Surgery in refractory metabolic derangements: Report of a case

No Abstract

Breast Cancer Prevention And Detection

The breasts are phylogentically considered as modifications of sweat glands. They are present in all mammals and particularly become prominent in females as the hallmark of pubertal development. Like all bilateral structures, slight inequality in the size of the breast is normal. The male breast is small, though it is subject to the major diseases of the female breast. Breast symptoms induce such anxiety in the patient that malignancy needs to be excluded or confirmed and dealt with accordingly as soon as possible. Cancer of the breast is the commonest malignancy affecting women in many parts of the world. Globally, it accounts for 8.4% of female cancers but less than 1% of all cancers in the male, and 0.1% of male death. The incidence is rising. In the USA, about 175,000 new cases are diagnosed in the females, and about 46,000 die of it annually. In Britain, the corresponding numbers are 25,000 and 16,000. Japan has the lowest incidence 1 in 60 women in their life time, and the death rate is 13% of that in Britain. In Africa, the true incidence is not known , but the disease is becoming more common. In Accra Ghana, it accounts for 13.0% of all females cancers, 2nd only to cancer of the cervix. In University College Hospital, (UCH) Ibadan from 2960-80, cancer of the breast contributed 6% of the 17,496 cases of cancers seen. It was the 4th commonest after cancer of the cervix. In Jos the Plateau State of Nigeria, a 6-year retrospective study from 1979-1984 by Ihezue et al showed an incidence of 13 new cases a year reported in the South Eastern part of the country by other observers. Interestingly, no male patient was recorded in this study. However recent works in 1996, by Gukas, 1999 by Igun recorded one male patient each. Highland Medical Research Journal Vol.1(2) 2002: 26-2

Splenic abscess in Jos

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, splenectom

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

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially