Metastatic choriocarcinoma presenting as advanced renal cell carcinoma: A case report

Choriocarcinoma is an aggressive tumour arising as a malignant transformation of the gestational trophoblastic disease or rarely from the germ cells in the ovary and from testicular mixed germ cell tumour. Renal involvement due to Choriocarcinoma is rare we report here one of such rare cases. A 26yr old woman presented with painful right sided loin swelling with painless total haematuria of 3weeks duration .Abdominal Ultrasound and CT scan showed a solid Right kidney mass with a cystic component. She had right radical nephrectomy.Histopathological examination revealed metastatic choriocarcinoma. The challenges we faced in her management is highlightedand a brief review of literature on the subject is presented

Safety of the surgeon: ‘Double-gloving’ during surgical procedures

Background. In the face of increasing HIV/AIDS prevalence in subSaharan Africa, we evaluate the effectiveness of ‘doublegloving’ during surgery as a means of protecting the surgeon operating on patients with a known or unknown HIV status.Methods. A prospective study was conducted to determine the rate of glove puncture and intraoperative injury in categories of patients with known positive, known negative or unknown HIV status.Results. The surgeon and the first assistant double-gloved in all the 1 050 procedures performed between 2009 and 2013, and a total of 8 400 surgical gloves were used. Sixty-nine patients (6.6%) were HIV-positive, 29 patients (2.8%) were HIV-negative, and the HIV status was unknown for the remaining 952 patients (90.7%). The overall glove puncture rate in the study was 14.5%. The glove puncture rate was 0%, 31% and 15% for HIV-positive, HIV-negative and HIV status unknown, respectively, and thisdifference was statistically significant. The mean operating time in the  group with glove punctures was 148 min (95% confidence interval (CI) 135 - 161), while mean operating time in the group without glove puncture was 88 min (95% CI 84 - 92).Conclusion. Double-gloving offers protection against intraoperative injury. Knowing the HIV status of the patient offers additional protection to the operating surgeon. While we recommend routine double-gloving for surgeons working in HIVprevalent patient populations, we also advocate for the routine screening for HIV in all surgical patients

Households\u2019 Consumption Pattern of Snail ( Archachatina species) in Oluyole Local Government Area of Oyo State, Nigeria

The present study investigates household consumption pattern of snail meat in Oluyole Local Government Area of Oyo State. A multistage random sampling technique was used to administer the questionnaires to a total of 120 respondents. Data collected were analyzed using both descriptive statistics and inferential statistics. The socioeconomic factors analyzed showed that age group between 31 and 40 (45.0%) consumed snail more while age group between 51 and 60 (11.70%) consumed less snails. The majority of respondents were Married (60.8%) and possess secondary education (54.2%). Most of the respondents (95.8%) consume snail meat but most of them consume snail meat on a seasonal basis unlike beef and fish. Furthermore, fried form of snail meat is mostly (65%) preferred when compared to cooked form (24.2%). The regression analysis shows that the consumption of snail meat depended on the price, household size, educational level, household income, nutritive value, occupation and its availability. Problems associated with snail meat consumption in the study area include Price, income level, unavailability and cultural belief. Based on the findings, this study recommends that extension workers should engage the public on the need to get involved in the rearing of snails to make it readily available all year round and thus make it more affordable for all sundry

Riedel’s thyroiditis in a black African: A case report and review of literature

Riedel’s thyroiditis is a rare cause of the enlargement of the thyroid gland. The etiology is not fully known. There has been no report of Riedel thyroiditis in our country. We report a case of a 61‑year‑old man with the disease as well as review the literature. We present the case of 61‑year‑old carpenter seen in our clinic with 2½ years history of painless anterior neck swelling associated with hoarseness of voice. He had multiple hard nodules on the left lobe of the thyroid gland with multiple cervical lymph nodes enlargement. No feature of hypothyroidism or thyroiditis. Clinical diagnosis of malignant goiter was made although Fine‑needle aspiration for cytology did not suggest malignancy. He had surgery, findings included nonresectable hard multinodular left thyroid lobe from which a wedge biopsy was taken, Histology of the specimen revealed Riedel’s thyroiditis. He was managed with oral Prednisolone and Tamoxifen with remarkable improvement in his clinical symptoms. Riedel’s thyroiditis is a rare disease. It can easily mimic malignant goiter hence proper histological diagnosis will be necessary to differentiate. Review of medical literature showed that Riedel thyroiditis has not been reported in a black African patient inhabiting the sub‑Sahara Africa. This was a report of Riedel thyroiditis in a black Nigerian patient that was successfully managed on oral glucocorticoid, tamoxifen and L‑thyroxine.Keywords: Malignant goiter, Nigerian patient, prednisolone, Riedel’s, tamoxifen, thyroiditi

