Testicular torsion: Needless testicular loss can be prevented

Background: The risk of losing the testis is an ever present threat in patients with testicular torsion, who delay before presenting to the surgeon. A retrospective study was carried out to audit patients with acute scrotal pain who came to the Trans Ekulu Hospital Enugu, the promptness of offering them surgical treatment and the results.Materials and Methods: Patients operated upon for suspected torsion of the testis at Trans Ekulu Hospital Enugu over a 10‑year period (1993–2003) were studied. The intervals between the onset of scrotal pain and presentation at the hospital were recorded. The duration of scrotal pain, findings on examination of the scrotum, time of starting surgical operation, and the number of viable testes seen intraoperatively were documented.Results: Twenty‑two patients were found to have undergone emergency scrotal exploration and their ages ranged from 10 to 38 years with a mean of 22.7 years. Eight of these patients came within 3 hours of onset of scrotal pain, one patient came within the 6 hours, and the rest came late. These patients were operated upon shortly after arrival at the hospital. Sixteen patients (72.7%) had testicular torsion, 12 testes were viable, and 4 nonviable.Conclusion: Majority of our patients presented reasonably early. Those who had testicular loss came late. However, some who came late still had viable testes

Enterocutaneous fistula: A review of 82 cases

Objective: Enterocutaneous fistula is an unpleasant and troublesome complication of abdominal operations. The objective was to review the outcome of treatment of patients treated for enterocutaneous fistula.Materials and Methods: This is a retrospective study of 82 teenage and adult patients, who suffered from enterocutaneous fistula, seen over an 11 year period, in the University of Nigeria Teaching Hospital, Enugu. Patients’charts were reviewed for biodata, etiology of the fistula, volume of the fistula output, and result of treatment. Majority of the fistulas occurred after abdominal operations; many by general practitioners. After treatment for correction of fluid and electrolyte deficits, they were all tried on conservative therapy with enteral nutritional support as the main stay ofmanagement. Those, whose fistulas did not close, underwent surgical treatment. Total parenteral nutrition, octreotide, fibrin glue, and wound vacuum assisted closure (VAC) were not used for treating these patients.Results: Spontaneous healing of fistulas occurred in 26 patients (31.7%), whereas 42 patients out of 50 (84%) healed after definitive operation. Fourteen patients (17%) in this study, died.Conclusion: Proper management of fluid and electrolyte imbalances, enteral nutritional support, control of sepsis and correctly timed surgical therapy, resulted in this good healing rate and acceptable mortality, without the use of parenteral nutrition, biologic fibrin glue injection or VAC. Suggestions are offered about steps that may help in eradicating someof these enterocutaneous fistulas.Key words: Enterocutaneous fistula, enteral nutritional support, operative or non-operative treatmen

Treatment of unilateral giant fibroadenoma by breast reduction skin incision: The inverted “T” technique

Background: Giant fibroadenoma (GFA) has been defined as fibroadenoma greater than 5 cm in it’s the widest diameter and/or weighing more than 500 g. A benign lesion, its size also raises the possibility of malignancy requiring differentiation from a malignant breast disease. When unilateral GFA presents with a severe breast asymmetry, due to its size, it is not correctable by simple enucleation alone. Postoperative asymmetry from volume and ptosis disparity results, which needs to be addressed at the primary surgery. The inverted “T” technique, which is effective in volume reduction and ptosis correction in breast hypertrophy, can be applied in the treatment of unilateral GFA.Aim: This is a retrospective review of all GFA treated by inverted “T” method.Materials and Methods: A retrospective review was carried out on all patients with GFA treated by inverted “T” skin pattern method over a period of 20 years (January 1988 to December 2007). The procedures were carried out at the University of Nigeria Teaching Hospital and the National Orthopedic Hospital, Enugu. Information, which included patients’ demographics, pre‑operative assessment, operative findings and outcome of surgery were obtained from the case files of the patients. The degree of ptosis was recorded for each patient. Diagnosis of GFA was made after clinical evaluation and pre‑operative tissue biopsy. Immediate results of treatment were based on the patients’ satisfaction, visual assessment of symmetry of size of breasts, correction of ptosis and position of nipple areola complex (NAC).Results: Atotal of 27 patients underwent inverted “T” technique for excision of GFA in their breasts. Their average age was 17.5 years (range 12‑25 years) delay in presentation ranged from 2 months to 15 months. In 16 patients (59.2%), the left breast was involved in GFA whilst the tumor occurred on the right breast in 11 (40.7%). The tumor weighed on the average 1500 g (range 655‑2200 g). Average diameter of the tumor was 15 cm (range 12‑20 cm). All quadrants of the breasts were involved at presentation. The inferior glandular pedicle bearing the NAC was used in all patients. The length of the pedicle ranged from 8 cm to 14 cm whilst the width ranged from 6 cm to 8 cm. Lactation was reported by three patients who went on to successfully breast feed. Complications were minimal. Most were minor wound healing problems and minor breast asymmetry. Epidermolysis in 2, hypertrophic scar in 6,minor breast asymmetry in 3 and delayed healing at the “T” junction in the inframammary fold in 4 were the common complications. All patients were satisfied with the result obtained.Conclusion: In GFA with a significant breast asymmetry, excision through inverted “T” technique was successful in achieving postoperative symmetry with the opposite breast in these patients. Complications were minimal.Key words: Breast reduction, giant fibroadenoma, inverted “T” techniqu

Nitrate and drinking water from private wells: Will there be an epidemic of cancers of the digestive tract, urinary bladder and thyroid?

