Background: Chronic Leg Ulcers (CLU) are common cutaneous manifestation of sickle cell disease (SCD) and a major cause of debility. CLU results from vaso-occlusion, poor venous pressure, hypercoagulabilty and trauma. The incidence of CLU is variable based on geographical region. Treatment modalities include debridement and skin grafting. The aim of this study was to determine the prevalence, incidence, hematological parameters and treatment modalities of CLU among SCD patients in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria. Patients and Methods: It was a retrospective study of adult SCD patients between January-December 2012 at ABUTH Zaria. Case notes of SCD patients were retrieved and data on socio-demographics, hematological parameters and CLU were extracted and analyzed using Epi Info. Data was analysed using descriptive analysis and comparisom of mean by student's t-test. Results: Of the 446 SCD patients attended to during the study period 14 had CLU. The incidence of CLU was 0.45% among the SCD patients studied. The male to female ratio was (M: F = 1.3:1). CLU occurs commonly around the malleoli in 78.6% whereas other sites constituted 21.4%. In 77.8% of CLU low steady state PCV was seen, 76.9% had reticulocytosis whereas 81.8% had high platelet count > 477 × 10⁹/l. Recurrence rate was 78.5% with osteomyelitis (16.7%) and limitation of movement (16.7%) as a frequent complications of CLU. Wound debridement and dressing was the commonest surgical management option but with a high recurrence rate. Conclusion: Prevalence of CLU is low in SCD patients in Zaria; occurring commonly in patients with low steady state PCV, reticulocytosis and thrombocytosis. Debridement and skin grafting has good cure rate and lower recurrence of CLU.

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Small bowel obstruction is a common condition, encountered in the emergency room of the surgery department. Uncommon causes include gallstone ileus, worm infestation, internal hernias, mesentric ischemia, trichobezoars or phytobezoars, Crohn's disease, postoperative strictures, and diverticulosis. Even more uncommon is primary enterolithiasis. Enterolith, the enterogenous foreign bodies, are rare clinical and radiological entities. True enteroliths are formed due to precipitation and deposition of substances from alimentary chime. Primary enterolithiasis is a rare entity, occurring in association with pathological conditions that lead to hypomotility and stasis, like Crohn's disease, small intestine diverticulae, traumatic or postoperative strictures of ileum, ulcerative colitis and blind loops. Primary enterolithiasis may be asymptomatic or may present with sub-acute or acute intestinal obstruction, but specific radiological diagnosis of primary enterolithiasis is uncommon. Definitive treatment of enterolithiasis with small intestinal obstruction is essentially surgical. The options at laparotomy are manual lysis of the calculus without enterotomy or removal by enterotomy. Bowel resection is indicated in cases with definitive bowel pathology. We are presenting five cases of enterolithiasis, which we encountered in the Surgery Department of L.L.R.M. Medical College, Meerut from January 2006 to December 2012. Clinical presentation, diagnosis, investigations and treatment have been discussed along with a review of literature.

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The gastrointestinal tract (GI tract) is the most common site for extranodal lymphomas with the majority of the non-Hodgkin's B-cell type. It involves any part of the GI, the most frequent sites in the order of occurrence are the stomach, small intestine, and ileocecal region. A 17-year-old male presented with intermittent abdominal pain, altered bowel habits associated with vomiting of 1 month duration. Computerized tomography of the abdomen revealed an eccentric mass in the jejunum with significant luminal narrowing. Limited resection of jejunum showed an intraluminal polypoidal growth with a homogenous cut surface. Microscopic examination of the mass revealed a diffusely infiltrating monotonous population of large lymphoid cells with round to oval vesicular nucleus, prominent nucleoli and moderate to scanty cytoplasm, admixed with few multinucleated giant cells with wreath like arrangement of nuclei, binucleated cells, and atypical mitosis. The tumor was involving the submucosa, infiltrating the muscularis propria and extending into the sub serosa. Immunohistochemistry showed diffuse positivity for CD45, CD30, anaplastic lymphoma kinase-1 (ALK-1), and focal positivity for CD43. The immunohistochemical stains for B-cell lineage CD20, CD79a, T-cell markers CD3, CD2, CD4, CD8, CD7, and other markers namely bcl2, bcl6, CD5, CD138, CD56, Mum1, and PAX-5 were negative. Six lymph nodes isolated showed features of reactive follicular hyperplasia and were free of tumor. A diagnosis of primary ALK positive anaplastic large cell lymphoma of T-cell type of jejunum was made. Patient has completed three cycles of chemotherapy comprising of cyclophosphamide, prednisone, vincristine, and doxorubicin and is in remission until the last follow-up.