Early experience with stapled gastrointestinal anastomoses in a Nigerian hospital

Background: Hand-sewn gastrointestinal anastomoses has been the traditional approach to gastrointestinal anastomosis in Nigeria while stapled anastomoses are infrequently performed in few centers. Objectives: To describe the outcome of our initial experience with stapled gastrointestinal anastomoses in a semi-urban patient population. Patients and Methods: Consecutive patients who had stapled gastrointestinal anastomoses between January 2011 and June 2014 in a Nigerian tertiary hospital were prospectively evaluated. Indications for operation, procedures performed and anastomoses constructed and postoperative outcome of each patient were documented. Results: Nineteen patients including seven males and 12 females had stapled anastomoses within the period. Their ages ranged between 41 and 68 (mean 52.5) years. Six (31.6%) Roux-en-Y gastrojejunostomies, 6 (31.6%) ileo-colic, 3 (15.8%) ileo-ileal, 2 (10.5%) colo-colic, and 2 (10.5%) colo-anal anastomoses were performed. Indications include antral gastric cancer in 4 (21.1%), right colon cancer 4 (21.1%), ileal perforations in 3 (15.8%) while 2 (10.5%) each had left colon cancer, common bile duct obstruction, rectal cancer and ruptured appendix. Mean duration of operation was 108 ± 46 min and mean duration of postoperative stay was 5 ± 2.6 days. No intraoperative complications were recorded and no anastomotic leakage occurred. At a median follow-up of 5 months no staple related stricture had occurred. Conclusions: Stapled gastrointestinal anastomoses are associated with a good outcome in our center. We propose a prospective, large-population randomized comparison of the technique with hand-sewn anastomoses

Use Of Continuous Axillary Brachial Plexus Block Facilitates Assessment Of Motor Functions During Tendon Repair

Objective: To report the successful use of continuous axillary brachial plexus block in the assessment of muscle functions during tendon repair. Methods: A prospective observational study carried out at Obafemi Awolowo University Teaching Hospital, Ile-Ife between November 2006 and December 2007. The study included patients scheduled for repair of upper limb tendon secondary to trauma. American Society of Anaesthesiologist (ASA) health status 1 and 2 were included. 24 healthy patients who presented with laceration of upper limb tendon had continuous axillary block for the repair of the tendon using a catheter infusion technique. 0.5% Ropivacaine hydrochloride was the local anaesthestic solution. Monitoring of motor and sensory functions was done both intraoperatively and postoperatively. Results:The awake patients were able to carry out basic motor functions which facilitated assessment of tendon repair in all the 24 patients. Anaesthesia was adequate in 21 (87.5%) of the patients. 3 patients requested for supplementary analgesia. Only one patient developed features suggestive of local anaesthetic toxicity. Conclusion: Insertion of axillary catheters for the purpose of continuous brachial plexus block can facilitate assessment of functions following tendon repair when appropriate local anaesthestic agents with motor sparing effects are selected. Keywords: Axillary block, assessment, motor functions, Nigeria Journal of Orthopaedics and Trauma Vol. 7 (2) 2008: pp. 60-6

Clinical Pattern Of Male Breast Cancer In Ile-Ife, Nigeria

Background: Carcinoma of the breast in males is of interest because it is relatively uncommon and because presentation of the disease in hospitals is usually late owing to poor awareness and neglect. This study aimed to describe the pattern of the disease in our hospital. Method: Consecutive cases of male breast cancer presenting at the Ife Hospital Unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria between January 1993 and December, 2003 were studied noting the manifestation, duration of symptoms, diagnoses, treatment and outcome in the patients. Results: Of 249 histologically proven cases of breast cancer managed during the study period, 8(3.2%) were males, giving a male to female ratio of 1:31. They were aged 51-80 years with a mean of 64.7 +SD9.7 years. Mean duration of symptoms before presentation was 9 months. Painless breast mass and ulceration were the commonest symptoms. All patients presented in the late disease stage, 3(37.5%) in AJCC stage III and 5(62.5%) presented with stage IV disease. Histopathology in 6(75%) confirmed invasive ductal carcinoma, the two others had only fine needle aspiration cytology diagnosis. Three of the patients had simple mastectomy while others due to advanced disease could only be offered adjuvant chemotherapy and radiotherapy. After 2 years of follow-up, 3(37.5%) patients had died, one patient had re-presented with recurrence at the site of operation while the other 4 patients (50%) had been lost to follow up. Conclusion: The study underlined the uncommon occurrence of male breast cancer and late presentation, low survival rate and poor follow up of cases in our environment. Keywords: Male breast cancer, Presentation, OutcomeSahel Medical Journal Vol. 11 (1) 2008: pp. 24-2

