Phaeochromocytoma in a 4-year old girl: case report

This is a report of a 4-year old female Nigerian patient with phaeochromocytoma, a rare surgically correctable cause of hypertension, highlighting the problems in diagnosis and management in our sub region with review of the literature

Missed Diagnosis of a Delayed Diaphragmatic Hernia as Intestinal Obstruction: A Case Report

Penetrating diaphragmatic injury rarely occurs in isolation. Diagnosis of traumatic diaphragmatic hernia resulting from penetrating diaphragmatic injury may be delayed or missed with attendant high morbidity and mortality. We reported a 28-year-old man who presented with features of subacute intestinal obstruction which became severe over the last four days. He had a stab injury to his left lower chest wall that was sutured 31/2 years prior to the development of symptoms. Emergency laparotomy with incidental findings of missed diaphragmatic hernia with gangrenous jejunal segment was found. The hernia was reduced, gangrenous segment  resected with end to end anastomosis, and repair of diaphragmatic rentdone. He had an uneventful recovery and follow up. There is the need to maintain high index of suspicion of Traumatic Diaphragmatic Hernia (TDH) in a patient with recent or previous thoraco-abdominal injury that will reduce the rate of missed or delayed diagnosis.Key words: penetrating chest injury, diaphragmatic hernia, delayed, missed diagnosis

Tuberculous Ileal Perforation In A HiV Positive Patient A Case Report And Review Of Literature

Tuberculosis is prevalent worldwide. Even in developed countries there is a resurgence of tuberculosis mainly due to increasing HIV infection. Tuberculous ileal perforation is uncommon. It is, however, a potentially fatal complication of intestinal tuberculosis especially inHIV/AIDS patient. To highlight tuberculous ileal perforation as an underestimated complication of intestinal tuberculosis in anHIVpatient presentingwith acute abdomen. A 42 year old HIV positive long distance truck driver with tuberculous ileal perforation is presented and related literatures reviewed. Intestinal perforation due to abdominal tuberculosis is an aetiological factor in acute HIV abdomen.High index of suspicion remains the key to diagnosis.Keywords: Tuberculosis, Ileal Perforation,HIV Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 386-38

Isolated gallbladder rupture following blunt abdominal trauma

The gallbladder is a relatively well‑protected organ; consequently its rupture following blunt abdominal injury is rare and usually associated with other visceral injuries. Isolated gallbladder rupture is extremely rare. We report a healthy Nigerian adult male who sustained isolated gallbladder rupture following blunt abdominal injury from riding a motor cycle (Okada). A high index of suspicion with positive bile aspirate might lead to early diagnosis. Open cholecystectomy is a safe option of treatment in a resource poor centre especially in delayed presentation and has a good outcome.Key words: Blunt abdominal trauma, gallbladder rupture, isolate

Outcome of surgery for toxic goitres in maiduguri: A single teaching hospital’s perspective

Background: Thyrotoxicosis a common endocrine disorder of the thyroid gland in Nigeria is commonly treated surgically. The outcome of thyroidectomy for toxic goiters in Maiduguri Nigeria is evaluated.Materials and Methods: Over the last 5 years (Jan 2005-July 2010), in a prospective review, the demographic, and clinical data of patients operated for toxic goiters in our department was entered, into a predesigned proforma and analyzed. The objective of the study is to review our experience with subtotal and near-total thyroidectomy as treatment for benign toxic goiters.Results: Seventy-eight patients, 11 males (14.1%) and 67 females (85.9%), with male: female ratio of 1:6.1 and the mean age of 30 ± 10.9 (range, 17-65 years), underwent thyroidectomy for toxic goiters. The mean duration of symptoms was 41.9 (range 3-126 months). There were 53 patients with toxic diffuse goiters (Grave’s disease) with their mean age of 27.6 ± 6.93 (range 17-38 years), 23 with toxic multinodular goiters, the mean age of 43.7 ± 15.68 (range 17-65 years) and two with toxic nodule. There was no case of permanent recurrent laryngeal nerve palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 9 (11.5%) patients and hemorrhage with hematoma, requiring exploration in 4 (5.1%). There were two cases of wound infection and no postoperative mortality. The mean hospital stay was 7.6 ± 2.34 (range 5-15 days). There was no disease recurrence over a mean follow-up of 20.7 (range 2-48) months.Conclusion: Subtotal thyroidectomy is an effective procedure for the treatment of thyrotoxicosis with few postoperative complications and majority of patients being euthyroid after long follow-up

Transmission Selects for HIV-1 Strains of Intermediate Virulence: A Modelling Approach

