Acute appendicitis in Lagos: a review of 250 cases.

OBJECTIVES: Acute appendicitis is common. This prospective study of 250 cases of acute appendicitis was performed to critically analyse the pattern of presentation, management, operative findings and treatment outcome. The effect of length and position of the appendix in relationship to acute inflammation was also determined. PATIENTS AND METHODS: Two hundred and fifty cases of acute appendicitis were studied, including those found to have appendicitis at surgery despite other preoperative diagnosis. Patient biodata, clinical signs and symptoms were recorded. Haematological and biochemical parameters were determined after which all patients with a diagnosis of acute appendicitis had appendicectomy under general anaesthesia. All relevant peri-operative data were recorded. Excised appendices were sent for histological examination. RESULTS: There were 133 males and 117 females giving a gender ratio of 1.2:1. The mean age was 25.7 +/- 10.3 years, with majority of cases (42.8%) occurring in the third decade of life. Abdominal pain (100%), fever (48.4%), anorexia (48.0%), vomiting (47.8%) were the common symptoms. Commonly elicited signs included right iliac fossa direct tenderness (74.4%), rebound tenderness (59.2%), localised guarding (42.8%) and right rectal wall tenderness (43.2%). The mean white cell count was not significantly elevated (mean 8538 +/- 4166 per mm3, P > 0.05). Sixty three percent (156/245) of all appendices were retrocaecal in position. Mean length of the appendices was 10.4 +/- 2.9 cm. The length and position of appendices were not significantly different between those who had acutely inflamed and normal appendices (P = 0.923) Two hundred and forty five patients (98%) with a diagnosis of acute appendicitis had appendicectomy. The commonest postoperative complication was wound infection (8%), overall complication rate was 13.5% and negative appendicectomy rate was 13.4%. CONCLUSION: The presentation, management and treatment outcome of acute appendicitis in our centre are similar to those of other centres in our sub-region. Complication rates were low.

Efficacy of natural honey in the healing of leg ulcers in sickle cell anaemia.

In order to assess the reported efficacy of natural honey in the healing of chronic ulcers, the efficacy of locally applied natural honey was compared to that of Eusol solution in an open trial involving 20 patients with sickle cell anaemia (SS) who were in steady clinical states and had chronic leg ulceration. All patients were admitted to hospital for the 4 week duration of the trial for bed rest, daily aseptic dressings, and weekly measurement of the size of the ulcer. Fifteen patients with a total of 19 leg ulcers were evaluable at the end of the trial. Eleven ulcers were dressed with honey while 8 were dressed with Eusol. No significant differences were found in rates of healing of the ulcers in either treatment groups. This trial does not support the suggestion that natural honey is superior to Eusol in the healing of chronic sickle cell leg ulceration.