The Undescended Testes in Children: a Prospective Epidemiological Study

Background: The management of undescended testes remains a topical issue. This study was aimed at determinining the presentation and outcome of children presenting with undescended testes at the Lagos University Teaching Hospital (LUTH).Methods: This was a prospective cross-sectional study that included all male children aged 1-15 years with undescended testes who were treated by the paediatric surgery unit in LUTH from January 2010 to December 2011Results: A total of 56 boys with 73 undesecended testes were surgically treated during the study period. The median age at operation was 3.0 years (range: 1 to 11years). Seventeen (30.4%) boys had bilateral undescended testes while 39 (69.6%) boys had unilateral undescended testes . Associated anomalies were present in 6 (10.7%) boys- hypospadias in 5 (8.9%) boys and vertebral anomaly in 1 (1.8%) boy.. Open orchidopexy was performed in 59 (80.8%) cases while stagedorchidopexy was done in 11 (15.1%) cases. There were 4 (5.4%) post operative complications -3 cases of postoperative hematoma and 1 case of wound dehiscence.Conclusion: Children with undescended testes present late in Lagos. About a third of patients with undesended testes in our centre have bilateral undescended testes while about 10% have associated congenital anomalies.Key words: Undescended, Testis, Children, Epideniolog

Cyfluthrin-induced hepatotoxicity in rats

The hepatotoxic effect of continous administration of cyfluthrin was investigated in rats. Rats (Rattus norvegicus) were grouped into A (0 ppm) control, B (100 ppm) and C (200 ppm) with the indicatedamount of cyfluthrin administered orally for 15 weeks.The hepatotoxicity level was assessed by monitoring the changes in the organ to body; weight ratio, micronutrient level (iron, zinc, copper andselenium), the nutritional status (total carbohydrate, total glucose, total protein, total amino acids, total lipid and total cholesterol), the lipid peroxidation level (reduced glutathione and thiobarbiturate) and theantioxidant enzyme activities (glutathione peroxidase, glutathione reductase, catalase, and glucose-6-phosphate dehydrogenase). A dose-dependent decrease in the organ-to-body ratio was observed. Themicronutrient level in the test groups increase significantly. The total carbohydrate, total glucose, total amino acids and total protein show a significant decrease in the test groups. There is no significantdifference observed in the tissue cholesterol at both dosages under investigation. Lipid peroxidation was increased in the test groups as indicated by a significant increase in the thiobarbiturate level and asignificant decrease in the reduced glutathione level. All the antioxidant enzymes studied increased significantly. Cyfluthrin is potentially hepatotoxic under continuous administration in rats

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Diagnostic value of high resolution ultrasound in localisation of the undescended testis in children

Background: The use of ultrasonography in the pre-operative localisation of undescended testes has become controversial due to fears about its  accuracy. This study was designed to ascertain the accuracy, sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography in the localisation of the undescended testes in children.Patients and Methods: A prospective evaluation of all boys undergoing operation for undescended testes at the Lagos University Teaching  Hospital, Idi-Araba, Lagos, over a 12 month period was performed. Thepre-operative clinical and ultrasound fi ndings were compared with the fi ndings on surgical exploration.Results: Forty boys with 52 undescended testes were studied. The mean age of the boys at the time of surgery was 4.0 ± 0 years (range 1-11  years). Fortysix (88.5%) testes were localised pre-operatively by ultrasound- 20 of 22 (90.9%) palpable testes and 26 of 30 (86.7%) non-palpable testes. Intra-operatively, 49 (94.2%) of the undescended testes were found while 3 (5.8%) were absent/vanishing testes. Ultrasoundevaluation had an accuracy of 86.5%, sensitivity of 89.8%, and specifi city of 33.3%, PPV of 95.7% and a NPV of 16.7%.Conclusion: Ultrasound assessment is beneficial in pre-operative  evaluation of children with undescended testes. Key words: Children, pre-operative assessment, ultrasonography,  undescended teste

Duplication cyst of ascending colon presenting as an ileal volvulus in a child: A case report and review of literature

Alimentary tract duplications are uncommon congenital anomalies that  may be found anywhere along the gastrointestinal tract. They have a  diverse presentation and often times present with complications of  intestinal obstruction and/or lower gastrointestinal haemorrhage. We report a very rare fi nding of a colonic duplication cyst which presented as an ileal  volvulus in a young girl. While available investigations were non-specifi c, the child survived on account of an early decision to operate. She had  resection of the duplication cyst and ileo-colic anastomosis. She made  good recovery postoperatively. A high index of suspicion is necessary on the part of clinicians to recognise this condition. Early operative  intervention is necessary in the developing world setting where state of the  art investigations are not available for accurate pre-operative  diagnosis.Key words: Congenital anomalies, colonic duplication cysts, complications, ileo-colic anastomosis, volvulu