Metastatic Carcinoma Of The BreastWith Inguinal Lymph Node Involvement: A Report Of Two Cases

Metastatic carcinoma of the breast may display varied clinicopathological patterns. Lymphatic spread to the inguinal lymph nodes is,however, very rare. To report two cases of advanced breast carcinoma with metastases to the inguinal lymph nodes in two Nigerian women. The University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Two Nigerian women, one aged 40 years with an invasive lobular carcinoma of the right breast, and the other aged 48 yearswith an infiltrating ductal carcinoma of the left breast, presented withmetastases to their corresponding inguinal lymph nodes diagnosed by open biopsy. The first had a right simple mastectomy done and was lost to follow up before any adjuvant therapy could be administered.The second died before any definitive treatment could be offered. Metastasis to the inguinal nodes is rare and signifies an advanced disease. The pathogenesis is speculative, probably fromretrograde embolisation. Keywords:Breast carcinoma,metastases, inguinal lymph nodes Nigerian Journal of Clinical Practice Vol. 11 (4) 2008: pp. 383-38

An audit of basic practical skills acquisition of final year medical students in a Nigerian medical school

Background/Objective: Young medical graduates undertaking their  housemanship are naturally expected to demonstrate reasonable competence in basic practical skills. Failure to do this may not only be a source of anxiety to the doctor but also potentially dangerous to the  patient. The objective was to assess the level of exposure of final year medical students of a Nigerian medical school to basic practical skills.Materials and Methods: This is a descriptive cross-sectional study.  Structured questionnaires were distributed to a set (all) of 86 final year medical students of the University of Port Harcourt immediately after their last lecture in their final posting in medicine and surgery. The  questionnaires listed some selected basic practical skills (e.g. phlebotomy,male urethral catheter insertion, etc.) that house officers are expected to be competent in. The students were asked to anonymously fill them and return same before leaving the lecture hall.Results: Of the 86 students, 84 completed and returned the  questionnaires, giving a 97.7% response rate. No student had performed an arterial puncture for an arterial blood sample. Seventy-six students  (90.5%) had not inserted a naso-gastric tube. Only 14 (16.7%) students had successfully inserted more than 10 intravenous canulae. A significantnumber, 38 (45.2%), had never inserted a urinary catheter (for male  patients) nor had any experience with bag/mask skills. Majority, 59  (70.2%) had had some experience with intravenous antibiotics  administration. Forty-one (48.7%) students had had 6 or more successful attempts at venous blood sampling.Conclusion: The exposure level of final year medical students to basic  practical skills was low

The pattern of trauma in private general medical practice set-up Port Harcourt

BACKGROUND: Private general medical practice establishments appear to be treating a significant number of trauma cases including more serious ones. Aim: To find out the extent of such treatment of trauma and what has made this possible. METHODS: All trauma cases treated in a private general medical practice set up in Port Harcourt between January 1,2000 to December, 31 2002 were studied. The records were analysed with respect to age, sex, type of trauma and treatment given. Also analysed were complications, hospital stay and outcome of treatment. RESULT: Forty-two trauma related cases were treated. The commonest age affected was between the 2nd and 4th decades with a peak in the 4th decade. The male/female ratio was 3.2:1. Lacerations constituted the commonest injury followed by fractures of long bones. Assault and road traffic accidents were the commonest causes of the injuries and males were more commonly involved. The majority of patients (59.5%) were treated and discharged the same day. For those who were admitted, the mean hospital stay was 16.9 days. The more severe and complicated trauma were handled by locum specialist surgeons. The commonest complication encountered was wound infection. There was no mortality. CONCLUSION: A wide variety of trauma cases is now treated at the private general practitioner level. The management of the more complicated trauma is due to the services of specialist doctors. KEY WORDS: Pattern of trauma, private general practice, Port Harcourt Nigerian Journal of Orthopaedics and Trauma Vol.3(1) 2004: 16-1

Ileal carcinoid

No Abstract. Nigerian Journal of Medicine Vol 15 (3) July-September: 340-34

Acute abdominal conditions in people with sickle cell disease: A 10-year experince in Port Harcourt, Nigeria

Background: Abdominal crises (vaso-occlusive) are not infrequent in patients with sickle cell anemia. They usually present as acute abdomen. These patients none the less present with other causes of acute abdomen like others without hemoglobinopathy. Six cases of surgical acute abdomen in sickle cell disease patients treated in the University of Port Harcourt Teaching Hospital (UPTH) are presented. Materials and Methods: Six sickle cell anaemia patients presenting with acute abdominal conditions from 1999 to 2008 (inclusive) in the University of Port Harcourt Teaching Hospital were studied retrospectively (two patients) and prospectively (four patients). After initial resuscitation, appropriate surgical procedures, namely, appendicectomy (2), cholecystectomy (1), open drainage of splenic abscess (1), and release of adhesive band (1) were performed. Results: Six cases were treated (female/male ratio 2:1). Four patients were in the 11-20 year age group. Two patients had appendicectomy and two presented with acute cholecystitis/cholelithiasis, one of whom had open cholecystectomy. One young girl had drainage of splenic abscess and a 42-year-old male had division of obstructive adhesive band at laparotomy. There were two complications, namely, postoperative haemorrhage (in cholecystectomy patient) and acute chest syndrome (in one appendicectomy patient). These were successfully managed with blood transfusion and antibiotic/oxygen therapy, respectively. There was no mortality. Conclusion: Sickle cell anaemia patients are not exempt from acute abdominal conditions requiring surgery. A high index of suspicion coupled with repeated clinical examination is needed for early diagnosis and appropriate treatment.DOI: 10.4103/1596-3519.8207

