Diagnostic Utility of Pre and Post HSG Transvaginal Sonography: The Birth of a New Beginning

Background: The use of ultrasonography in the investigation of infertility has progressed rapidly and has currently become an integral part of the management of infertility in women. The advent of pre and post hysterosalpingogram (HSG) sonography has anecdotally improved the sensitivity and specificity of HSG in the assessment of tubal anomalies. Aim: To report a case of a peritoneal spillage of contrast during HSG which did not reveal fluid in the pouch of Douglas on abdominal and tranvaginal sonography. Methods: A case of pre and post HSG transvaginal sonography is reported with review of relevant literature. Results: HSG showed bilateral spillage of dye without any significant increase in pouch of Douglas fluid on pre and post HSG ultrasongraphy Conclusion: Pre and post HSG sonography have improved the HSG diagnostic accuracy of tubal normalcy as against patency. The quantity of fluid in the pouch of Douglas in the post HSG sonogram (culdosonogram) gives an indication of a free or localized peritoneal spillage. Key Words: hysterosalpingogram, 'culdosonography', Gynaecology

Pattern of Bone Tumours Seen In A Regional Orthopaedic Hospital In Nigeria

Background: Primary bone tumour is a challenge to Orthopaedic surgeons working in developing countries due to late presentation as a result of ignorance and poverty. This is further compounded by limited number of specialist personnel, diagnostic and therapeutic centres. Consequently, they are associated with high rate of morbidity and mortality, which can be reduced with early presentation.Materials and methods: This is a retrospective review of all histologically proven primary bone tumours seen at National Orthopaedic hospital Enugu,South east Nigeria, over a 6 year period.Results: Sixty eight (68) cases met the study criteria and were reviewed. Male:Female ratio was 1.35:1, with a mean age of 22.8years and peak frequency in the 11-20years age range. A total of 28(41.1%) were benign, 21(30.9%) were malignant while 19(27.9%) were tumour-like conditions. The commonest benign tumour was osteochondroma, accounting for 44.7% of non-malignant lesions, while fibrous dysplasia was the commonest tumour-like condition(23.4%). Primary malignant bone tumours accounted for 30.9% of all pathologies, with osteosarcoma(17) accounting for 80.1% of all malignant lesions. The commonest region affected is the leg i.e proximal tibia. Duration of symptoms before presentation ranged from 1month to 12years, with the commonest presenting complaint being apainless lump.Conclusion: Primary bone tumours is commonest in young males, usually benign and affecting the Tibia. Associated late presentation results in increased morbidity and mortality. Hence, efforts need to be geared towards public enlightenment in developing countries, to ensure early presentation, thereby reducing morbidity and mortality

Giant Mucinous Cystadenoma in Nnewi, Nigeria

Mucinous ovarian tumors are the second commonest type of epithelial ovarian tumors. Most of these tumors are benign. Occasionally, these tumors may reach enormous dimensions without being symptomatic. We reported the occurrence of a huge benign ovarian tumor (mucinous cystadenoma) in Nnewi. The data were collected from history taking, clinical examination, laboratory investigation, ultrasonographic examination, operative findings and histopathological examination of the surgical specimen. The case was reported as a massive ovarian mucinous cystadenoma. This case report emphasizes the importance of a thorough evaluation of women who presented with vague abdominal pain. Although the condition is very rare, it is potentially hazardous if early diagnosis and timely intervention is not institutedKeywords: Cystadenoma, Mucinous, Nnew

Effect of Sida corymbosa leaf extract on serum uric acid, urea and creatinine levels of alloxan-induced diabetic albino wistar rats

This study was designed to investigate the effect of Sida corymbosa (SC) leaf extract on serum uric acid, urea and creatinine levels in alloxan induced diabetic albino wistar rats. A total of 30 albino wistar rats each weighing 100g were assembled and divided into three groups (A-C) consisting of 10 rats in each group. Group A received SC treatment, B did not receive SC treatment, while group C served as the control group. 400mg/kg of aqueous extract of SC leaf was administered orally to the rats in group A but not in group B, while group C received only water for 7 days. Blood samples were collected into plain containers for estimation of serum uric acid, urea and creatinine. Serum uric acid, urea and creatinine were analyzed using Uricase, Urease-Berthlot and Jaffe Slot Alkaline picrate methods respectively. Results showed a significant increase in the mean serum levels of uric acid, urea and creatinine after SC treatment, when compared to the pre- treatment status. Similarly, there was a significant decrease in the mean weight of the rats after SC administration. Therefore, SC may have potential harmful effect on the kidney.Keywords: Sida corymbosa, Kidney, Urea, Uric Acid, Creatinine

Prevalence and pattern of stillbirths in a tertiary institution in South-East Nigeria

Background: Death of a foetus in-utero is devastating both to the parents and the attending obstetrician. Knowledge of the relative importance of the different causes will help in the prevention or reduction of its occurrence.Aim: This study evaluated the prevalence and pattern of stillbirths at the Nnamdi Azikiwe University Teaching Hospital Nnewi, Anambra State, South-East Nigeria.Methodology: This was a retrospective study of 297 stillbirths at the Nnamdi Azikiwe University Teaching Hospital, Nnewi from 1st January, 2007 to 31st December, 2011.Results: The stillbirth rate was 56.9/1000 deliveries. Majority of the cases 238 (80.1%) were unbooked. One hundred and twenty-nine (43.4%) were nulliparous. There were 180 (60.6%) male stillbirths while 117 (39.4%) were females. The major causes were abruptio placentae 40 (13.5%), prolonged pregnancy 38 (12.8%), uterine rupture 37 (12.5%) and pre-eclampsia 31 (10.4%). Seventy (23.6%) cases were unexplained.Conclusion: The stillbirth rate is high in our centre. There is need for quality, accessible and affordable antenatal care and delivery services to reduce the rate of stillbirth. Establishment of a subspecialty of prenatal diagnosis and foetal medicine will help in reducing the rate of stillbirths in our environment.Keywords: Foetal death, nulliparous, obstetric care, risk factors, unbooke

Advanced Abdominal Pregnancy in a Diabetic Multipara- is Delivery of the Placenta Always a Problem? A Case Report

Introduction: Abdominal pregnancy is a comparatively rare type of ectopic gestation with a high fetal and maternal morbidity and mortality. Although this entity had been well documented, it still remains a serious dilemma for most obstetricians in practice because of the difficulties in early diagnosis and proper management. The occurrence in a diabetic woman could make management even more complex. Objective: This is to report a case of advanced abdominal pregnancy occurring in a diabetic multipara. Method: A case report of abdominal pregnancy in a diabetic multipara who was referred to the Nnamdi Azikiwe University Teaching Hospital, Nnewi and relevant review of literature. Result: Following a laparotomy, the baby was delivered, and placenta completely removed. Conclusion: The delivery of the placenta following an abdominal pregnancy may not pose a problem in some patients. Appropriate pre-operative diagnosis and timed intervention is recommended

Case Report - Vaginal myomectomy of a prolapsed gangrenous cervical leiomyoma

We report a challenging case of a huge gangrenous prolapsed cervical leiomyoma in a multiparous HIV positive lady. A 37-year-old para 3 lady presented with a progressively increasing irreducible mass protruding out per vaginam, 3 months duration of heavy menses, and symptoms of a urinary tract infection. We performed a vaginal myomectomy and she did well postoperatively. A prolapsed gangrenous cervical leiomyoma is a rare condition with only a few cases reported in the literature. Vaginal myomectomy for this condition can be performed in experienced hands without difficulties

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa