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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Background: Rapunzel syndrome is an extremely rare form of trichobezoar extending from the stomach to the small intestine and sometimes even beyond the ileocecal valve. Approximately 50 cases of Rapunzel syndrome have been reported in the literature, and most of them being young women. The aim of this study was to review the clinical features and outcome of pediatric patients with Rapunzel syndrome. Patients and Methods: We present a retrospective study performed from January 1995 to December 2013. The study included eight paediatric patients. The clinical features including history of trichophagia, intraoperative findings, bezoar characteristics and operative were analyzed. Results: The age of patients ranged from 4 years to 15 years. Only one (12.5%) child was in teenage group, whereas the rest of the patients (87.5%) were below the teenage group. There were five (62.5%) females and three (37.5%) males. Patients had varied presentations like chronic abdominal pain (100%), abdominal distension (75%), epigastric fullness (75%), features of intestinal obstruction (50%), and anorexia (25%). Trichophagia could not be elicited in four patients (50%). Impending intestinal perforation and Intussusception was seen in one (12.5%) each. Six (75%) patients had trichobezoar, while plastobezoar (plastic bezoar) and mixed bezoar was present in one (12.5%) each. Conclusions: Rapunzel syndrome is also seen in children below the teenage group. Although more common in females, it is seen in both sex. Chronic abdominal pain and distension are main presenting features, while history of trichophagia is absent in 50% cases. It should be included in the differential diagnosis in children, especially females with chronic abdominal pain, even if history of trichophagia is absent.

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Tumoral calcinosis is a disease characterized by peri-articular deposition of calcium phosphate mostly around major joints of the body. A 60-year-old female was suffering from painful swelling over the left greater trochanteric area for past 4 months. No similar lesion was detected on any other part of the body. Thorough biochemical and radiological work up was done followed by excision of swelling. Pathology revealed Tumoral calcinosis. Patient is being followed up regularly for any recurrence.

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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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Background: Nail avulsion is a commonly performed office procedure. It can be used successfully along with other adjuvant therapies in various nail disorders. The objective of this study was to evaluate the efficacy and safety of nail avulsion in nail disorders. Patients and Methods: A total of 35 patients with nail changes of onychomycosis, ingrown toenail, subungual or periungual wart and dystrophic nail were studied over a period of 2 years. Nail avulsion was carried out in each patient with adjuvant therapy in the form of electrosurgery, chemical matricectomy and systemic antifungal medications. Each patient was reviewed for any postoperative complication and recurrence. Results: Most common nail disorder was onychomycosis (60%). Male: Female ratio was 1: 1.3. Maximum recurrence rate was seen in subungual or periungual wart (20%). No postoperative long-term complications were seen. Conclusion: Nail avulsion is a simple, easy-to-carry procedure. Recurrence of certain nail disorders can be decreased by combining nail avulsion with other adjuvant therapy.

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A gossypiboma also known as textiloma or cottonoid are terms used to describe a foreign object, such as a mass of cotton matrix or a sponge that is left behind in a body cavity during an operation. It is an uncommon surgical complication. The manifestations and complications of gossypiboma are so variable that diagnosis may be difficult and patient morbidity is significant. The incidence of retained surgical instruments is estimated at 1 in 100-3,000 of all surgical interventions and 1 in 1,000-1,500 for all intra-abdominal operations. We report a case of extrusion of forgotten gauze following vaginal hysterectomy in a 49-year-old woman. The gauze migrated into the bladder presenting with acute urinary retention. She had vesicostomy retrieval of the gossypiboma and repair of the defect on posterior wall of the bladder. She did well postoperatively with no complication. Any woman that had pelvic surgery and is presenting with recurrent pelvic pain, urinary tract infection (UTI) and lower urinary tract irritative, or obstructive symptoms gossypiboma should be suspected and investigated.

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Subdural hygroma is an unusual complication of posterior fossa tumor surgery. We present two cases where patients developed subdural hygroma following posterior fossa surgery for brain tumors. This rare complication manifested with headaches, nausea, unsteadiness and nystagmus two weeks after seemingly uncomplicated surgery. There have been a few such cases described in the literature; mostly following foramen magnum decompression. The exact etiology of subdural hygroma post-posterior fossa surgery remains unknown; however, there are speculations that external hydrocephalus and intracranial hypotension may play a part. After exhausting conservative options, both patients underwent ventriculo-peritoneal shunting, which resulted in the resolution of their symptoms with corresponding resolution of the subdural hygroma on radiological imaging. We present two cases where subdural hygroma following surgery was successfully treated with a ventriculo-peritoneal shunt. We also highlight the paucity in literature regarding subdural hygroma as a complication of posterior fossa surgery and suggest management of such patients.

