Contralateral breast cancer

E. S. Garba

Department of Surgery, Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria

Reprint requests to: Dr E. S. Garba. Department of Surgery, Ahmadu Bello University Teaching Hospital, P. M. B. 2016, Kaduna, Nigeria

Abstract

The incidence of contralateral breast cancer is increasing at a frightening rate. It ranges from 0.22% to 68%.This second breast cancer remains, however largely sub-clinical. There are pathological and clinical factors, which can be utilized to identify those women at a particularly higher risk of contralateral breast cancer. These factors include: family histories, Lobular carcinoma in-situ (LCIS), precancerous mastopathy, extensive intraductal papilloma, and duct cell hyperplasia with cell atypia. The risk is eleven times higher in these patients. This recognition is important so that this group can be treated before a second invasive carcinoma occurs. This will invariably improve survival. The concept of bilaterality of breast cancer treatment should be introduced at first visit in patients presenting with a unilateral lesion. Prophylactic mastectomy has the potential for reducing the incidence of second breast cancer in patients with an extraordinary high risk. Good cosmetic results can now be expected with bilateral mastectomies and reconstruction. The prospect for patients with synchronous or metachronous bilateral breast carcinoma is poor and worse than a unilateral lesions.

(Nig J Surg Res 2003; 5: 1 – 6)

Key words: Contralateral, breast cancer

 

 

Ketamine for preemptive analgesia in major gynaecologic surgery

S. D Amanor-Boadu, A. A Sanusi, *A. O Arowojolu and A. A Abdullahi

Departments of Anaesthesia, and *Obstetrics and Gynaecology, College of Medicine, University College Hospital, Ibadan, Nigeria

Reprint requests to: Dr S. D Amanor-Boadu, Department of Anaesthesia, College of Medicine, U. C. H, Ibadan, Nigeria

Abstract

Background: It has been suggested that the prolonged pain and hyperalgesia occurring after an injury is due to central sensitization in the spinal cord. N- methyl D- Aspirate (NMDA) receptors are activated by glutamate and aspartate and have been implicated in the wind-up phenomenon of central sensitization. Ketamine blocks the NMDA receptor sites and has been suggested to provide preemptive analgesia. This study was designed to assess the pre -emptive analgesic effect of ketamine in Nigerians.

Method: Two groups of twenty patients scheduled for intra-abdominal gynecological operation were randomly assigned to receive either 0.5mg/kg ketamine pre-incision or post incision. They all had standard general anaesthesia with pentazocine for intra-operative analgesia. Post-operatively, the time to first request for analgesic (TFA) and pain intensity, using the visual analogue scale (VAS) at that time were noted. Pain intensity was also scored at 4, 8, 12 and 24 hours. Adverse reactions and patient satisfaction were recorded.

Results: The TFA for the pre-incision group was significantly longer than the post-incision group. The pain intensity scores at the periods measured were not significantly different in both groups.

Conclusion: It is concluded that at 0.5mg/kg body weight, ketamine prolongs the TFA but a sustained preemptive effect of ketamine could not be demonstrated.

Nig J Surg Res 2003; 5: 7 – 11)

Key words: Preemptive analgesia, ketamine

 

 

A clinicopathological study of lipomas of the head and neck

K. C. Ndukwe, V. I. Ugboko, G. Somotun, *K. E. Adebiyi

and O. A. Fatusi

Departments of Oral, Maxillofacial Surgery, and Oral Pathology, and Morbid Anatomy and Forensic Medicine*, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria

Reprint requests to: Dr K. C. Ndukwe, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria

E-mail: [email protected]

Abstract

Background: Lipoma of the head and neck region are fairly common.

Methods: This twelve year retrospective study evaluated thirty-nine cases of head and neck lipomas in Nigerians.

Results: They constituted 14.4% of benign tumours of the head and neck region and 17.6% of total body lipomas seen within the study period. There were two peaks in the age distribution with patients in the fifth and seventh decades of life recording the highest number of cases. More males were affected with a male-female ratio of 2:1. Most cases (33.3%) were seen in the neck, followed by the scalp (23.1%). Only one intra oral case presenting on the tongue was recorded. The two patients with multiple lipomas were negative for associated systemic disease. Two histological variants were seen (conventional and fibrolipoma).

Conclusion: Tumours of adipose tissue are common head and neck neoplasms. While conventional lipomas are the commonest histological variants, the diagnosis of these lesions may be arrived at from clinical presentations supplemented with histological examinations. Treatment by surgical excision (lipectomy) produces satisfactory results.

