Hand Tumours in Lagos, Nigeria: A Clinicopathologic Study

Background: Hand tumours occur infrequently and are commonly benign, however when malignant they could be life threatening. This study was aimed at determining the prevalence, demographics, the clinical presentations and treatment outcome of hand tumours among patients attending the hand service of the Lagos University Teaching Hospital.Methods: We studied the clinical and pathological records of a 124  consecutive hand tumours that presented at hand clinic of the Lagos University Teaching Hospital(LUTH) between June 2003 and June 2013 .Results: A total of 124 patients were seen of which 98 had excision biopsies . The male to female sex ratio was 1: 1.3. The mean age at presentation was 32.7 years sd ± 8.44 years. An overwhelming majority (94.9%) had their procedures done under local/regional anaesthesia. Two patients died and three of the tumours recurred during the follow up period. The commonest histopathological diagnoses included ganglion cyst, giant cell tumor of the tendon sheath and pyogenic granuloma constituting 23.8%. 15.7% and 6.7% of the cases seen respectively.Conclusion: Hand tumours in Lagos tend to affect young adults with a slight female preponderance. Majority of the tumours were benign. Primary hand malignancy was uncommon and mortality was low. Nearly all (97%) of the surgically treated patients returned to their premorbid occupation.Key words: Hand tumours, biopsy, soft tissue

Awareness and practice of breast screening and its impact on early detection and presentation among breast cancer patients attending a clinic in Lagos, Nigeria

Background: Breast cancer is  the most common malignancy among females in Nigeria. The concept of breast screening (BS) is that it would result in presentation at earlier stages. We evaluated the impact of BS on early detection and presentation of breast cancer and determined the aspects BS need improvement.Patients and Methods: All patients with a diagnosis of malignant breast lump attending clinics at a tertiary hospital in Nigeria were recruited into the study over a 2‑year period. Self‑administered questionnaires were given to patients. Data collected were demographics, knowledge about BS, practice of BS, the motivation to practice BS and the source of information on BS.Results: Of 218 patients seen, 147 (67.4%) patients presented at the surgical outpatient clinic and 71 (32.6%) at the radiotherapy clinic, with age 48.01 ± 0.80 years. A total of 156 (71.6%) were aware of BS, while 62 (28.4%) were not aware. A logistic regression analysis showed that only the level of formal education predicted awareness of BS, P = 0.001 Nagelkerke’s R2 = 0.126. Awareness of BS was mainly from electronic media 87 (55.7%). There was no significant difference in the ages of those aware and practicing BS 48.03 ± 1.05 years, and those not practicing BS 46.32 ± 1.94 years, P = 0.446. There was no significant difference in presentation for those practicing BS 7.41 ± 1.30 months, and those not practicing BS 11.38 ± 2.91 months, P = 0.175, with 64% practicing BS presenting late, while 77% not practicing BS presenting late, χ2 = 2.432, P = 0.488. A logistic regression analysis did not show any demographic or clinical parameters as predictive P = 0.225 Nagelkerke’s R2 = 0.126.Conclusion: The high level of awareness and practice of BS was not translated into the presentation with early breast cancer.Key words: Breast screening, mammography, physician clinical examination, self‑breast examinatio

Anatomic Variations in the Palmar Cutaneous Branch of the Median Nerve Among Adults in Lagos, Nigeria

Dysesthesias due to palmar cutaneous branch of median nerve injuries infrequently follow carpal tunnel release surgeries.Objective: To determine the course of palmar cutaneous branch of the median nerve in wrist of adult Nigerians, identify the common variations, determine its relations to the palmaris longus (PL) in the region of the distal wrist crease. And on these basis, suggest a safe incision for carpal tunnel surgery in Nigerians. Materials and Methods: Detailed anatomic dissection of the palmar cutaneous branch of the median nerve was carried out with the aid of a loupe magnification on 40 Nigerian cadaver wrists. The origin, course in the distal forearm, wrist and proximal palm was traced. Measurements of the distances between the radial and ulnar branches of the nerve and the PL were made. The distance between origin of the nerve and the distal wrist crease was measured as well. The common branching pattern of the nerve was noted. Results: The palmar cutaneous branch of the median nerve was present in all dissected wrists. The mean distance of the radial branch to PL was 0.81 cm (SD ± 0.3 cm), while the ulnar branch was 0.3 cm (SD ± 0.1 cm). from same structure. The mean distance from the origin to the distal wrist crease is 4.5 cm (SD ± 2.1 cm). We noted the terminal distal branching pattern of the nerve to be highly variable. Conclusion: The Palmar cutaneous branch of the median nerve is safe with an incision made at least 0.5 cm ulnar to the PL in carpal tunnel surgeries in Nigerians.Keywords: Carpal tunnel surgery, median nerve, palmar cutaneous branc

Early Experiences with Microvascular Free Tissue Transfer in Lagos, Nigeria

Objectives: Microvascular free tissue transfer within our subregion is fraught with considerable challenges. We aim to highlight our experiences gained with our first fifteen cases of microvascular free tissue transfer at the Lagos University Teaching Hospital. We believe our report will be useful to colleagues embarking on such reconstructions in similar settings. Materials and Methods: The clinical records of the first 15 cases of free flaps done at our center were reviewed. The indications for surgery, choice of flap, recipient vessels, duration of surgery and complications were noted. Results: Fifteen cases were done, 10 flaps survived, ten defects occurred following trauma while remaining five followed cancer resections. Anterolateral thigh and radial forearm flaps were the most common flap used. The mean duration of surgeries was 7.1 hours SD ± 1.10 hours. Our take back rate was 13.3%, with a salvage rate of 50%. Three flaps failed on account venous congestion while remaining two failed due to arterial occlusion.Conclusion: 66.67% free flap success rate recorded reflect our early experiences in our institution. We believe meticulous planning, careful vessel selection, close flap monitoring as well as improved infrastructural support can lead to much better success rates in microvascular reconstruction in our country.Keywords: Experiences, free, tissue, transfe

Civilian Firearm and blast injuries of the Hand in Lagos, Nigeria

A 6 year review of 43 patients who sustained Civilian firearm and blast injuries of the hand at the Lagos University Teaching Hospital was done. Majority of patients seen were young males (93.1%). The firearm injuries occurred during armed robbery attacks (80.1%), while majority(82.7%) of the blast injuries followed firework accidents during New year celebrations. The commonest pattern of injuries were soft tissue lacerations and avulsions. Others such as amputations, fractures, tendon and nerve disruptions occurred less frequently. The commonest surgical procedures performed include multiple debridements, skin grafts/flaps and other forms of wound closures. Fracture stabilization, tendon and nerve reconstruction were less commonly done. Over 92% required more than three surgical procedures, 63% of the patients studied were able return to their pre morbid occupations. In spite of the devastating injuries many patients managed were able to carry out most of the of their daily activities .Keywords: Firearm , blast, hand , injurie

Clinical and Proctosigmoidoscopic findings in Patients with Anorectal Sepsis in a Private Health Facility in Lagos, Nigeria

Background: Anorectal sepsis is a distressing condition which is sometimes inadequately treated.Objectives: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures.Method: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also notedResults: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found. Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity.Conclusion: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.KeyWords: Anorectal sepsis, fistula in ano, proctosigmoidoscop

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa