Background: Surgeons practicing in emerging nations like Nigeria which are still struggling to cope with institutionalized approach to patient safety and quality health care have a critical role in ensuring the safety of their patients. This article aims to provide an overview of the surgeon's role in the causation and prevention of surgical adverse events. Patients and Methods: The literature is reviewed using key terms: Surgical adverse events, postoperative morbidity and mortality, surgical safety and error management from Pubmed, Ajol, Google scholar, and Embase data bases. Results: An estimated 3-22% of surgical patients suffer adverse events, half of which may be preventable. Over three-quarters of adverse events are traceable to the operating theater from failures of surgical technique during routine operations. Preventable adverse events are symptomatic of both the surgeon and the health care system fallibility. Conclusion: Minimizing surgical adverse events require integrating safety into all the stages and the processes of surgical care. The surgeon's antidote to adverse events is to deliver quality service and leadership throughout the period of patient care.

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Background: Laparoscopic cholecystectomy has several advantages over open cholecystectomy. The purpose of this study was to compare the outcome between two-port and four-port laparoscopic cholecystectomy. Patients and Methods: Between October 2011 and September 2013, 200 patients with calculous cholecystitis were prospectively consecutively selected into two groups of 100 patients each for two-port and four-port laparoscopic cholecystectomy, respectively. Results: There were 39 males and 161 females. The mean operative time required in the two-port group was 46.66 ± 14.47 minutes and in four-port group was 48.79 ± 8.336 minutes (P value = 0.1297). Three patients were converted to four-port laparoscopic cholecystectomy in the two-port group. There were 25 minor complications (14 in the two-port group and 11 in the four-port group). The VAS scores were statistically significant at 1, 12, and 24 hours. An average requirement of 0.73 doses of analgesia in the two-port group and 1.36 doses in the four-port cohort was observed. The hospital stay was significantly shorter in the two-port group. Conclusion: The two-port laparoscopic cholecystectomy is safe and preferable due to fewer requirements of analgesics, better cosmesis, cost-effectiveness, shorter hospital stay, and reduced labor.

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Eosinophilic cystitis is a rare but distinct entity in patients presenting with bladder symptoms. We describe two cases of eosinophilic cystitis in whom no specific cause could be found with review of the literature. In one patient, the symptoms and radiological evaluation suggested a bladder tumour. However, transurethral resection of bladder lesion was done and histology revealed eosinophilic cystitis. The other patient presented with lower urinary tract symptoms of long duration and bladder biopsy revealed eosinophilic cystitis. Both patients were managed conservatively with anti-histamines and steroids and they improved well. The evaluation of the patient with eosinophylic cystitis should include cystoscopy and biopsy to establish histological diagnosis. After diagnosis the patients can be safely and successfully treated conservatively although recurrence is not uncommon.

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Background: Acid peptic disease is a common problem world over resulting from imbalance of acid and pepsin present in gastric secretions. It encompasses many conditions, including gastritis and peptic ulcer with dyspepsia being a common complaint. Prevalence of H. pylori is high in developing countries and low in developed countries. We study the prevalence of H. pylori and its association with age, sex, and dietary factors in patients with acid peptic disease. Materials and Methods: The study was conducted on 200 patients >= 18 yrs visiting SGRD hospital with complaints of dyspepsia, in a period of 2 years. Patients who refused endoscopy, who were medically unstable, those with suspected perforation, those with deranged coagulation profile, patients with history of intake of PPIs, bismuth compounds, antibiotics (metronidazole, amoxicillin, clindamycin, clarithromycin) in previous 1 week, those suffering from cholecystitis, cholelithiasis, pancreatitis, were excluded from the study. Patients were advised to stop all anti-ulcer drugs, antibiotics and bismuth containing drugs at least 1 week prior to the study. Informed consent was taken from the patients. These patients were subjected to detailed history and physical examination. A detailed questionnaire which collected presenting complaints, sociodemographic characteristics, dietary habits, smoking and drinking habits, history of regular intake of NSAIDs, any other co-morbid condition present, and abdominal ultrasonography findings, was filled. On upper GI endoscopy, gastric antral biopsies were taken and subjected to rapid urease test using a commercially available test kit. The results were noted and analyzed statistically. Results: Overall prevalence of H. pylori came out to be 80.5%. It was more in males than females. Prevalence increased with increasing age and was highest (90.9%) in age group >70 yrs. Most common dyspeptic symptom was fullness after meals. Prevalence was seen more in non-vegetarians (83.7%) than in vegetarians (78.1%) but statistically insignificant. Chronic gastritis was most common endoscopic finding with 96.1% prevalence of H. pylori associated with it and this was significant statistically (P < 0.05). Association with peptic ulcer did not come out to be statistically significant (P > 0.05). Conclusions: Prevalence of H. pylori is very high in our part of the world and rapid urease test presents an easy, accurate, cost-effective method for its detection. No significant association seen with gender, dietary factors, NSAIDs, smoking and alcohol intake. Chronic gastritis shows a significant association, while both duodenal and gastric ulcer did not show any significant association with H. pylori. So, taking into account the high prevalence, and association with chronic gastritis, treatment should be offered to every patient with such complaints and findings on endoscopy.