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Background: The incidence of multiple primary cancers is reported to be between 0.734% and 11.7%. The occurrence of another malignancy of different organ in patients with known malignant tumor is known as double malignancy and is categorized into synchronous; in which the cancer occurs at the same time or within 6 months and metachronous; in which cancer follows in sequence more than 6 months apart. We review the presentation and management of synchronous malignancies in two different organs. Patients and Methods: All the patients who underwent surgery for malignancy between July 2009 and July 2013 were reviewed and the patients who had synchronous malignancies were identified. Their clinical presentation, treatment and outcome were evaluated. Results: Out of a total of 286 patients with malignancies treated in our institute, four had synchronous primary malignancies (1.39%). Three of them underwent surgery simultaneously for both the malignancies and were given adjuvant chemotherapy. One patient presented with colonic obstruction due to sigmoid carcinoma which was operated in an emergency setting and was later in the postoperative period found to have a synchronous periampullary carcinoma. Two of the patients who were managed with surgery followed by chemotherapy are doing well. Whereas the other two patients have died. Conclusion: Treatment strategies in cases of double malignancy depend on treating the malignancy that is more advanced first, or sometimes both malignancies could be treated simultaneously. If both are amenable to surgical resection as in two of our cases both the malignancies may be dealt with at the same time. The prognosis of the patients with dual malignancies depends on the aggressiveness and the stage of presentation of the more advanced tumor.

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Background: Gallstone disease is a common surgical problem requiring cholecystectomy. It is known to produce diverse histopathological changes in the gallbladder ranging from acute or chronic inflammation to metaplasias and even malignancies. The aim of this study was to emphasize the importance of a detailed microscopic examination and to study the diverse range of histopathological lesions in cholecystectomy specimens. Materials and Methods: This is a retrospective study of 360 cholecystectomy specimens received in the Department of Pathology over a period of 2 years from November 2010 to October 2012. Clinical details and histopathological data were retrieved from the records. The variety of morphological changes in the diseased gall bladder were correlated with the clinical findings. Results: Overall, there were 360 cases consisting of 74 (21%) males and 286 (79%) females. Maximum number of patients was between 31 and 40 years (30.2%). Most common pathology noted in our study was chronic cholecystitis seen in 280 cases (77.7%). Other benign lesions were cholesterosis in 36 (10%) and acute cholecystitis in 10 (2.7%). Various other associated lesions and variants of cholecystitis were also encountered. A total of nine malignant lesions of gallbladder were observed, which included eight cases of incidental adenocarcinomas and one case showing lymphomatous involvement. Conclusion: Our study emphasizes that a routine cholecystectomy performed for a common condition like gallstone disease can result in a diverse and wide spectrum of histopathological lesions ranging from benign diagnosis to an unexpected gallbladder malignancy.

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Background: Episiotomy continues to be increasingly performed in our labor wards despite current scientific evidence restricting its use. The objective of this study was to determine the incidence, indications, and establish reference point for future studies on episiotomy in Aminu Kano Teaching Hospital. Patients and Methods: This was a 3-year retrospective study of vaginal deliveries in Aminu Kano Teaching Hospital, Kano, from January, 1, 2010 to December 31, 2012. The parturients who had episiotomy were identified from the labor ward register and the following information was extracted: Parity, type of vaginal delivery, gestational age at delivery, birth weight, Apgar scores, and estimated blood loss. The information obtained were analyzed and presented. Results: The episiotomy rate was 41.4%. Episiotomy was commonly performed in primigravidae (79.4%) than multigravidae (X² = 3017, P < 0.001), fetal macrosomia in 86.9% of the cases (X² = 669.7, P < 0.001) and assisted vaginal delivery seen in 75% of the cases (X² = 172.4, P < 0.001). Episiotomy was also associated with more postpartum blood loss when compared with parturients without episiotomy and was statistically significant (t = 95.82, P < 0.001). Conclusion: Episiotomy rate is high in Aminu Kano Teaching Hospital. Midwives and doctors conducting deliveries should be educated on the indications for episiotomy and early repair to reduce associated postpartum blood loss.

