Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria

Background: Appendicitis is a common clinical condition worldwide. Differences in incidences, sex, age, and seasonal variations have been reported widely, with paucity of information from Nigeria.Aim: To assess the trends in incidence and pattern of variation with age, sex, and seasons of the year.Materials and Methods: A review of the records of all patients with confirmed appendicitis treated in both the LAUTECH Teaching Hospital (LTH) and the Abake Medical Center (AMC), both situated in Osogbo, Nigeria, between January 2003 and December 2008, was done. LTH was a 320-bed University Hospital (with 100 surgical beds), while AMC was a 20-bed surgical center. The age, sex, and month of admission of all the histologically proven cases of appendicitis were retrieved and treated. Analysis was done using simple percentages, Student t or Chi-square tests, where applicable.Results: A total of 299 out of 321 cases of appendicitis recorded during the observed period were confirmed histologically from both hospitals (69.56% from LTH). Fifty-two percent were males. It made up 0.94, 1.43, and 1.86% of the total hospital admissions in 2004, 2006, and 2008, respectively. There has been an increasing incidence in both sexes almost in a similar pattern. The overall mean age was 25.79 years (M 25.94 and F 25.43 years) with 6% below the age of ten and 1.3% above 60 years. The highest incidence in males and females occurred in the second and third decades, respectively. Incidences were higher during the rainy season (April to September) 68%, P < 0.05), with peaks from June to August, when 39.5% of all cases presented.Conclusion: The increasing incidence of appendicitis in both sexes in this region may be due to the change to a Western lifestyle. The age distribution has a similar pattern in both sexes and 87% are 40 years or less, although the incidence is marginally higher in males. Higher prevalence of infections and allergens from pollens in the rainy season could contribute to a higher incidence of appendicitis

The Clinical Relevance of Diarrhoea in Patients with Suspected Uncomplicated Appendicitis

Background: Diarrhea is uncommon in uncomplicated appendicitis and when present, it tends to bring about delay in diagnosis, thus predisposing to complications.Methods: This was a retrospective study of all cases of uncomplicated appendicitis seen at LAUTECH Teaching Hospital, Osogbo, Nigeria over a 3 year period.Results: During the period under review, 153 with uncomplicated appendicitis were seen. Their ages ranged from 4 to 62 years with a median of 23.01 years. The M: F ratio was 1.15: 1. Diarrhea was more common in patients aged under 15 years (p = 0.003). Fifteen (9.8%) of the patients had diarrhea and was more common in females (12.67%) than in males (7.31%) ( p =0.201). Diarrhea was present in 4.34% and in 18.03% patients presenting before and after 72 hours respectively (p= 0.006). Fever (T &gt;38oC) was found in 91 patients, 11 of them had diarrhoea, compared to 4 of the 62 without fever ( p= 0.283 Fisher’s exact test ). There was no significant difference in rectal findings in patients with or without diarrhea (p= 1.000). The unsuspected perforation rate was 66.6% for those with diarrhoea and 0.7% for those without diarrhea ( p&lt;0.000, odds ratio of 274). About 22% and 5.3% of patients with and without pus collection respectively had diarrhea (p= 0.0049, O R 5.18). Diarrhea was significantly more associated with appendiceal perforation compared with simple appendicitis (p= 0.00001 odds ratio 77.5) and also compared with those with normal appendix (p =0.006). The median length of hospital stay was significantly higher in patients with diarrhea (p = 0.001)Conclusion: Diarrhea as a symptom of appendicitis is commoner in  children. It is associated with late presentation, more perforation, intra-bdominal pus and prolonged length of stay Key words: clinical relevance, diarrhea, appendiciti