(Nig J Surg Res 2003; 5; 12 – 17)

Key words: Head and neck, lipomas

 

 

Histopathological study of malignant melanoma in highlanders

A. Z. Mohammed, A. N. Manasseh, B. M. Mandong and *S. T. Edino

Departments of Pathology and *Surgery, Jos University Teaching Hospital, Jos

Reprint requests to: Dr. A. Z. Mohammed, Department of Pathology, Aminu Kano Teaching Hospital, P. M. B 3452, Kano, Nigeria

Abstract

Background:Malignant melanoma is a fatal skin cancer that is curable when detected and treated early. Recent reports indicate a rising incidence globally. This study aims at identifying the pattern of this neoplasm in Jos a geographical highland area.

Methods: The histology records of patients diagnosed as cases of malignant melanoma in the pathology laboratory of Jos University Teaching Hospital over a 10-year period (1989 - 1998) were retrospectively reviewed.

Results: Sixty-eight cases of melanoma were recorded comprising of 38 males and 30 females with a male to female ratio of 1.3:1 and a mean age of 50.4 years. Fifty-nine patients (82.4%) presented with foot lesions, six (8.8%) with groin lesions and 2 (2.9%) each with upper limb and conjuctival lesions. The vulva and oral mucosa were affected in 1.5% each of cases. The overwhelming majority (95.6%) were histologically nodular melanomas and 69.1% of the patients presented with stage V Clark’s level of invasion.

Conclusion: The pattern of melanoma in Jos conforms to the usual pattern seen in Black and Asian populations. Health education may lead to a future decline in the morbidity and mortality associated with the condition.

(Nig J Surg Res2003; 5: 18 – 22)

Key words: Malignant melanoma

 

 

Pattern of requests for interspousal donation and transfusion in University of Maiduguri teaching hospital

*S. G. Ahmed, O. Kyari and A. U. Ibrahim

*Department of Haematology and Obstetrics and Gynaecology, University of Maiduguri Teaching Hospital, Maiduguri, Nigeria

Reprint requests to: Dr. S. G. Ahmed, Department of Haematology, University of Maiduguri Teaching Hospital, P. M. B. 1414, Maiduguri, Borno State, Nigeria 

Abstract

Background: The cases of 66 female patients who needed transfusion and requested for interspousal directed blood donations from their husbands at the UMTH Blood Bank from 1997 to 2001 were reviewed. The patients required blood for elective procedures, and wanted to be transfused with the blood of their husbands (interspousal transfusion) in order to avoid the risk of HIV infection, believing in the safety of their husband’s blood but unaware of the remote immunological and clinical consequences of such transfusions, including haemolytic disease of the newborn in subsequent pregnancies.

Method: The patients were assessed with respect to age, educational status and past history of transfusion with husbands’ blood. The patients were appropriately counseled regarding the risks associated with such transfusions.

Result: Out of the 66 patients studied, 51 (77%) were within the ages of 30-39 years while the remaining 15 (23%) patients were aged 20-29 years. Up to 58 (88%) of the patients had post secondary school education while the remaining 8 (12%) patients had secondary school education only. After counselling, 62 (94%) patients relinquished their earlier request for interspousal transfusions and opted for screened non-directed homologous donor blood while the remaining 4 (6%) patients opted for autologous donation. However, 3 (5%) patients had positive history of previous interspousal transfusion.

Conclusion: Counseling efforts must be intensified against this apparently safe but undesirable and dangerous form of transfusion.

(Nig J Surg Res 2003; 5: 23 – 26)

Key words: Blood donation, directed, interspousal

 

 

Splenic abscess in Jos

A.T. Kidmas, G.O. Igun, P.O. Obekpa and A .A. Anele

Department of Surgery, Jos University Teaching Hospital, Jos

Reprint requests to: Dr. A. T. Kidmas, Department of Surgery, Jos University Teaching Hospital, P. M. B. 2076, Jos. E-mail: [email protected]

This paper was presented at the 34^th Annual Scientific Conference of the International College of Surgeons (Nigerian Section), Jos, Nigeria, 18-20 March 1999

Abstract

Background: Splenic abscess is an uncommon surgical condition that constitute 0.14-0.7% of necropsy specimen. Delayed or missed diagnosis may result in a fatal outcome.

