Ovarian Non-Hodgkin's Lymphoma presenting as obstructive jaundice - a case report.

OBJECTIVE: To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice. PATIENT: A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14cm x 12cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 mmol/l and conjugated bilirubin of 204 mmol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home. CONCLUSION: Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.

Ovarian non-Hodgkin's lymphoma presenting as obstructive jaundice - a case report.

OBJECTIVE: To highlight the importance of considering abdominal Lymphoma as a differential diagnosis in the management of obstructive jaundice. PATIENT: A 51 year old female who presented with abdominal swelling associated with features of obstructive jaundice. Significant findings included jaundice on examination, with abdominal ascites. Laparotomy revealed three litres of icteric fluid. There was a huge left ovarian tumour measuring 14 cm x 12 cm. Massive peritoneal seedling involved the whole abdomen and pelvis was noted. Following surgery allowing for adequate wound healing, the patient was placed on appropriate chemotherapy. INVESTIGATION/DIAGNOSIS: Histology of excision biopsy revealed high grade Non-Hodgkins's Lymphoma. Screening for human deficiency virus (HIV) was negative. However the erythrocyte sedimentation rate (ESR) was raised at 92 mm Westergren in the first hour. The liver function tests were deranged with total bilirubin of 274 micromol/l and conjugated bilirubin of 204 micromol. serum Ast and Alt were also significantly raised. Total proteins, urea and electrolytes remained essentially within normal limits. The patient was placed on CHOP combination therapy. She attained remission after four cycles of chemotherapy and was discharged home. CONCLUSION: Abdominal Non-Hodgkin's Lymphoma should be a strong consideration in the management of obstructive jaundice.

Widal agglutination titres in the diagnosis of typhoid fever.

BACKGROUND: Typhoid fever has continued to pose considerable health problems world-wide. This problem is made worse by misdiagnosis through the use of a single pretreatment Widal agglutination test in may developing countries. OBJECTIVE: This is to enable us establish the appropriate titres suitable for a reliable diagnosis of typhoid fever in our environment. METHODS: A total of 300 subjects were recruited into the study comprising 260 apparently healthy individuals aged 12 years and above and 40 patients with typhoid fever confirmed by isolation of S. typhi from blood and/or stool. The Widal slide agglutination test method was first used to screen subjects. Serum samples showing agglutination were then serially diluted with 0.85% saline from 1/40 to 1/1280 and subjected to tube dilution. RESULTS: Thirty-six (13.8%) of the healthy subjects had S. typhi 'O' agglutinin and 48(18.5%) had 'H' agglutinin in their serum while 37(92.5%) of patients with culture-confirmed typhoid fever had 'O' agglutinin and 38(95.0%) had 'H' agglutinin. At a cut-off titre of 'O' agglutinin = 80, the diagnostic sensitivity and specificity were 90% and 87.3%, and for 'H' agglutinin = 80, the sensitivity and specificity are 90% and 88.5% respectively. The predictive value of a positive test at 'O' = 80 is 52.2% and of a negative test is 98.3% while the positive predictive value of 'H' = 80 is 54.6% and negative predictive value is 98.3%. CONCLUSION: Because of the difficulties in isolating S. typhi from blood, stool or other body fluids in developing countries, a diagnostic Widal agglutination titre of 'O' and 'H' agglutinins = 80 will be considered useful in the diagnosis of typhoid fever in our environment.

Day case surgery: experience in a tertiary health institution in Nigeria.

