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1.
West Afr J Med ; 32(1): 8-13, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23613288

RESUMO

OBJECTIVE: To evaluate the usefulness of prostate specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of cancer of the prostate (CaP) amongst unscreened patients. PATIENTS, MATERIALS AND METHODS: A prospective study 168 unscreened men who were referred for evaluation for CaP. They all had a 10-core extended transrectal prostatic needle biopsy using size 16 Tru Cut needle for either an elevated serum total PSA of > 4 ng/ml or abnormal DRE findings or both. Overall cancer detection rate was determined and detection rates were determined separately for patients with elevated PSA with normal DRE, abnormal DRE with normal PSA and those with both indications. The performances of each indication were determined separately and in combination in terms of their sensitivity, specificity, predictive values and accuracy. The results were compared amongst patients with different indications for biopsy. RESULTS: The overall cancer detection rate was 44.0%. Detection rates in patients with elevated PSA with normal DRE and abnormal DRE with normal PSA were 30.0% and 17.4% respectively. There was statistically significant increased detection of 61.2% amongst patients with both indications. The overall sensitivities of PSA, DRE and combination of both were 94.6%, 75.7% and 70.3% respectively while the specificities were 20.2%, 44.7% and 64.9% respectively. The accuracies of PSA, DRE and combination of both indications were 53%, 58% and 67.3% respectively while the PPVs were 48.3%, 51.9% and 61.2% respectively. Mean Gleason score was 6.82 while the overall complication rate was 23.2% CONCLUSION: Neither PSA nor DRE is sensitive, specific, predictive or accurate enough on its own to be an ideal screening or diagnostic test for CaP. Therefore, optimal evaluation of patients with suspected CaP is best achieved with both even in unscreened populations.


Assuntos
Exame Retal Digital , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/diagnóstico , Adenocarcinoma/diagnóstico , Idoso , Biópsia , Hospitais de Ensino , Humanos , Masculino , Programas de Rastreamento/métodos , Nigéria , Valor Preditivo dos Testes , Estudos Prospectivos , Próstata/patologia
2.
Nig Q J Hosp Med ; 22(2): 91-3, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23175904

RESUMO

Intrauterine contraceptive device (IUCD) is a commonly utilized reversible contraceptive technique especially in the developing world. Though effective, it is not immune to complications. Migration of the device is a rare but serious complication which may be symptomatic or asymptomatic. We report a case of a 45yr old woman who had IUCD inserted 20 years earlier and had forgotten about it since she subsequently had three full term pregnancies leading to successful vaginal deliveries. The forgotten IUCD was discovered incidentally during evaluation of the woman for haematuria as it had migrated to the wall of the bladder. The case is reported to increase index of suspicion as detailed clinical history is important in evaluating cases of haematuria.


Assuntos
Hematúria/etiologia , Migração de Dispositivo Intrauterino , Feminino , Hematúria/diagnóstico , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
3.
Nig Q J Hosp Med ; 22(1): 14-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23175873

RESUMO

BACKGROUND: Anorectal sepsis is a distressing condition which is sometimes inadequatelytreated. OBJECTIVES: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures. METHOD: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also noted RESULTS: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found . Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity. CONCLUSION: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.


Assuntos
Doenças Retais/complicações , Doenças Retais/terapia , Sepse/etiologia , Sepse/terapia , Adulto , Fatores Etários , Idoso , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Doenças Retais/diagnóstico , Doenças Retais/epidemiologia , Sepse/diagnóstico , Sepse/epidemiologia , Fatores Sexuais , Sigmoidoscopia/estatística & dados numéricos
4.
Niger Postgrad Med J ; 19(3): 137-42, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23064168

