Tension pneumoventricle: A report of two cases

Pneumocephalus is often a complication of head trauma and cranial surgeries. Massive intraventricular pneumocephalus is an uncommon entity. We report the cases of two patients presenting same day with a clinical diagnosis of open head injury following separate road traffic accidents whose computed tomography (CT) brain images confirm skull base and vault fractures with massive pneumocephalus and tension pneumoventricles. CT scan remains invaluable in proper evaluation of head injury, and its complications for early and appropriate intervention toward reducing morbidity and mortality.Keywords: Computed tomography scan, pneumocephalus, tension pneumoventricl

Endoscopic resection of an esophageal leiomyoma with overlying dysplasia without specialized equipment

Leiomyomas are rare benign esophageal tumors. Association of this subepithelial lesion with abnormal epithelium is rarer. Endoscopic mucosal resection is an alternative to surgery for removing suitable mucosal and submucosal lesions from the gastrointestinal tract. This procedure is seldom performed in developing countries due to limited equipment and expertise. We describe a case of esophageal leiomyoma with overlying dysplasia in the mid esophagus that was completely removed endoscopically in a developing country without the standard accessory equipment. Traditional thoracotomy would have been associated with higher cost and morbidity.Keywords: Dysplasia, endoscopic resection, esophageal leiomyom

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

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

Laparoscopic Surgery in a Nigerian Teaching Hospital for 1 Year: Challenges and Effect on Outcomes

BACKGROUND: Laparoscopic surgery has developed rapidly in developed nations within a relatively short time to become a major method of treating surgical diseases, with increasing application across specialties. However this is not the situation in developing countries like Nigeria. This may be as a result of local challenges to the performance of laparoscopic procedures. It is important to identify what these challenges are.METHODOLOGY: We prospectively studied problems encountered during the performance of laparoscopic procedures, and their effects on the procedure in a Nigerian teaching hospital for a year. Demographic information, laparoscopic procedure, problems encountered and effect on procedure, and outcomes were analyzed using descriptive statistics.RESULTS: Our sample consisted of 21 patients who had laparoscopic procedures performed by the authors; 12 (57%) were therapeutic procedures. Average age was 34.1 years (range 18-50 years) and majority (61.9%) were female. Problems encountered included non functioning/malfunctioning equipment (76.2%), power outages (33.3%), and dead light source bulbs (14.3%).  There were 5 (23.8%)  conversions to open surgery as a result of problems encountered; another conversion (4.8%) was to tackle an ascending colon tumour discovered at laparoscopy. CONCLUSION: The performance of laparoscopic procedures in a Nigerian public hospital is affected largely by inadequate and often malfunctioning equipment, and attention to these may reduce rates of conversion to open surgery.KEY WORDS:  Laparoscopic procedures

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

Experience in the management of the mass casualty from the January 2010 Jos Crisis

Background: On the 17 of January 2010, a sectarian crisis broke out in Jos the capital of Plateau state, Nigeria. It created a mass casualty situation in the Jos University Teaching Hospital. We present the result of the hospital management of that mass casualty incident.Objective: To share our experience in the management of the mass casualty situation arising from the sectarian crisis of Jos in January 2010.Methodology: We retrospectively reviewed the hospital records of patients who were treated in our hospital with injuries sustained in the Jos crisis of January 2010.Results: A total of 168 patients presented over a four day period. There were 108 males (64.3%) and 60 females (35.7%). The mean age was 26 ± 16 years. Injury was caused by gunshots in 68 patients (40.5%), machete in 56 (33.3%), falls in 22 (13.1%) and burning in 21 (13.1%). The body parts injured were the upper limbs in 61(36.3%) patients, lower limbs 44 (26.2%) and scalp 43 (25.6%). Majority, 125 (74.4%) did not require formal operative care. Fourteen (8.3%) patients had complications out of which 10 (6.0%) were related to infections. There were 5 (3.1%) hospital mortalities and the mean duration of hospital stay was 4.2 days. The hospital operations returned to routine 24 hours after the last patient was brought in. As a result of changes made to our protocol, management proceeded smoothly and there was no stoppage of the hospital response at any point.Conclusion: This civil crisis involved mostly young males. Injuries were mainly lacerations from machete and gunshot injuries. Majority of the victims did not require formal surgical operations beyond initial care. Maintaining continuity in the positions of the Incident commander and the mass casualty commander ensure a smooth disaster response with fewer challenges.Keywords: Conflict, disaster, hospital response, mass casualty, traum