BACKGROUND: Previous studies on day case surgery in Nigeria have focused mainly on the immediate peri-operative care of the patients within the service hospital. OBJECTIVE: To assess patients' satisfaction and postoperative complications within the first seven days following day case surgery. METHODS: A post discharge patient's survey was conducted on the 7th Postoperative day in 102 consecutive patients who had undergone day care surgery. Patients were interviewed about their postoperative experiences, type of complications and treatment applied, and visits to hospitals or community health facilities/providers. They were also asked to comment on their satisfaction or otherwise of day case treatment. RESULTS: There were 32 occasions of treatment provided to 24 patients (23.5%) after discharge. Seventy-two patients (70.6 %) reported one or more complications, with pain being present in all of them. Some patients received treatment more than once, and for more than one complaint. Pain was the most common reason for seeking treatment. There was no mortality. Eighty-six (84.3%) patients expressed satisfaction with day case treatment, while 10 (9.8%) patients (9.8%) expressed dissatisfaction and 6 (5.9%) patients were indifferent. CONCLUSION: Day surgery provided satisfactory outcome for the majority of our patients, with low complication rates.

Pattern and outcome of emergency surgery in a new Nigerian Teaching Hospital--The LAUTECH Osogbo experience.

AIMS AND OBJECTIVES: To present a 5 years experience on the pattern and outcome of emergency operations in a new teaching hospital. MATERIALS AND METHODS: A retrospective study carried out between April 1998 and March 2003 with appropriate data extracted from the available case notes. RESULTS: Two thousand and seventy operations were performed within the period of study. Seven hundred and twenty six of them were done as emergency. Obstetrics' and Gynaecology cases were 66.6% while 33.4% (including six cases of perforated uterus and gangrenous bowel from unsafe abortion) belong to the general surgery and specialty emergencies. Waiting time, mean of which was 39.5+/-2.7 hours, was unduly prolonged. Mortality was 10.3%. CONCLUSION: The high morbidity and mortality as reflected in this study could be reduced through prompt surgical interventions, education on contraceptive awareness and legistilation against unsafe abortion.

Knowledge, attitudes and practices of the educated and non-educated women to cancer of the breast in semi-urban and rural areas of SouthWest, Nigeria.

OBJECTIVES: That women with cancer of the breast seek medical help late is a common occurrence in developing countries. We decided to see if education and environment play any role in this and in cancer screening. A semi-structured questionnaire was drawn to inquire about knowledge, attitude (beliefs) and practices of women to breast cancer and available cancer screening methods in their environment- particularly Self and Clinical Breast Examination. PATIENTS AND METHODS: The questionnaires, prepared in English and vernacular, were given to women and women relations seen in the surgical clinics and wards of Ladoke Akintola University Teaching Hospital, Osogbo and some primary health centers, for various ailments. Traders in market places and rural communities were included. RESULTS: Analysis was by SPSS, chi-square, percentage frequency and tested at probability level of 0.05. Eight hundred and thirty two respondents were collected. Six hundred and twenty five (72.2%) were from Semi-urban while 207(27.8%) were from the rural regions. The age range was between 15 and 72 years with a mean age of 30.89+/-11.58. The educational level showed that 304(36.4%) had tertiary education. Six hundred and four (72.6%) have previous knowledge of cancer of the breast, 149(17.4%) offered possible aetiological reasons, and 341(41.1%) have some knowledge of associated symptoms. Available screening methods of Self and Clinical breast examination was practised by 393(47.2%) of the respondents. One hundred and fifty five (32.3%) would give consent to mastectomy while as many as 619(74.4%) have deep fear of the disease. CONCLUSION: Despite a relatively high literate level in the study group, knowledge of aetiological causes of breast cancer, including risk factors is abysmally low; so is knowledge and attitude to symptoms. Because of this poor/inadequate knowledge, as well as available screening methods, efforts should be made to upgrade the knowledge of our women through Information, Education and Communication (I.E.C) on cancer of the Breast and the consequences of late presentation.

Sexual risk behaviour among young people in Osogbo, Osun state Nigeria.

By analysing data randomly collected via administration of questionnaire by interview of individuals on sexual risk behaviour to 628 young people living in Osogbo, Nigeria, the results of the questionnaire revealed that the mean age of first sexual encounter was 17.4 years for men and 16.5 years for women. Men tended to have multiple sexual partners more than the women (74.4% and 25.1%, respectively), while there was a highly significant relationship between sexually transmitted disease and multiple sexual partners among singles with P<0.001 and P= 0.000. We concluded that parents and government alike should teach sex education at home, and in schools involving intensive counselling.