RESUMO

AIMS AND OBJECTIVES: To compare the cancer detection rates of sextant and ten- core biopsy protocol amongst patients being evaluated for prostate cancer. PATIENTS AND METHODS: This is a prospective study involving 125 men with suspicion of prostate cancer. They all had an extended 10-core transrectal digitally-guided prostatic biopsy using Tru-Cut needle. Indications for biopsy were presence of one or more of the following: elevated Prostate Specific Antigen (PSA), abnormal Digital Rectal Examination (DRE) findings and abnormal prostate scan. Sextant biopsies were collected first, followed by four lateral biopsies in all patients. Both groups of specimen were kept and analyzsed separately by the same pathologist. The cancer detection rates of sextant and extended (combination of sextant and lateral) 10-core biopsy protocols were determined and compared. Pearson's Chi square and McNemar tests at two degrees of freedom with level of significance set at 0.05 ( P <0.005) were used to determine the statistical significance. RESULTS: The overall cancer detection rate of 10-core prostate biopsy was 48.8%. Of all positive biopsies, the sextant biopsy protocol detected 52 cancers (85.2%) while the lateral biopsy protocol detected 58 cases (95.1%). Three (3) cancers were detected by the sextant protocol only while the lateral protocol detected nine (9) cancers where sextant technique was negative for malignancy. Ten-core extended protocol showed a statistically significant increase of 14.8% over the traditional sextant. (P=0.046). The overall complication rate of ten-core biopsy was 26.4% and the procedure was well tolerated in most patients. CONCLUSION: We conclude that a ten-core prostate biopsy protocol significantly improves cancer detection and should be considered as the optimum biopsy protocol.


Assuntos
Adenocarcinoma , Biópsia por Agulha , Protocolos Clínicos/normas , Exame Retal Digital/métodos , Próstata/patologia , Neoplasias da Próstata , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Idoso , Biópsia por Agulha/efeitos adversos , Biópsia por Agulha/métodos , Pesquisa Comparativa da Efetividade/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores/métodos , Nigéria , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/patologia , Melhoria de Qualidade
5.
Niger J Clin Pract ; 15(3): 315-9, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22960968

RESUMO

OBJECTIVE: To determine the significance of an extended 10-core transrectal biopsy protocol in different categories of patients with suspected prostate cancer using digital guidance. MATERIALS AND METHODS: We studied 125 men who were being evaluated for prostate cancer. They all had an extended 10-core digitally guided transrectal prostatic biopsy done for either an elevated serum prostate-specific antigen (PSA) or an abnormal digital rectal examination finding or both. Sextant biopsy samples were collected first, followed by additional four lateral biopsies in all patients. Both groups of specimens were analyzed separately. The cancer detection rates of both sextant and extended 10-core biopsy protocols at different PSA levels and digital rectal examination (DRE) findings were determined and compared. The level of significance of difference in cancer detection was determined using Pearson's Chi square test with level of significance set at <0.05. RESULTS: The overall cancer detection by the extended technique was 61 (48.8%) cases while the sextant protocol detected cancer in 52 cases. The 10-core extended protocol yielded an increase in cancer detection rate of 14.8% but the improvement in detection rate was only statistically significant in the sub-set of patients with PSA between 4.1 and 10 ng/mL, with or without abnormality on DRE, with an overall increase detection rate of 33%.(P=0.04) CONCLUSION: Our study has shown that a 10-core prostate biopsy protocol significantly improves cancer detection in patients with suspected early cancer. It should therefore be the optimum biopsy protocol for patients with gray-zone PSA value, with or without abnormal DRE.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia com Agulha de Grande Calibre/normas , Protocolos Clínicos/normas , Neoplasias da Próstata/patologia , Idoso , Idoso de 80 Anos ou mais , Exame Retal Digital , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Antígeno Prostático Específico/sangue
6.
Niger J Clin Pract ; 15(2): 156-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22718163

