African
Journals Online
Nigerian Journal of Surgical Research
VOLUME 2 NUMBER 3 - 4 JULY - DECEMBER 2000
Abstracts
A Review of Types of Injuries Sustained Following Road Traffic Accidents and their Prevention
A. H. Rafindadi
Department of Pathology, Ahmadu Bello University, Zaria, Nigeria
ABSTRACT
Road traffic (RTA) accidents are a common cause of morbidity and mortality in all parts of the world. As an epidemiological problem, the control of the host (accident victim), the agent (the vehicle) and environmental factors involved in their causation should be considered. The health personnel who look after accident victims need to know the injury types and their mechanisms encountered in RTA. The accident victim can be the occupant of a motorcar, a motorcyclist, pillion passenger, a cyclist or a pedestrian. Motorcar occupant can be the driver who may sustain injury to the wrists, forearm and pelvis or fracture of the ribs from the steering wheel. The driver and other front seat passenger can have lacerations on the face from hitting the windscreen, characteristic bruises and lacerations to the knees and skin from the dashboard or cervical spine injury through whiplash injury if there are no headrests on the seats. Backseat passenger may hit the back of the front seat or the sides of the car. Any of the occupants can be thrown out of the vehicle if the door springs open. Motor cyclists, pillion passengers, cyclists and pedestrians hit by a moving vehicle sustain primary and secondary impact injuries from the impact with the body of the vehicle, and or secondary injuries when they hit the ground or other object. Alcohol is an important factor in the cause of RTA, but additionally, some medical conditions such as advanced diabetes, hypertension, some prescribed drugs like tranquillisers and sedatives, stress and diseases that blunt locomotion and sensations in the elderly can influence the causation of accidents. Prevention will involve control of the host factors - illnesses, alcohol, accident repeaters and enforcement of driving regulations; agent factors - through better vehicle design using human engineering; and environmental factors through better road design and maintenance (Nig J Surg Res 2000; 2:100-104)
KEY WORDS: Road Traffic Accidents (RTA), epidemiology, prevention
Faeco-histological Method of Studying Worm Endemicity with the Vermiform Appendix
W. I. B. Onuigbo
The Medical Foundation and Clinic, Uwani, Enugu
ABSTRACT
Worms are endemic in various parts of the world, the patterns varying from community to community, even in the same country. A rough index of those common among Nigerians of the Igbo ethnic group has been obtained using a histological study of the ova present in the luminal faeces of the vermiform appendix in 559 operative specimens. Eighteen patients (3%) manifested 56 ova, which were identified as ascaris 29, trichuris 18, hookworm 6 and schistosome 3. It is hoped that the faeco-histological method will throw comparative and useful lights on some research worthy questions in different communities all over the world (Nig J Surg Res 2000; 2:105-107 )
KEY WORDS: Worm endemicity, appendix, faeces, histology
Urological Tumours in Jos University Teaching Hospital, Jos, Nigeria
(A Hospital-based Histopathological Study)
*B. M. Mandong, D. Iya, P.O. Obekpa and K. S. Orkar
Departments of *Pathology and Surgery, Jos University Teaching Hospital, Jos
ABSTRACT
This is a hospital based retrospective histopathological study of urological tumours in 10 years. Specimens consisted of all surgical excisions, trucut and fine needle biopsies of kidney, prostate, urinary bladder, testis and penis. Urological tumours accounted for 11.45% of all malignant tumours during the period of study. Prostate cancer accounted for 44.1%, urinary bladder 31.7%, kidney 17.3%, testis 5.8% and penis 1%. The study also showed that urinary bladder tumour and malignant tumours of the kidney were found predominantly in males in the ratio of 3:1. There was a high rate of prostate cancer, changing pattern of urinary bladder cancer from squamous cell carcinoma to transitional cell carcinoma. This finding is in contrast to what has been reported in some African countries. Urological tumours appear common in our surgical specimens and constitute significant proportion of malignancies in Jos University Teaching Hospital. This study forms the bases for further evaluation and epidemiological studies (Nig J Surg Res 2000; 2:108-113)
