Postcoital Haemoptysis: A Case Report and a Review of the Literature

Haemoptysis is rarely reported following coitus, and cardiac decompensation has been mostly implicated in the aetiology. We present a 53-year-old Nigerian, known hypertensive diabetic woman with background ischaemic heart disease who presented with postcoital haemoptysis of one-year duration. Echocardiography revealed combined ischaemic and mitral valvular heart disease, probably of rheumatic aetiology. There has been no previous report in an African population. This case illustrates the need to rule out coitus as a rare but potential cause of haemoptysis in middle aged patients with underlying cardiac pathologies and the need for an extensive cardiac workup in a population with predominantly pulmonary causes of haemoptysis

Urethral Reconstruction Using Cell-Based Tissue Engineering Approaches

The estimated prevalence of urethral stricture disease is 229–627 per 100,000 males, though there are regional variations. Trauma, either from external force or iatrogenic causes, is currently the most common single cause of urethral stricture, although, as with prevalence, there are geographical variations. The presentation usually occurs with lower urinary tract symptoms, sometimes with urinary retention and, rarely, with watering can perineum. The symptoms are best evaluated with a combination of the American Urological Association (AUA) Symptom Index and urinary flow rate measurements for both new cases and suspected recurrences. Time-tested retrograde urethrography remains the gold standard for a confirmatory diagnosis; however, it is limited by its inability to evaluate the posterior urethra and associated morbidities, such as abscesses and fistulas, thus three-dimensional imaging techniques are emerging as adjunct investigations. These modalities are not currently used universally, but their unavailability is not expected to be a serious hindrance to decision-making by a versatile reconstructive urologist. Urethroplasty is regarded as the gold standard treatment for urethral stricture; excision and primary anastomosis, buccal mucosa graft, skin graft, and pedicle flap techniques have all been used. Notably, buccal mucosal graft urethroplasty has gained popularity above the others because of its versatility and success rate; this is considered to equate to urethral tissue engineering, which is at present confined to only a few centres

Management of chest drains: A national survey on surgeons-in-training experience and practice

Background: Chest tube insertion is a simple and sometimes life-saving procedure performed mainly by surgical residents. However with inadequate knowledge and poor expertise, complications may be life threatening. Objective: We aimed to determine the level of experience and expertise of resident surgeons in performing tube thoracostomy. Methodology: Four tertiary institutions were selected by simple random sampling. A structured questionnaire was administered to 90 residents after obtaining consent. Results: The majority of respondents were between 31 and 35 years. About 10% of respondents have not observed or performed tube thoracostomy while 77.8% of respondents performed tube thoracostomy for thefirst time during residency training. The mean score was 6.2 ± 2.2 and 59.3% of respondents exhibited good experience and practice. Rotation through cardiothoracic surgery had an effect on the score (P = 0.034). About 80.2% always obtained consent while 50.6% always used the blunt technique of insertion. About 61.7% of respondents routinely inserted a chest drain in the Triangle of safety. Only 27.2% of respondents utilized different sizes of chest tubes for different pathologies. Most respondents removed chest drains when the output is <50 mL. Twenty-six respondents (32.1%) always monitored air leak before removal of tubes in cases of pneumothorax. Superficial surgical site infection, tube dislodgement, and tube blockage were the most common complications. Conclusion: Many of the surgical resident lack adequate expertise in this lifesaving procedure and they lose the opportunity to learn it as interns. There is a need to stress the need to acquire this skill early, to further educate and evaluate them to avoid complications