Retrospective analysis of mathieu’s urethroplasty for anterior hypospadias repair in circumcised children: A single center experience

Introduction: Mathieu’s technique (peri-meatal based flap) makes use of the urethral plate in the repair of anterior hypospadias, thereby creating an almost natural neo-urethra. In a circumcised baby or after previous unsuccessful repair, Mathieu’s flap may be one of the few options left torepair anterior hypospadias.Objectives: To evaluate the result of Mathieu’s flap repair for anterior hypospadias in a resource poor setting.Materials and Method: This is a retrospective review of post-circumcision anterior hypospadias managed by Mathieu’s flap repair between January 1996 and December 2006 in the paediatric surgical unit of the Obafemi Awolowo University Teaching Hospital, a tertiary hospital in theSouth Western Nigeria.Results: Mathieu’s flap repair was performed in 16 patients with isolated anterior hypospadias; 15 (93.8%) were circumcised before presentation. The complications were urethrocutaneous fistula in 3 (18.8%), wound infection in 2 (12.5%) and flap necrosis in 1 patient (6.3%). Final outcomewas satisfactory in all patients.Conclusion: Mathieu’s flap remains a viable option in the repair of anterior hypospadias even after circumcision

Challenges of Surgical Repair of Hypospadias in Ile-Ife, Nigeria

Objective: To document the presentation, outcome and challenges of management of hypospadias in a resource-limited setting.Patients and Methods: For this retrospective study we analyzed the files of  all patients with hypospadias managed at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria between 1996 and 2006. The parameters studied were the patients’ bio-data, clinical presentation,treatment and outcome. Results: During the 10-year period under review 51 cases of hypospadias were managed. The majority of the patients (n=39, 76.5%) presented within the first year of life with a mean age atpresentation of 1 year and 8 months, though most of the repairs were done in the 2nd, 3rd and 4th years of life. Of the 51 patients 46 (90.2%) came from rural and semi-urban areas and 18 (35.3%) had been circumcised before presentation. Surgical repair consisted of preputial island flap in 22 patients (43.1%) followed by a peri-meatal based flap (Mathieu procedure) in 16 patients (31.4%). The MAGPI procedure was used in 5 patients (9.8%) and the Snodgrass procedure in 1 (2%).Staged repair was necessary in 7 patients (13.7%). Post-operative complications were encountered in 15 patients with urethrocutaneous fistula being the commonest one (11 patients, 21.6%). Conclusion: Our results show that hypospadias can be successfully managed in a low- resource setting

Polyp prevalence at colonoscopy among Nigerians: A prospective observational study

Background: This study was aimed at identifying the prevalence, distribution, and clinicopathologic characteristic of colonic polyps among Nigerians undergoing colonoscopy at the Obafemi Awolowo University Teaching Hospitals complex, Ile‑Ife, Nigeria. We also determined the polyp detection rate (PDR), polyps per colonoscopy (PPC) and adenoma detection rate (ADR).Materials and Methods: This is a prospective study of all colonoscopy examinations performed at the endoscopy unit of our hospital from January, 2007 to December 2013. The patient demographics, indications for colonoscopy, colonoscopic findings, number of the polyps, their sizes, possible risk factors in the individual case histories, and histopathological characteristics of the polyps.Results: During the study period, a total of 415 patients met the inclusion criteria and only 67 out of these had colonic polyps. The overall PDR was 16.1%. The age ranged was 2‑87 years with a median of 57 years. Forty‑three (64.2%) patients were 50 years or above and there were 40 (59.7%) males. Thirty‑three (49.3%) patients were referred as a result of lower gastrointestinal bleeding, 14 (20.9%) for colorectal cancer (CRC) and 13 (19.4%) for routine screening. Thirty‑nine (58.2%) patients had the polyps at the rectosigmoid region of the colon, 17 (25.4%) had the polyps located proximal to sigmoid colon and 11 (16.4%) patients had multiple polyps involving both segments. Adenomatous polyps was the most common (28 [47.5%]) histopathological finding of which two patients had adenomatous polyposis. Other findings include inflammatory polyps in 17 (18.8%) patients, 5 (8.5%) patients each had hyperplastic and malignant polyps, while 4 (6.8%) patients had juvenile polyps. The ADR was 6.8 and the PPC was 0.2. Statistically, patients 50 years and older were more likely to have adenomatous and hyperplastic polyps than those younger than this age (P = 0.010).Conclusion: We conclude that polyps are probably not as rare among black Africans especially when they are above 50 years. Our histopathological finding of adenomatous change in a good proportion of the detected polyps show that they are likely to be associated with CRCs in our compatriots and as such we would recommend a routine screening colonoscopy for Nigerians aged 50 and above.Key words: Adenoma, hyperplastic, inflammatory, Nigeria, polyps, prevalenc

Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria

Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long‑term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty‑seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino‑pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within the first 30 days of life and those who presented afterwards were 325 (±251) μmol/L and 141 (±100) μmol/L respectively, P = 0.003. Surgical interventions included trans‑vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 μmol/L after 1‑month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors.Keywords: Excision, treatment outcome, urethral valve

Performance and Digestibility of West African Dwarf Sheep fed varying forage and concentrate ratios

