Reasons for cancellations of urologic day care surgery

Objective: The numerous economic and social benefits associated with the practice of day care surgery could be eroded by frequent cancellations. We therefore determined the reasons for such cancellations in a tertiary care centre in Nigeria.Patients and Methods: This was a prospective study of all consecutive urologic day cases seen at Jos University Teaching hospital, Nigeria from January 2003 to December 2004.Results: A total of 270 patients were seen during the study period with ages from 2 weeks to 100 years (median 55 years) and male to female ratio of 14:1. The procedures carried out were mainly urethroscopy/urethrocystoscopy in 103 (38.2%) patients, visual internal urethrotomy in 48 (17.8%) and trucut prostatic biopsy in 33 (12.2%) patients. Sixteen (5.9%), 16(5.9%), 9(3.3%) and 8(3.0%) patients had examination under anaesthesia / bladder biopsy for suspected bladder carcinoma, urethral dilatation, testicular biopsy and total orchidectomy for carcinoma of the prostate respectively.There was a cancellation rate of 15.6% (n=42) mainly due to the inability of the patients to come (24 patients, 57.1%), inadequate materials in the theatre (9 patients, 21.4%), power failure (4 patients, 9.5%), strike action (3 patients, 7.1%) and financial difficulties (2 patients, 4.8%).Conclusion: We are still faced with a high cancellation rate of urologic day cases and these are mainly due to avoidable reasons. Patient as well as physician education and provision of adequate materials andinfrastructural development are recommended to reduce these; so as to gain maximally from urologic day surgery practice

Thyroidectomy under local anaesthesia: how safe?

In order to compliment the inadequate health facilities in the rural areas in Nigeria, nongovernmental organisations provide adhoc outreach health camps that offer treatment in various medical specialties including surgery. Rural outreach health camps. To evaluate the safety of thyroidectomy under local anaesthesia at rural outreach setting with inadequate facilities for general anaesthesia. This was a prospective descriptive study of 33 consecutive cases of thyroidectomy performed using field block with 1% lignocaine and adrenaline 1: 200,000 dilution during two free medical outreaches that held at Jos,Nigeria inMarch andOctober 2005 respectively, lasting twoweeks each. : A total of 33 primary thyroid operations were performed consisting of 30 subtotal thyroidectomies (91%), 2 lobectomies (6%) and one total thyroidectomy (3%), The patientswere aged between 23 and 62 years with a mean age of 45.8years. There were 3males and 30 females with a male: female ratio of 1:10. There was no mortality butmorbidity was 2/33 (6%) Two complications were recorded in 2 patients and were superficial surgical site infection (3%) and reactionary haemorrhage (3%). We conclude that thyroidectomy under local anaesthesia is a safe procedure in experienced hands at rural settingswith inadequate facilities for general anaesthesia. Keywords: Thyroidectomy; Local anaesthesia; Safety;Rural outreach;Nigeria Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.37-4

Distal ileal stenosing subserosal lipoma: A case report

Lipoma is the commonest soft tissue tumour and ubiquitous in distribution.The gastrointestinal tract is a rare site for this neoplasm.This 38 years old patient presented to the surgical emergency unit of the Jos University Teaching Hospital with features of intestinal obstruction which was confirmed by plain abdominal X-ray. Patient was resuscitated and had exploratory laparotomy. At surgery,a dilated,oedematous,and pale segment of ileum was seen measuring 56cm in length and 10cm short of the ileo-caecal junction, where an obstruction had occurred.The distal segment was collapsed.A limited right hemi-colectomy was done with ileocolic anastomosis.Specimen received at the Histopathology Laboratory consisted of 45cm of the ileum,the caecum,appendix,and proximal 25cm of the colon in continuity.There was stenosis affecting the distal 30cm of the ileum.The wall of the stenosed part of ileum had intramural fat at the sub-serosal locale. Histology confirmed the presence of sheets of matured adipocytes between the muscularispropria and serosa.Patient condition improved and was discharged seven days after surgery.This case is reported five months after surgery.We recommend that lipoma be at all times considered in the differential diagnosis of intestinal obstruction.Keywords: Subserosal lipoma,ileal stenosis,intestinal obstructio

Management of the mass casualty from the 2001 Jos crisis

Background: We report our experience in the hospital management of mass casualty following the Jos civil crisis of 2001.Materials and Methods: Aretrospective analysis of the records of patients managed in the Jos civil crisis of September 2001, in Plateau State, Nigeria. Information extracted included demographic data of patients, mechanisms of injury, nature and site of injury, treatment modalities and outcome of care.Results: A total of 463 crisis victims presented over a 5 day period. Out of these, the records of 389 (84.0%) were available and analyzed. There were 348 (89.5%) males and 41 females (10.5%) aged between 3 weeks and 70 years, with a median age of 26 years. Most common mechanisms of injury were gunshot in 176 patients (45.2%) and blunt injuries from clubs and sticks in 140 patients (36.0%). Debridement with or without suturing was the most common surgical procedure, performed in 128 patients (33%) followed by exploratory laparotomy in 27 (6.9%) patients.  Complications were documented in 55 patients (14.1%) and there were 16 hospital deaths (4.1% mortality). Challenges included exhaustion of supplies, poor communication and security threats both within the hospital and outside.Conclusion: Most patients reaching the hospital alive had injuries that did not require lifesaving interventions. Institutional preparedness plan would enable the hospital to have an organized approach to care, with better  chances of success. More effective means of containing crises should be employed to reduce the attendant casualty rate.Key words: Challenges, civilian conflicts, crisis, disaster, mass casualty, trauma, violenc