KEY WORDS: Urological tumours, prostate, urinary bladder, changing pattern
Improved Outcome of Fracture Treatment by Early Operative Reduction: Results of a Surgical Audit
B. A. Solagberu and L. O. Abdur-rahman
Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
ABSTRACT
An audit is a useful means of examining improvements in the art and science of clinical practice. We applied this to surgery to determine improved outcomes of fracture treatment by early operative reduction. This was carried out at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, by comparing two years, 1997 when there was less emphasis and 1998 when there was a greater emphasis on operative reduction of fractures. Hospital records in the orthopaedic wards, operating rooms and the physiotherapy unit of all patients admitted were reviewed retrospectively. Two years, 1997 and 1998 were analysed for age, sex, type of treatment and quality of outcome. A total of 247 admissions into orthopaedic wards were made in 1997 leading to 79 major operations, 20 of which were operative reduction of fractures (25.3 %). In 1998, 239 patients were admitted out of which 174 major operations were performed, 72 of which were operative reductions (41.4 %, P = 0.014). Patients' stay in hospital was shorter in 1998 with 81% of patients staying 3 months and less compared to 40 % in 1997 (P = 0.000). Improved outcome of stiff knee joints from physiotherapy was judged good and excellent in 66.7 % and 20 % in 1998 compared to 28.3 % (P = 0.00005) and 1.9 % (P = 0.003) in 1997, respectively. These results suggest generally improved outcome when fractures are treated by early operative reduction because of shorter hospital stay, early return to work, improved nursing care and joint function. (Nig J Surg Res 2000; 2:114-122)
KEY WORDS: Surgical Audit, Operative reduction, Fractures, Outcome
Myxoma of the Jaw Bones: Analysis of 27 Cases
S. O. Ajike, U. E. Amanyeiwe and E. O. Adekeye
Maxillofacial Unit, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria
ABSTRACT
Twenty-seven patients with histologically confirmed cases of odontogenic myxoma of the jaws were managed in a 10-year period. They represent 8.5% of all odontogenic tumours seen during the period. There was a female preponderance with the female to male ratio of 2.4:1. The age range was 11-70 years with majority occurring in the 4th decade. No apparent site predilection was noted. The duration of symptoms before presentation was 2 months to 14 years (mean 2.3 years). All the patients presented with facial swellings. Radiologically, majority (63%) were multilocular. In 85.2% radical ablation was the treatment employed. The follow-up period was 1 to 13 years and a recurrent rate of 3.7% was noted. A treatment protocol is suggested (Nig J Surg Res 2000;2:123-126)
KEY WORDS: Jaws, odontogenic tumours, myxoma
The Frequency and Clinical Significance of Structural Haemoglobin Variants in Donor Blood at University of Maiduguri Teaching Hospital
S. G. Ahmed, *A.W. Hassan and **U.A. Ibrahim
Departments of Haematology, *Surgery and **Medicine, University of Maiduguri Teaching Hospital, Maiduguri, Borno State
ABSTRACT
The Haemoglobin (Hb) genotypes of 1672 healthy blood donors at the university of Maiduguri Teaching hospital (UMTH) during the year 1999 were analysed. Hb AA, AS and SC were detected in 78.94%, 21% and 0.06% of the donor population respectively. There is the need for strict application of Hb electrophoresis on all donor blood in order to detect rare cases of mild forms of sickle cell disease who may present as donors. All blood banks should label their blood units with the appropriate tags to indicate the Hb genotype (Hb AA or Hb AS) status of the donor; and clinicians must indicate on transfusion request forms whenever the use of Hb AA rather than HbAS blood is specifically indicated as may be the case in the management of sickle cell disease patients on exchange transfusion. In this way we can improve the efficacy of transfusion therapy in sickle cell disease and related conditions (Nig J Surg Res 2000; 2:127-130)
KEY WORDS: Haemoglobin Electrophoresis, Blood Donor
Does Topical Application of Bupivacaine (marcaine) to Skin Graft Donor Site Have Any Effect on Moriarty Sign?
