Understanding Medical Ethics In A Contemporary Society

No Abstrac

Incidence of Negative Appendectomy: Experience From a Company Hospital in Nigeria

Objective: The aim of this study was to determine the rate of negative appendectomy in a company hospital in Nigeria. Background: Appendicitis is one of the most common abdominal conditions requiring surgical intervention. Appendectomy, like most surgical procedures, has its complications and therefore should only be undertaken when indicated. Case series have reported the incidence of negative appendectomy in Western nations. The purpose of this retrospective study is to evaluate the incidence of negative appendectomy in a Nigerian hospital, where all the operations were carried out by consultant surgeons. Methods: All case files of patients who received an appendectomy at Chevron Hospital in Warri, Nigeria between January, 1999 and December, 2003 were reviewed. Demographic data, symptoms and signs on presentation, intra-operative findings and histological reports on the excised vermiform appendixes were extracted from the case files and analyzed. Results: The incidence of negative appendectomy in this study was 16.1%; all nine patients that had negative appendectomy were female. Conclusion: The incidence of negative appendectomy observed at Chevron Hospital in Warri, Nigeria is lower than that reported by most studies; one factor may be that all the patients in the present study were evaluated and operated on by consultant surgeons

Torsed Intraabdominal Testis: A Rarely Considered Diagnosis

Cryptorchidism, or maldescended testis, is a common problem encountered in pediatric age groups. Despite more than 100 years of research, many aspects of cryptorchidism are not well defined and remain controversial. However, cryptorchidism clearly has deleterious effects on the testis over time.1–

Emergency one-stage resection without mechanical bowel preparation for acute sigmoid volvulus

The traditional staged operation for acute sigmoid volvulus is giving way to one-stage resection. Similarly, the conventional requirement for bowel cleansing is being increasingly questioned. In this report, we reviewed the outcome of our management over a ten-year period. There were 24 patients aged 23-100 years. Of these, 21 had one-stage primary resection with no clinical anastomotic leak and only one wound infection and fascial dehiscence. The two deaths from this group were due to respiratory failure in a patient aged 100 years and overwhelming sepsis in a younger patient with bowel gangrene from ileosigmoid knotting. We conclude that emergency one-stage resection for acute sigmoid volvulus without mechanical bowel preparation is safe

Pattern and Outcome of Typhoid Perforation in Benin City

Over a 26-year period, there were only twenty four cases of perforated typhoid that were operated at the University of Benin Teaching Hospital. Four cases had incomplete data and were excluded from the study and only twenty cases were therefore included in the study. Of the twenty patients, there were 12 males and 8 females and the age range was between 11 and 45 years, with a mean of 25.65 years. The main complaints were fever, abdominal pain, vomiting, diarrhea or constipation. Most of the patients presented late to the hospital. Most of the patients had single perforations. Simple closure was the method of treatment in most of the patients. Wound infection was the major post operation complication. The average hospital stay was 16.3 days. We conclude that compared with other tertiary health institutions in Nigeria, the incidence of typhoid perforation is low at the University of Benin Teaching Hospital, Benin City, Nigeria and simple closure of perforations is efficient in managing typhoid perforations

Knowledge, attitude and practice of Nigerian women towards breast cancer: A cross-sectional study

BACKGROUND: Late presentation of patients at advanced stages when little or no benefit can be derived from any form of therapy is the hallmark of breast cancer in Nigerian women. Recent global cancer statistics indicate rising global incidence of breast cancer and the increase is occurring at a faster rate in populations of the developing countries that hitherto enjoyed low incidence of the disease. Worried by this prevailing situation and with recent data suggesting that health behavior may be influenced by level of awareness about breast cancer, a cross-sectional study was designed to assess the knowledge, attitude and practices of community-dwelling women in Nigeria towards breast cancer. METHODS: One thousand community-dwelling women from a semi-urban neighborhood in Nigeria were recruited for the study in January and February 2000 using interviewer-administered questionnaires designed to elicit sociodemographic information and knowledge, attitude and practices of these women towards breast cancer. Data analysis was carried out using Statistical Analysis Software (SAS) version 8.2. RESULTS: Study participants had poor knowledge of breast cancer. Mean knowledge score was 42.3% and only 214 participants (21.4%) knew that breast cancer presents commonly as a painless breast lump. Practice of breast self examination (BSE) was low; only 432 participants (43.2%) admitted to carrying out the procedure in the past year. Only 91 study participants (9.1%) had clinical breast examination (CBE) in the past year. Women with higher level of education (X(2 )= 80.66, p < 0.0001) and those employed in professional jobs (X(2 )= 47.11, p < 0.0001) were significantly more knowledgeable about breast cancer. Participants with higher level of education were 3.6 times more likely to practice BSE (Odds ratio [OR] = 3.56, 95% Confidence interval [CI] 2.58–4.92). CONCLUSION: The results of this study suggest that community-dwelling women in Nigeria have poor knowledge of breast cancer and minority practice BSE and CBE. In addition, education appears to be the major determinant of level of knowledge and health behavior among the study participants. We recommend the establishment and sustenance of institutional framework and policy guidelines that will enhance adequate and urgent dissemination of information about breast cancer to all women in Nigeria