Colonoscopy in a Tertiary Hospital in Nigeria

Background: Colonoscopy is an accurate method of diagnosing colonic disease but is technically demanding and operator dependent. Colonoscopy is not a common procedure in Nigeria. After the restructuring of the endoscopic unit of a tertiary hospital in Nigeria, a preliminary survey was carried out with the aim of determining the diagnostic yield and spectrum of cases seen. Methodology: Results of colonoscopies performed by surgeons in the endoscopic unit of the Jos University Teaching Hospital, a tertiary medical centre in Plateau State, Nigeria were retrospectively analysed for a period of 6 months. The diagnostic yield and findings were analyzed. Results: A total of 43 colonoscopies were performed, the mean age was 43.5 years (range, 8 to 80 years). Male patients were 28. Most (82%) were performed on outpatient basis. Diagnostic yield was 79%. The most common pathology found was haemorrhoids (58.1%). Normal colonoscopy was the outcome in 20.9% of patients. Other lesions were polyps (6.9%) and cancers (4.7%). Multiple lesions were found in 5 patients (10.9%). Conclusion: Haemorrhoids are the most common lesions presently found in patients undergoing colonoscopy performed by surgeons in Jos University Teaching Hospital. Polyps and cancers are found less commonly.Key Words Colonoscopy, haemorrhoids, polyp

Pioneering Laparoscopic General Surgery in Nigeria

Background: Laparoscopic Surgery has revolutionized surgical operations due to its unique advantages of a shorter hospital stay, minimal surgical trauma and a better cosmetic outcome. There are a few reports from Nigeria reporting laparoscopic surgery in gynaecology. To the best of our knowledge, there has been no reports on laparoscopic general surgery from Nigeria. We therefore wish to document our experience with laparoscopic general surgery in Nigeria.Patients and Methods: This was a prospective analysis of all consecutive patients presenting for laparoscopic surgery at Adoose Specialist Hospital Jos from June 2008 till date. Results: A total of 24 laparoscopic surgeries were performed during the study period. The mean age of the study population was 39.4± 11.5years with age range of 18 to 65 years. There were 4 males and 20 females (M: F=1:5). The main surgeries performed included cholecystectomy in 13 (54.2%) patients, appendicectomy in 7 (29.2%) and adhesiolysis in 3 (12.5%). There was one conversion in this study giving a conversion rate of 4.1%. Identifiable co-morbid factors were seen in 7 patients (29.2%) Conclusion: Laparoscopic general surgery is feasible in Nigeria; it is a safe and reliable way of conducting abdominal operations that should be encouraged in developing countries.Keywords; laparoscopic general Surgery, safety, Challenges, Nigeri

Histopathological Types of Breast Cancer in Gombe, North Eastern Nigeria: A Seven-Year Review

This was a retrospective analysis of all consecutive breast cancer specimens submitted to the Pathology Department Of Federal Medical Centre, Gombe which renders histopathology services to four states in the North Eastern region of Nigeria. A total of 172 cases of malignant breast tumours were recorded during the 7 years under review. Out of the 172 cases of breast cancers analysed, 7(4%) were in males while the remaining 165(96%) were in females giving a male: female ratio of 1:24. The most common histopathological type of breast cancer found in this study was Invasive Ductal Carcinoma no special type (NST) accounting for 78.8% of cases (Afr J Reprod Health 2011; 15[1]: 107-109

Uncomplicated adult choledochal cyst: Management challenges in a developing economy

No Abstract

Pattern of Urological Malignancies Seen at Federal Medical Centre Gombe North Eastern Nigeria

No Abstract

Knowledge and Attitude to Breast Self-Examination Among a Cohort of Medical Students in Nigeria

Background: Breast cancer is a leading cause of cancer mortality worldwide with a gloomy outcome especially in late presentation commonly seen in developing nations. Early detection through screening however improves the prognosis and patient survival. Breast self examination is a recognized and acceptable modality for screening breast cancers especially inresource scarce settings since early detection and treatment offers appreciable benefit to the patient. The objective of this studyis to assess the knowledge, attitude and practice of breast self examination (BSE) among a group of potential healthcare givers.Methodology: This was a self administered questionnaire based study carried out on a class of final year medical students in a Nigerian Teaching Hospital.Results: There were a total of 98 respondents aged between 24 and 39 years (mean = 27.4 years). There were 59 (60.2%) males and 39 (39.8%) females (M: F= 3:2). Ninety three (94.9%) respondents have heard of BSE with only 5% having adequate knowledge of BSE. Twenty nine (74.4%) of the female respondents practice BSE.Conclusion: There is poor knowledge, attitude and practice of BSE among final year medical students of the Jos University Teaching Hospital