Inhalation Injury in Burns Patients in Ibadan

I. O. Adigun, O. M. Oluwatosin,  *S. D. Amanor-Boadu and *O. A. Oluwole

Departments of Surgery and *Anaesthesia, College of Medicine, University of Ibadan, and University College Hospital, Ibadan

Reprint requests to: Dr O M Oluwatosin, Department of Surgery, University College Hospital, Ibadan

ABSTRACT

Background: Inhalation injury is one of the most prominent determinants of mortality in major burn patients. This study was undertaken to ascertain the factors that could be used to predict the occurrence of inhalation injury in a burnt patient, with a view to alerting the burn care providers for a reappraisal of the management protocol in this category of patients.

Method: A retrospective study of patients managed for burns in 2 years. Descriptive and logistic regression analyses were performed on the following variables of patients with burns; age, sex, aetiology, extent of the burns, presence or absence of inhalation injury and outcome.

Result: One hundred and sixty four patients with a mean (S. D.) age of 25.0 (16.9) years suffered a total body surface area (TBSA) burn of 35.8%  (S. D. 26.9). Twenty-seven (16%) sustained inhalation injury. Among those who suffered inhalation, mean (S. D) TBSA was 50.4% (25.1) while in those without inhalation injury, mean (S. D) TBSA was 32.9% (26.4). While the overall mortality was 36%, the mortality of patients with inhalation injury was 78%. Of the variables, age, sex, aetiology and TBSA, only TBSA could be used to predict an occurrence of inhalation injury.

Conclusion: Reasons for the high mortality included lack of facilities for monitoring blood gasses as well as for ventilatory support and delays in early skin coverage. A high index of suspicion and knowledge of the appropriate management of inhalation injury are important for a good outcome.

(Nig J Surg Res 2001; 3: 50 – 55)

KEY WORDS: burns, inhalation injury

 

Occurrence of Post-orchiectomy Hot Flushes in Nigerians: A Preliminary Report

J. C. Orakwe

Department of Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

Reprint requests to: Dr. J. C. Orakwe, P. O. Box 1863, Onitsha, Nigeria.

ABSTRACT

Background:            Hot flushes have been reported in men after bilateral orchiectomy for carcinoma of the prostate, but such complaints are uncommon in the urology clinics in Nigeria. This study set out to determine the occurrence of hot flushes in Nigerian patients who had bilateral orchiectomy for advanced carcinoma of the prostate.

Method:  Twenty-four patients seen over a five-year period were prospectively evaluated. They all had bilateral orchiectomies for advanced carcinoma of the prostate.

Result: Fourteen (58%) of patients studied had hot flushes of varying frequency and severity. All started within eight weeks of the operation. Empirical treatment with 1mg diethylstilboesterol daily was effective and abolished symptoms in all the patients within four weeks of commencement of therapy.

Conclusion: Post-orchiectomy hot flushes of enough severity to necessitate treatment do occur in Nigerians and effort should be made to diagnose and treat them. (Nig J Surg Res 2001; 3: 56 – 61)

KEY WORDS: Prostate cancer, Treatment, Orchiectomy, Diethylstilboestrol, Hot flushes

 

Pharyngo-oesophageal Foreign Bodies in Maiduguri

*B. M. Ahmad, D. Dogo and Y. Abubakar

Departments of *Ear, Nose and Throat Surgery and Surgery, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria.

Reprint requests to: Dr. Babagana M. Ahmad, Department of Ear, Nose and Throat Surgery, College of Medical Sciences, University of Maiduguri, P.M.B. 1069, Maiduguri, Borno State, Nigeri.a.

ABSTRACT

Background: Pharyngo-oesophageal impaction of foreign bodies is an otolaryngological emergency.

Methods: A retrospective study of 79 patients with pharyngo-oesophageal foreign bodies managed in 5 years.

Results: Children aged group 0 - 4 years were the most affected. The one Naira and 50 Kobo coins were the most common foreign bodies (45, 68.4%) encountered. Other foreign bodies seen were bone 14 (17.7%), meat 3 (3.8%), pins and needles (3.8%) and denture 1(1.3%). The miscellaneous group constituted 5%. Foreign body in the form of needle were found in some magicians. 

Conclusion: The need to educate parents on close monitoring of their children to avoid such accidents is stressed. (Nig J Surg Res 2001; 3: 62 – 65)

KEY WORDS:  Phyaryngo-oesophageal, Foreign bodies, Maiduguri.

An Audit of Mandibular Third Molar Surgery

B. D. O. Saheeb and O. N. Obuekwe

Department of Oral and Maxillofacial Surgery, University of Benin Teaching Hospital, Benin City, Nigeria.

Reprint Requests to: Dr. B. D. O. Saheeb, P. O. Box 2799, Benin City, 300-001, Edo State, Nigeria. E-mail: [email protected]

ABSTRACT

Background:   The objective of this audit was to identify areas where there could be improvement in patient management as well as evaluating our methods of treatment and effective utilisation of resources.

Methods: A retrospective study of mandibular third surgery at the University of Benin Teaching Hospital, Benin City in one year.