RESUMO

OBJECTIVE: The objective was to determine the incidence of bladder stones in patients with spinal cord injury (SCI) and to assess if catheter encrustation or positive urinary culture of Proteus mirabilis is predictive of bladder stones. BACKGROUND: Bladder stones are common urological complication in those with SCI managed with indwelling urinary catheter. Detection and removal of bladder stones are important to prevent possible further complications. DESIGN: This was a prospective cohort study. MATERIALS AND METHODS: Ultrasound scan was performed in persons with SCI seen from 1st January to 31st December 2009 who had indwelling urethral catheter for at least 3-month post-injury. Indwelling urethral catheters were examined for encrustation at the time of removal, urine culture taken specifically for P. mirabilis and ultrasound scan done to detect bladder stones. RESULTS: There were 89 patients with spinal cord injury and 68 (76.4%) patients were evaluated during the review period. Twenty-nine (42.6%) patients had bladder stones and 22 (32.3%) patients had catheter encrustation. Of the 22 patients with catheter encrustation, 19 (86.3%) also had bladder stones. Forty-six (67.6%) patients had no catheter encrustation. Of these, 7 (14.7%) were found to have bladder stones. Thirty-seven (38.2%) urine cultures were positive for P. mirabilis. Of these 37 (54.4%) patients, 27 also had bladder stones. Catheter encrustation (P = 0.004) and a positive urine culture of P. mirabilis (P = 0.007) in patients with indwelling urinary catheter is highly predictive of the presence of bladder stone. CONCLUSIONS: This study shows that a large number of SCI patients have an indwelling urethral catheter and suggests that ultrasound scan for the presence of stone should be schedule in a catheterized SCI patient if catheter encrustation or a positive urine culture of P. mirabilis is noted.


Assuntos
Cateteres de Demora/efeitos adversos , Proteus mirabilis , Traumatismos da Medula Espinal/complicações , Cálculos da Bexiga Urinária/microbiologia , Humanos , Nigéria , Estudos Prospectivos , Ultrassonografia , Cálculos da Bexiga Urinária/diagnóstico por imagem , Cateterismo Urinário/efeitos adversos , Urina/microbiologia
7.
Arab J Urol ; 10(4): 394-400, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26558056

RESUMO

OBJECTIVES: To assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4-10 ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied. PATIENTS AND METHODS: The study included 105 patients aged >50 years, with a palpably benign prostate gland and intermediate levels of total PSA (4-10 ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined. RESULTS: The mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostate detected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P < 0.05). CONCLUSIONS: In evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography-directed biopsy was used.

8.
Nig Q J Hosp Med ; 22(3): 221-3, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-24564101

RESUMO

Intrauterine contraceptive device (IUCD) is a commonly utilized reversible contraceptive technique especially in the developing world. Though effective, it is not immune to complications. Migration of the device is a rare but serious complication which may be symptomatic or asymptomatic. We report a case of a 45 yr old woman who had IUCD inserted 20 years earlier and had forgotten about it since she subsequently had three full-term pregnancies leading to successful vaginal deliveries. The forgotten IUCD was discovered incidentally during evaluation of the woman for haematuria as it had migrated to the wall of the bladder. The case is reported to increase index of suspicion as detailed clinical history is important in evaluating cases of haematuria.


Assuntos
Hematúria/etiologia , Migração de Dispositivo Intrauterino , Feminino , Hematúria/diagnóstico , Humanos , Pessoa de Meia-Idade , Fatores de Tempo
9.
Niger Postgrad Med J ; 18(1): 30-3, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21445110