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Background: Tracheostomies are often performed in children to relieve severe respiratory difficulties. However, complications are associated with this life-saving surgery. The objective of this study was to establish the pattern, indications, complications, timing of surgery and outcomes following tracheostomy in children. Patients and Methods: We carried out a 10-year retrospective review of medical records of children (0-15 years) who had undergone tracheostomy, between June 2003 and May 2013 in a single tertiary hospital. Data retrieved included demographics, indications, timing of surgeries and complications. Results: In this review, 127 cases that include 83 boys and 44 girls were considered for the study. In all, 64 percent (83) of the patients were boys whereas 44 (34.6%) were females with M/F ratio of 1.8:1. Age ranged between 2 months-15 years with a mean age of 3.56 (SD ± 2.56). About 15.7% (20 cases) were preschoolers whereas 57.5% (73 cases) were between 3-5 years, which accounted for majority of the cases. The most common indication was to relieve upper airway obstruction secondary to foreign body aspirations in 90 children (70.8%). Other indications include infections in 27 children (21.6%). Complications were noted in 36 children (28.3%) including tube blockage in 9 (7.08%), tube dislodgement in 4 (3.1%), and peritubular granulation tissue in 4 cases (3.1%). Tracheostomy-related death occurred in 1 case (0.8%). Conclusion: Tracheostomy is a life-saving procedure with potential causes for complications occurring in children. If avoidable indications are excluded, the morbidity will be reduced. Parents and caregivers must monitor their children to avoid aspiration of foreign bodies eventually leading to tracheostomy.

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Background: National Cancer Institute (NCI) formulated a five-tiered system for reporting cytological smears from the breast. Of these, C1, C2 and C5 are usually unequivocal. The equivocal categories C3 (atypical probably benign) and C4 (suspicious probably malignant) need to be evaluated to determine their cyto-morphologic correlation and thus provide useful information on the degree of clinical weight that can be put on them in patient management. Patients and Methods: A retrospective study of cytological smears made from palpable breast lesions performed over a 5-year period from 2008-2012. The C3 and C4 smears were then compared with final histological diagnoses for these categories and their diagnostic value calculated. Result: There were 1,162 smears taken over the study period, and 200 (17.2%) had subsequent histology. Of the 200 smears, 20 were C3 and 27 were designated as C4. Subsequent histology upgraded 7 (35%) of the C3 cases to malignant and 23 (85%) of the 27 C4 cases were malignant. The difference between these two proportions is statistically significant (P < 0.005). The overall Suspicious Rate was 23.5% and C4 reports had a sensitivity of 76.7%, specificity of 76.5%, positive and negative predictive values of 85.2% and 65.0% respectively. Conclusion: A fair degree of clinical reliance can still be placed on cytologically categorized C3 and C4 breast smears. However, the rate of reporting of these categories can be reduced with availability of ancillary radiological techniques such as mammography and ultrasonography.

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A twenty seven year old female patient presented to the hospital with recurrent pain in the right hypochondrium of five years duration. She had a history of failed cholecystectomy four years back. A CT and MRI scan, revealed splenenculi, midline liver, cholelithiasis, truncated pancreas and dextrocardia. These symptoms were attributed to the calculous cholecystitis. Laparoscopic cholecystectomy was done and patient recovered uneventfully. Here we are presenting the first instance of successful laparoscopic cholecystectomy in a patient with heterotaxy syndrome, as it is a unique challenge for operating surgeons. The purpose of this report is to encourage further research to establish a protocol for the management of these patients with a rare congenital anomaly. This will help us establish a protocol for such patients so as to minimize complications intra operatively.

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Hydatid disease is relatively frequent in our country. Asymptomatic hydatid disease may present with complications, but unusual locations as well as multiple primary or secondary hydatid disease pose special diagnostic and therapeutic challenges. In humans, hydatid disease commonly involves the liver (75%) and the lungs (15%). The remaining (10-15%) of the cases involve other regions of the body. Synchronous multiple cysts represent less than 2% of all cases. The disseminated intra-peritoneal hydatid disease is a very rare finding. We report such a presentation wherein the abdominal cavity, retro peritoneum and pelvis contain multiple hydatid cysts. The challenges encountered in the diagnosis and treatment of this patient are highlighted.

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A thirty-year-old fertile man with a history of right-sided cryptorchidism presented to the surgical outpatient department with a right iliac fossa mass of two months duration. On computed tomography scan of the abdomen, diagnosis of malignant testicular mass with right ectopic kidney and eventration of right hemidiaphragm was made. Exploratory laparotomy with surgical resection of mass was done, which was histopathologically diagnosed as seminoma of the right testis. The unique developmental anomalies and associated seminoma made us report this case. These developmental anomalies may be a possible sequence of events or merely a coincidental combination.