Method: A retrospective study of patients with splenic abscess treated at Jos University Teaching Hospital over a ten-year period.

Results: Eight patients were managed. There were 2 males and 6 females aged between 18 and 65 years (median age 31 years). Duration of symptoms ranged between 2 to 16 days with a median of 7 days. The main clinical features were fever, left hypochondriac pain and tender splenomegaly occurring in 87.5%, 100% and 87.5% respectively. Abscess cavity was solitary in seven cases. All except one patient had antibiotics and splenectomy. The commonest organism cultured was staphylococcus aureus, 5 of 7 cultures (71.4%). Postoperative complication included wound infection two, acute pancreatitis one and over- whelming post splenectomy infection (OPSI) in one. There was one mortality (12.5%).

Conclusion: Prompt diagnosis and treatment based on a high index of suspicion will reduce the high morbidity associated with this rare disease. It is hoped that as appropriate skill and imaging techniques become more available in developing countries, more splenic abscess patients will be managed by percutaneus drainage especially that solitary abscess cavity seems dominant in our environment.

(Nig J Surg Res 2003; 27 - 31

Key words: Spleen, abscess, splenectomy

 

 

Management of cystic lymphangiomas in Ile-Ife, Nigeria

O. A. Sowande, O. Adejuyigbe and A. M. Abubakar

Pediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching hospital, Ile-Ife, Nigeria

Reprint requests to: Dr. O. A. Sowande, Paediatric Surgery Unit, Department of Surgery, Obafemi Awolowo University Teaching hospital, P. M. B. 5538, Ile-Ife, Nigeria

Abstract

Background: The management of cystic lymphangiomas is and challenging. Of all the available modalities of treatment, surgery remains the gold standard but it is associated with significant morbidity and mortality.

Method: Retrospective analysis of 28 cases of cystic lymphangioma seen at the Obafemi Awolowo University Teaching Hospital, Ile-ife, Nigeria.

Results: There were 16 boys and 12 girls with a median age of 6 months. The cervical region was most commonly involved site in 19(67.9%) children. Eight (28.6%) of the patients had morbidity at presentation. Only 24 of the 28(86%)patients had surgical excision. Complete macroscopic excision was possible in 15 (62.5%) patients. There was one death (4.2%) at induction of anaesthesia due to rupture of a cervical cyst at intubation with aspiration. Post-operative complications occurred in 10 (41.7%) patients. Recurrence was reported in 1(4.6%) patient.

Conclusion: The presentation of cystic lymphangiomas in our own environment is diverse. There is a high preoperative morbidity. Surgery remains the only option available in this environment but is associated with a high e complication rate.

(Nig J Surg Res 2003; 5: 32 – 37)

Key words: Cystic lymphangioma, morbidity, mortality

 

 

Anorectal carcinoma involving the female genital tract: the morbidity and implications for sexual function

L. M. D. Yusufu, S. Y. Sabo and V. I. Odigie

Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

Reprint requests to: Dr. L. M. D. Yusufu, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. E-mail: [email protected]

Abstracts

Background: Carcinoma of the colon and anorectum affect a younger age group in Africans, and patients often present late with advanced disease.

Method: A retrospective review of 22 females treated for anorectal carcinoma.

Results: Fourteen females had genital tract involvement; their mean age was 33.8 years. Thirteen patients had abdominoperineal resection. The other patient had a divided colostomy. Adjuvant chemotherapy was given to 12 patients. Wound infection occurred in 3 patients, and wound dehiscence in one patient. Five patients resumed sexual activity 6 months after surgery. One patient died of pneumonia 23 days after surgery.

Conclusion: Anerectal carcinoma causes morbidity related to the genital tract and sexual function in females.

(Nig J Surg Res 2003; 5: 38 – 42)

Key words: Anorectum, carcinoma, female, sexual function

 

 

Audit of day case surgery in LAUTECH teaching hospital, Osogbo, Nigeria

S. O. Fadiora, K. S. Oluwadiya, *I. K. Kolawole, A. O. A. Aderounmu, A. S. Oguntola and M. O. Adejumobi

Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital (LAUTECH), Osogbo, Nigeria and *Department of Anaesthesia, University of Ilorin Teaching Hospital, Ilorin, Nigeria

Reprint requests to: Dr. S. O. Fadiora, Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital (LAUTECH), Osogbo, Nigeria

Abstract

Background/ method: A retrospective study of all patients operated as day-case at the Ladoke Akintola University Teaching Hospital Osogbo over a period of 14 months (October 2000 to November 2001) was carried out.

