Phaeochromocytoma in a 4-year old girl: case report

This is a report of a 4-year old female Nigerian patient with phaeochromocytoma, a rare surgically correctable cause of hypertension, highlighting the problems in diagnosis and management in our sub region with review of the literature

Fracture patternsas seen at the accident and emergency department of the university of maiduguri teaching hospital Nigeria: - a five year prospective study

Most trauma resulting from vehicular accidents or otherwise, often involve the skeleton (made up of 206 bones), resulting into a fracture. Fractures are a cause of high morbidity and occasionally mortality. Objective: The aim of this study is to analyze the anatomical regions most involved, fracture types, their causes, outcome of treatment and the commonest complication of the fracture in our environment. Method: A five year prospective study (January 2005 to December 2009) was undertaken. All patients presented at the Accident and Emergency Unit of the University of Maiduguri Teaching Hospital, both fresh and old fractures were included. All were followed up to discharge from the hospital and some years after. Those that died were noted. A proforma was used to collect the data. Follow up was between 2 to5 years. Results: During the period of the study, there were 24, 041 emergencies that reported to UMTH, 6,535(27.2%) were due to RTA and 596 (2.5%) had fractures, presenting with 677 fractures. There were 477(80.2%) males and 189(19.8%) females, giving a ratio of 4:1. The lower limbs were affected in 247(41.5%) patients, upper limbs in 146(24.6%), more than one region 54(9.1%), maxillofacial 47(7.9%), skull 41(6.9%), spinal fractures 33(5.5%) andpelvic fractures 28(4.7%). There were 435(73.2%) motor vehicular cases, (3.4%) follows domestic accidents and11(1.9%) from assaults. There were 66 associated injuries. Conclusion: Fractures occurred in about 10% of RTAs with males more involved than Females (4:1) and motor vehicular accidents causing most of the fractures. The lower limbs were more involved and most of the fractures were closed. Association with head injury leads to more mortality

Outcome of surgery for toxic goitres in maiduguri: A single teaching hospital’s perspective

Background: Thyrotoxicosis a common endocrine disorder of the thyroid gland in Nigeria is commonly treated surgically. The outcome of thyroidectomy for toxic goiters in Maiduguri Nigeria is evaluated.Materials and Methods: Over the last 5 years (Jan 2005-July 2010), in a prospective review, the demographic, and clinical data of patients operated for toxic goiters in our department was entered, into a predesigned proforma and analyzed. The objective of the study is to review our experience with subtotal and near-total thyroidectomy as treatment for benign toxic goiters.Results: Seventy-eight patients, 11 males (14.1%) and 67 females (85.9%), with male: female ratio of 1:6.1 and the mean age of 30 ± 10.9 (range, 17-65 years), underwent thyroidectomy for toxic goiters. The mean duration of symptoms was 41.9 (range 3-126 months). There were 53 patients with toxic diffuse goiters (Grave’s disease) with their mean age of 27.6 ± 6.93 (range 17-38 years), 23 with toxic multinodular goiters, the mean age of 43.7 ± 15.68 (range 17-65 years) and two with toxic nodule. There was no case of permanent recurrent laryngeal nerve palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 9 (11.5%) patients and hemorrhage with hematoma, requiring exploration in 4 (5.1%). There were two cases of wound infection and no postoperative mortality. The mean hospital stay was 7.6 ± 2.34 (range 5-15 days). There was no disease recurrence over a mean follow-up of 20.7 (range 2-48) months.Conclusion: Subtotal thyroidectomy is an effective procedure for the treatment of thyrotoxicosis with few postoperative complications and majority of patients being euthyroid after long follow-up

Childhood intussusception in north eastern Nigeria: a review of its surgical management