Thyrotoxicosis in Benin City: a study of surgical treatment of 50 patients

Thyrotoxicosis is regarded as uncommon in sub-tropical Africa, although recent reports seem to indicate an increasing frequency of this disease. From January 1986 to April 2001, 50 patients were operated upon for thyrotoxicosis at the University of Benin Teaching Hospital. Forty seven of them were females and three males (ratio 15.7:1). Poor compliance with drug therapy, relapse in symptoms, increase in the size of the goitre and cosmesis were the main indications for surgery. Sub-total thyroidectomy uniformly produced good results from the limited follow-up; few complications were associated with this procedure. The patients generally had good haemoglobin levels 65 10g% on admission and no blood transfusion was used in the series during or after surgery. There was no mortality. It is recommended that in sub-tropical Africa, surgery for thyrotoxicosis is a safe, effective and reasonably cheap procedure when compared to other modalities of treatment

Knowledge Attitude and Practice about Breast Cancer among Civil Servants in Benin City, Nigeria

Background: Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer, its complications and the management. Methods: The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study, but only 385 respondents completed and returned the forms. Results: Two hundred and seventy seven (72.0%) respondents had tertiary level of education. Sixty six (17.1%) respondents were in the 30-34-year age group. Three hundred and twelve (81.0%) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5%) respondents knew that a positive family history of breast cancer is a risk factor, while two hundred and seventy four (71.2%) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4%) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7%) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5%) respondents would visit the hospital as the first reaction if they were to detect a breast lump, while twenty three (6.0%) respondents would ignore the lump. While three hundred and twenty seven (85.0%) respondents have heard of breast self- examination, only one hundred (26.0%) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0%) respondents have heard of mammography, only twenty seven (7%) respondents go for yearly mammography screening. Three hundred and seventy two (96.6%) respondents know that mastectomy is done as part of the management of breast cancer, but only forty nine (12.7%) respondents have heard about conservative surgery. Conclusion: The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed, it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital.Contexte: Le cancer du sein est souvent associ\ue9 \ue0 une morbidit\ue9 et une mortalit\ue9 s\ue9v\ue8re particuli\ue8rement lorsque les patientes consultent tard. La raison principale de cette consultation tardive est le manque de sensibilisation sur le cancer du sein, ses complications et son traitement. M\ue9thode: L'\ue9tude a \ue9t\ue9 men\ue9e \ue0 l'aide d'un questionnaire structur\ue9. Au total de 400 femmes fonctionnaires ont \ue9t\ue9 enr\uf4l\ue9es dans l'\ue9tude, mais seulement 385 compl\ue9t\ue8rent et retourn\ue8rent le questionnaire. R\ue9sultats: Deux cent soixante dix sept (72,0%) des participantes avaient un niveau d'\ue9ducation tertiaire. Soixante six (17,1%) \ue9taient de la tranche d'\ue2ge de 30 \ue0 34 ans. Trois cent douze (81,0%) savaient parfaitement que le nodule du sein est habituellement la premi\ue8re manifestation du cancer du sein. Cent quarante quatre (37,5%) savaient qu'un ant\ue9c\ue9dent familial de cancer du sein \ue9tait un facteur de risque, tandis que deux cent soixante quatorze (71,2%) r\ue9pondirent qu'un cancer dans un sein chez une femme augmentait le risque d'avoir un cancer dans l'autre sein. Deux cent soixante et onze (83,4%) savaient que le cancer du sein pouvait s'\ue9tendre d'un sein \ue0 l'autre et deux cent trente (59,7%) savaient que le cancer pouvait s'\ue9tendre \ue0 d'autres parties du corps. Cent quatre vingt trois (47,5%) seraient pr\ueates \ue0 consulter \ue0 titre de premi\ue8re r\ue9action si elles \ue9taient amen\ue9es \ue0 constater un nodule du sein, tandis que vingt-trois (6,0%) l'ignoreraient. Alors que trois cent vingt-sept (85,0%) avaient entendu parler de l'auto palpation du sein, seulement cent (26,0%) pouvaient correctement d\ue9crire cette proc\ue9dure. Pendant que cent quarante cinq (35,0%) avaient entendu parler de la mammographie, seulement 27 (7%) proc\ue8dent \ue0 une mammographie annuelle. Trois cent soixante douze (96,6%) savent que la mammographie est pratiqu\ue9e comme un \ue9l\ue9ment de la prise en charge du cancer du sein, mais seulement quarante neuf (12,7%) ont entendu parler de chirurgie conservatrice. Conclusion: Le niveau de connaissance sur le cancer du sein parmi les fonctionnaires de Benin City est bas. Il y a n\ue9cessit\ue9 d'organiser des s\ue9ries de programmes d'\ue9ducation pour \ue9clairer les femmes au sujet du cancer du sein. Cela peut se faire par des agences gouvernementales ou des organisations non gouvernementales. Proprement ex\ue9cut\ue9, cela devrait influencer l'attitude des femmes de Benin City a propos des maladies du sein et encourager les consultations pr\ue9coces