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Ingestion of foreign body (FB) is known to occur in both children and adults. In adults, it is mainly accidental, although it may be intentional in the mentally unstable. Various objects have been swallowed by such individuals. We recently managed a 28-year-old schizophrenic who presented to us with an impacted fish hook in the rectum which he had swallowed. The fish hook which was protruding was removed under local anesthesia. This case highlights the fact that all sorts of bizarre objects may be ingested by the mentally unstable. Careful examination and investigation is usually followed by successful outcome of treatment

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Background: Surgical procedures in obstetrics and gynecology have witnessed significant improvements in terms of morbidity and mortality. This is not unrelated to advancement in asepsis and anesthesia over the years. This study aimed at describing the pattern of surgical procedures in obstetrics and gynecology at a tertiary health center in Northern Nigeria. Patients and Methods: This is a retrospective study of patients who had surgical procedures in Obstetrics and Gynecology at Aminu Kano Teaching Hospital, Nigeria from 1 ^st January, 2005 to 31 ^st December 2009. The data retrieved from their case notes were analyzed using Mini Tab Electronic Statistical Software. Information extracted were age, type of surgery and anesthesia used. The data analyzed were presented using simple tables. X ² and P value were used to test for significant statistical associations where appropriate. Results: A total of 2741 operations were done within the period under review. The mean age of the patients was 29.95 ± 8.26 years. Emergency surgeries were performed in1643 (59.9%) patients while the remaining 1098 (40.1%) were elective. General anesthesia was used for the majority 2093 (76.4%) of the cases. Cesarean section accounted for the majority (62.6%) of the procedures performed. Other surgeries include myomectomy (4.2%), total abdominal hysterectomy (4.7%), and andlaparotomy (9.3%) among others. Obstetric cases accounted for 1510 (55.1%) of the surgeries conducted while 1231 (44.9%) were gynecological cases. Conclusion: Most of the procedures were emergency obstetric surgeries performed under general anesthetic. Caesarean section rate was highest among all surgical procedures. There was statistically significant association between the type of surgery and the administered form of anesthesia.

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Background: Sentinel lymph node (SLN) tumor metastasis size (TMS) and extra-capsular extension (ECE) are predictive of non-SLN metastasis. We hypothesized that SLNTMS and ECE would also be predictive of systemic metastasis and death. Materials and Methods: Data from 2,001 women with breast cancer who underwent SLN biopsy were prospectively collected and retrospectively analyzed. SLNTMS and ECE were measured, reported according to standard pathologic protocols and recorded. Data were analyzed from 252 patients with both SLNTMS and ECE information available. Cancer-specific mortality and all-cause mortality were observed, calculated and multivariable analyses performed to identify significant interacting variables amongst demographics, clinical stage and pathological characteristics. Results: Thirty eight treated patients died from any cause and 12 died of cancer during the 16.4 year follow-up. Patients with ER expression had a significantly lower risk of dying of cancer compared to those who lacked ER expression (HR = 0.198, 95% CI 0.06-0.62; P = 0.006). SLNTMS (P = 0.929 and 0.677) and ECE (P = 0.723 and 0.926) were not significant in the multivariable models of either disease specific or all-cause mortality. Conclusion: Neither SLNTMS nor the presence of ECE affected disease-specific or overall mortality in our breast cancer patients.