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Background: The fundamentals in the treatment of acute peritonitis include resuscitation, treatment of septicemia, control of the contaminating source and peritoneal toilet. Numerous studies have shown the roles of different solutions such as normal saline, antibiotics and betadine as intraperitoneal lavage, in reducing morbidity and mortality of peritonitis. The objective of this study was to present our findings on the role of intraperitoneal lavage with normal saline and normal saline followed by super-oxidized solution in patients with acute peritonitis. Materials and Methods: The patients were randomly allotted by slip method into two groups of 50 each. In the control group, after the definitive surgery for the pathology of peritonitis, the peritoneal cavity was lavaged with normal saline and closed after putting drains. In the study group, after the definitive surgery the peritoneal cavity was lavaged with saline followed by 100 ml of super-oxidized solution and drains were closed for 1 h after abdominal closure. The patients were followed-up for morbidity and mortality. Results: Surgical site infection (SSI) was present in 27 out of 100 cases in both groups. In the study group, out of 7 infected cases, intraperitoneal fluid cultures were positive in 6 cases, but only 3 had positive swab cultures. In the control group, out of 20 infected cases, swab culture was positive in 16 cases (p = 0.0399). Among the study group, bowel sounds return in 4.10 ± 1.20 days compared to 5.9 ± 1.17 in the control group. In the study group, fever >100°F developed in 14 (28%) patients in the post-operative period whereas in the control group it was 29 (58%) (p < 0.0024). SSI rates in the two groups were (7/50) 14% and (20/50) 40% respectively (p = 0.0034). Conclusion: This study suggests that super-oxidized solution is effective and safe in reducing post-operative complications including SSI, burst abdomen and episodes of post-operative fever.

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Background: The intima-media thickness (IMT) has been established as an early predictor of general arteriosclerosis in patients with hypertension. The aims of this study were to establish the relationship between carotid IMT (CIMT) and blood pressure of hypertensive adult patients and to correlate CIMT with age and body mass index (BMI) in hypertensive adult patients. Patients and Methods: This prospective study was carried out from November 2012 to February 2013 on 200 hypertensive patients aged 21-70 years. The common carotid artery (CCA) was scanned using an ALOKA SSD-3500 ultrasound scanner with Doppler facility and a 7.5MHz linear transducer. Three measurements of the CIMT were obtained at 1cm proximal to the right and left carotid bulb and the mean value of the three measurements was recorded. Results: There were 200 patients comprising 67 males and 133 females. Their ages ranged 21-70 years, mean of 50.62 ± 10.46 years. The right and left mean CIMT was 0.99 ± 0.13 and 0.99 ± 0.18, respectively; while the overall mean CIMT for both sides was 0.99 mm ± 0.13. The mean BMI for the studied group was 29.09 ± 5.68. The mean systolic and diastolic blood pressure (SBP and DBP) was 157.0 ± 15.5 and 97.6 ± 11.2 mmHg, respectively. There was a significant difference in the mean CIMT value for each SBP and DBP groupings. CIMT correlated positively with age and blood pressure, but had a negative correlation with BMI. Carotid plaques were seen in the CCA wall of 20 patients (10%). Conclusion: In hypertensives, age and blood pressureare the most important determinants of CIMT. The incidence of carotid plagues in our patients was high; therefore, good control of blood pressure in hypertensives may reduce the incidence of carotid plaques and stroke.