Background: Intussusception is the commonest cause of intestinal obstruction in the 3 months to 2 years age group. Adequate awareness of its presenting features is important for an early diagnosis and treatment. Aim: To present an experience of its surgical management in Nigerian infants and children. Setting: The University of Maiduguri Teaching Hospital. Methods: A retrospective study of patients with intussusception seen and treated between January 1999 and December 2002 was done. Their case files were studied for age, sex, presentation, definitive treatment and outcome of treatment. These were analyzed using tables. Results: Thirty-seven infants and children were seen during the study period. There were 24 males (64.8%) and 13 females (35.1%). The male to female ratio was 1.8:1. The mean age was 14.7 ± 22.61 months (range 2 months - 8 years). Twenty-two (59.4%) of the patients were aged between 3 and 9 months and 25 (67.5%) were below one year. The commonest presenting symptoms were abdominal pain (86.4%), vomiting (75.6%) and palpable abdominal mass (54.0%). Twenty-one patients (56.7%) presented to hospital latter than 72 hours from the onset of symptoms. At laparotomy, the commonest type of intussusception was ileocolic (48.6%). Twenty-three (62.1%) patients had simple manual reduction while 14 (37.8%) had bowel resection and anastomoses. There was no recurrence of intussusception after a mean follow-up of 27.8 ± 29.5 weeks. The mortality rate was 16.2%. Conclusion: Intussusception is a common cause of intestinal obstruction in infants and children in this environment. Late presentation is common and accounts for the high mortality. Outcome of treatment can be improved with high index of suspicion Keywords: Intussusception, Infants, Childhood, Surgical and non-surgical reductionPort Harcourt Medical Journal Vol. 3 (1) 2008: pp. 27-3

Pyomyositis in north - eastern Nigeria: a 10-year review

Background: Pyomyositis is a suppurative disease of skeletal Muscle and a well-known disease with frequent occurrence in the tropics and subtropics, which continues to cause significant morbidity. Despite several studies of the disease in various regions of the tropics, there has been none from the northeast region of Nigeria, consisting of a largely rural population where the climate is hot and dry with little annual rainfall.Methods: A retrospective study of all patients seen and treated for pyomyositis in the University of Maiduguri Teaching Hospital from April 1990 to April 2000 was undertaken.Results: Fifty four patients with pyomyositis were seen and managed comprising 36 Males and 18 Females (M: F ratio 2:1). Two peak age incidences of 6-10 years and 31-40 years were noted. Most were from a labouring population and presented with a fully evolved disease affecting the large and powerful muscles of the thigh and calf in 59.7% of cases, the glutei in 12.9% and the trunk in 9.7%. The smaller muscles of the arm and forearm and head and neck were rarely affected. 8 patients had multiple lesions. Staphylococcus aureus was cultured in 91.8% of cases sensitive to cloxacillin, augmentin, chloramphenicol and erythromycin in that order.Conclusion: Prompt diagnosis, appropriate supportive therapy, effective antibiotic therapy and early drainage of abscesses have resulted in minimal mortality despite late presentation although hospital stay was prolonged

Arrow injuries in North Eastern Nigeria

Background: Arrow injuries are common presentation at the Federal Medical Centre (FMC), Nguru, North East Nigeria. The injuries are mostly unreported and there is neither a policy nor an action plan to curb their incidenceAim: To establish an accurate data base for this clinical entity in this part of Nigeria and suggest ways to curb it. Methods: A prospective study of all patients presenting with arrow shot injuries at FMC, Nguru, from January 2007 to June 2009. The age, gender, tribe, occupation, motive of assault, perpetrator information, part of body injured, treatment given and outcome were collected in a proforma.  The data was analyzed using Microsoft Excel.Results: All 57 patients seen were males. Their ages ranged from 13 to 60 years, with the mean age of 32.9±12.2years. The peak age incidence was 21-30years, accounting for 21cases (36.8%). Fighting between herdsmen and farmers over grazing land was the most common cause of arrow shot injuries, accounting for 25 cases (43.9%), followed by armed banditry with 17 cases (29.8%). Fighting over women was the cause in 10 cases (17.5%). Most of the patients had high Revised Trauma Score. Resuscitative and surgical procedures carried out resulted in recovery of 55 patients. Two patients with the highest number of arrow shots (11 and 4 each) and low Revised Trauma Score of  2 and 4 respectively, died pre-operatively.  Conclusion: The rate of arrow shot assault injuries in the North East of Nigeria remains  high with its attendant morbidity and mortality. It stems mainly from interpersonal conflicts between herdsmen and farmers over grazing land. Mapping out of grazing lands away from farm lands, enlightenment campaigns, improvement of socio-economic conditions as well as enforced legislative control on the use of bow and arrow will go a long way to reduce the incidence of arrow shot injuries in the region.&#160