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Parotid duct fistula is uncommon but difficult-to-treat complication that often results from a penetrating trauma. While there is general consensus in the literature as to the management of acute parotid injuries, treatment of chronic fistulas remains controversial. Congenital parotid duct fistula is a rare entity. Herein we present a 20-year-old female who presented with a parotid duct fistula since birth. Clinical evaluation revealed no accessory parotid gland or duct. Patient was found to have a combination of more prominent Plica semilunaris of the left eye, a finding not so far reported in the literature. Following complete examination and investigations, intra oral transposition of the fistulous opening and tract was done. We present this case for its rarity and the gratifying outcome of the surgical procedure.

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Background: The chest radiographic appearances of human immunodeficiency virus (HIV)-seropositive patients presenting with pulmonary tuberculosis (PTB) are diverse, creating difficulty in diagnosis and treatment. This study determined the relationship between the degree of immunosuppression and the various radiological patterns of PTB in HIV-infected patients with TB. Materials and Methods: Sixty consecutive patients with PTB, and positive for HIV antibodies as detected using enzyme-linked immunosorbent assay and confirmed by immunoComb 11 (IMMUNOCOMBFIRM), who presented at the infectious diseases clinic of University of Maiduguri Teaching Hospital, Maiduguri and fulfilled the inclusion criteria were included in to a prospective cross-sectional study after obtaining an informed written consent. CD4+ lymphocytes counts were obtained for all the patients. Posterior anterior and lateral chest radiographs were obtained. The chest radiographic images were evaluated for the presence of either typical or atypical patterns of PTB. Results: The mean CD4 counts of those with typical and atypical PTB pattern were 339.8 ± 139.52 and 138 ± 41.78 cells/μl, respectively (P = 0.001). Majority of the patients with typical pattern had a CD4 count of ≥200 cells/μl and they belonged to the HIV/PTB on highly active antiretroviral therapy (HAART) group (56.3%) as against 21.4% of HIV/PTB antiretroviral (ARV)-naïve patients. More of HIV/PTB patient who were ARV-naïve and had CD4 count <200 cells/μl presented with atypical pattern (60.7%) as against 25% of HIV/PTB on HAART. None of the patients with HIV/PTB ARV-naïve with CD4 count <200 cells/μl presented with typical pattern. Conclusion: We concluded that radiographic patterns of PTB in HIV varied over a spectrum and are related to HIV disease stage and that atypical radiographic pattern was a good predictor of low CD4 counts.

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There is paucity of data regarding studies on leprosy and HIV/AIDS co-infection. We present a case of lepromatous leprosy in a known HIV/AIDS patient that presented with chronic leg ulcers. This case report is presented because of its rarity and the fact that physicians managing HIV/AIDS patients are likely to miss leprosy in such patients due to the decreasing prevalence of leprosy worldwide. Informed written consent was obtained from the patient for the purpose of this study.

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Background: Congenital anomalies around the umbilicus are not uncommon. Surgical repair and reconstruction is often required in the neonatal period. Proper location of the neo-umbilicus after reconstruction is important. This study was designed to identify the normal location of the umbilicus in Nigerian newborns. Material and Methods: The distance between the suprasternal notch and the umbilicus (SU), between the suprasternal notch and the pubic symphysis (SP), between the xyphoid process and the umbilicus (XU) and between the Xyphoid process and the pubic symphysis (XP) were measured using a measuring tape and the XU/XP and SU/SP ratio calculated. Results: The mean XU/XP ratio was 0.66 ± 0.06 (range 0.43-0.83) while the mean SU/SP ratio is 0.79 ± 0.05. There was no significant difference in the XU/XP or SU/SP ratio between the two sexes. There was also no significant correlation between the birth weight, height, OFC, Gestational age with XU/XP ratio and SU/SP ratio in both sexes. Conclusion: In conclusion, the umbilicus is located in 66% of the distance between the xyphoid process and the pubic symphysis or 79% of the distance between the suprasternal notch and the pubic symphysis in Nigerian neonates.