Generalised Burkitt's lymphoma involving both breasts--a case report.

BACKGROUND: Burkitt's lymphoma is a disease of children age ranging 8-10 years. Lymphoma involving the breast is an unusual clinical entity, which is rarely distinguished preoperatively from other more common forms of breast cancer. The Management differs from the more typical adenocarcinoma of the breast in that the emphasis is on systemic therapy. CASE: We report a 27-year-old pregnant Nigerian civil servant at 28 weeks gestation, who presented with multiple organ swellings including both breasts. She was diagnosed histologically as primary breast Burkitt's lymphoma. She was treated with systemic chemotherapy after spontaneous abortion. She had a recurrence of the lesion in the right breast a month later that was excised. Presently there is no evidence of any mass. CONCLUSION: Compared with breast carcinoma, primary breast lymphoma is a rare disease but should be considered in the differential diagnosis of breast masses.

Ureteric injuries following pelvic operations.

BACKGROUND: Iatrogenic injuries to the ureter are hazardous complications of pelvic operations, causing severe morbidity and even mortality. OBJECTIVE: To present our 10 years experience in the management of such ureteric injuries. DESIGN: A retrospective study carried out between January 1990 and December 1999. SETTING: Two busy health institutions, namely Ife State hospital and Wesley Guild Hospital, both of the Obafemi Awolowo University (OAU) Teaching Hospitals Complex, Ile-Ife, Nigeria. RESULTS: The incidence of iatrogenic injury was 0.4%. Ureteral transection was the commonest lesion (58%). Ureteroneocystostomy was performed in 70% of the operated cases. Those diagnosed at the time of injury and treated with end-to-end anastomosis had the best results. CONCLUSION: The proper identification and, when necessary, isolation of the ureter during operations in which there is a risk is crucial in reducing the incidence of ureteral injuries.

Micro-colon associated with multiple ileal atresia in a newborn infant--case report and literature review.

We report a case of a 5-day-old infant male who presented with abdominal distention and inability to pass meconium. Barium enema revealed microcolon, and at surgery the etiology was found to be multiple proximal ileal atresia.

Tracheostomy in surgical practice: experience in a Nigerian tertiary hospital.

BACKGROUND: Tracheostomy continues to be a standard surgical procedure for airway management. OBJECTIVE: This study was conducted to evaluate the indications, and complications associated with the utilization of open surgical tracheostomy in our center. DESIGN AND SETTING: It is a retrospective study of all patients that had open surgical tracheostomy at the Obafemi Awolowo University Teaching Hospital, Ile-Ife. Nigeria during a 15-year period between January 1986 and December 2000. PATIENTS AND METHODS: The medical records of the forty-four patients that had open surgical tracheostomy in the operating theatre within the study period were evaluated. RESULTS: There were 12 females and 32 males. The mean age was 33.6 +/- 24.8 years. The indications for tracheostomy were trauma (n =15), infections (n = 13), laryngeal (benign and malignant) tumors (n = 9), other head and neck malignancies (n = 4), neurological cases with respiratory failure (n = 2), and tracheomalacia (n = 1). All the tracheostomies were performed as an emergency as all the patients presented in respiratory obstruction. Transverse incision was employed in n = 35 cases, while the longitudinal incision was employed in n = 3 and the type of incision was not specified in the remaining six cases. Laryngeal stenosis was found in 6.9% of cases and the mortality was 25%. CONCLUSION: Upper airway obstruction was the major indication for tracheostomy in our center; and the high mortality may be due to the primary medical problems rather than the complications of tracheostomy alone.

Motorcycle limb injuries in a developing country.