Purpose: To estimate the nitrate levels in private wells located in different parts of Enugu and discuss the future health implications following chronic ingestion of well water.Materials and Methods: The map of Enugu was used to divide the city into many 25 units, using grid lines 1 cm apart. Cluster sampling method was used to collect samples. These samples were sent to two laboratories for estimation of nitrate levels. The people drawing water from the different wells were interviewed to determine what they used the water for.Result: The subjects who were interviewed said they ingested the water. The nitrate levels found in these wells (median value of 31 mg/L) were  significantly higher than the internationally accepted levels of nitrate in water for ingestion, (P < 0.0001).Conclusion: High nitrate levels drinking water is dangerous to health and can cause methemoglobinemia in children. It may also increase cancer risk in adults because nitrate is endogenously reduced to nitrite and subsequent nitrosation reactions give rise to N‑nitroso compounds (NOCs), which are highly carcinogenic and can act systemically.Key words: Cancer, contamination, nitrates, private well

Breast Lumps: A 21‑Year Single‑Center Clinical and Histological Analysis

Objective: To review the presentation and histological diagnosis of breast lumps of patients seen in Trans Ekulu Hospital Enugu Southeastern Nigeria from 1993 to 2013 in a period of 21 years. Materials and Methods: This is a retrospective study covering a period of 21 years. Case notes of patients containing clinical information and their histology reports were studied. Results: Only 38% of the patients came within 3 months of finding lumps in their breast. Onehundred and thirty‑seven patients (83%) had benign disease, i.e., fibroadenoma, mammary dysplasia, cysts, adenomas, tuberculosis, phyllodes tumor, mastitis, and lipoma. Only 16.9% i.e., 28 patients had breast cancer, out of which two females were in their 20s, and three were males. Conclusions: Benign breast diseases, i.e., fibroadenoma, fibroadenosis, cysts, adenomas, tuberculosis, phyllodes, mastitis, and lipoma are the commoner breast diseases in our locality.Keywords: Breast lumps, biopsy, Enugu, single centre, Southeastern Nigeri

Surgical operations in elderly patients

Background: Operations on patients over 65years of age are increasing steadily in number and complexity because of increase in number persons living up to 65years and above.Objective: Frequently, elderly patients are encountered in hospitals with different diseases that can only be treated by either minor or major surgical operations. Yet, there is scarcity of documented studies about surgical operations on the elderly in this country. This formed the stimulus for this study.Method: This is a retrospective study. Data concerning 119 patients aged over 65years, operated upon from 1993-2009, at Trans Ekulu Hospital Enugu, South-East Nigeria, were analyzed. These clinical data were collected from the theatre register and patients’ case notes. The surgical operations were undertaken by a consultant surgeon, while the two gynaecological cases were done by a consultant gynaecologist.Results: Out of these 119 elderly patients aged 65-94years operated upon, 82 were males and 37 were females. Sixty-six were major and 53 minor procedures. Hypertension was the most common co-morbid condition. There were 12 deaths recorded in the major category, and none in the minor operations. Haemorrhage, infection and cancer were responsible for the deaths.Conclusion: Most of the patients who underwent these surgical operations derived benefits both for improved quality of life and increased life expectancy. The elderly tolerate surgical procedures well, provided the risk factors are well controlled

Adenoid cystic carcinoma of the breast at Enugu Nigeria

Background: (Adenoid cystic carcinoma (ACC) of the breast is a rare type of neoplasm that is histologically indistinguishable from other examples in other sites and generally has a good prognosis). To characterize the clinical and pathological features of ACC in our environment, as well as the treatment offered to our patients, a review of the clinical records of patients treated at the University of Nigeria Teaching Hospital Enugu was undertaken. Patients and Methods: Case notes of breast cancer patients stored in the medical records department were retrospectively reviewed with a view to studying those with ACC. Follow up on these patients were documented. Result: Adenoid cystic carcinoma of the breast was diagnosed in 9 out of 222 patients treated for cancer of the breast, from 1995-2000. Patients aged 34-70years were afflicted with this disease. A lump in the breast led to the initial suspicion of a tumor. Some of them had pain in the breast. Many of the patients came with advanced disease. Surgical treatment ranged from simple mastectomy to modified radical mastectomy with radiotherapy and chemotherapy in some patients. Conclusion: The disease is rare at Enugu but contrary to findings elsewhere, majority of our patients had advanced disease. Those with early disease appeared to have a good outcome. Keywords: Adenoid cystic carcinoma; Enugu; rare; advanced disease Nigerian Journal of Clinical Practice Vol. 10 (1) 2007: pp.70-7

Gallstones

Gallstone disease is a worldwide medical problem, but the incidence rates show substantial geographical variation, with the lowest rates reported in African populations. Publications in English language on gallstones which were obtained from reprint requests and PubMed database formed the basis for this paper. Data extracted from these sources included authors,country, year of publication, age and sex of patients, pathogenesis, risk factors for development of gallstones, racial distribution, presenting symptoms, complications and treatment. Gallstones occur worldwide, however it is commonest among North American Indians and Hispanics but low in Asian and African populations. High biliary protein and lipid concentrations are risk factors for the formation of gallstones, while gallbladder sludge is thought to be the usual precursor of gallstones. Biliary calcium concentration plays a part in bilirubin precipitation and gallstone calcification. Treatment of gallstones should be reserved for those with symptomatic disease, while prophylactic cholecystectomyis recommended for specific groups like children, those with sickle cell disease and those undergoing weight.loss surgical treatments. Treatment should be undertaken for a little percentage of patients with gallstones, as majority of those who harbor them never develop symptoms. The group that should undergo cholecystectomy include those with symptomatic gallstones, sickle cell disease patients with gall stones, and patients withmorbid obesity who are undergoing laparotomy for other reasons. Keywords: Cholecystectomy, dissolution therapy, gallstones, risk factor