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Leiomyosarcomas of the inferior vena cava (IVC) with direct invasion of the kidney without involvement of renal vein is rare. A 33-year-old male presented with right flank pain. Contrast enhanced computed tomogram (CT) of the abdomen showed 8.3 cm × 7.5 cm × 5.7 cm vascular mass arising from the suprarenal and hepatic segment of IVC. The IVC was partly occluded by the mass, which was invading right adrenal gland and kidney with normal renal vein. CT guided biopsy revealed low grade leiomyosarcoma. Smooth muscle actin and desmin were positive while S-100, CD34 and C-KIT negative. The patient underwent excision of IVC leiomyosarcoma and right nephrectomy with reconstruction of IVC using saphenous vein and right renal vein graft. Histopathological examination revealed high grade spindle cell sarcoma. Postoperatively, patient received radiation therapy. Patient remained disease free for 2 years after treatment. Surgery remains the primary modality of treatment, whereas the role of chemotherapy and radiotherapy, either as a primary modality or as an adjuvant, remains to be proven. Some recent reports claim promising results, but randomized trials do not exists considering the rarity of this disease.

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A 75-year-old male patient presented with history of dysphagia following inadvertent passage of loose dentures into the esophagus. Patient could only swallow liquids thereafter and had persistent pain in the throat. Upper gastrointestinal endoscopy confirmed the presence of denture in mid esophagus at approximately 22-25 cm from incisors but the denture could not be removed as it had got impacted in the esophagus. Thoracotomy and esophagotomy was planned because repeated endoscopic removal was unsuccessful. Right posterolateral thoracotomy was performed through the fifth intercostal space and longitudinal esophagotomy in the mid esophagus was done to extract the impacted dentures followed by primary repair of the esophagus. The patient recovered well and he was discharged on the eighth postoperative day.

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Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become a major health problem worldwide. MRSA is a common pathogen implicated in Hospital-acquired infection. About 20% of patients undergoing surgery acquire at least one nosocomial infection leading to increased morbidity, mortality, hospital stay and cost of treatment. This study was designed to appraise the incidence of nasal carriage of MRSA among patients admitted for otorhinolaryngological surgical intervention in a teaching hospital. Patients and Methods: A total of 50 nasal swabs were collected from hospitalized patients at the Otorhinolaryngology Department of the University of Benin Teaching Hospital, South-South region of Nigeria during the period of three months extending from July to September 2012. Each sample was processed using standard microbiological protocols. Results: In all, 25 (50%) of the isolated organisms were Staphylococcus aureus, 6 (12%) were Staphylococcus epidermidis and 19 (38%) were Staphylococcus lugdunensis. Forty percent of the S. aureus isolated were resistant to methicillin. All the multidrug resistant strains of S. epidermidis and S. lugdunensis were also resistant to methicillin. The isolates showed resistance to the various classes of antimicrobial agents tested with the least against the aminoglycosides. Conclusion: Our results suggest that a more effective and adequate preparations such as infection control and patients selection are required to reduce the spread of multidrug resistant strains in otorhinolaryngology practice.

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Branchiogenic carcinoma, which is squamous cell carcinoma arising in a branchial cyst, is extremely rare and a highly contentious clinicopathologic entity. Initially described by von Volkmann in 1882, it was better defined by Martin et al. in 1950 and the definition further refined by Khafif et al. in 1989. In spite of this, the skepticism about this entity persists. The existence of primary branchiogenic carcinoma is controversial according to some authors this malignancy is more conceptual than a real clinic pathological entity. It's very difficult to distinguish a primary branchiogenic carcinoma from a cystic nodal metastatic one. There are different diagnostic criteria for primary branchiogenic carcinoma, but its efficacy is still challenging. We present a case, wherein the patient underwent excision of a branchial cyst on the left side of the neck, which revealed squamous cell carcinoma in its lining.

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