BACKGROUND: Motorcycles have become a very popular means of transportation in Nigeria. This paper is a hospital based study of limb injuries resulting from motorcycle accidents in an urban centre in Nigeria. METHOD: All patients reporting to the emergency department of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife with limb injuries resulting from motorcycle accidents between June 1998 and May 1999 were selected for this prospective study. RESULT: One hundred and fifteen (79.3%) out of the 145 victims of motorcycle accidents that reported to the hospital had injuries involving their limbs. The Male: Female ratio was 2.8:1. The mean age was 31.9 +/- 16.7 (S. D.) years, and 20-29 years; the most commonly involved age group. 42.2% were due to collision with automobiles, 22% pedestrian while 8.7% were collisions between motorcycles. The use of protective/safety devices was practically non-existent. Seventy-six (66.1%) patients had lower limbs injuries, 25 (21.7%) patients had upper limb injuries while the remaining 14 (12.2%) injured both upper and lower limbs. The tibia was the most commonly fractured bone (32 patients, 27.8%) followed by the femur (25 patients, 21.7%). Eighty-six patients (74.8%) with fractures were managed by close reduction and splinting. Eighteen (15.7%) patients had internal fixation. CONCLUSION: Motorcycle accident is an important cause of limb injuries in the developing worlds. Motorcyclists need to be encouraged to use protective/safety devices.

Diagnosis of Helicobacter pylori infection correlation between clo-test (urease enzyme) and gastric mucosal histology.

BACKGROUND: There are few histopathologists in West African region. Histology results on gastric mucosal biopsies for Helicobacter pylori (HP) usually take between one to two weeks to be out. On the other hand, clo-test results for Helicobacter pylori can be read between 5 minutes to 24 hours. Is one justified to commence therapy based on the clo-test ahead of the histology result? Where there is no histopathology services as in many centers in West Africa can one rely on clo-test alone? AIM: To evaluate the correlation between clo-test (urease) and histological findings of gastric mucosal biopsies. DESIGN: Prospective study. SETTING: Endoscopic unit of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. PATIENTS: Twenty duodenal ulcer (DU) patients seen consecutively in the endoscopy unit. INTERVENTION: Upper gastrointestinal tract endoscopy, antral biopsies for the clo-test and histopathology. RESULT: There was 100% correlation between the clo-test and histological findings among all the 20 patients. CONCLUSION: Clo-test (urease) is reliable enough to be used to commence therapy aimed at ulcer healing and HP eradication.

Intestinal obstruction from a forgotten artery forceps: a case report.

A 43-year-old multiparous patient p2+0 all alive who had abdominal hysterectomy secondary to ruptured uterus 2 1/2 years prior to presentation, was seen with acute (surgical) abdomen. An artery forceps was seen on plain abdominal X-ray and subsequent laparotomy revealed gangrenous ileum. The entire length of the ileum was involved, including the ileocecal valve and part of the cecum. The patient had limited right hemicolectomy and anastomosis of the distal part of the jejunum with the proximal section of the transverse colon. The post-operative period was uneventful and she was discharged to outpatient clinic 2 weeks post operatively.

Cryptorchidism in a local population in Nigeria.

OBJECTIVE: To screen for undescended testis, retractile testis and other anomaly of the external genitalia in randomly selected Nursery/Primary schools in Osogbo, Nigeria. DESIGN: A prospective study involving seven different Nursery/Primary schools with 1615 male pupils ages 2-10 years were screened. SETTING: Five private Nursery/Primary schools and two government owned primary school in Osogbo. METHODOLOGY: Permission was sought from the schools' Headmasters through the proprietors of the private schools, Local inspector of Education of government primary schools, and the ethical committees of the University and the Teaching Hospital Male pupils were examined by three groups made up of a consultant and a resident in each group. RESULTS: A total of 1615 male pupils were examined out of which 40 pupils (2.5%) were found to have undescended testis, five of these (12.5%) had bilateral cryptorchidism. Eighteen had right undescended testis (45.0%) while seventeen (42.5%) presented with left undescended testis. Four pupils had retractile testis two on each side and another four had a co-existing hydrocoele with their undescended testis. CONCLUSION: Prevalence of Cryptorchidism in the age group in this study is significant. There is need to screen male children so that early detection and correction may be effected.