O. M. Oluwatosin, F. O. Abikoye, S. A. Ademola, A.A. Sanusi and O. A. Soyannwo
Plastic Surgery Unit, Department of Surgery, University College Hospital, Ibadan, Nigeria
ABSTRACT
Moriarty sign designates that when split skin donor site is more painful than recipient site, good graft take is likely. This prospective study was designed for the dual purpose of confirming the validity of Moriarty sign and to determine if bupivacaine topical anaesthetic application to split skin donor site will influence the sign. The difference in response to pain indicated by the Moriarty sign between patients that had topical analgesic treatment and those that did not was statistically significant from day one to day five post operatively. Routine application of long acting topical analgesic to donor site is advocated (Nig J Surg Res 2000; 2:131-134)
KEY WORDS: Bupivacaine, local anaesthetic, skin graft, pre-emptive analgesia.
Initial Experience With Posterior Chamber Intraocular Lens Implant
C. D. Mpyet and U. I Ahmad
Department of Ophthalmology, Jos University Teaching Hospital, Jos
ABSTRACT
The results of extracapsular cataract extraction with posterior chamber intraocular lens implant at the Jos University Teaching Hospital are reviewed. The results suggest that despite lack of facilities to calculate the lens power for emmetropia, the use of a standard lens of about 19.0D will provide a good number of our patients with good functional vision and a quick return to independent life (Nig J Surg Res 2000; 2:135-138)
KEY WORDS: Posterior chamber, lens implant
Mortality and Morbidity Following Repair for Lumbosacral Myelomeningoceles
G. O. Igun, A. Z. Sule, N. K. Dakum and A. S. Opaluwa
The Neurosurgery Unit, Department of Surgery, Jos University Teaching Hospital, Jos
ABSTRACT
A retrospective study of 220 infants with myelomeningoceles was carried out to evaluate the results of management by non-operative (NO) and Delayed Surgical Closure (DSC). One hundred and twenty infants were managed by NO versus 100 for DSC during a 14-year period. There was an increase in the number of infants with patchy sensory loss from 15% at admission to 25% at 3 months post admission in NO versus an increase from 19% to 60 % for DSC. Similar figures for faecal incontinence for NO were 50% to 55% versus 52% to 68% for DSC. Hospital mortality for NO was 33% versus 6% for DSC. Wound infection occurred in NO in 46% versus 10% for DSC. At 2 years in NO, there were no survivors versus 52 surviving children in DSC. This study suggests treatment by DSC compared to NO was more effective in decreasing the mortality and morbidity associated with management of lumbo-sacral myelomeningoceles (Nig J Surg Res 2000; 2:139-143)
KEYWORDS: Myelomeningoceles, delayed surgical closure, mortality, morbidity
Civilian Conflicts in Nigeria: The Experience of Surgeons in Kaduna
E. S. Garba, M. E. Asuku, *M. O. Ogirima, Y. Ukwenya,
A. D. Adamu and N. O. Udezue
Departments of Surgery and *Orthopaedic Surgery, A. B. U. Teaching Hospital, Kaduna, Nigeria
ABSTRACT
On February 21st -23rd 2000 Kaduna city witnessed a civil conflict resulting inevitably in mass casualties. Many dangerous weapons were used such as arrows, firearms, knives, and open fire. Two hundred and seventy three patients were seen in emergency unit of A. B. U. Teaching Hospital, Kaduna. One hundred and nineteen (43.6%) patients were admitted. The human and material resources were inadequate. Emergency resuscitations were carried out. Twenty-two laparotomies were performed without antibiotic cover. Many problems were encountered, as there was no established disaster management team. There was no adequate transportation system to convey the victims into the hospital and resuscitation materials were inadequate. We recommend that a standard disaster management team be established in our major hospitals and such hospitals should be well equipped to cope with these emergencies (Nig J Surg Res 2000; 2:144-147)
KEY WORDS: Civil conflict, emergencies, casualty, disaster management team, facility
Anomalous Gonadal Arteries in Relation to the Renal Vein: A Preliminary Study in Nigerians
S. S. Adebisi and S. P. Singh
Department of Human Anatomy, Faculty of Medicine, Ahmadu Bello University, Zaria
ABSTRACT
