Breast Lumps in NAUTH, Nnewi :A 5 year Review

Background Breast lump is the most common reason for presenting to breast clinics. It is a source of great anxiety to a female when it is discovered. Objective This study aims at a clinico-pathologic review of breast lump as a presenting complaint. Material and Methods A 5-year retrospective analysis of 550 patients presenting with a complaint of breast lump to the breast clinic of NnamdiAzikiwe University TeachingHospital (NAUTH) Nnewi, fromJanuary 2004 December 2008. Results Breast lump was the presenting complaint in 550(82.8%) of 664 patients presenting to the breast clinic. The lump was painless in 458 (83.3%), associated with pain and breast ulcer in 59(10.7%) and 33(6.0%) patients respectively. Females constitute 548(99.6%) with only 2(0.4%) males. There was no palpable lump in 23 patients (4.2%) on clinical examination and only 54 patients (9.7%) ad >1 lump. The clinical diagnosis were breast cancer in 260 patients (47.3%), fibroadenoma in 175 (31.8%), fibrocystic changes in 67 (12.2%) patients. The others were different types of benign diseases. Histopathology report was available in 294 patients with 161(54.8%), 56(19.0%) and 46(15.6%) patients diagnosed respectively as having invasive cancer, fibroadenoma, and fibrocystic changes. Conclusion Our study shows that breast lump was the most common presenting complaint with most patients not presenting early. Fewer lumps are discovered by breast self examination. The finding that breast cancer was slightly more common than benign breast lesions is at variance with most studies probably due to proliferation in our environment of private owned hospitals by general practitioners where most of the benign lesions are probably managed. But the finding of fibroadenoma as the most common of the benign lesions is similar to that reported by other researchers in Nigeria and other parts of theworld.KeyWords: breast lump, Nnewi,Revie

Unusual Presentation of Gall Bladder Perforation

Background: Gall bladder perforation (GBP) is a rare but life threatening complication of cholecystitis. Therefore, it continues to be an important problem for the surgeon. Aim: To report a case of perforated gall bladder mimicking perforated peptic ulcer disease. Methods: A case report of gall bladder perforation that was managed at the Nnamdi Azikiwe University Teaching Hospital. Result: A 67 years old woman who had a clinical diagnosis of perforated peptic ulcer disease secondary to chronic NSAID use but with intra-operative finding of Niemeier's type II gall bladder perforation. Conclusion: High index of suspicion is required to diagnose perforated gall bladder mimicking perforated peptic ulcer disease. Keywords: Gall bladder perforation, Peptic ulcer disease, Niemeier's Classificatio

An Unusually Large Submandibular Gland Stone. A Case Report.

A Case of 65 year old man that presented with 40 years history of right lower jaw swelling, that became associated with pain two weeks prior to presentation. Examination revealed an elderly man with an enlarged tender right submandibular gland. The medial margin was suppurating. X-ray of the right lower jaw revealed large stone, while ultrasound scan of the right submandibular region revealed an associated abscess. The latter was incised and drained, while excision of the right submandibular gland and calculus was carried out three weeks later. 5.0cm - sized stone was excised. This turned out to be the second largest salivary gland stone recorded in literature. Conclusion Giant salivary gland stone which ( greater than 1.5cm) is rare. To the best of our knowledge, our index patient with a calculus measuring 5.0 x 3.0cm is the second largest stone in literature is remarkable KeyWords: Giant Salivary Gland Stone, Submandibular Glan

Parasitic Infections In A Developing Country: The Vermiform Appendix As A Victim

The vermiform appendix may become a yielding target and an innocent victim of intestinal parasitism. This is likely to occur more readily in those parts of the developing world in which the parasitic load in the community is high. This high parasitic load more commonly afflicts people of low socio-economic class. This report is of two cases of appendicitis secondary to intestinal parasitism, in the first case by Ascaris lumbricoides (round worm) and in the second case by Schistosoma haematobium. Tropical Journal of Medical Research Vol. 11 (2) 2007: pp. 38-4

Carcinoma Of The Gallbladder At The Nnamdi Azikiwe University Teaching Hospital – A 5-Year Retrospective Study