RESUMO

AIMS AND OBJECTIVES: To determine if there is any change in the common causes of gross haematuria among adults Nigerians and to determine what proportion of these aetiologies is due to urological malignancies. PATIENTS AND METHODS: Consecutive adults with presenting with gross haematuria seen in our centre were studied prospectively between February 2006 and January 2007. All patients had detailed clinical and diagnostic evaluation including urine cytology, flexible/rigid urethrocystoscopy, ultrasonography and intravenous urography to determine the causes of their haematuria. Other special investigations including CT scan and tissue biopsies were only used in selected patients as indicated. RESULTS: The cause of haematuria was determined in 74 patients (93.7%) while haematuria was of undetermined origin in 5 patients (6.3%). Fifteen different specific diagnoses were made as the causes of haematuria in this study. The three commonest individual causes of haematuria were benign prostatic hyperplasia (30.4%), bladder carcinoma (12.6 %) and carcinoma of the prostate (10.1%). Urological malignancies were diagnosed in 29.1 % of the patients. The Urological malignancies detected were bladder cancers (12.6 %), prostate cancers (10.1%), renal Cell Carcinoma (5.1%) and urethral Carcinoma (1.3%). The incidence of the cancers increased with age; 82.6% of the patients with malignancies were aged 50years and above while only 17.4% were below 50 years of age (P= 0.045). Urological malignancies were also more common in men (73.9 %) than in women (26.1 %) (P < 0.05). CONCLUSION: We conclude that there is changing trend in the aetiologies of gross haematuria among adult Nigerian patients with urological malignancies being now more prevalent than previously reported in our environment.


Assuntos
Carcinoma/complicações , Hematúria/etiologia , Neoplasias Urológicas/complicações , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Carcinoma/epidemiologia , Feminino , Hematúria/diagnóstico , Hematúria/epidemiologia , Hospitais de Ensino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Prospectivos , Distribuição por Sexo , Neoplasias Urológicas/epidemiologia , Adulto Jovem
10.
Nig Q J Hosp Med ; 20(1): 32-7, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20450029

RESUMO

BACKGROUND: Genitourinary injuries (GUI) are relatively uncommon. Even though mortality from isolated injuries is rare, they are commonly associated with significant and life long morbidity. OBJECTIVE: This study is to assess the pattern of the injuries and the overall short term treatment outcome in our environment. METHODS: Fifty consecutive patients diagnosed with genitourinary injuries seen by the Urology Unit through the Accident and Emergency, emergency referrals (or consultations) from the ward or theatre between June 2004 to February 2006 were included in the study. Information collected included demographic data, pattern of presentation, aetiology of injury, type of injury the type of treatment and the immediate outcome. RESULTS: There was a total of 61 injuries in 50 patients. Road traffic accidents was the commonest cause of GUI (58%) followed by straddle injuries (18%) and iatrogenic causes (12%) and miscellaneous (12%). The male- female ratio was 6:1. The urethral was also the most commonly injured organ (60.6%), followed by the kidney (11.5%). The testes were the least injured organs (1.6%). The blunt renal injuries and extraperitoneal bladder injuries were managed by non operative means while most other injuries were managed by surgical intervention. Immediate treatment outcome was satisfactory in most patients. There was one mortality. CONCLUSION: Most cases of GUI are preventable. Improved safety on the roads,'proper training of surgeons and attention to clinical and surgical details will go a long way in preventing GUI. Early intervention significantly reduces the morbidity and mortality.


Assuntos
Sistema Urogenital/lesões , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
11.
Nig Q J Hosp Med ; 20(1): 38-41, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20450030

RESUMO

BACKGROUND: The increasing awareness concerning breast cancer has led to significant interest in breast masses in general. As a result there is considerable interest in the clinicopathologic studies of breast masses in various populations. OBJECTIVE: To study the clinicopathologic pattern of breast masses at a private health facility in Lagos, Nigeria. METHOD: The records of all patients who presented between January 1993 and December 2002 with breast lumps at the Lagoon Hospital Apapa were reviewed. Their biodata, clinical presentation and histopathological diagnosis were retrieved. RESULTS: 189 consecutive patients were studied comprising of 180 females and nine males. The peak age incidence for benign disease was 21-30 years while it was 31-40 years for those with malignant masses. Majority (66.1%) presented with painless solitary lumps. 46 (77.2%) patients had benign lumps while 43 (22.8%) had malignant lesions. The commonest benign lesion was fibrocystic disease (47.9%) while infiltrating ductal carcinoma was the commonest pathological diagnosis in the malignant group (83.1%). CONCLUSION: From this study benign breast masses outnumber malignant ones by more than 3:1 in this population. The commonest pathological diagnosis was fibrocystic disease in benign lesions and infiltrating ductal carcinoma for malignant masses.