Results: Seventy-six patients were operated as day-cases within the study period, but 74 case notes (97.4%) were available for analysis. There were 46 males (62.2%) and 28 females (37.8%), giving a male: female ratio of 1.6:1. the age ranged between 11 and 70 years (mean 27.26 ± 23.89 years). The commonest procedure performed was excisional biopsy, which constituted 40.5% of all procedures; followed by herniorrhaphy, which accounted for 28.4%. Pain was the commonest immediate postoperative problem. This responded to analgesics like dipyrone, pentazocine and paracetamol. There were minimal postoperative complications at home and mortality was zero. None of the patients came for admission after surgery.

Conclusion: We concluded that day-case surgery is feasible, safe and acceptable to our patients; other hospitals are encouraged to undertake day-case surgery service.

Nig J Surg Res 2003; 5: 43 – 49)

Key words: Day case surgery, audit

 

 

Prevalence and antimicrobial susceptibility of Neisseria gonorrhoeae isolated from patients in various locations of Kaduna state, Nigeria

¹E. D. Jatau, ¹M. Galadima, ²L. E. Odama and ³J. K. P. Kwaga

¹Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria, ²National Institute for Pharmaceutical Research and Development, Abuja, Nigeria, ³Department of Veterinary Public Health, and Preventive Medicine, Ahmadu Bello University,

Zaria, Nigeria

Reprint requests to: Dr. M. Galadima, Department of Microbiology, Ahmadu Bello University, Zaria, Nigeria

Abstract

Background/Method: A total of one thousand seven hundred and fifteen (1715) patients, consisting of nine hundred and thirty eight (938) female and seven hundred and seventy seven (777) male patients were screened for Neisseria gonorrhoeae infection from seven locations representing the four geographical zones of Kaduna State.

Results: Out of the 1715 patients screened, 275 (16.03%) were found positive for N. gonorrhoeae infection. The prevalence rate of N. gonorrhoeae infection per location were in Zaria 70 (22.08), Kaduna 32 (21.33%), Pambeguwa 58 (18.35%), Kafanchan 25 (16.66%), Kachia 19 (12.66%), Giwa 31(11.70%), and Soba 34 (10.76%). Results showed that the age group 15-20 years had the highest prevalence of infection (31.05%) followed by the age group 36-40 years and 21-25 years with prevalence of 26.06% and 22.80% respectively. The highest prevalence in males (23.91%) occurred in the age group 36-40 years while the highest prevalence of infection in the female patients (11.18%) was found in the age group 15-20 years. Out of the 275 gonococcal isolates, 225 (81.82%) were resistant to penicillin, 206 (74.91%) to ampicillin, 122(44.36%) to tetracycline, 34(12.36%) isolates to erythromycin, and 16(5.82%) isolates were resistant to gentamicin. All the 275 N. gonorrhoeae isolates were sensitive to Ceftriaxone, Ceproxine and Oflozacin. Out of the 225 penicillin resistant strains of N. gonorrhoeae189 (84%) were positive for beta-lactamase production. The prevalence of beta-lactamase (Penicillinase) producing N.gonorrhoeae (PPNG), was statistically significant with X^{2 =} 12.25 which was greater than X²t value. Generally there was high prevalence rate of N.gonorrhoeae infection in Kaduna State and the

Conclusion: N. gonorrhoeaeisolates were highly resistant to most commonly used antibiotics in the treatment of gonorrhoea in Kaduna State.

(Nig J Surg Res 2003; 5: 50 – 56)

Key words: Gonorrhoea, antibiotic susceptibility, treatment

 

 

Omphalocoele and gastroschisis: management in a developing country

Aba F. Uba and Lohfa B. Chirdan

Paediatric Surgery Unit, Department of Surgery, Jos University Teaching Hospital, Jos

Reprint requests to: Dr. Aba F. Uba, Paediatric Surgery Unit, Department of Surgery, Jos University Teaching Hospital, P. M. B. 2076, Jos, Plateau State.

E-mail: [email protected] or [email protected]

Abstract

Background: The management of omphalocoele and gastroschisis presents a lot of challenges. While most of these challenges have largely been overcome in developed countries, the same cannot be said of the developing countries.

Methods: The medical records of neonates with omphalocoele and gastroschisis seen at Jos University Teaching Hospital between January 1991 and December 2001 were retrospectively reviewed.