Early Experience with Stapled Gastrointestinal Anastomoses in a Nigerian Hospital

Background: Hand‑sewn gastrointestinal anastomoses has been the traditional approach to gastrointestinal anastomosis in Nigeria while stapled anastomoses are infrequently performed in few centers. Objectives: To describe the outcome of our initial experience with stapled gastrointestinal anastomoses in a semi‑urban patient population.Patients and Methods: Consecutive patients who had stapled gastrointestinal anastomoses between January 2011 and June 2014 in a Nigerian tertiary hospital were prospectively evaluated. Indications for operation, procedures performed and anastomoses constructed and postoperative outcome of each patient were documented. Results: Nineteen patients including seven males and 12 females had stapled anastomoses within the period. Their ages ranged between 41 and 68 (mean 52.5) years. Six (31.6%) Roux‑en‑Y gastrojejunostomies, 6 (31.6%) ileo‑colic, 3 (15.8%) ileo‑ileal, 2 (10.5%) colo‑colic, and 2 (10.5%) colo‑anal anastomoses were performed. Indications include antral gastric cancer in 4 (21.1%), right colon cancer 4 (21.1%), ileal perforations in 3 (15.8%) while 2 (10.5%) each had left colon cancer, common bile duct obstruction, rectal cancer and ruptured appendix. Mean duration of operation was 108 ± 46 min and mean duration of postoperative stay was 5 ± 2.6 days. No intraoperative complications were recorded and no anastomotic leakage occurred. At a median follow‑up of 5 months no staple related stricture had occurred. Conclusions: Stapled gastrointestinal anastomoses are associated with a good outcome in our center. We propose a prospective, large‑population randomizedcomparison of the technique with hand‑sewn anastomoses.Keywords: Anastomoses, gastrointestinal, Nigeria, staple

Classification Types Of Postoperative Enterocutaneous Fistula As A Determinant Of Outcome Of Treatment In Ile-Ife, Nigeria

Objective: Post operative enterocutaneous fistula, in this environment, continues to excite interest because it runs a distressing course, and it is often associated with high mortality and morbidity. Determining the classification type best suited to suggest the outcome would be helpful in guiding the management of the condition. Setting: Ife Hospital Unit, Obafemi Awolowo Teaching Hospitals Complex, Ile – Ife. Outcome Measure: To determine the clinical pattern of post operative external enterocutaneous fistula and the classification method that best predict outcome of the condition. Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine involved were retrieved and analyzed. Patient with incomplete clinical information were excluded from the study. Result: There were 30 patients aged 17 to 65 years, mean of 33 years ±SD 12.23 years, with male to female ratio of 2:1. Length of hospital stay ranged from 1 to 43 weeks. Majority 28 (93.3%) were referred after primary operation at the lower cadre hospitals. Enterocutaneous fistula followed intestinal resection in 15 cases (50.0%) and was post appendicectomy in 9 cases (30.06%). Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally. Overall mortality was 12 (40 %) was high. Compared with the other classifications considered in the study classification into high and low output highly correlated with the outcome of treatment logistic regression p < 0.006 versus p = 0.123 and p = 0.244 respectively for Sitges – Serra and schein and groups. Conclusion: In this study majority of patients with enterocutaneous fistula were referred from Private and State hospitals set up. This might be a reflection of the generally lower level of technical surgical skills at this level of healthcare facilities. Classification of enterocutaneous fistula into high and low output was still useful in our environment for predicting prognosis and may, therefore, be used to guide management strategies. Keywords: Post operative enterocutaneous fistula, Treatment outcome determinant, Classification.Sahel Medical Journal Vol. 11 (4) 2008: pp. 105-10

Reference Human Rotavirus A Genome Sequence from a Previously Vaccinated Child with Diarrhea in Nigeria.

In 2018, a 26-month-old girl, fully vaccinated with Rotarix in 2016, presented with fever, diarrhea, and vomiting. A rapid test showed that her feces contained rotavirus A (RVA). VP7 reverse transcription-PCR (RT-PCR) and Illumina sequencing showed that a G1P[8] strain with a Wa-like genotype constellation was the etiologic agent. This is the first near-complete RVA genome sequence from Nigeria.status: Published onlin