Peripheral vascular injuries and their management in Accra

Background: The true incidence of vascular injuries in Ghana is not known on account of low reporting. Objective: We performed a study aimed at reviewing the pattern of injuries to peripheral vessels, and also the pattern of referral, presentation and management of these injuries at the Korle-Bu Teaching Hospital, Accra. Method: The study covered the period of January 1989 to March 2005 and involved a review of all peripheral vessel injuries referred for vascular surgical opinion.Results: Fifty two (52) patients with aged between 13- 50 years were reviewed. Penetrating trauma (82.7%) and blunt trauma (11.5%) were the commonest modes of injury. Arterial injuries (63.5%) and combined arterial and venous injuries (23.1%) were the commonest forms of injury. Brachial artery injuries were the commonest injuries seen. Associated nerve injuries occurred in 25% of patients most of whom also had brachial artery injuries. Late presentations of false aneurysmsand arteriovenous fistulae were seen in 40.4% patients. There were delays in referring patients (range 1 hour to 4 years). Vascular investigations like angiograms and duplex scanning were obtained in only 25.0% of patients. Vascular reconstruction was successfulin 84.6% patients and 7.7% of patients required major limb amputation and an equal number of patients died from other injuries. Conclusion: There is undue delay in referring patients with vascular injuries for intervention due to the inability of the initial attending medical personnel to recognize these injuries. Most of these injuries can be adequately treated without the use of sophisticated investigations,which are usually expensive

A study of breast cancer in korle bu teaching hospital: assessing the impact of health education

Introduction: Many patients with breast cancer report late with advanced disease. It is not known if recent breast awareness education programmes have led to a change in this trend at the Korle BuTeaching hospital (KBTH). Method: A prospective study of the characteristics of breast cancer patients seen by a surgical unit atKBTH over a three year period. Results: There were 158 patients, 156 females and 2 males. The age group most commonly affectedwas 40-49. The upper outer quadrant of the breast was affected in 67/158 (42.4%) and all quadrants affected in 29/158 (18.4%). Ninety one (57.6%) had Stage III – IV disease and the average durationof symptoms was 10 months. Average tumour size was 6cm x 7cm. Diagnosis was by triple assessment with Fine needle aspiration cytology the most frequently used pathological investigation.Invasive ductal carcinoma was the commonest pathological type (115/134). Eighty three (52.5%) had mastectomy and 12 (7.6%) had wide local excision. Neoadjuvant chemotherapy was given to 77/123 (62.6%), 5 of whom had complete pathological response. Fifty five (34.8%) were lost to follow up: 20 before treatment commenced, 15during or after neoadjuvant chemotherapy and 14 after treatment. Eleven developed lymphoedema. There were 42 metastatic events affecting 35 patients during follow-up, including pleura (11),brain (10) and lungs (9). Conclusions: Breast cancer continues to affect a young population and patients still present late with advanced disease. Education needs to be intensified, but research into the reasons for late presentation will help address the reasons/ misconceptions responsible for this state of affairs

A study of breast cancer in korle bu teaching hospital: assessing the impact of health education

Introduction: Many patients with breast cancer report late with advanced disease. It is not known if recent breast awareness education programmes have led to a change in this trend at the Korle BuTeaching hospital (KBTH). Method: A prospective study of the characteristics of breast cancer patients seen by a surgical unit atKBTH over a three year period. Results: There were 158 patients, 156 females and 2 males. The age group most commonly affectedwas 40-49. The upper outer quadrant of the breast was affected in 67/158 (42.4%) and all quadrants affected in 29/158 (18.4%). Ninety one (57.6%) had Stage III – IV disease and the average durationof symptoms was 10 months. Average tumour size was 6cm x 7cm. Diagnosis was by triple assessment with Fine needle aspiration cytology the most frequently used pathological investigation.Invasive ductal carcinoma was the commonest pathological type (115/134). Eighty three (52.5%) had mastectomy and 12 (7.6%) had wide local excision. Neoadjuvant chemotherapy was given to 77/123 (62.6%), 5 of whom had complete pathological response. Fifty five (34.8%) were lost to follow up: 20 before treatment commenced, 15during or after neoadjuvant chemotherapy and 14 after treatment. Eleven developed lymphoedema. There were 42 metastatic events affecting 35 patients during follow-up, including pleura (11),brain (10) and lungs (9). Conclusions: Breast cancer continues to affect a young population and patients still present late with advanced disease. Education needs to be intensified, but research into the reasons for late presentation will help address the reasons/ misconceptions responsible for this state of affairs