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Background : Urinary retention is a common problem in the elderly. The incidence increases with age so that a man in his 70s has a 10% chance and a man in his 80s has more than 30% chance of having an episode of acute urinary retention. Inadequate management of the condition can lead to unnecessary morbidity and occasionally mortality. Increasing knowledge over the years of its pathophysiology has greatly improved the management. Thus, the objective of this study is to review the current concepts in the management of urinary retention in men. Materials and Methods: Current literature on the pathophysiology and management of urinary retention in men was reviewed. The PubMed database was searched using the key words; pathophysiology, management, urinary retention, and men. Results: Urinary retention is a common problem in the elderly worldwide; the incidence rises with age, and by the 9th decade of life, a man has more than 30% chance of an episode of retention. There are three main pathophysiologic mechanisms: Increased urethral resistance secondary to bladder outlet obstruction, impaired bladder contractility, and loss of normal bladder sensory or motor innervations. It may be acute, acute-on-chronic, or chronic. It is now generally agreed from urodynamic studies that the traditional slow decompression of the bladder in chronic retention does not serve its aim of gradual reduction of vesical pressure; thus, the current practice is immediate and complete decompression and managing anticipated complications of postobstructive diuresis or hematuria whenever they occur. Conclusion: Advanced age and bladder outlet obstruction secondary to benign prostatic hyperplasia remain the commonest risk factors for urinary retention. Secondary bladder dysfunction in bladder outlet obstruction, detrusor myogenic dysfunction, and alteration of bladder innervations are the major mechanisms. Immediate and complete decompression in both types of retention is the current practice.

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Fibrous proliferation of testicular tunica also known as fibrous pseudotumor of the testis are are uncommon lesions. These lesions are usually difficult to clinically differentiate from testicular tumors. We describe two cases of pseudotumors of the paratesticular region. The tumors in both cases simulated the appearance of a neoplastic process on gross examination. The first patient presented with a testicular mass while the second presented with acute scrotal abscess. A fibromatous pseudotumor completely encased the testes in both patients. In addition to fibrosis, ossification of the tunica led to "eggshell calcification" on imaging in the first case. Both tumors were successfully resected with an uneventful recovery. Histological examination revealed hypocellular dense collagen bundles with areas of coagulative necrosis with mononuclear inflammatory infiltrate. No evidence of cellular atypia or increased mitosis was seen. There was no tumor recurrence at 15 months follow-up. Fibrous pseudotumors should be considered in the clinical differential diagnosis of testicular and paratesticular masses.

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The child development from conception through early years of life is marked by many changes. Tooth eruption follows the chronology corresponding to the date, when tooth erupts into the oral cavity. These dates have been established in the literature and are subject to small variations depending upon hereditary, endocrine, and environmental factors. However, the chronology of tooth eruption suffers a more significant alteration in terms of onset and the first tooth or teeth may be present at birth, called as natal teeth. Natal teeth are rare in extremely preterm infants. In this paper we present a rare case regarding the eruption of mandibular natal tooth in a 10-day old, 7-month preterm normally delivered infant.

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Swelling of parotid glands following surgeries undertaken under general anaesthesia are rare. These are termed as anaesthesia mumps or acute postoperative sialadenitis. It may be unilateral or bilateral. It may present immediately or over a variable period. It resolves spontaneously over a period of hours and days. An eight-year old child developed swelling of left parotid gland. The swelling occurred on the first postoperative day, following cholecystectomy for cholelithiasis under general anaesthesia. Induction and course of general anaesthesia was smooth. It was treated symptomatically. Swelling subsided after three days without instituting any specific therapy. Oral hygiene care was maintained with chlorhexidine mouth wash. The aim of this case report is to draw attention of the surgical fraternity to this condition which may be encountered in the immediate postoperative period and raises alarm but does not merit any aggressive management. It resolves spontaneously with symptomatic care.