A review of typhoid perforation in a rural African hospital.

In Wesley Guild Hospital Ilesa in the South-West region of Nigeria a retrospective study of 105 consecutive cases operated upon for typhoid perforation between January 1988 and November 2001 was carried out. The ages of the patients were between 4 to 70 years with a mean age of 19.2 +/- 8.81. There were 84 males (80%) and 21 females (20%) giving a ratio of 4:1. Diagnoses were based on clinical and radiological findings. All the patients had laparotomy after resuscitations with intravenous fluids, electrolytes replacement, broad spectrum antibiotics, Nasogastric intubation/suctioning and urethral catherterisation. There were five negative laparotomies (4.8%). Eighty patients (76.2%) had a single perforation, while the rest 20 had multiple perforations. The perforations were located between 7 cm and 100cm from the ileo-Caecal junction. Apart from the patients who had resection and primary anastomosis, 95 (90.5%) had 2 layered closure of the perforation. The most common complications were wound infections (26.7%). Intra-abdominal abscesses (9.5%) and would dehiscence (7.6%). The mortality rate was 16.2% showing a remarkable improvement in the West African Subregions.

Gossypiboma simulating huge ovarian mass: a case report.

A case of 36 year old Po+1 with retained abdominal gauze pack following myomectomy necessitating, exploratory laparatomy is presented. The need to pay attention to counting of instruments and gauze packs before closing the abdomen coupled with use of gauze impregnated with radio-detectable material is emphasized.

Imperforate anus associated with oesophageal atresia and tracheo-oesophageal fistula.

This paper reports the concurrence of imperforate anus, oesophageal atresia and tracheo-esophageal fistula in a 24 hours old baby. The importance of the non-random coexistence of these anomalies is emphasised.

Medical problems in geriatric surgical patients.

Age is often a marker for co-morbid illness that may complicate attempts at surgery, hence careful preoperative assessment and vigorous treatment of the pre-operative medical condition with adequate post-operative supports are needed for safe surgery. In our series, a fifteen months study period, six hundred and Ninety five patients were operated upon out of which forty four patients were 65 years old and above (6.3% ); Age ranged between 65 years and 80 years (mean age of 70 years). The patients with medical problems were sixteen (36.4% ) out of which urinary tract infection was the most common (43.8% ). The most common anaesthetic technique was spinal anaesthesia in 45.5%, the most common operative procedure was herniorrhaphy (36.4% ); followed by prostatectomy (26.5% ). Three of the patients presented with wound infection; mortality was 2.3%, which occurred in a patient who died of multiple organ failure.

Burn injuries in a young nigerian teaching hospital.

A total of 36 patients were seen and managed at the Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria, over a period of five years (2000 to 2004). There were 28 males and 8 females (male to female ratio, 3.5:1). The ages ranged from 1 to 46 yr (mean, 14.5 yr). The burn surface area percentage ranged between 2.5 and 70% (mean, 22.9%). Flame constituted the commonest source of injury (66.7%). Other agents were scalding (9 patients = 25%) and electrical burns (3 patients = 8.3%). The sources of flame burns were kerosene lantern/stove explosion (7 patients = 29.2%); petrol explosion (7 patients = 29.2%); road accidents followed by an explosion (3 patients = 12.5%); one case each (4.2%%) involving ethanol explosion, gun powder explosion, firewood, a lighted candle that ignited furniture and then a whole house; and other unexplained sources (3 patients = 12.5%). Mortality in this study was 7 cases (19.4%). Death was due to acute respiratory distress syndrome in one patient, sepsis in five, and tetanus infection in one. We conclude that most of the injuries were preventable. Education regarding refuelling a lighted lantern/stove, discouraging the storing of petrol in the house, and driving with care will reduce the number of accidents and subsequent possible burn injuries. Children should be monitored carefully to prevent scalding from hot water and food.