Results: A total of 149 impacted mandibular third molars were surgically removed from 133 patients. There were 70 (47%) males and 79 (53%) females with an age range of 18 - 78 years. The commonest type of impaction was mesioangular 95 (63.8%). The commonest indication for surgery was pericoronitis 48 (32.2%). One hundred and twenty five (94%) of patients had local anaesthesia while 8 (6%) had local anaesthesia/intravenous. Four (2.7%) patients had paraesthesia of the lower lip as a result of inferior alveolar nerve damage while one (0.7%) had lingual nerve paraesthesia. No proper record keeping of procedures was observed in all the cases analysed.

Conclusion: This study has identified poor record keeping and non-adherence to standard protocol by residents in patient management. (Nig J Surg Res 2001; 3 : 66 – 74)

KEYWORDS: Audit, Mandibular, Third Molar, Surgery

Chloramphenicol Induced Hearing Loss

F. O. Ogisi

Ear Nose and Throat Unit, Department of Surgery, University of Benin Teaching Hospital, Benin City.

Reprint requests: Dr. F. O. Ogisi, Department of Surgery, University of Benin Teaching Hospital, P. M. B. 1111, BeninCity, Nigeria.

ABSTRACT

Background: With the widespread use of the drug Chloramphenicol in treatment of typhoid fever, a number of cases of deafness are coming to light following such treatment. However the pattern and level of the resulting hearing impairment has not received much attention in the literature.

Method: A prospective study of ototoxicity over a 3- year period by means of questionnaire, clinical and otological examination and audiological tests to identify cases of significant hearing loss attributable to Chloramphenicol administration.

Result: Out of a total of 49 cases of drug ototoxicity seen during a 3- year period, 21 cases  (43%) were due to Chloramphenicol and the deafness was most commonly associated with parenteral administration, though actual doses could not be ascertained from the histories. Hearing impairment was bilateral and severe to profound at onset in most cases (66%), with no improvement noticed even after cessation of drug use. Follow-up tests where possible, carried out 6 to 12 months later showed no improvement in thresholds.

Conclusion: Hearing impairment as a complication of Chloramphenicol usage is severe in most cases and associated with poor prognosis both in respect of chances of spontaneous recovery as well as the degree of concommitant hearing handicap. The need to prevent this grave iatrogenic tragedy by limiting the use of this drug is stressed.

(Nig J Surg Res 2001; 3: 75 – 80)

KEY WORDS: Hearing Loss, Chloramphenicol, Typhoid Fever, Handicap

Urinary Retention Caused by Foreign Body

N. K. Dakum and D. Iya

Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria.

Reprint requests to: Dr. N. K. Dakum, Department of Surgery, Jos University Teaching Hospital, P.M.B. 2076,            Jos, Nigeria. E-mail: [email protected]

ABSTRACT

A 54-year-old man was referred from a private hospital with recurrent episodes of urinary tract infection and urinary retention, 18 months following transvesical prostatectomy for benign prostatic hyperplasia. A retained gauze embedding a stone was removed from the bladder neck at exploration. Adherence to sound surgical principle will avoid the hazards of retained gauze and other instruments.

(Nig J Surg Res 2001; 3: 90 – 92)

KEY WORDS: Retained Gauze, Prevention

Faecal Impaction Presenting as Acute Appendicitis: A Report of 2 Cases

D. O. Irabor

Department of Surgery, University College Hospital, Ibadan, Nigeria.

Reprint requests to: Dr. D. O. Irabor, Department of Surgery, University College Hospital, P.M.B. 5116, Ibadan, Nigeria. E-mail: [email protected]

ABSTRACT

This paper highlights different manner in which faecal impaction presents i.e. with acute severe right lower quadrant abdominal pain. Two illustrative cases of young adult males are presented, they had clinical features suggestive of acute appendicitis, which turned out to be due to faecal impaction.  Digital rectal examination and plain abdominal x-rays were helpful in the diagnosis of faecal impaction.  The simple treatment of soap and water enema with oral liquid paraffin ensured that unnecessary appendicectomies were avoided. Interestingly one of the patients developed an acute appendicitis 5 months after his initial presentation when he had recurrent faecal impaction.  He had an appendicectomy performed.  A cause and effect relationship between faecal impaction and acute appendicitis is also discussed briefly.

(Nig J Surg Res 2001; 3: 93 –99)

KEY WORDS: Right Lower Quadrant Pain, Appendicitis, Faecal Impaction

Spontaneous Rupture of the Bladder Due to Haemangioendothelioma: A Case Report

N. H. Mbibu, *A. H. Rafindadi and L. Khalid

Departments of Surgery and *Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.

Reprint requests to: Dr. N. H. Mbibu, Urology Unit, Department of Surgery, A. B. U. Teaching Hospital, Zaria, Nigeria.

This Paper was Presented at the Annual Urologic Conference, University of Nigeria Teaching Hospital, Enugu, Nigeria, 6 – 7 November 1999.

ABSTRACT

Spontaneous rupture of the bladder is uncommon. A 55-year-old man presented with spontaneous rupture of the bladder from a vessical haemangioendothelioma. Treatment was by wide excision. The patient was well at 3 years of follow up. The diagnosis and biologic behaviour of this uncommon tumour is discussed.

(Nig J Surg Res 2001; 3: 100 –103)

KEY WORDS: Bladder, Spontaneous Rupture, Haemangioendothelioma