Giant solitary neurofibroma in the gluteal area of a patient without neurofibromatosis

Neurofibromas are benign tumours arising from neurons and perineural cells. Although they are common in neurofibromatosis, occasionally solitary neurofibromas may occur. A rare case of solitary neurofibroma presenting as a giant gluteal mass in a male patient without a personal or family history of neurofibromatosis is presented. Pre-operative imaging gave useful information about the extent of the mass which was then totally excised with histology revealing a non-plexiform neurofibroma. Distinguishing between isolated neurofibromas and those associated with neurofibromatosis is important because the treatment and prognosis differ greatly with the former having a good prognosis after total excision

Prevalence of cholelithiasis among persons undergoing abdominal ultrasound at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

Background: The prevalence of gallstones among Ghanaians is unknown. We aimed to determine the prevalence of gallstones among persons undergoing abdominal ultrasound at the Komfo Anokye Teaching Hospital (KATH).Methods: We performed a cross-sectional study of patients aged ≥14years presenting to KATH for abdominal ultrasound between 2009 and 2012. Patient demographics were recorded. The gallbladder was assessed by ultrasonography. Cholelithiasis was defined as presence of gallstones or absence of gallbladder. Data was expressed as descriptive and inferential statistics.Results: There were 2824 participants. 55% were females. Mean age was 47±18 years. Mean body mass index (BMI) was 24.0±5.5. Mean parity among females was 3±3. Prevalence of cholelithiasis was 5.9 (95%C.I:5.0,6.8). Females had a high prevalence compared to males (6.8 vs 4.7). Prevalence increased steadily by age. Prevalence was 6.6, 5.1 and 8.8 for patients with BMI <18.5, 18.5-24.9 and ≥30 respectively. Prevalence among women with parity of 0,1-5 and >5 was 3.1, 6.7 and 6.4 respectively.On multivariate regression analysis, female sex (AOR=1.55;p<0.05), age≥40 years (AOR=2.05;p<0.01), BMI<18.5 (AOR=1.25;p>0.05) or BMI≥30 (AOR=1.39;p>0.05) and family history of gallstones (AOR=11.9;p<0.01) increased the odds of cholelithiasis.Conclusions: Prevalence of cholelithiasis among patients undergoing ultrasonography at KATH was 5.9. Patient age, sex and family history significantly influenced the prevalence.Key words: Cholelithiasis, Prevalence, Kumasi, Ghan

Surgical Treatment of Peripheral Aneurysms in Patients with Behcet’s Disease

AbstractIntroductionOur aim was to report our experience with 23 patients presenting with 32 peripheral aneurysms secondary to Behcet’s disease (BD) and their outcome after vascular surgery.MethodsThe study was retrospective in nature. Except for those presenting with aneurysm rupture, patients underwent surgery after treatment of acute inflammatory lesions. All aneurysms appeared to be pseudo-aneurysms. Graft interposition with polytetrafluoroethylene or saphenous vein was most commonly employed. Postoperatively, all patients were put on immunosuppressive and antiplatelet therapy. Follow-up was done every 6–12 months, complications recorded and managed appropriately.ResultsAll the patients were males. The mean age at diagnosis of a peripheral aneurysm was 41.0 ± 9 years. There were 17 (53%) femoral, 8 (25%) popliteal, two carotid, two external iliac, two brachial and one internal iliac aneurysms. Fourteen (61%) patients had a single peripheral aneurysm while nine had two. Surgery was performed for all initially presenting 23 aneurysms. Six patients with multiple peripheral aneurysms had surgery for their second asymptomatic aneurysm. The mean follow-up period was 84 ± 62 months. Of 29 aneurysms operated on, 7 (24%) anastomotic pseudo-aneurysms and 11 (38%) graft occlusions developed. Five (22%) patients underwent major lower extremity amputations. Six (26%) mortalities were recorded.ConclusionSurgery for peripheral aneurysms in BD is warranted in many instances. Results of operation can be improved by prolonged monitoring. However, despite all efforts, peripheral aneurysm involvement in BD worsens the prognosis

Intestinal obstruction in older children in Komfo Anokye Teaching Hospital: A tertiary referral centre in Kumasi, Ghana

Background Childhood intestinal obstruction can either be congenital or acquired and both types result in high morbidity and mortality in  developing countries, mainly as a result of late presentation and diagnosis.Patients and methods From January 2007 to December2010, a retrospective analysis of all older children with  intestinal obstruction admitted to Komfo Anokye Teaching Hospital (Kumasi, Ghana) was carried out. This was to establish the causes of intestinal obstruction and to determine its morbidity and mortality among the children studied.Results There were 98 children who were treated with a diagnosis of intestinal obstruction during the period. The mean age of the children, in months, was 34.7 ±5.0 SEM (range 3–180, median age 10 months), with a male : female ratio of 1.5 : 1. About 70.6% of the children were  admitted with acquired causes of intestinal obstruction and 29.4% with congenital causes of intestinal obstruction. In all, 21.2% of the children, treated for intestinal obstruction, underwent bowel resection as a result of nonviability of a segment of the intestine; the majority of the bowel resections were performed in the intussusception group. The mean length of hospital stay, in days, was 8.2± 5.7. There were 15 children (15.3%) with various postoperative complications, mainly surgical site infections; the mortality rate was 11.2%. Here again, most of the deaths occurred in the intussusception group of children.Conclusion Intestinal obstruction is a serious emergencyin children and must be diagnosed early and treated  promptly to avoid high morbidity and unnecessary deaths among children in our subregion

Starting a Laparoscopic Surgery Programme in the Second Largest Teaching Hospital in Ghana

Background: Komfo Anokye Teaching Hospital (KATH) is the second  largest hospital in Ghana. Two years have elapsed after performance of the first laparoscopic cholecystectomy.Objectives: To examine our experience and lessons learned.Design: Retrospective review.Setting: Komfo Anokye Teaching Hospital (KATH). Subjects: We reviewed leadership support, the role of a surgeon champion, training of physician and OR staff, influence of surgeons from outside Ghana and equipment status. The results of laparoscopic cholecystectomies performed from 2010-2012 were compared with information available from open cholecystectomies over the same period.Results: Evidence of leadership support included equipment purchase and invitation of outside experts yearly from 2008. A KATH surgeon champion was identified in 2010. A dedicated OR team received training and exhibited excellent ownership of equipment preparation. Since 2010, 25 laparoscopic cholecystectomies have been performed, 17 independently by a single surgeon. Average operative time was 1.41 hours and length of stay (LOS) 1.5 days. Conversion rate was 4.0%(1/25). Complication rate was 20.0%(5/25), none involving haemorrhage or injuries to bile ducts or bowel. Median patient satisfaction score was 5 on a scale of 1-5 where 5 is most satisfied. Complication rates and hospital stay were lower than for open cholecystectomy (20.0%vs34.5%, p>0.05 and 1.5days vs 6.6days, p<0.001 respectively). Operative times were on average 27min onger for laparoscopic cholecystectomy (p<0.01).Conclusion: Laparoscopic cholecystectomy at KATH has become a reality with less complications rates, shorter LOS, and trends towards improved patient satisfaction. Expanding laparoscopic surgery in Ghana requires its inclusion into residency training programmes and public education about its benefits for both patients and physicians

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London