This is a preliminary report of anomalous gonadal arteries in 82 Nigerian cadavers in which the gonadal arteries arched over the renal vein. There were 68 males and 14 females cadavers. Anomalous cases were observed in 34 (52%) of testicular arteries and none in ovarian arteries on the right side; 37 (64%) of testicular arteries and 3 (27%) of ovarian arteries on the left side. Partial occlusion or compression of the renal vein due to the arching gonadal arteries could result in varicocele and hypertension. The knowledge of such anomalous is useful in surgery and human anatomy (Nig J Surg Res 2000; 2:148-151)
KEY WORDS: Gonadal artery, anomalous course, surgical anatomy
Spontaneous Rupture of the Bladder Complicating a Massive Benign Prostatic Hyperplasia
N. Eke and S. N. Elenwo
Urology Unit, Department of Surgery, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
ABSTRACT
A 76-year-old man presented with acute urinary retention due to a huge benign prostatic hyperplasia. Although 1.5 litres of turbid urine was initially drained through a urethral catheter, the suprapubic mass persisted and subsequently increased in size. He developed acute retention due to blood clot. Even after the catheter was changed, he remained in retention necessitating emergency prostatectomy. Rupture of the bladder with extravasation of urine and necrotising fasciitis was found at surgery. The prostate gland was very large. It was also located so low and posteriorly that the index finger was unable to enucleate the adenoma. The recti had to be divided transversely to improve access. A metal urethral dilator was used to complete the enucleation. The specimen weighed 246 gm and on histology showed BPH. He recovered to void urine satisfactorily (Nig J Surg Res 2000; 2:152-154)
KEY WORDS: Spontaneous bladder rupture, massive benign prostatic hyperplasia
Orbito-Ocular Teratoma: A Case Report
E.A. Akabe, C.D. Mpyet and B.M. Mandong*
Departments of Ophthalmology and *Pathology, Jos University Teaching Hospital, Jos
ABSTRACT
Orbital teratomas are rare. This is a report of a case of orbito-ocular teratoma with malignant transformation in a seventeen-day-old girl. Treatment was by exenteration. The baby was lost to follow-up shortly after discharge and so could not have a prosthesis fitted (Nig J Surg Res 2000; 2:155-157)
KEYWORDS: Orbito-ocular, teratomas, malignant transformation, exenteration
Ectopic Pregnancy Coexisting with Intrauterine Pregnancy
D. I. Ifenne
Department of Obstetrics and Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria
ABSTRACT
A 28-year-old woman, para 2+0, presented with amenorrhoea for 10 weeks, associated with right lower abdominal pain and vaginal bleeding for 3 weeks. She later developed progressive abdominal distension and dizziness. A tender (6cm in diameter) mass was felt in the right iliac fossa, and the uterus was 8 week size. A pelvic ultrasonography showed a singleton intrauterine pregnancy, a right adnexa mass and fluid in the rectouterine pouch. At laparotomy, a ruptured right ampulary gestation sac and 8 week size uterus were found and a right total salpingectomy done. Postoperative course was uneventful and the patient delivered a live, 2.5kg baby at term. Though heterotopic pregnancy is uncommon, assisted conception may increase the incidence and a high index of suspicion is necessary for prompt diagnosis and treatment (Nig J Surg Res 2000: 2:158-160)
KEY WORDS: Heterotopic pregnancy, suspicion
An Improvised Active Drain
M. O. Ogirima
Department of Orthopaedic Surgery, Ahmadu Bello University Teaching Hospital,
Kaduna
ABSTRACT
An improvised active drain is designed from intravenous infusion set and recycled RedivacR or Haemovac® bottle. Outcome of the use of this system on 100 patients is presented. This suction drainage system had been used in major orthopaedic and common minor surgical procedures and no significant complication was observed. This improvisation is relevant in a depressed economy where it is difficult to buy new sets of this type of drainage system (Nig J Surg Res 2000; 2:161-163)
KEY WORDS: Active drain, improvised
Intestinal Malrotation: Presentation in the Older Child
L. Sabiu, A. Sheshe, L. B. Chirdan and E. A. Ameh
Paediatric Surgery Unit, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria
(Nig J Surg Res 2000; 2: 164 - 167)
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