Cut Throat Injuries at a University Teaching Hospital in Northwestern Tanzania: A Review of 98 cases.

Cut throat injuries though rarely reported in literature pose a great therapeutic challenge because multiple vital structures are vulnerable to injuries in the small, confined unprotected area. A sudden increase in the number of cut throat patients in our centre in recent years prompted the authors to analyze this problem. This study was conducted in our local setting to describe the etiology, patterns and treatment outcome of these injuries. This was a combined retrospective and prospective study of cut throat injury patients who were managed at Bugando Medical Centre between February 2009 and January 2013. Statistical data analysis was done using SPSS software version 17.0. A total of 98 patients with cut throat injuries were studied. Males outnumbered females by a ratio of 2.4: 1. The median age of patients was 26 years (range 8 to 78 years). Majority of patients (79.6%) had no employment and most of them (65.3%) came from rural community. Homicide was the commonest (55.1%) cause, followed by suicidal attempts (34.7%) and accidental (10.2%) injuries. Interpersonal conflict (24.4%) was the most common motivating factor for homicidal injury whereas psychiatric illness (16.2%) and road traffic accidents (9.2%) were the most frequent motivating factors of suicidal attempt and accidental injuries respectively. The majority of injuries were in Zone II accounting for 65.3% of cases and most of them had laryngeal (57.1%) injury. Surgical debridement, laryngeal/hypopharynx repair and tracheostomy were the most common surgical procedures performed in 93.9%, 73.5% and 70.4% of patients respectively. Postoperative complication rate was 57.1%, the commonest being surgical site infections in 28.1% of patients and it was significantly associated with late presentation and anatomical zones (P < 0.001). The overall median duration of hospitalization was 12 days. Patients who had postoperative complications stayed longer in the hospital and this was statistically significant (p = 0.011). Mortality rate was 11.2% and was significantly associated with co-morbidities, delayed presentation and presence of complications (p < 0.001). The follow up of patients was poor. Cut throat injuries are a major cause of morbidity and mortality among young adult males in our setting. Addressing the root causes of violence such as poverty, unemployment, and substance abuse will reduce the incidence of these injuries in our environment

Foreign bodies in the nose

No Abstract. Nigerian Journal of Medicine Vol 15 (3) July-September: 301-30

Re implantation of an Avulsed Maxillary Permanent Central Incisor in an Eight-Year-Old Girl – Case Report.

No Abstract

Epistaxis in Port Harcourt

No Abstract. Nigerian Journal of Medicine Vol 15 (3) July-September: 298-30

Cleft lip repair under local anaesthesia: experience in two tertiary hospitals in Nigeria

Introduction: Time and costs are saved performing procedures (where applicable) under local anaesthesia. Some patients refuse surgery for fear of general anaesthesia. Indeed local anaesthesia is preferred over general anaesthesia where practicable, but lip repair is commonly done under general anaesthesia. Some surgeons carry out cleft lip repairunder local anaesthesia even in paediatric age group. However, only few reports on the actual technique and experience are available from this sub region.Materials and methods: A retrospective study of lip repairs done under local anaesthesia from September 2004 to June 2009 is presented. Theatre records were reviewed; excluded were all patients who had ketamine premedication, and patients who had only a touch up for a notch. Following conscious sedation, 2% lignocaine in (1 in 50 000)adrenaline solution was infiltrated at the cleft margins and the procedure carried out.Results: Forty patients were studied, 31 from the first centre and 9 from the second. All were day procedures, no readmissions for any reasons were noted and no wound infection. One revision of a resultant notch following repair with local anaesthesia was done. No patient declined surgery in the period and all returned for palatoplasty where the palate was involved.Conclusion: Local anaesthesia is safe, cost saving, improves compliance and acceptable in Nigeria for cleft lip repair

Oral Health Problems And Causes Of Tooth Loss At The University Of Nigeria Teaching Hospital, Enugu-Nigeria