Results: There were 42 neonates with omphalocoele and 12 with gastroschisis. The median age at presentation of neonates with omphalocoele with intact sac was 72 hours (range 1-5 days) while the median age for those with ruptured sac was 14 hours (range: 3-36 hrs). The median age at presentation of neonates with gastroschisis was 10 hours (range: 2-40 hrs.) Six neonates with ruptured omphalocoele and 4 with gastroschisis had gangrenous bowel at presentation. Eighteen neonates with omphalocoele had associated congenital anomalies, mostly involving the gastrointestinal and genitourinary systems. No neonate with gastroschisis had associated congenital anomaly. Sixteen neonates with omphalocoele were managed non-operatively, while 26 had operative treatment at initial presentation. Of these, 14 had primary fascial closure, 8 had skin closure, and 4 had improvised silo. All neonates with gastroschisis had primary fascial closure at presentation. A total of 22 neonates died: eighteen omphalocoele (11 of them managed surgically) and 4 gastroschisis.

Conclusion: The management of neonates with omphalocoele and gastroschisis continues to pose challenges in our environment, with high mortality rate. Health education, provision of neonatal intensive care facilities, availability of total parenteral nutrition in ours, and similar environment may improve the survival rate of this group of patients.

(Nig J Surg Res 2003; 5: 57 - 61)

Key words: Omphalocoele, gastroschisis, developing countries

 

 

Confirmation of malaria parasitaemia and management of postoperative pyrexia

C. E. Ohanaka and I. Evbuomwan

Department of Surgery, College of Medical Sciences, University of Benin, Benin City

Reprint requests to: Dr. Chibundu E. Ohanaka, Department of Surgery, University of Benin Teaching Hospital, P. M. B. 1111, Benin City, Nigeria

Abstract

Background: Patients who undergo surgical operations sometimes develop fever in the post-operative period. Full examination of the patient is essential to detect any obvious pathology. Often, Malaria is considered as a possible cause.

Method: Seventy consecutive patients who had operations under general anesthesia were studied. Each had blood examination for malaria parasites pre-operative and post-operative. Pyrexia was fully investigated, including laboratory investigation for Malaria parasitaemia.

Results: Thirty patients developed fever in the post-operative period; in 11 of them had malaria parasites were detected in the blood and responded to anti-malaria drugs. Of the other 19, no surgically related cause of the fever could be found in 10 and these were empirically treated for malaria; 6 had good response. Six other patients had positive post-operative malaria parasitaemia but had no fever, demonstrating the endemicity of malaria.

Conclusion: There is benefit in the use of anti-malaria drugs in fever where there is no obvious pathology, even when laboratory confirmation of malaria parasitaemia cannot be done.

(Nig J Surg Res 2003; 5: 62 – 66)

Key words: Malaria parasitaemia, postoperative pyrexia

 

 

Unusual computed tomographic features of intracranial tuberculoma: a case report

¹M. O. Obajimi, ¹A. M. Agunloye, ²A. Adeolu, ³E. E. U Akang

¹Departments of Radiology, ²Neurosurgery and ³Pathology, University College Hospital, Ibadan

Reprint requests: Dr. (Mrs.) M. O. Obajimi, Department of Radiology, College of Medicine, U.C.H., Ibadan

Abstract

A case report of a 57-year old woman who presented with signs and symptoms of intracranial mass. Computed tomographic (CT) and clinical features were unusual and suggestive of a parasaggital Meningioma. However an accurate diagnosis of a tuberculoma was made at surgery and histopathological examination.

(Nig J Surg Res 2003; 5: 67 – 69)

Key words: Intracranial tuberculoma, computed tomography, meningioma

 

 

Rare high origin of the radial artery: a bilateral, symmetrical case

I. O. Okoro and B. C. Jiburum

Department of Anatomy, College of Medicine, Imo State University, Owerri, Nigeria

Reprint requests to: Dr. I. O. Okoro, Department of Anatomy, Imo State University, P. M. B. 2000, Owerri, Nigeria. E-mail: [email protected]

Abstract

Arterial variations in the upper limb can occur at the level of the axillary, brachial, radial and ulnar arteries as well as the palmar arches. This is a report of bilateral, symmetrical high origin of the radial artery from the axillary artery. Knowledge of such variations is important in vascular and reconstructive surgery.

(Nig J Surg Res 2003; 5: 70 – 72)

Key words: High origin, radial artery, bilateral, symmetrical