Risk factors for inguinal hernia in adult male Nigerians: a case control study.

BACKGROUND: We sought to evaluate selected risk factors for development of inguinal hernia in adult male Nigerians in a hospital based case control study. The aim was to identify the risks for this condition in our population. This may assist in instituting appropriate preventive measures towards early detection and treatment. METHODS: All male patients aged 18 years and above who presented with primary inguinal hernia at the General Surgical clinic of Ikorodu General Hospital between April 2009 and March 2011 were enrolled into the study as cases. Control subjects were selected randomly from the general out-patient clinic. Participants were interviewed during their first clinic attendance using a standardised questionnaire to record their bio-data and the presence or absence of the risk factors. All study cases had hernia repair and the type of hernia, whether indirect or direct was determined and documented. SPSS version 15.0 was used in the statistical analysis and the risk factors among the cases and controls were compared using univariate and multivariate logistic regression analysis. RESULTS: A total number of 404 male patients were interviewed. Two hundred and two were the cases while the remaining 202 were the controls. Significant risk factors for inguinal hernia were positive family history of inguinal hernia (p < 0.001 and strenuous work activities (p < 0.001). Among the cases, 132 (65.3%) had indirect hernia while the remaining 70 (34.7%) had direct hernia. Positive family history (p = 0.011) and straining during urination or defecation (p = 0.047) were the factors significantly associated with the type of hernia. CONCLUSION: Family history of inguinal hernia and strenuous work activity are the significant risk factors for this condition in our setting. Public health initiatives targeting those at higher risk of hernia development may help early detection and treatment; thereby reducing morbidity and mortality from this condition.

Preliminary report of the effectiveness of tetracycline sclerotherapy in treatment of ganglion.

Ganglion, a benign cyst, most common soft tissue tumor of the hand, usually occurs in the hand, wrist, and foot. It is difficult to treat as reoccurrence is common after surgery and also following other treatment procedures. In this study, sclerotherapy technique in 20 patients treated using a solution of tetracycline after aspiration is described. Most of the patients in this study were between the ages of 20 and 35 years. 16 patients had ganglion on the dorsum of the wrist, 2 patients had bilateral ganglion, and 2 patients had ganglion on the dorsum of the foot. Under aseptic conditions, the ganglions were aspirated using size 21 G needles, and then 1 mL equivalent to 100 mg/mL solution of tetracycline was injected. In the postoperative followup ranging between 18 months to 5 years, 2 reoccurrences were noticed that required the same technique. This procedure is simple, safe, effective, and cheap when compared to surgery and other nonsurgical procedure of treating ganglion.

Management of priapism: a case report.

Priapism is a pathologic condition of persistent penile erection in absence of sexual excitation, is a true erectile disorder. Although it is not common, it carries a major significance as possible complications of the disorder include penile fibrosis and permanent erectile dysfunction. All health care professionals should appreciate the importance of priapism and follow current principles of treatment to avert the complications of priapism

The value of plain abdominal radiographs in management of abdominal emergencies in Luth.

OBJECTIVE: The plain abdominal x-ray is still the first imaging modality in diagnosis of acute abdomen. The aim of this study was to find the value of plain abdominal x-ray in the management of abdominal emergencies seen in Lagos university teaching hospital. BACKGROUND: The accurate diagnosis of the cause of acute abdominal pain is one of the most challenging undertakings in emergency medicine. This is due to overlapping of clinical presentation and non-specific findings of physical and even laboratory data of the multifarious causes. Plain abdominal radiography is one investigation that can be obtained readily and within a short period of time to help the physician arrive at a correct diagnosis The relevance of plain abdominal radiography was therefore evaluated in the management of abdominal emergencies seen in Lagos over a 12 month period (April 2002 to March 2003). METHOD: A prospective study of 100 consecutively presenting patients with acute abdominal conditions treated by the general surgical unit of Lagos University Teaching Hospital was undertaken. All patients had supine and erect abdominal x-ray before any therapeutic intervention was undertaken. The diagnostic features of the plain films were compared with final diagnosis to determine the usefulness of the plain x-ray RESULTS: There were 54 males and 46 females (M:F 1.2:1). Twenty-four percent of the patients had intestinal obstruction, 20% perforated typhoid enteritis; gunshot injuries and generalized peritonitis each occurred in 13%, blunt abdominal trauma in 12%, while 8% and 10% had acute appendicitis and perforated peptic ulcer disease respectively. Of 100 patients studied, 54% had plain abdominal radiographs that showed positive diagnostic features. Plain abdominal radiograph showed high sensitivity in patients with intestinal obstruction 100% and perforated peptic ulcer 90% but was less sensitive in patients with perforated typhoid, acute appendicitis, and blunt abdominal trauma and generalized peritonitis. CONCLUSION: In conclusion, this study shows that abdominal radiographs are useful when appropriate criteria are followed in requesting for the investigation. The investigation should be requested for all patients with moderate to severe abdominal tenderness, those with gunshot injuries, blunt abdominal trauma and generalized peritonitis. It should be an integral part of management of patients with clinical suspicion of bowel obstruction and gastrointestinal perforation.

Haemosuccus pancreaticus as a rare initial manifestation of pancreatic carcinoma.

BACKGROUND: The major symptoms of cancer of the pancreas, even those of the head, are insidious weight loss, abdominal pains, back pain, anorexia, nausea, vomiting and generalized malaise. Jaundice is present in about 90% of the patients with cancer of the head and 10-40% of those with cancer of body and tail. Massive haemorrhage is an uncommon presentation. Most causes of G. I haemorrhage respond to conservative treatment. Haemosuccus Pancreaticus is a care cause of gastrointestinal hemorrhage and can prove difficult to diagnose. OBJECTIVE: To highlight the carcinoma of the head of pancreas as a possible cause of massive upper G.I haemorrhage. METHODS: Case 1: Mr. H. A., a 32 year old man who presented with repeated episodes of massive upper G. I. hemorrhage for which he was transfused on several occasions. He later presented in shock, was resuscitated and had emergency laparatomy. case 2: Miss B.O, A 30 year old lady presented with massive upper G.I hemorrhage not responsive to conservative measures. She had exploratory laparotomy and findings were bleeding pancreatic tumour that eroded into the duodenum. RESULTS: Both patients were found to have pancreatic caranoma with bleding into the pancreatic ducts. CONCLUSION: Haemosuccus pancreaticus may present as one of the early symptoms of carcinoma of the pancreas in young patients in our environment.