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A vermiform appendix in an inguinal hernia is known as Amyand's hernia. The incidence of having a normal appendix within the hernia sac varies from 0.5% to 1%, whereas only 0.1% of cases complicate into acute appendicitis, underscoring the rarity of the condition. This is a case series of three cases with different presentations and their management. The first case is of a 42-year-old male who was admitted as a routine case of a right-sided indirect inguinal hernia, with a history of occasional pain in the swelling. On surgical exploration of the sac, contents of the hernia sac included omentum and an acutely inflamed appendix with the appendix densely adherent to the hernia sac. Appendicectomy was performed and a herniotomy was done. A herniorrhaphy was performed by modified Bassini repair. The second case is of a 28-year-old young male who presented with a right-sided indirect inguinal hernia. He had no specific complaints associated with the hernia. He was operated under local anesthesia and intraoperatively in the hernia sac, appendix was an incidental finding and an appendicectomy was not performed. The third case is of a 58-year-old man who presented to the emergency with an obstructed hernia. The patient was operated upon in the emergency operation room, and on opening the sac, there was serosanguineous collection and the cecum along with the inflamed appendix. Appendicectomy was done without stump inversion. The superficial inguinal ring was found to be constricting the neck of hernia sac, which was divided. Routine herniotomy and herniorrhaphy was done by modified Bassini method.

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Background: Acute Pancreatitis (AP) is an inflammatory process. The average mortality rate in severe AP approaches 2%–10%. Gall stones and alcohol abuse account for 70% of cases of acute pancreatitis. Almost all patients have acute upper abdominal pain. Systemic complications and multi organ system failure may develop. Patients and Methods: A prospective study conducted from November 2016 to December 2017 in Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, India, in patients who were diagnosed to have acute pancreatitis. A total of 54 patients were enrolled in the study out of which four patients had left against medical advice. The data collected were evaluated to see the outcome. Results: Majority of patients 22 (44.0%) were in age group ranging from 41 to 60 years. Males were dominant (58%). The most common etiology was alcoholism followed by gall stone. The majority of patients were found with abdominal pain (100.0%). The majority of the patients were having moderate Balthazar CT Severity Index (CTSI) (54.0%). In all, 43 patients were having pancreatic complications and pancreatic necrosis was the commonest; 31 developed extra-pancreatic complications, among which pleural effusion was the commonest. Some patients were having multiple complications. The duration of hospital stay was highest in severe group of Balthazar CTSI. Rise in total leucocyte count, serum amylase level and low calcium levels were significantly associated with increase in pancreatic/extra-pancreatic complications. There was only 1 (2%) patient who died and remaining 49 (98%) patients were discharged. Conclusion: Most common etiology of acute pancreatitis was alcohol consumption (50%) followed by gall stones (32%). Increases in total leucocyte count, serum amylase level and low level of serum calcium were significantly associated with increase in pancreatic/extra-pancreatic complications leading to higher morbidity and hospital stay. Patients with higher Balthazar CTSI were having higher morbidity.

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Background: Ureterocele is a cystic dilatation of the distal ureter. It remains a rare urologic condition in non-Caucasians and is even less common in adults. Single-system ureteroceles are usually found in adults, and thus the name "adult" ureterocele. Though uncommon, urologists practicing in this region should be acquainted with the management. Materials and Methods: A retrospective review of folders of 10 adult patients who were admitted for surgical treatment of ureterocele in our center between 2000 and 2009 was done. The information obtained included: age, sex, type and number of ureterocele, associated disease, type of surgical intervention, complications, and follow-up. Results: The age range was 20-49 years, with a mean age of 31 years. Of these patients, seven were females and three were males. Six patients had unilateral ureterocele while four had bilateral disease, making a total of 14 ureteroceles. The presenting symptoms were flank pain and painful micturition, each occurring in 60% of the patients. Genitourinary tuberculosis was diagnosed in 4 (40%) patients. Other associated pathologies were impacted stone in the ureterocele and vesical schistosomiasis. The treatment was mainly by open method (70%), while the rest had endoscopic treatment. All the patients did well and there were no significant perioperative complications. Conclusion: The finding of associated pathology in our patients supports the theory of an acquired origin. Urologists practicing in this region need to have a high index of suspicion and be acquainted with the variable clinical presentations, radiographic features, and treatment options in order to be able to effectively manage these occasional cases.