Background: Carcinoma of the gallbladder is often missed because of the low index of suspicion.Aims and Objectives: To review the incidence, pattern and outcome of carcinoma of the gallbladder in our center and to highlight the need for early diagnosis. Design: Retrospective survey of all cases of carcinoma of the gallbladder.Setting: Nnamdi Azikiwe University Teaching Hospital serving rural, semi-urban and urban communities.Patients and Methods: Patients who had histologically confirmed carcinoma in the general surgical units of the Nnamdi Azikiwe University Teaching Hospital over a 5-year period were reviewed and, from their case notes, the following information on sex, age, mode of presentation, time of diagnosis, stage of disease, treatment given and outcome were extracted.Results: Twenty-one cases of gallbladder carcinoma were seen out of a total of 692 cases of different types of cancers seen in the general surgical units, giving an incidence of 3.04%. Six were males and 15 were females, age ranged between 39 and 72 years, a mean of 55; with the peak age in the 7th decade of life. Eleven patients (5.24%) presented with features of chronic cholecystitis and had cholecystectomy. Ten patients presented with obstructive jaundice in a stage too advanced for any form of palliative surgical treatment The outcome was good in patients who presented with features of cholecystitis but who turned out to be cases of early carcinoma of the gallbladder because after five years of follow-up, none of them has shown any features of recurrence. There was no mortality in this group and the patients have remained in good health. However, the prognosis was poor in those patients who presented with obstructive jaundice. They remained very ill, with worsening general condition. They were discharged home on request of their relations and were lost to follow-up. Conclusions: Carcinoma of the gallbladder may present as cholecystitis. It is advisable for clinicians to have this in mind before, during and after cholecystectomy. Early presentation to hospital by patients would avert delay and improve early diagnosis, early treatment, and better outcome.Key Words: Carcinoma, gallbladder, NigeriaNigerian Journal of Clinical Practice Vol 8(1) 2005: 10-1

Scrotal explorations in a developing country: The pattern at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Objective: To evaluate all surgeries involving exposure of scrotal contents in order to establish a pattern, if any.Patients and methods: All consecutive patients with scrotum-related pathologies who presented to the authors over a seven-year period wereprospectively studied.Results: Nine hundred and eighty-eight patients were studied. Their ages ranged from three days to 90 years, with a mean age of 42 years.Indications for scrotal exploration included a wide range of paediatric, general surgical and urological pathologies. The commonest included herniae in 393 (39.8%) patients, prostatic carcinoma in 192 (19.4%), hydrocoele in 182 (18.4%) and varicocoeles in 99 (10.0%) patients.The commonest surgical procedures were herniorrhaphies in 217 (22.0%) patients, orchidectomies in 239 (24.2%) patients, herniotomies in 212(21.5%) patients, hydrocoelectomies in 155 (15.7%) patients, varicocoelectomies in 99 (10.0%) patients and orchidopexies in 52 (5.3%) patients. The commonest complications of scrotal exploration included scrotal oedema in 547 (55.4%) patients and wound infection in 63 (6.4%) patients. The approaches used were trans-scrotal in 392 (39.7%) patients and trans-inguinal in 596 (60.3%) patients. In 344 (34.8%) patients, both the left and the right hemiscrota were explored, while 323 (32.7%) and 321 (32.5%) had only right and only left hemi-scrotal exploration respectively.Conclusion: Scrotal exploration incorporates many surgical procedures which are carried out on males of all age groups for various inguino-scrotalconditions. Complications are common, and since very vital organs are involved, surgeons should be well trained in both trans-scrotal and transinguinal approaches to avoid embarrassing consequencies

Experience with amodified technique for outpatient closed suprapubic cystostomy for the rural surgeon.

