Spinal anaesthesia in lower abdominal and limb surgery: A review of 200 cases

Background: Modern technology has produced better equipment than was available hitherto with the result that spinal anaesthesia is undoubtedly simpler, cheaper and above all, safer than it used to be. These notwithstanding, it is used infrequently. The aim of the study was to evaluate the safety, benefits and applicability of subarachnoid spinal anaesthesia in a tertiary referral centre in a developing country.Methods: This was a prospective analysis involving 200 patients requiring anaesthesia for lower abdominal and limb surgery at the Jos University Teaching Hospital, Jos. Subarachnoid spinal anaesthesia was performed through the L2/L3 or L3/L4 interspace employing either 0.5% bupivacaine hydrochloride in 8% glucose monohydrate (Marcain heavy Astra) 2-4mls or 5% lignocaine (heavy xylocaine Astra) 1-2mls. Patients with uncorrected or undercorrected hypovolaemia, uncorrected anaemia or heart disease, local sepsis and those on anticoagulant therapy or who had bleeding disorders were excluded. Also excluded were children. Results: A total of 200 patients with age range of 15-90 years and a mean age of 34.48 years were studied. The male to female ratio was 1:1.74. Eighty of them underwent caesarean section (38 emergency and 42 electives), 26 prostatectomy, 24 appendicectomy, 19 herniorraphy, 11 haemorrhoidectomy, 9 fissurectomy, 7 total abdominal hysterectomy, 5 Manchester operation, 4 myomectomy, while the remaining 15 were for other procedures involving the lower abdomen or limb. Complications noted were: nausea (17.50%) and vomiting (3.5%), pain at injection site (15.5%), chills/shivering (15.0%), post-spinal headache (0.5%) and hypotension (3.0%). Subarachnoid anaesthesia was non-fatal. One hundred and ninety patients (95%) were satisfied with spinal anaesthesia. Conclusion: Spinal anaesthesia though safe is not without hazards. Spinal anaesthesia may be used for most operations in the lower abdomen (including caesarean section), perineum or leg. Nigerian Journal of Surgical Research Vol. 7(1&2) 2005: 226-23

Analysis of some risk factors for abruptio placentae in Jos, northern Nigeria

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The Outcome of Preoperative HIV Screening for Gynaecological Patients in North Central Nigeria

Background: The incidence of HIV is high in sub-Saharan Africa including Nigeria despite interventions to check the disease. This study aimed to determine the prevalence of HIV among women with gynaecological conditions.Patients and Methods A retrospective analysis of women undergoing gynaecological operations between 2008 and 2010. Results A total of 109 (42%) patients were screened for HIV pre operatively. Their mean age was 31.6 years. Six (5.5%) of the 109 patients tested positive for HIV. All the patients who tested positive were married. Conclusion There appears to be a high prevalence of HIV infection among women with gynaecological conditions in our setting.Keywords: HIV, prevalence, women, gyanecological operation

Persistent Breech Presentation in a Bicornuate Uterus: A Case Report

We report a case of persistent breech presentation in a primigravida with bicornuate uterus that was initially diagnosed by early ultrasound scan. Persistent breech presentation later in the pregnancy necessitated an elective caesarean section at term. The diagnosis was confirmed intraoperatively by exteriorizing the uterus. The literature regarding bicornuate uterus was reviewed.Key Words Bicornuate Uterus, Persistent Breec

The Impact of HIV/AIDS Epidemic on the Choice of Specialties among Medical Students and House officers in Jos, Nigeria