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Introduction : The incidence of AIDS-associated Kaposi's sarcoma (AAKS) is increasing in the West African sub-region. The objective of this study was to describe the epidemiologic and clinical features of AAKS. Materials and Methods : This study was carried out in a tertiary health center with a federal government supported AIDS treatment program in Zaria, Nigeria. The subjects comprised 137 consecutive patients evaluated for AAKS from 2006 to 2011. Following evaluation appropriate specimens were taken for histologic, virologic, and immunologic assessment. Result : There were 137 patients representing 1.4% of HIV infected patients seen during the study period. The male to female ratio was 1.3:1. Their ages ranged from 2 to 58 years, mean of 32 ± 6 and females were younger than males. Mean duration of symptoms was 4.2 ± 1.5 months. Kaposi's sarcoma was the AIDS-defining disease in 95 (69.3%) patients while in 42 (30.7%) it was diagnosed between 1 and 15 months after the diagnosis of HIV infection. The lower limbs were the most frequent sites of lesions. Females had more disseminated lesions involving an increased number of lesions at multiple anatomical sites compared with more localized lesions in the males (OR 2.7, 95% CI 1.5-7.0). The CD4 count ranged from 19 to 798 cells/mm ³ , median 132; interquatile range 102-317 cells/mm ³ while the median HIV RNA copies/ml of plasma was 51,723 (ranged 250-917, 254). Conclusion : The prevalence of AAKS is increasing in our institution. Female patients were younger and had more disseminated disease that progressed faster than in males. Timely identification of HIV-infected patients is essential to avoid the consequences of immunological deterioration associated with delayed anti-retroviral therapy.

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Introduction: Hand complications of diabetes mellitus are rare compared to those in the foot. They occur in the ratio of 1:20 in our observations. We managed 36 patients with tropical diabetic hand syndrome and propose a classification for the disease that will allow communication between physicians and prognostication. Materials and Methods: Patients with hand infections and background diabetes mellitus were admitted. Their age, sex and occupations were noted. A clinical diagnosis was made and drained. Wound swab for culture was taken. Wounds were generally serially debrided at bed side with wound being allowed to granulate over time to be subsequently closed by split thickness skin graft. Results: Thirty six patients were studied. Based on their clinical diagnosis, they were classified into three (I,II,III) groups in increasing order of severity. The classification correlated with the type and severity of the disease. It also guided the choice of appropriate treatment. Conclusion: Based on our findings, tropical diabetic hand syndrome was classified and prognosticated based on the degree of soft tissue and bone involvement. The classification allows for communication with other physicians.

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Transverse testicular ectopia (TTE) is a rare congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Müllerian duct syndrome (PMDS), true hermaphroditism, inguinal hernia, hypospadias, pseudo-hermaphroditism, and scrotal anomalies. Most of the reported cases are in children with very few reported cases in adults. We report a case of 30-year-male, who presented with right reducible inguinal hernia and left undescended testis. Diagnosis was confirmed preoperatively by ultrasound followed by diagnostic laparoscopy and open inguinal exploration for orchiopexy. Bilateral transseptal orchiopexy and hernioplasty were performed. He had an uneventful recovery. Due to lack of awareness most of these cases are diagnosed accidentally intraoperatively. Preoperative diagnosis can be achieved by proper knowledge and imaging techniques (ultrasonography and magnetic resonance imaging). Surgeons who frequently repair inguinal hernias should be aware of disease and appropriate surgical management options available to them when this condition is unexpectedly identified during inguinal exploration. The embryology, clinical features and management algorithm are discussed herewith with review of pertinent literature.

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Abcess within a brain tumor is very rare and is usually seen in a pituitary tumor. We present a patient with glioblatoma that was found to contain abcess at operation. A 50-year-old man presented with a rare case of glioblastoma associated with intra-tumoral abscess formation manifesting as seizures, headache and vomiting after fever, cough, and chest infection. Computed tomography and magnetic resonance imaging demonstrated a ring-enhanced lesion mimicking malignant glioma. Craniotomy and tumor removal were performed. Abscess formation within the intra-axial tumor was found intra-operatively. Histological examination revealed glioblastoma with abscess and the etiological agent was anaerobic gram-negative bacilli. The post-operative recovery of the patient was satisfactory. Abcess in a gliobastoma is uncommon. The suspected route of microbial migration and colonization in this tumor was probably bacteremia from chronic lung infection. Careful evaluation and appropriate treatment would lead to a good outcome.