Gunshot injuries in the Niger Delta region of Nigeria

Background: Violent trauma especially by gunshot injuries appears to be on the increase worldwide. There is inadequate data from many centres in Nigeria to support this observation. Aim: To determine the pattern of gunshot injuries in the University of Port Harcourt Teaching Hospital (UPTH). Methods: This was a prospective study covering a period of three years (January 2002-December 2004). A standard proforma was used to record all cases of gunshot injuries reporting to the UPTH. Details sought were age, gender, occupation, gun type, anatomic region of the body involved and treatment given. Other information recorded were time of injury, duration of hospital stay, injury time before presentation, assailant and outcome. Information was obtained directly from victims, relations, the police or those accompanying the victim. Where surgical operations were done or patients were admitted to the wards, relevant information or findings were then retrieved from theatre and ward records. Results: There were 135 patients (120 males and 15 females) between the ages of 1½ -67 years. Students and civil servants constituted the largest number. Seventy-one injuries were due to high velocity missiles while 64 were low velocity. Armed robbery and attacks by “unknown assailants” were the commonest modes of attack with 47 and 41 victims respectively. The lower limbs, abdomen and chest were the most frequent anatomic regions involved recording 38, 28 and 27 cases respectively. There were 9 cases in which multiple anatomic sites were affected. The majority of patients (56) presented within 12-18 hours after injury; only 9 cases presented within 6 hours. Twenty-nine patients underwent laparotomy while 14 had thoracostomies. Forty-nine patients were treated and discharged. Minor surgery (like wound debridement) was the commonest treatment in 43 patients. All cases of fracture among these were subsequently referred to the trauma unit for appropriate treatment. Thirty patients died giving a mortality rate of 22.2%. Conclusion: Gunshot injuries constitute a major cause of violent trauma in the Niger Delta Region of Nigeria with a high and disturbing level of morbidity and mortality. Port Harcourt Medical Journal Vol. 1(1) September 2006: 34-3

Colorectal carcinoma in Port Harcourt

Background: Colorectal carcinoma, the commonest malignant tumour of the gastrointestinal tract, is rather uncommon in Nigeria, occurring often at a relatively early age. Aim: To report experience with colorectal carcinoma in the University of Port Harcourt Teaching Hospital (UPTH). Methodology: Patients treated for colorectal cancer at the UPTH over a 19- year period (1987-2006) and had complete information, were studied. Data were collected from patients\' case notes, ward registers, theatre records and histopathology reports. The data were analyzed with respect to age, gender, clinical features and investigations. Other indices studied were treatment, postoperative complications, duration of hospital stay and outcome/mortality. Results: The records of 36 cases were available for study. Male to female ratio was 2:1. The 41-60 year age range recorded the highest number of cases (52.8%). Weight loss, change in bowel habit, rectal bleeding, and abdominal/rectal mass constituted the main symptoms. Diagnosis was made from clinical examination, double contrast barium enema and proctosigmoidoscopy/biopsy. The rectum and caecum/ascending colon were commonly affected. The appropriate surgical treatment was duly performed. Some patients had postoperative adjuvant treatment using 5-fluorouracil only. Postoperative complications included surgical site infection, persistent perineal discharge, perineal pain, and obstruction of colostomy, hepatic encephalopathy and obstructive uropathy. The average duration of hospital stay was 12 days and follow-up assessment ranged from 3 months to 14 years. The postoperative mortality at three years was high. Conclusion: Colorectal carcinoma is relatively uncommon in our environment. The younger age groups tend to be more affected. Late presentation resulted in poor survival in spite of surgical treatment and adjuvant therapy. Keywords: Colorectal carcinoma, Port Harcourt, Late presentation, Low survival ratePort Harcourt Medical Journal Vol. 2 (3) 2008: pp. 198-20

Entero-utero-vaginal fistula: a rare complication of unsafe abortion

Background: Pregnancy whether wanted or not poses significant risks for women especially in developing countries with wide spread ignorance,  poverty and limited facilities. Unsafe abortion exposes them to increased morbidity and mortality. Aim: To report a case of entero-utero-vaginal fistula in a teenager following unsafe abortion. Setting: University of Port Harcourt Teaching Hospital , Port Harcourt. Case report: A 17-year-old secondary school girl who terminated a mid trimester pregnancy with unskilled health providers is presented. Her  uterus  and  a  loop  of  small   bowel  were perforated leading to leakage of faeces through the uterus and vagina. She had a laparotomy for the repair of the perforated uterus and resection and end-to-end anastomosis of the damaged small bowel. She was discharged in a satisfactory state but with enormous social and financial post abortion care. Conclusion: This case highlights the need for continued emphasis on preventing unsafe abortion, abstinence, contraceptive services and access to safe abortion.    Key words: Unsafe abortion, Entero-utero-vaginal fistul