Bilateral Breast Cancer: Experience in a Poor Resource Black African Setting

Background: Breast cancer is the most common malignancy in women in Nigeria. Women previously treated for ipsilateral breast cancer have increased risk of developing contalateral breast cancer (CBC), the chance of which increases with longer period of survival and is associated with worse prognosis. Reports from Nigeria are few on this.The aim of this study was to assess the prevalence, predisposition, presentation, and outcome of management of bilateral breast cancer (BBC) in a population, South-western Nigeria.Methods: A review of bio-data of all patients with BBC seen in LTH, Osogbo, Nigeria between 2001 and 2008 was done. Age, parity, age at menarche and first child birth, family history, duration of symptoms, tumour characteristics and exposure to cigarette, oral contraceptive pills (O.C Pills) and outcome of treatment were also assessed.Results: BBC constituted 4.6% of the 256 breast cancer patients. Eight (73%) were metachronous and 91% were infiltrating ductal carcinoma. Patients’ mean age, mean age at menarche and first child birth were 39, 14.5+3 and 22.5yrs respectively. Mean parity was 3.5 child birth, 91% were premenopausal and all have menstruated for 12-31yrs. None had positive family history while only 1 and 3 had insignificant exposure to cigarette and O.C pills respectively. The mean interval between the 2 onsets was 18mths (0-68mths). 91% of all tumours were advance, while 81% of the first tumours were on the right. Mean duration before presentation for the first and second tumours were 261 and 111days respectively. One patient has survived for 2 years thus far.Conclusion: The incidence of BBC was 4.26%. Most patients were young and premenopausal with mostly infiltrating ductal carcinoma (NOS) and presenting with late stage disease, hence poor prognosis. Aggressive follow-up of patients with ipsilateral cancer will aid early detection of CBC

Any Association Between ABO /Rh Blood Groups and Breast Cancer ?

No Abstract

Gastrointestinal stomal tumour-case report and a review of the literature

Gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours, comprising 1% of all GI malignancies. This is a report of a middle-aged man diagnosed with GIST of the duodenum. He had gastrojejunostomy and para-aortic lymph node biopsy for histology. He was subsequently commenced on 5-fluorouracil but with little response.Keywords: Gastrointestinal tract, stromal tumour

Cancelation of elective surgical case in a teaching hospital, South-western Nigeria

No Abstrac

Review Article: Anorectal abscesses: a review of presentation and management.

Background: Anorectal abscesses are surgical emergencies that demand early and appropriate intervention. However, perianal symptoms and local inflammation that are the main features in majority of cases may be lacking to localize and diagnose this condition thereby leading to a diagnostic conundrum with delayed or improper treatment and dire consequences. Objective: This study reviews the aetiology, various modes of presentation of this disease entity and its treatment to facilitate an early diagnosis and intervention. Method: A review of literature on the subject was carried out using internet, pubmed medline seach and review of journals. Outcome: Those patients with unusual and subtle presentations are more likely to suffer the dire consequences of the disease. Conclusion: There is the need for awareness of the various modes of presentations and management of this entity. It should also be considered as a differential diagnosis of causes of low back and pelvic pains to stem the consequences associated with mis-diagnosing and treating this condition.Sahel Medical Journal Vol. 10 (3) 2007: pp. 72-7

Evaluation of preoperative blood ordering practice for mastectomy and thyroidectomy in a teaching hospital

No Abstract

Clinical Spectrum of Benign Breast Diseases In Osogbo, Nigeria.

No Abstract Availabl

Splenic Operations In A Teaching Hospital, South-Western Nigeria

Background/Objective: To review all Splenic operations performed at LAUTECH Teaching Hospital (LTH) over a four year period- highlighting the indications, associated injuries in trauma patients, complications, outcome of management and follow up care. Patients and Methods: Information including demographic data, indications for operation, treatment and follow up care were obtained from case notes, theatre records and histology laboratory records; these were analyzed by simple percentage. Result: Twenty-six cases (M: F-18:8) with ages ranging between two and fifty-two years (mean 24.8 years) were treated. Eighty-eight percent were done as emergencies, 95% of these were for blunt abdominal injuries. Road traffic accident was the cause in above 50% of all patients with injuries while other indications included TSS, haematological, etc. Four (17%) of trauma patients had splenic preservation procedures done. Patients with wound infection, wound dehiscence and acute gastric dilatation were seven, five and one, respectively. No case of overwhelming post-splenectomy sepsis was seen. Mortality was 15.4%. Conclusion: As trauma is the most common indication for operations on the spleen, spleen conservation should be practiced more often where open procedures are indicated. Keywords: Splenic operations, Spleen conservation surgery, Trauma, Post-operative care, Nigeria Sahel Medical Journal Vol. 11 (1) 2008: pp. 15-1