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Spontaneous colocutaneous fistula is a rare clinical entity usually associated with diseases like diverticulitis, crohn's disease and post radiotherapy treated malignancy. This case illustrates the challenges of diagnosis and management of such patients. We present a 60-year old lady who had a lump in left lumbar region which started discharging feculent material ten day prior to presentation. There was history of progressively worsening constipation and weight loss but no rectal bleeding or jaundice. There was a necrotic patch with feculent discharge from left lumbar region with underlying lump that was 5 Χ 4 cm, firm, non-tender and immobile. Following complete evaluation including abdomino-pelvic ultrasound that revealed an ill-defined mass arising from sigmoid colon, a diagnosis of colocutaneous fistula secondary to colonic malignancy was made. After resuscitation, the patient had exploration and Hartmann's procedure. Histopathology confirmed growth as adenocarcinoma and patient was placed on chemotherapy. We present this case to illustrate the challenges of diagnosis and management of such patients.

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Empyema thoracis is quite appreciated as a purulent pleural effusion. The basis for open drainage as an option for the treatment of chronic empyema thoracis is that the lung is trapped beneath a thickened and fibrosed visceral peel, which stabilizes and shields the trapped lung from the possible effect of pneumothorax when such a lung is exposed to the atmosphere either deliberately or accidentally. This is often unappreciated by many clinicians especially those with limited experience. From first principles, pus anywhere requires drainage and this applies equally to pleural space pus. Since these patients are often unfit for stressful procedures like decortication or the underlying lung is often unhealthy and will fail to expand or would be seriously violated in an attempt to free it, open drainage provides a safe and suitable option for the treatment of this pathology. We present the successful management of two patients by this approach as well as the review of literature in this respect.

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Background: Cholecystitis is a common indication for major abdominal surgeries. It may occur with or without obstruction of common bile duct. Obstruction leads to secondary bacterial infection of bile. Bactibilia is an important predisposing factor for post-operative complications. Hence, this study was designed to determine the prevalence of bacteria in bile samples of cholecystitis patients and to correlate bactibilia and post-operative wound infection. Materials and Methods: Bile samples collected intra-operatively were subjected to gram stain, culture, and antibiotic sensitivity testing. The patients were followed-up for post-operative complications. If post-operative wound infection was found, cultures were done and correlated with bacteria isolated from bile samples. Results: Bactibilia was found in 27/50 (52%) of patients. Polymicrobial flora was found in 10% of bile samples. Escherichia coli, Klebsiella pneumoniae and Enterococcus faecalis were the predominant organisms isolated. None of the anaerobes were isolated. Extended spectrum β-lactamase and AmpC β-lactamase (AmpC) production was seen in 47% and 31.5% of Enterobacteriaceae isolates respectively. Post-operative wound infection was found in six (12%) patients who had bactibilia. Combination of piperacillin-tazobactam and amikacin was most effective in prophylactic regimen. Conclusion: The organisms responsible for bactibilia were found to cause post-operative infections in the same patient warranting the use of prophylactic antibiotics in every patient undergoing cholecystectomy. All patients undergoing open cholecystectomy should receive prophylactic antibiotics to prevent post-operative wound infections.