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Background: Endoscopy is important in the investigation of symptoms arising from the lower gastrointestinal (LGI) tract. Characteristics of patients undergoing LGI endoscopy (LGIE) in Kumasi, Ghana, are largely unknown. This paper reviews the indications and findings of diagnostic LGIE in three endoscopic centers in Kumasi, Ghana. Patients and Methods: A review of the records of all patients undergoing diagnostic LGIE in the three centers from October 2006 to December 2011 was undertaken. Results: Three hundred and twenty-four LGIE procedures were performed. The most common primary indication was bleeding per rectum. The most common primary endoscopic finding was hemorrhoids (42.0%) followed by colorectal tumors (9.6%). 31.8% of the patients had normal endoscopic findings. Most pathologies found on LGIE were more common in patients aged 45 or older. Among patients whose indication for LGIE was bleeding per rectum, almost half had hemorrhoids as their primary finding while 13.9% had either a colorectal tumor or polyp. Conclusion : The proportion of our patient population found to have a colorectal tumor or its precursor was not insignificant. We thus recommend patients aged 45 or older presenting with LGI symptoms in Kumasi to undergo LGIE, especially if the main symptom is bleeding per rectum.

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Background: There is a rising trend in the use of miniplates over Kirschner's wire for treating hand fractures. The improved system of internal fixation by miniplates has many advantages over the Kirschner's wire. The purpose of this prospective study was to evaluate the differences between these two commonly used methods of internal fixation in fractures of proximal phalanges and metacarpals in terms of radiological union and functional outcome. Patients and Methods: The study included a total of 40 patients with a mean age of 35.72 years. The patients excluded from the study included those with a compound injury, severe osteoporosis, and severe co-morbid conditions. The patients were divided into two groups (Group A - treated with Kirschner's wire and Group B - treated with miniplate) with 20 cases each. The outcomes of treatment were compared in the two groups using Student's t-test and chi-square test. Results: The average time for radiological union in Group A (Kirschner's wire) was 8 weeks, while it was 8.7 weeks in Group B (miniplate). There was no statistically significant difference in the radiological union time between the two groups (P = 0.464, chi-square = 1.532). Stiffness was the most common associated complication in this study. It was more common in the group treated with Kirschner's wire (30%) compared to the group treated with mini fragment plating (20%). In Group A, 75% of cases had shown good to excellent results; while in Group B, 85% of the cases had similar result. There was no statistically significant difference (P = 0.737, chi-square = 1.268) in outcome in both groups. Conclusions: Both Kirschner's wire and miniplate are good methods of internal fixation in fractures of metacarpal and proximal phalanx. Though patients who were treated with miniplating had better functional results, but the difference was not statistically significant.

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Background: Portal hypertension is a major abnormality of the portal venous system and it is a commonly encountered clinical condition with multiple causes and several sequelae. The need for an imaging parameter that will aid its early diagnosis cannot be overemphasized, bearing in mind that portal pressure monitoring devices are not available in most tertiary hospitals in Nigeria. This prospective study was aimed at using ultrasound to determine the normal Portal Vein Congestive Index among adults in Zaria, Nigeria. Patients and Methods: The study was conducted over a period of 6 months spanning 15 ^th November 2011 to 14 ^th May 2012 at the Radiology Department of Ahmadu Bello University Teaching Hospital, Zaria. Following an overnight fast by the 186 eligible participants, the portal vein diameter, cross sectional area and flow velocity were obtained using ultrasound Doppler equipment (Mindray diagnostic ultrasound system, Model DC-3, 2010-2012, Nanshan, Shenzen, PR China). B-Mode gray-scale for the assessment of dimensions, and Duplex Doppler Ultrasound Scan techniques for interrogation of the flow pattern and velocity. These parameters were then used to obtain the congestive index of the subjects. Results: The portal vein hemodynamic parameters were as follows mean (SD): Cross sectional area, 1.097 cm ² (0.203) (ranged 0.89-1.30); mean flow velocity, 15.44 cm/s (2.628) (ranged 12.80-18.10); and congestive index, 0.0722 cmS (0.0135) (ranged 0.0587-0.0857). All measurements in males were significantly higher than those in females (P < 0.001); and the portal vein congestive index increased significantly with age (P = 0.006). Conclusion: Reference values of normal congestive index of the portal vein have been established and may be used for the assessment of patients with liver diseases or portal hypertension in this environment.

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