Inferior vena cava injury: survival of a rare case

The inferior vena cava is the most commonly injured abdominal vessel and accounts for about 25% of abdominal vascular injuries. Despite improved preoperative care and operative techniques, the mortality rates for the inferior vena cava injuries are still high due to delayed presentation, inadequate or delayed fluid resuscitation, difficulty of diagnosis and technical problems in repair. A case of the inferior vena cava injury encountered after abdominal stabinjury with about 4cm vertical tear of infrarenal vena cava, survived due to immediate transportation, appropriate and successful perioperative fluid and blood resuscitation, prompt surgical management with a team approach and critical post-operative surgical management.Keywords: The inferior vena cava (IVC), stab wound, venorrhaphy, haemoperitoneu

The impact of delays on the outcomes of emergency abdominal surgeries in Komfo Anokye Teaching Hospital, Kumasi, Ghana

Emergency abdominal surgery is the most appropriate intervention for patients who suffer traumatic abdominal injuries, acute surgically-related disease processes, or surgical complications. The greater burden of difficulty in accessing surgical care falls on those living in low and middle income countries (LMICs). The situation is often associated with undue delays for surgical intervention for emergency admission. A descriptive cross-sectional and quantitative research design was used to sample 109 participants using a convenience sampling technique with well-defined inclusion criteria. Data were collected with a structured questionnaire, using an electronic data-collecting tool and extracted onto STATA 13 for analysis. A multivariate logistic regression analysis was carried out, taking into consideration odd ratios where statistical significance was derived with p<0.05. Sixty-eight (62.4%) of the participants were males and 41 (37.6%) females. A delay of more than 24 hours from the onset of symptoms was found in 58.7%. Delays in the decision to go to the hospital (pre-hospital delay) and waiting time in the theatre bay (in-hospital delay) were significantly associated with long stay in hospital

A Conceptual Shift in Educational Logo Designs: The Impact of Kwame Nkrumah’s Cultural Policy on Ghana’s Educational Philosophy

This paper explores the conceptual shift in educational logo designs as an indirect result of Kwame Nkrumah’s cultural policies on Ghana’s educational philosophy. The study was an Art Historical research situated within the qualitative research paradigm and the data collection instruments used were interviews, field notes, observation and discussions. It had a population of a defined class of cultural policy makers, art historians, traditional rulers, nationalists, visual artists and Ghanaians resident both in and outside Ghana. The study was concerned with qualities and non-numerical characteristics of the data. The data collection techniques used was observation and structured interviews and the data collected was in the form of narrations. The study examined how the ideologies of the founding fathers of the formal educational institutions established in Ghana both before and after political independence. It identifies the significance of the ethnic insignias and Adinkra symbols used in capturing their visual corporate identities as against the reorientation of the thinking of the “new” Ghanaian. The selected educational institutions used for the study are Adisadel College - Cape Coast, Wesley Girls' Senior High School - Cape Coast, St. Augustine’s College - Cape Coast, Ghana National College - Cape Coast, University of Cape Coast - Cape Coast, Kwame Nkrumah University of Science & Technology – Kumasi and University of Education, Winneba – Winneba. Keywords: Adinkra, Ideologies, Kwame Nkrumah’s cultural policies, Philosophy of Africa’s formal education

Increasing Liana Abundance and Basal Area in a Tropical Forest: The Contribution of Long‐distance Clonal Colonization

Recent evidence suggests that liana abundance and biomass are increasing in Neotropical forests, representing a major structural change to tropical ecosystems. Explanations for these increases, however, remain largely untested. Over an 8‐yr period (1999–2007), we censused lianas in nine, 24 × 36 m permanent plots in old‐growth and selectively logged forest at La Selva Biological Station, Costa Rica to test whether: (1) liana abundance and basal area are increasing in this forest; (2) the increase is being driven by increased recruitment, decreased mortality, or both; and (3) long‐distance clonal colonization explains the increase in liana abundance and basal area. We defined long‐distance clonal colonization as lianas that entered and rooted in the plots as vegetative propagules of stems that originated from outside or above the plot, and were present in 2007, but not in 1999 or 2002. Our hypotheses were supported in the old‐growth forest: mean liana abundance and BA (≥1 cm diameter) increased 15 and 20 percent, respectively, and clonal colonization from outside of the plots contributed 19 and 60 percent (respectively) to these increases. Lianas colonized clonally by falling vertically from the forest canopy above or growing horizontally along the forest floor and re‐rooting—common forms of colonization for many liana species. In the selectively logged forest, liana abundance and BA did not change, and thus the pattern of increasing lianas may be restricted to old‐growth forests. In summary, our data support the hypothesis that lianas are increasing in old‐growth forests, and that long‐distance clonal colonization is a major contributor

Quality of life of colorectal cancer survivors in a Ghanaian population

Objective: We collected data to evaluate the quality of life of patients who have survived between one and 8 years from the diagnosis of colorectal cancer. Data description: We collected quality of life (QoL) data from colorectal patients who were diagnosed between 2009 and 2015 at the Komfo Anokye Teaching Hospital (KATH) and have survived until January 2017. The dataset consists of patients\u27 demographic data, clinicopathological characteristics, and QoL data. The validated QoL instruments for data curation was an adopted version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-CR29. The QLQ-C30 was a 30-item general cancer instrument with 5 functional subscales, and 9 symptom subscales, whereas the QLQ-CR29 was a 29-item scale that consisted of 3 functional QOL subscales and 14 symptom subscales, that are associated with colorectal cancer and its treatment. The QoL instrument was coded such that higher scores indicated increased function and better QoL, and higher symptom scores represent worse symptoms

