Prostatic cancer after prostatectomy for benign prstatic hyperplasia in Nigeria

Objectives: To establish the prevalence of ‘prostatic cancer after a previous prostatectomy for benign prostatic hyperplasia (BPH)’ and to find out if there are any differences in clinical presentation, histological characteristics and response to treatment, between this type ofcancer of prostate and that of prostatic cancer in patients with intact prostate.Design: A prospective study carried out between January 1989 and December 1998.Setting: University of Nigeria Teaching Hospital, Enugu and JAMA Urological Clinic in Enugu, Nigeria .Subjects: All patients presenting with histologically diagnosed carcinoma of the prostate during the study period.Interventions: Transperineal, transurethral and open prostatic biopsies. Hormonal manipulations, transurethral prostatic resections, and ureteroneocystostomies.Main outcome measures: Clinical presentation, histological characteristics of the tumour, and patient survival.Results: Eight hundred and forty seven new cases of cancer of prostate were seen during the study period and 39 of them had had prostatectomy for histologically diagnosed BPH in the past (tissues were cut by step sectioning technique), giving a prevalence rate of 4.6%. Ages of these 39 patients ranged from 64 to 89 years (mean 71.6 years), while that for the rest of carcinoma of prostate ranged from 56 to 87 (mean 70.4 years). Time interval between prostatectomy for BPH and presentation with prostatic cancer ranged from one to 10 years in 36 patients (mean 6.6 years) while the remaining three patients presented after 15, 20 and 22 years respectively. Histology in all the 847 patients showed adenocarcinoma. When the two groups were compared, there were no statistically significant differences in clinicalpresentation, histological grading, type of treatment and final outcome.Conclusion: Prostatic carcinoma after prostatectomy for BPH is not uncommon. It should be managed in the same line as those with cancer in intact prostate

Testicular cancer: Management challenges in an African developing country

Background. Advances in oncology have greatly improved the prognosis of testicular cancer. In developing countries, however, the outcome is still poor. Patients and methods. Twenty-four patients managed for testicular cancer at two centres (University of Nigeria Teaching Hospital, Enugu, Nigeria, and JAMA Urological Clinic, Enugu) between April 1984 and March 2003 were prospectively studied. Histopathological data were obtained in all cases. Results. Peak age incidence was 20 - 29 years. Testicular swelling was the principal complaint in 23 patients. The mean interval between onset of symptoms and presentation was 5.3 months. Two patients (8.3%) presented with stage 1 disease, 7 (29.2%) with stage 2, 7 (29.2%) with stage 3, and 8 (33.3%) with stage 4. Seventy-five per cent of tumours were right-sided, and 25% were left-sided. Treatment consisted of radical orchidectomy in all patients and cisplatin-based chemotherapy and radiotherapy in some patients. One patient with a tumour in an intra-abdominal testis underwent laparotomy. The most common histological types were seminoma and embryonal carcinoma. A fifth of the patients died, while half were lost to follow-up. The mean follow-up period was 9 months. Conclusion. Morbidity and mortality of testicular cancer is high in developing countries. Late presentation, poverty, paucity of resources and the high cost of newer imaging modalities and treatment are major challenges to management. Better health funding and education regarding testicular self-examination is essential

Patients’ satisfaction with eye care services in a Nigerian Teaching Hospital

Background: Understanding the patientsf perception of services received is essential as the parameters important to the patient may be quite  different from that to the eye health provider.Aim: This study aims to evaluate patientsf satisfaction with the care received from the pioneer teaching hospital in south.eastern Nigeria and use it to audit services.Materials and Methods: This was a descriptive cross.sectional study. An interviewer.administered questionnaire was administered to 307 consecutive consenting patients seen at the eye clinic of the University of Nigeria Teaching Hospital Enugu in April 2013. The questionnaire asked questions regarding satisfaction with the time spent in the clinic, attitudeof various categories of staff, physical facilities, cleanliness of the clinic and willingness to come again to the clinic or recommend it to others.Results: The respondents were more satisfied with the attitude of the doctors and nurses than that of revenue and medical records clerks (P = 0.001). Most patients, 288 (93.8%) expressed satisfaction with the overall cleanliness of the eye clinic; 220 (71.7%) and 288 (93.8%) were not satisfied with the toilet facilities and cost of services, respectively. Only 140 (45.6%) participants will recommend the hospital to others strongly, 145 (47.2%) will do so hesitantly.Conclusion: Majority of the patients were satisfied with the services  received. The major dissatisfaction points were cost of services and inadequate toilet facilities.Key words: Developing country, eye care services, patient satisfactio

Refractive errors in children with autism in a developing country

Background: In a resource.limited country visual problems of mentally challenged individuals are often neglected.Aim: The present study aims to study refractive errors in children diagnosed with autism in a developing country.Materials and Methods: Ophthalmic examination was carried out on children diagnosed with autism attending a school for the mentally  challenged in Enugu, Nigeria between December 2009 and May 2010. Visual acuity was assessed using Lea symbols. Anterior and posterior segments were examined. Cycloplegic refraction was performed. Datawas entered on the protocol prepared for the study and analyzed using Statistical Package for the Social Sciences version 17 (Chicago IL, USA).Results: A total of 21 children with autism were enrolled in the school; 18 of whom were examined giving coverage of 85.7%. The age range was 5.15 years, with a mean of 10.28 years (standard deviation } 3.20). There were 13 boys and 5 girls. One child had bilateral temporal pallor of the disc and one had bilateral maculopathy with diffuse chorioretinal atrophy.  Refraction revealed 4 children (22.2%) had astigmatism and 2 children (11.1%) had hypermetropia.Conclusion: Significant refractive error mainly astigmatism was noted in the children with autism. Identifying refractive errors in these children early and providing appropriate corrective lenses may help optimize their visual functioning and impact their activities of daily life in a positive way.Key words: Autism, developing country, refractive erro

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Structured extracapsula cataract extraction-intraocula lens microsurgical training: Report of a trainee's experience

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Weill-Marchesani Syndrome in Nigeria: Report of a case that presented With Bilateral Cataract

This study reports a single case of Weill-Marchesani syndrome in an adult Nigerian. This syndrome is typically characterized by progressive joint stiffness, short stature, brachydactyly, microsherophakia and ectopia lentis. The patient had progressive loss of vision from bilateral cataract. To the best of our knowledge, there is no previously reported case of the syndrome in Africa. Key Words: Weill-Marchesani syndrome, Nigerian, cataract Nigerian Journal of Ophthalmology Vol.12 (1) 2004: 23-2

Visual loss in a school for the blind in Nigeria

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