Background: HIV/AIDS is a scourge that has seriously compromised the lives of millions of people, especially those living in sub-Saharan Africa. With continued high prevalence, there is a high risk of healthcare workers, especially those in the surgical specialties, acquiring the infection. This study was done to investigate the impact of HIV on the choice of surgical specialties in a training institution located in Jos, north-central Nigeria. We hypothesized that the awareness of the risk of acquiring infections associated with surgical practice has no significant impact on the choice of surgical specialties among final-year medical students and house officers at our institution. Method: A cross-sectional questionnaire based survey was conducted on final-year medical students and house officers during their training in Jos University Teaching Hospital (JUTH), Jos. Two hundred questionnaires were randomly distributed to final year medical students and house officers who volunteered to participate in the survey. The completed questionnaires were returned to the researchers and information obtained was analyzed using Epi info 3.3. Results: Of the 200 questionnaires distributed, 135 with relevant information were returned for analysis, giving a response rate of 67.5%. Of these respondents, 96.3% said they planned to specialize after their basic medical training and the majority of these (97.8%) were aware of the increased risk associated with surgical specialties, with 83.7% acknowledging the transmission of HIV and hepatitis B as being the greatest risk. About 53.0% of the respondents said they planned to pursue surgical specialties. Fifty three percent (53.3%) and sixteen Percent (16.3%) based their choice of specialty on job satisfaction and favourable work schedule respectively. The knowledge of the risk of acquiring HIV/AIDS affected choice of specialty in only 21% of the respondents. Conclusion: The awareness of most recently graduated medical doctors and final-year medical students of the risk of acquiring HIV in surgical specialties seems to have not deterred them from wanting to pursue surgical specialties. We recommend improvements in the work environment and adherence to universal precautions to reduce the risk of transmission of HIV and other infections to surgeons practicing in the region. Keywords: HIV/AIDS, choice of surgical specialties, Jos.Nigerian Journal of Medicine Vol. 17 (2) 2008: pp. 203-20

A Four Year Review of Foetal Outcome of Obstructed Labour in Jos, Nigeria

Background: In developed parts of the world, obstructed labour and its attendant sequelae are almost nonexistent. In most developing countries however, the situation is quite different. Obstructed labour occurs with high frequency and is associated with poor obstetrical outcome. The aim of this study was to assess the foetal outcome of obstructed labour in Jos, Nigeria.Methodology: The records of 390 patients with obstructed labour managed over 4-years in Jos University Teaching Hospital (JUTH) out of the 8840 women who delivered during the period were retrieved and studied retrospectively. The data were analyzed using descriptive statistics with Microsoft Excel 2007.Result: The women were aged 16 to 40 years, 52.8% of them were below the ages of 20 years. Majority of the women (42%) were primigravidae. The incidence of obstructed labour was 4.98%. Most of the babies (70%) weighed more than 3.4kg. The perinatal mortality rate was 46.9%.Conclusion: Obstructed labour is quite common in Jos and is associated with very high foetal wastage. Reducing early marriages and expanding access to emergency obstetrics services for women with childbirth emergencies will improve maternal and foetal outcome among women with obstructed labour

A 10-year audit of gynaecological surgeries performed in the paediatric age group at the Jos University Teaching Hospital

Background: Surgeries performed for gynaecological conditions in children and adolescents are not common in our environment. Adequate facilities and the skill to perform the required procedures may also be lacking. We were interested in reviewing the practice of paediatric gynaecological surgery in our facility.Patients and Methods: A retrospective study of case files and theatre records of children below the age of 16 years who had surgeries at the Jos University Teaching Hospital over a 10 year period was undertaken.Results: A total of 89 surgeries were performed in this age group during the period under review. Twentyeight (33.4%) of the patients were below the age of 11. The most common surgical procedure was for themanagement of septic abortion (21.3%). Correction of congenital malformations of the genital tract accounted for 21.4% (19) of the surgeries performed. Fourteen (15.7%) laparotomies were performed for ovarian cysts. Conclusion: Though the number of surgeries performed on children for gynaecologic reasons may appear small, the skills required to manage them should be enhanced and the requisite facilities provided

Analysis of cases of rape as seen at the Jos University Teaching Hospital, Jos, north central Nigeria

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Splenic rupture masquerading ruptured ectopic pregnancy

Ectopic pregnancy has been described as a ‘great masquerader'. It mimics virtually every condition that causes acute abdomen in women of reproductive age group. The classical triad of presentation of delayed menses, irregular vaginal bleeding and abdominal pain may not be encountered at all! Overwhelming features of abdominal pain, amenorrhea, pallor, abdominal tenderness, shifting dullness with positive pregnancy test gave a clinical diagnosis of ruptured ectopic pregnancy. At laparotomy, an intrauterine gestation with normal tubes and ovaries with complete splenic rupture were found. She had total splenectomy. Highland Medical Research Journal Vol. 4(1) 2006: 119-12