Recent data shows that HIV-1 is characterised by variation in viral virulence factors that is heritable between infections, which suggests that viral virulence can be naturally selected at the population level. A trade-off between transmissibility and duration of infection appears to favour viruses of intermediate virulence. We developed a mathematical model to simulate the dynamics of putative viral genotypes that differ in their virulence. As a proxy for virulence, we use set-point viral load (SPVL), which is the steady density of viral particles in blood during asymptomatic infection. Mutation, the dependency of survival and transmissibility on SPVL, and host effects were incorporated into the model. The model was fitted to data to estimate unknown parameters, and was found to fit existing data well. The maximum likelihood estimates of the parameters produced a model in which SPVL converged from any initial conditions to observed values within 100–150 years of first emergence of HIV-1. We estimated the 1) host effect and 2) the extent to which the viral virulence genotype mutates from one infection to the next, and found a trade-off between these two parameters in explaining the variation in SPVL. The model confirms that evolution of virulence towards intermediate levels is sufficiently rapid for it to have happened in the early stages of the HIV epidemic, and confirms that existing viral loads are nearly optimal given the assumed constraints on evolution. The model provides a useful framework under which to examine the future evolution of HIV-1 virulence

Pattern and management of chest injuries in Maiduguri, Nigeria

Background: Chest injuries constitute a continuing challenge to the trauma or general surgeon practicing in a developing country. This study reviews the pattern and management of these injuries mainly by general surgeons. Methods: A retrospective review of 78 patients admitted into the surgical wards of the University of Maiduguri Teaching Hospital (UMTH) with chest injuries between January 1997 and December 1999. Results: Over the three-year period, 78 patients with various forms of chest injuries were managed in the UMTH. There were 62(79.5%) males and 16 (20.5%) females, giving a male to female ratio of 3.8:1. The age ranged between 5 - 67 years with a mean of 32.28 years. Most of the injuries 48(61.53%) were penetrating; 24(30.76%) were due to low velocity guns, 10(12.8%) from arrow shots and 6(10.34%) from stab wounds. Blunt injuries constituted the remaining 30(38.46%) and were all as a result of road traffic accidents (RTA). All patients had chest radiographs from which the commonest lesions; simple rib fractures, haemopneumothorax, haemothorax and pneumothorax were diagnosed. There were none with major vascular or oesophageal injuries. The commonest extra-thoracic associated injuries were limb fractures and abdominal injuries. Most patients 44(56.4%) required tube thoracostomy as definitive treatment. Four patients (5.12%) required thoracotomy. The commonest complications were infective in nature. The overall mortality was 2.56%. Conclusion: There was a high incidence of chest injuries following gun shuts and arrow shots from armed bandits. The management of seemingly serious chest injuries were well within the competence of general surgeons. Key Words: Chest injuries, pattern, management Annals of African Medicine Vol.3(4) 2004: 181-18

Aetiology, management and outcome of entero-cutaneous fistula in Maiduguri, Nigeria

Background: Enterocutaneous fistula (ECF) remains an important surgical problem with significant morbidity and mortality. This study aims to review the aetiology and management outcome in a depressed economy like ours. Methods: A retrospective review of 54 patients with ECF admitted into the surgical wards of the University of Maiduguri Teaching Hospital (UMTH) between January 1994 and December 2004 (11 year period ). Results: Thirty two (59.3%) were males and 22 (40.7 %) were females giving a male/female ratio of 1.5 to 1. The age ranged from 1 to 58 years with two peak incidents of 20-29 years and 40-49 years. Eighteen cases (33% ) occurred following appendicectomy, 12 (22% ) following laparotomy for intestinal obstruction, 10 (18.5% ) following laparotomy for abdominal malignancies, 7 (13% ) followed laparotomy for penetrating abdominal injuries, 3 (5.5% ) followed laparotomy for perforated typhoid enteritis, 2 (3.7 %)cases were due to spontaneous rupture of strangulated and neglected inguinal hernia, 1 (1.9% )case followed chest tube insertion for pleural effusion in a PTB patient and 1 (1.9% ) case followed a native healer's incision on a lumber hernia. Altogether,45 (83.3%) were referred cases from peripheral hospitals.Fourty one (76%) were high output type, while 13 (24%) were low output type. . Most patients 32 (59.3%) healed spontaneously on conservative management. Eighteen (33% ) had surgical intervention . Eight patients demised giving a mortality rate of 15%. The average hospital stay was 56 days. Conclusion: The main cause of ECF in our environment is postoperative (94.4%) with post appendicectomy cases alone accounting for 33%. Majority of our patients (66.7%) were managed conservatively. Keywords: Enterocutenous fistulae; aetiology; management; outcome; Maiduguri Nigerian Journal of Clinical Practice Vol.10 (1) 2007: pp.47-5