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Background: Oral cancers are not uncommon. We have analyzed the incidence of nodal metastasis in oral cancer clinically and compared it with the final histopathology examination (HPE) report, correlating the pathologically positive lymph nodes with different parameters such as tumor sites, pathological stage, differentiation, lymphovascular, perivascular extension and perineural invasion. Materials and Methods: This retrospective study was carried out on patients who were evaluated with a histological diagnosis of oral cancer from 2008 to 2012. Lymph node positivity was established by clinical and ultrasound evaluation in 218 patients who underwent neck dissection for oral cancer. This was compared with the histopathology findings. Results: The most common site of oral cancer was buccal mucosa. Histopathologically, majority were squamous cell carcinoma (SCC). Lymph node positivity was observed for different sites as follows: buccal mucosa (26.7%), gingivo-buccal sulcus (20.8%), retromolar trigone (40%), tongue (50%), and floor of mouth (100%). In well-differentiated SCC, node positivity was 25.4%. In moderately differentiated SCC, it was 52.3% and in poorly differentiated SCC, it was 50%. Five cases of verrucous carcinoma did not show any lymph node positivity. According to the pathological staging, the lymph node positivity was as follows: T1 (25.58%), T2 (23.59%), T3 (37%), and T4 (34.78%). Out of 218 patients, 5.5% patients showed positive resected margin, 1.8% patients showed skip metastasis, and 14.6% patients had lymphovascular or perivascular invasion. Univariate analysis showed significant correlation of lymph nodal metastasis with various clinicopathological parameters like tumor site, stage, and differentiation. Conclusion: In our female predominant study group, mostly locally advanced tumors were encountered involving the alveobuccal subsites. Standard neck dissections play an important role in the control of neck disease.

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Background: Glaucoma is a common cause of blindness in developing nations. The objective of this study is to determine the severity of primary open angle glaucoma and audit health records of glaucoma patients in our center. Materials and Methods: A retrospective case note search of glaucoma patients from out-patient clinic was carried out between January 2001 and December 2010. Data analysis included descriptive statistics and exact binomial 95% confidence interval (CI) calculated for the mean estimates. Results: Seventy-six patients (152 eyes), comprising 49 (64.5%) males and 27 (35.5%) females were included in the study. The age ranged from 15 to 88 years (mean: 54.2 ± 14.5). Forty-five (59.7%) presented with normal vision and 10 (13.2%) had visual acuity <3/60 in at least one eye. Cup-Disc-Ratio (CDR) on the right eyes were ≤0.6 = 12 (15.8%), >0.6 < 0.9 = 27 (35.5%), >0.9 = 35 (46.1%) and left eyes were 15 (19.7%), 29 (38.2%), 28 (36.8%), respectively. Mean intraocular pressure (right eyes) at presentation was 20.3 mmHg (95% CI, 17.4-23.3) and reduced to 13.4 mmHg (95% CI, 10.7-16.0) at the last readings while left eyes from a mean of 20.3 mmHg (95% CI, 16.9-23.8) reduced to 12.1 mmHg (95% CI, 10.0-14.3). The mean presenting CDR were 0.79 (95% CI, 0.74-0.83) and 0.73 (95% CI, 0.68-0.79) in right and left eyes, respectively. CDR showed statistical significance with age (p < 0.001, yate-corrected X ² -test) but not with sex (p = 0.807). Conclusion: Late presentation of glaucoma cases is a major problem in Calabar. We recommend public enlightenment, case detection, and early treatment to reduce ocular morbidity.

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Background: A surgical fire is a rare but life-threatening event. They are always unexpected and commonly occur in head and neck surgeries resulting in severe burns, disfigurement, and in some cases death. Injuries are not limited to patients alone as they may also involve health-care personnel in the operating theater. There is a resurgence in the awareness of this intra-operative challenge as well as an understanding of the need for a team approach to prevention. Materials and Methods: The surgical fire triangle is a useful paradigm that describes the three elements necessary for initiation of a surgical fire i.e., ignition source, fuel, and an oxidizer. This review will identify operating theatre contents capable of acting as ignition/oxidizer/fuel sources and highlight the management and prevention of surgical fires. Results: Surgical fires can be prevented by education across all professional boundaries in the operating theater. This will entail information on how the elements of the fire triangle interact, recognizing how standard operating room equipment can initiate a fire, and vigilance for the circumstances that increase the likelihood of a surgical fire. Conclusion: Promoting a culture of fire safety in the theater is not optional. Education on the prevention of surgical fires should be included in the curriculum of undergraduate medical students. There is an urgent need to stimulate debate within National burn associations in this context, leading to the formation of proposals to be incorporated into existing National burn prevention plans.

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