Objective: Standard surgical procedures as practiced in the developed countries are often inapplicable in rural practices, especially in thedeveloping countries, due to the absence of appropriate and adequate facilities. The authors developed and here describe and share theirexperience with a modification of the standard technique for outpatient suprapubic cystostomy adaptable to the rural surgeonMaterials and Methods: This innovative technique was used on seventy-five patients over a period of ten years. Simple instruments usuallyavailable in most rural centres were used for the technique.Result: The procedure was successful and well tolerated in all the patients who satisfied the indications and criteria for its use. Among the fewcomplications observed were haematuria, which was transient in six patients (8%) and wound infection in ten patients (13.3%). Bacteraemiawith or without urinary tract infection observed in fifty patients (66%), was not primarily due to the procedure.Conclusion: The technique provides a simple, quick, and safe outpatient procedure for closed suprapubic cystostomy using minimal instrumentsand other surgical facilities. It is recommended for the rural surgeo

Experience with predonated autologous blood transfusion in open prostatectomy

Objectives: To find out the practicability, the acceptability, the effectiveness and the safety level of pre-donated, autologous blood transfusion (ABT)in patients who underwent open prostatectomy.Study design: Prospective.Patients and methods: It was a prospective study carried out in Nigeria over a 5-year period. All patients were properly informed of the study andtheir consent obtained for pre-operative blood donation and intra-operative and/or post-operative autologous blood transfusion. Inclusion criteriawere strictly observed.Results: During this study period, 260 open prostatectomies were carried out. One hundred and ten (110) patients fulfilled the inclusion criteria butonly 100 patients actually had autologous blood transfusion (ABT).Conclusion: This study shows that ABT is practicable, acceptable, safe and cost-effective. This option should be emphasized and offered to patientsundergoing open prostatectomy

A Review Of In-Hospital Surgical Mortality At The Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

Aims and Objectives: A retrospective study to determine In-hospital surgical mortality rate, gender and age distribution of cases and operations associated with In-hospital surgical mortality at the Nnamdi Azikiwe University Teaching Hospital, Nnewi. Patients and Methods: Data was collected from the theatre operation registers, ward registers and case notes of all patients who were admitted into the surgical wards including those who died within 30 days of admission. From the 1st of January 2000 to 31st December 2003. Results: Two thousand, Nine hundred and ninety two (2,992) patients were admitted into the surgical wards under the care of surgeons within the period of study and there were 249 deaths giving an In-hospital surgical mortality rate of 8.3%. Only 124 cases notes could be retrieved from the records dept. (50%). Ninety-seven (78.2%) of these patients were males and 27(21.8%) were females giving a (male: female ratio of 3.6:1). The age of the patients ranged from less than 1yr to 95yrs. Forty three (34.7%) patients were operated upon while 81 (65.35) patients did not have any form of operative intervention because the patients presented late and were in poor clinical states. The ratio of those who were operated upon to those who were not operated upon was 1:1.9. Conclusion: In-hospital surgical mortality of 8.3% in our centre is the same as that for low volume hospitals (LVHS) in developed countries. Also, from this study, In-hospital surgical mortality was not operation related since more deaths occurred in patients who were not operated because of late presentation, hence aggressive enlightenment campaigns aimed at encouraging people to report early to hospital may help to reduce the rate of In-hospital surgical mortality in our centre. Keywords: In-hospital, surgical mortality, operation related.Tropical Journal of Medical Research Vol. 11 (2) 2007: pp. 26-3

ASA classification and in-hospital deaths in surgery

Background: ASA (American Society of Anesthesiologists’) classification appears to have a direct relationship to in-hospital mortality in surgery,provided other factors that can equally affect mortality are favorable.Aims and objectives: To study the relationship between ASA classification and in-hospital mortality within the surgical service in our center.Design: Retrospective study.Setting: Nnamdi Azikiwe University Teaching Hospital, a tertiary institution serving rural, semi-urban and urban communities.Patients and methods: Searching through the records, all the in-hospital deaths that occurred in our center between 1st August 1999 and 31st July2006, a 7-year period, were studied with a view to seeing what the ASA classification of the patients were at the time they were admitted, nature ofsurgical intervention, type of anesthesia, time of death after admission/surgery, and cause of death.Results: A total of 251 in-hospital deaths occurred in the surgical service during the period under review. However, only 106 of the patients(42.2%) had records of ASA classification before death. These were recruited into this study. Ten of the patients (9.4%) were in ASA classification V; 57 (53.8%) were in ASA IV; 32 (30.2%) in ASA III and only seven (6.6%) were in ASA II. None of the patients was in ASA I or ASA VI.Seventy-six patients (71.7%) presented as emergencies.Conclusion: There appears to be a direct relationship between ASA classification and the rate of in-hospital mortality within the surgical service:higher ASA classification being associated with higher in-hospital deaths