Context Several oral diseases and conditions are associated with tooth loss. Objective: The aim of this study was to determine the prevalence of oral health problems seen at the University of Nigeria Teaching Hospital (UNTH) in one year with the view to highlighting causes of tooth loss in this environment. Methods This study utilised data from the Record book of the Oral Diagnosis unit of the Dental clinic in UNTH, Enugu. Records of patients seen from January to December 2008 with complete information were included in the study. Data obtained were patient's age, gender, provisional diagnosis, teeth lost and reasons for the loss. The data were computer- analysed; Chi square statistics was used to test for association and differences. Values were considered significant when p-value was equal to or less than 0.05. Results A total of 1663 entries were made; 686 (41.3%) were males and 977 (58.7%) females. On the whole, 110 (6.6%) had traumatic injuries, 70 (4.2%) had malocclusion while 583 (35.1%) had periodontal disease. Periodontal disease, pulpitis and dental caries were not only the most common oral health problems encountered but also the major causes of tooth loss. Conclusion The major causes of tooth loss in our study were periodontal disease and dental caries and its sequelae. Since these two diseases are preventable, existing measures to check them should be more aggressively pursued. Also, recruitment of manpower to manage the different conditions would be very timely for greater retention of teeth despite an aging society.Key words: Oral health; Tooth loss; UNTH; Enug

Complications from Stereotactic Body Radiotherapy for Lung Cancer

Stereotactic body radiotherapy (SBRT) has become a standard treatment option for early stage, node negative non-small cell lung cancer (NSCLC) in patients who are either medically inoperable or refuse surgical resection. SBRT has high local control rates and a favorable toxicity profile relative to other surgical and non-surgical approaches. Given the excellent tumor control rates and increasing utilization of SBRT, recent efforts have focused on limiting toxicity while expanding treatment to increasingly complex patients. We review toxicities from SBRT for lung cancer, including central airway, esophageal, vascular (e.g., aorta), lung parenchyma (e.g., radiation pneumonitis), and chest wall toxicities, as well as radiation-induced neuropathies (e.g., brachial plexus, vagus nerve and recurrent laryngeal nerve). We summarize patient-related, tumor-related, dosimetric characteristics of these toxicities, review published dose constraints, and propose strategies to reduce such complications

The Role of Adjuvant Radiotherapy After Gross Total Resection of Atypical Meningiomas

Atypical meningiomas (AMs) frequently recur after gross total resection (GTR). We conducted a meta-analysis to evaluate the benefit of adjuvant therapy after GTR of AMs. A PubMed/MEDLINE search identified studies detailing AMs treated by GTR alone or GTR and adjuvant radiotherapy (RT) published between 1984 and 2012. Original data from 14 retrospective studies were combined and analyzed. Odds ratio (OR) and χ2 testing were used when appropriate. Selected datasets were used to generate each variable, where available. A total of 757 patients (male/female ratio 9:10) with AMs were included; 72.52% (n = 549) of AMs were treated by GTR alone, and 27.47% (n = 208) underwent adjuvant RT after GTR to a median dose of 54 Gy. The crude recurrence rate was twice as high without adjuvant RT (33.7% vs. 15%, P = 0.005). The 1-year local control rate was 90% for GTR and 97% for GTR + RT (OR = 3.36, P = 0.11). The median 5-year local control rate was 62% for GTR and 73% for GTR + RT, respectively (OR = 1.71, P = 0.06). The 5-year overall survival for each group was 90% (OR = 0.97, P = 0.95). A total of 85% of recurrences were salvaged, 33% by RT and 67% by surgery. Radiation-related toxicity was <10%, at a median follow-up of 42 months. Postoperative RT for AMs may decrease risk for relapse of disease and improve local control, although most tumors are salvageable with surgery or radiation. Although the data suggest little or no impact of postoperative RT on survival, further investigation regarding the long-term efficacy and toxicity of radiation is warranted

Stereotactic body radiotherapy for benign spinal tumors: Meningiomas, schwannomas, and neurofibromas.

Stereotactic body radiation therapy (SBRT) is a relatively new technology, and its use among patients with benign spinal tumors has limited prospective data. Similar to intracranial benign tumors treated successfully with SBRT, benign spinal tumors of the same histology can also develop, and SBRT may be an effective treatment alternative in inoperable or recurrent cases. Outcomes in patients with neurofibromatosis type 1, neurofibromatosis type 2, or schwannomatosis treated with SBRT have also been reported. Single institution reports have shown local control rates over 90% and improvement in clinical symptoms. The optimum dose and fractionation to maximize local control and minimize toxicity is unknown, with few incidences of radiation treatment-related toxicities. Given the location and benign nature of these tumors, careful management of dose to critical organs is essential. With continued follow-up, the optimum use of SBRT in patients with benign spinal tumors can be better defined