Assuntos
Doenças Mamárias/epidemiologia , Doenças Mamárias/patologia , Adolescente , Distribuição por Idade , Idoso , Doenças Mamárias/diagnóstico , Criança , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
12.
Afr J Med Med Sci ; 25(3): 255-9, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10457801

RESUMO

Over a 36-month period, prognostic factors in childhood intra-abdominal abscesses were evaluated in fifty-five Nigerian children (38 boys [69.1%] and 17 girls [30.9%] aged 2 months-15 years (mean 8.9, SD 4.3 years). The mortality rate was 20%. The adverse prognostic factors were: a high fever, a positive blood culture, subphrenic location of abscesses, abscesses associated with a typhoid perforation, post-operative abscesses, presence of organ impairment, and multiple abscesses occurring together in the same patient. The age of the patient, duration of illness before hospitalization as well as the number and type of microorganisms cultured from the abscess did not have any influence on the prognosis in the children in this study.


Assuntos
Abscesso Abdominal/etiologia , Abscesso Abdominal/mortalidade , Infecções Bacterianas/etiologia , Infecções Bacterianas/mortalidade , Abscesso Abdominal/cirurgia , Adolescente , Antibacterianos/uso terapêutico , Infecções Bacterianas/cirurgia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Febre/microbiologia , Hospitalização , Humanos , Lactente , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
13.
Cent Afr J Med ; 39(8): 172-5, 1993 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-8020083

RESUMO

A case of amoebic recto-vaginal fistula is presented, with a review of literature on this rare complication of intestinal amoebiasis. A temporary defunctioning sigmoid colostomy was necessary. This in combination with oral metronidazole and tetracycline resulted in spontaneous closure of the fistulous tract. Non-traumatic recto-vaginal fistula poses a major diagnostic problem especially in the tropics where many granulomatous infections are endemic and could mimic carcinoma.


Assuntos
Disenteria Amebiana/complicações , Fístula Retovaginal/parasitologia , Adulto , Biópsia , Colostomia , Terapia Combinada , Disenteria Amebiana/tratamento farmacológico , Disenteria Amebiana/parasitologia , Disenteria Amebiana/patologia , Feminino , Humanos , Metronidazol/uso terapêutico , Prognóstico , Radiografia , Fístula Retovaginal/diagnóstico por imagem , Fístula Retovaginal/cirurgia , Tetraciclina/uso terapêutico
14.
Ann Trop Paediatr ; 11(2): 123-7, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-1715142

RESUMO

A retrospective review of 41 intussusceptions encountered in 39 children seen over an 8-year period in Ile-Ife, Nigeria is presented. Most cases (61.5%) occurred in infancy. This contrasts with previous reports from Nigeria where intussusception has been presented as being commoner in older children. Vomiting, abdominal pain, excessive crying and passage of bloodstained stools were the main presenting symptoms. An abdominal mass was palpable in only 28.2% of patients. Generally, patients presented late in hospital with only two (5.1%) arriving within 24 hours of the onset of illness. Hydrostatic reduction with barium enema was attempted in these two patients, and it successfully reduced the intussusception in one and caused partial reduction in the other. Nineteen patients (46.3%) required bowel resection. There were nine deaths, giving a mortality rate of 23.1%. The relatively high bowel resection and mortality rates were attributed to the delay in seeking medical treatment.


Assuntos
Intussuscepção/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Intussuscepção/diagnóstico , Intussuscepção/mortalidade , Masculino , Nigéria/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida
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