Colorectal cancer survival rates in Ghana: A retrospective hospital-based study

BACKGROUND: Colorectal cancer (CRC) is one of the commonest cancers associated with diverse prognosis times in different parts of the world. Despite medical interventions, the overall clinical outcomes and survival remains very poor for most patients in developing countries. This study therefore investigated the survival rate of colorectal cancer and its prognostic factors among patients at Komfo Anokye Teaching Hospital, Ghana. METHODOLOGY: In this retrospective cohort study, a total of 221 patients diagnosed with CRC from 2009 to 2015 at the Surgical and Oncological units of Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana were employed. The survival graphs were obtained using the Kaplan-Meier method and compared by the Log-rank test. Cox regression analysis was used to assess prognostic factors. All analyses were performed by SPSS version 22. RESULTS: The median survival time was 15 months 95% CI (11.79-18.21). The overall survival rate for CRC over the 5 years period was 16.0%. The survival rates at the 1st, 2nd, 3rd, 4th and 5th years were 64% 95% CI (56.2-71.1), 40% 95% CI (32.2-50.1), 21% 95% CI (11.4-30.6) 16% 95% CI (8.9-26.9) and 16% 95% CI (7.3-24.9). There was a significant difference in the survival rate of colorectal cancer according to the different stages (p = 0.0001). Family history [HR = (3.44), p = 0.029)], Chemotherapy [HR = (0.23), p = CONCLUSION: The study has clearly demonstrated that survival rate for CRC patients at KATH, Ghana is very low in a 5 years period. This is influenced by significant number of clinical and pathological prognostic factors. Identification of prognostic factors would be a primary basis for early prediction and treatment of patients with colorectal cancer

Radiation Dose-Volume Effects in the Esophagus

Publications relating esophageal radiation toxicity to clinical variables and to quantitative dose and dose–volume measures derived from three-dimensional conformal radiotherapy for non–small-cell lung cancer are reviewed. A variety of clinical and dosimetric parameters have been associated with acute and late toxicity. Suggestions for future studies are presented

Minimal clinically important difference of the EORTC QLQ-CIPN20 for worsening peripheral neuropathy in patients receiving neurotoxic chemotherapy.

Context/objectivesThis is the first study to determine the minimal clinically important difference (MCID) of the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale (EORTC QLQ-CIPN20), a validated instrument designed to elicit cancer patients' experience of symptoms and functional limitations related to chemotherapy-induced peripheral neuropathy.MethodsCancer patients receiving neurotoxic chemotherapy completed EORTC QLQ-CIPN20 and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-NTX] at baseline, second cycle of chemotherapy (T2, n = 287), and 12 months after chemotherapy (T3, n = 191). Anchor-based approach used the validated FACT/GOG-NTX neurotoxicity (Ntx) subscale to identify optimal MCID cutoff for deterioration. Distribution-based approach used one-third standard deviation (SD), half SD, and one standard error of measurement of the total EORTC QLQ-CIPN20 score.ResultsThere was a moderate correlation between the change scores of the Ntx subscale and sensory and motor subscales of QLQ-CIPN20 (T2: r = - 0.722, p < 0.001 and r = - 0.518, p < 0.001, respectively; T3: r = - 0.699; p < 0.001 and r = - 0.523, p < 0.001, respectively). The correlation between the change scores of the Ntx subscale and the QLQ-CIPN20 autonomic subscale was poor (T2: r = - 0.354, p < 0.001; T3: r = 0.286, p < 0.001). Based on the MCID derived using distribution-based method, the MCID for the QLQ-CIPN20 sensory subscale was 2.5-5.9 (6.9% to 16.4% of the subdomain score) and for motor subscale was 2.6-5.0 (8.1%-15.6% of the subdomain score).ConclusionThe MCID for the EORTC QLQ-CIPN20 established using distribution-based approaches was 2.5-5.9 for the sensory subscale and 2.6-5.0 for the motor subscale. When noted in assessments even with small change in scores, clinicians can be alerted for appropriate intervention

Schwannoma extending from the umbilical region to the mid-thigh, compressing the major vessels of the right leg: A case report and review of the literature

Schwannomas are benign, usually encapsulated, nerve sheath tumours derived from Schwann cells. They commonly arise from the cranial nerves as acoustic schwannomas and are extremely rare in the pelvis and retroperitoneal area (<0.5% of reported cases) unless they are combined with Von Recklinghausen disease (type 1 neurofibromatosis). We report the case of a 23-year-old woman with a mass extending from the umbilical region in the abdomen to the upper two-thirds of the thigh. As this tumour is so rare, and in order to ensure optimal treatment and survival for our patient, a computed tomography-guided biopsy was performed before en bloc tumour excision. Because of the possibility of malignancy, complete excision of the mass was performed, with pelvic blunt dissection. Histological examination showed a benign neoplasm, originating from the cells of peripheral nerve sheaths; the diagnosis was a schwannoma. Abdominal schwannomas are rare neoplasms that can be misdiagnosed. Laparoscopy is a safe and efficient option for approaching benign pelvic tumours and may offer the advantage of better visualisation of structures owing to the magnification in laparoscopic view, especially in narrow anatomical spaces. However, in our case laparoscopy was not considered owing to the size and anatomical location of the tumour