma between 1998 and 2007 were retrospectively analysed using a pro forma. Management options were classified into nonoperative, operative salvage and splenectomy. RESULTS: The majority of patients suffered splenic injury as a result of motor vehicle accident (MVA) trauma or falls. Splenectomy was undertaken in 33 (60%) patients, 12 (22%) had non-operative management, and operative salvage was achieved in 10 (18%) patients. Significant determinants of splenectomy were grade of splenic injury, hierarchy of the surgeon, and hierarchy of the assistant. DISCUSSION: MVA injury and falls accounted for the vast majority of blunt abdominal trauma in this study. The rate and magnitude of energy transferred versus splenic protective mechanisms at the time of blunt abdominal trauma seems to determine the grade of splenic injury. Interest in splenic salvage surgery, availability of technology that enables splenic salvage surgery, and the experience of the surgeon and assistant appear to determine the surgical management. CONCLUSION: Legislation on vehicle safety and good parental control may reduce the severity of splenic injury in blunt abdominal trauma. When surgery is indicated, salvage surgery should be considered in intermediate isolated splenic injury to reduce the incidence of OPSI.