This study was conducted to determine performance and nutrient digestibility of twenty four West African Dwarf Sheep aged between 10 and 12 months fed varying levels of forage and concentrate. Animals were allotted to three treatment groups in a completely randomized design at 75% concentrate and 25% grass, 50% grass and 50% concentrate and 25% concentrate and 75% grass designated as treatment 1, 2 and 3, respectively. Daily nutrient intake, apparent digestibility, average daily gain, and protein efficiency were measured. Data were analyzed by one-way analysis of variance. The protein efficiency, average daily gain and daily nutrient intakes were significantly (P< 0.05) influence by the treatments. Apparent digestibility of nutrients by the sheep were also significantly (P< 0.05) different across the treatments except for the FE and DF which were not significantly (P> 0.05) influenced by the treatments. Diet 3 (75% forage and 25% concentrates) which supported superior sheep performance in most of the economical traits considered was thereby recommended.Keywords: Sheep, forage, concentrate, performance and digestibility

Situs inversus in association with duodenal atresia

Situs inversus in association with duodenal atresia is very rare. A high index of suspicion coupled with appropriate evaluation is necessary for diagnosis and operative planning. We report a case of a 5-day-old who presented with duodenal atresia associated with polysplenia and situs inversus with a review of the medical literature.Key words: Situs inversus, duodenal atresi

Determinants of mortality in neonatal intestinal obstruction in Ile Ife, Nigeria

Background: Neonatal intestinal obstruction (NIO) is a common cause of mortality. This study determined the causes of mortality in patients with NIO at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile Ife. Patients and Methods: Records of all cases of NIO managed at OAUTHC between January 1996 and December 2005 were retrospectively reviewed and the possible factors that may result in mortality were analysed. Results: Sixty-three neonates with intestinal obstruction were managed, representing 24.3% of the neonatal admissions during the study period. Forty-two were males and 21 were females (M:F = 2:1). The majority (71.4%) of the patients presented within the fi rst week of life. Anorectal malformation constituted 57.1% of the causes of NIO. Other causes included Hirschsprung's disease, duodenal atresia, intestinal malrotation with midgut volvulus and jejunal atresia. There were 18 deaths, with a mortality rate of 28.6%. Reoperation, postoperative bleeding and peroperative sepsis were signifi cant determinants of mortality. Conclusion: NIO is associated with signifi cant mortality in our centre. Repeat surgery, postoperative bleeding and sepsis were the signifi cant factors that contributed to mortality in NIO Keywords: Determinants, mortality, neonatal intestinal obstructionAfrican Journal of Paediatric Surgery Vol. 6 (1) 2009: pp. 11-1

Effect of diets containing different nutrient density on performance and faecal egg count of West African Dwarf rams

A study was conducted to determine the effect of different nutrient densities on performance characteristics and faecal egg count of West African Dwarf (WAD) rams semi-intensively managed. Twenty four yearling lambs between 10 – 15kg were used for the experiment. The lambs were allotted to two treatment groups containing 12 animals per group. They were released into the paddock containing sown pasture to graze for 6 hours per day. The animals were randomly assigned to treatments containing two levels of protein-energy density; low energy, low protein (LELP) and high energy, high protein (HEHP) in a completely randomized design. Performance characteristics of WAD rams showed that protein and energy density have significant effect (P<0.05) on weight gain, daily weight gain and protein intake. Metabolic weight gain was influenced (P<0.05) positively by the protein and energy density. Animals fed HEHP diets had significantly (P<0.05) higher protein intake (54.66 g) than those fed LELP diets (22.92 g). The slope observed for animals on HEHP diet was lower compared to that of their counterpart on LELP diet. Hence, HEHP diets improved performance of West African Dwarf sheep as well as reducing the gastrointestinal parasite infection due to lower FEC recorded.Keywords: Nutrient densities, performance, faecal egg coun

Effect of diets with different protein-energy density on the gastrointestinal nematode status of semi- intensively managed West African dwarf sheep

This study was conducted to determine the effect of different protein and energy density diets on the gastrointestinal parasite status of semi-intensively raised West African Dwarf (WAD) sheep. The different densities used were low energy-low protein (LELP); low energy-high protein (LEHP); high energy-low protein (HELP) and high energy-high protein (HEHP). Twenty four WAD sheep with an average weight of 11.5±0.41 kg, aged between 5 and 6 months were used. These were divided into four groups of six animals per group in a completely randomized design. Groups were each fed one of the diets, respectively, as supplement and released into a paddock grown with Stylosanthes hamata and Pennisetum pedicellatum, to graze for 12 weeks at 5 hours per day. The faecal egg count (FEC) ranged from 375 to 3483 eggs per gram (epg). The strongyle eggs had the highest (P<0.05) number whereas moniezia eggs were the least. The effect of the different protein-energy densities on the final FEC and the differences between the final and initial FEC were significant (P<0.05). The FEC obtained in animals fed LELP and LEHP showed 56.30 and 13.30 percentage reduction (P<0.05) in epg, respectively, whereas animals fed HELP showed percentage increase (P<0.05) of 104.30 epg. The highest trend (P<0.05) of infestation was obtained in those fed LELP while the least trend was obtained in those fed HEHP. It could therefore be concluded that diets high in protein and energy levels reduced the gastrointestinal nematodes of WAD sheep compared to other nutrient combinations.Keywords: Gastrointestinal nematode, Nutrient density, WAD shee