Background: Accurate imaging of rectourethral fistula is essential for optimal surgical management of infants with high-type anorectal malformation (ARM). The aim of this study was to study the role of nonfluoroscopic well-tempered pressure-augmented distal colostogram in high-type ARM in demonstrating rectourinary fistula, bladder anomalies, and for the presence of vesicoureteral reflux (VUR). Patients and Methods: We present a prospective study of 10 male infants who underwent a diverting colostomy in the neonatal period from January 2011 to December 2012. Our method of performing a colostogram is similar to conventional colostogram, but involves (a) meticulous bowel preparation preoperatively, ensuring that while doing the last distal colostomy wash before colostogram there is passage of clear saline from the urethral meatus to establish the presence of rectourinary fistula; (b) nonfluoroscopic study (c) performed with gentle and sustained pressure of contrast media, maintained over the period of the investigation; (d) bladder is completely filled with contrast media through rectourinary fistula and it is confirmed clinically; and (e) radiographic films in addition are taken in the micturating phase. Results: Rectourinary fistula was demonstrated in all (100%) cases. Rectoprostatic urethral fistula was present in three (30%) infants, rectobulbar urethral fistula in six (60%) patients, and one (10%) infant had type 4 congenital pouch colon (CPC) with colovesical fistula. Also three (30%) patients demonstrated unilateral primary vesicoureteral reflux (VUR), which was previously undiagnosed in all of them, as micturating cystourethrogram (MCU) was not attempted. Conclusions: Our study confirmed the level of anomaly and accurately demonstrated the type of fistula in all patients. It also detected the undiagnosed VUR in three (30%) cases. It obviated the need for a MCU.

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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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Diaphragmatic eventration is an abnormally elevated hemidiaphragm in the chest cavity with poorly developed muscle fibers. This condition can lead to abnormal displacement of intra-abdominal organs. It is a developmental anomaly and usually remains asymptomatic in early life. It presents later with respiratory and occasionally gastrointestinal complications. A clinical scenario of eventration of diaphragm, displacement of the stomach, the splenic flexure of colon, and the spleen with gastric volvulus is uncommon. Early diagnosis and prompt intervention prevents development of necrosis and perforation of stomach. We report a case of a 68-year-old male having left sided diaphragmatic eventration associated with acute on chronic intermittent organoaxial gastric volvulus and displaced intra-abdominal organs. He underwent surgical repair with a successful outcome.

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Background: Optimal treatment for sacrococcygeal pilonidal disease has not been determined because of high complications and recurrence rate. We conducted this study to evaluate the effectiveness of rhomboid excision with modified Limberg flap in the treatment of sacrococcygeal pilonidal disease. Patients and Methods: Twenty one patients with pilonidal sinus of both primary and recurrent presentations were operated from July 2011-July 2012. Following rhomboid excision of the pilonidal sinus a modified Limberg flap was performed and used to cover the defect under spinal anesthesia. Cases were followed up for median of 4 months post operatively. Results: Of the 21 cases, 16 (76%) had no post operative complications, either during their stay in the hospital (3-9 days) or during the follow up period (4 months). Five cases presented with different complications. One patient had recurrence, two had complications of both wound infection and wound dehiscence and underwent second operation under local anaesthesia. Conclusion: Rhomboid excision with modified Limberg flap is a promising surgical technique proved to be safe and effective in the treatment of both primary and recurrent pilonidal sinuses with less post-operative complications, short hospital stay and low recurrence rate.

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Renal silicate calculi are rare, with an incidence of 0.2% of all urinary calculi in humans. Several case reports showing that the long-term administration of magnesium trisilicate induced silica renal calculi. We report two cases of silicate renal calculi in children and the composition is purely silicon dioxide (100%) in both cases. The first child was a 7-year-old boy who presented with fever, vomiting, and loin pain for 2 months. His father and younger sister had undergone interventions for renal calculi. Intravenous urogram (IVU) revealed a left renal calculus of 2.2 × 1.8 cm which was treated by percutaneous nephrolithotomy (PCNL). The second case was an 8-year-old girl who's clinical and radiological evaluation lead to a diagnosis of left renal calculi which was treated by PCNL. In both cases the composition of the stone was 100% silicon dioxide.

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Background: The Zaria Cancer Registry (ZCR) documents cancer cases within Zaria and environ with the objective of monitoring, planning, and screening of population at risk of developing cancer. The objective of this paper is to review the pattern and distribution of cancers as documented in the ZCR. Materials and Methods: A 5-year analysis of cancer cases recorded from January 2009 to December 2013 was made. Data sourced were grouped into those primarily from the hospital (A) and referrals from hospitals within (B) and outside (C) Kaduna state. Data compilation was done using CANREG4 software and the International Classification of Diseases (ICD)-0 classification and coding system. Results: A total of 2,536 new cancers were recorded with 1,014 males and 1,522 females. Cancer diagnosis from the histology of primary disease cases accounted for 86.3%, while cytology diagnosis cases comprised 10.6%. Over 90% of the diagnosis was based on symptomatic presentation by patients, while 81.6% were well-differentiated cancers. The peak age distribution was in 4 ^th -6 ^th decades of life in 58.9% cases, while 138 cancers were recorded in children aged 10 years and below. A total of 68 (2.7%) cases were also recorded in adolescents. Morphologically, squamous cell carcinoma (SCC), adenocarcinoma (not otherwise specified (NOS)), and infiltrating duct carcinoma were the commonest. About 60% of patients received two or more treatment modalities. Conclusion: The cancer distribution pattern from this registry is reflective of the cancer distribution in the larger population. Breast cancer was most common in females and ranked first overall, while prostate cancer was the commonest in males. This information is useful in planning for effective cancer screening, prevention, and management.

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Background: Cataract is the leading cause of blindness in developing countries. Phacoemulsification is beyond the reach of many in these resources limited setting. Manual Small Incision Cataract Surgery (SICS) is a safe, low-cost, high-quality alternative. This is a review of outcome of SICS performed by trainee Surgeons during the first SICS training course in our centre. Patients and Methods: Eleven experienced Extracapsular Cataract Extraction (ECCE) surgeons from training centers across Nigeria were selected for a weeklong SICS training and conversion course. A review of visual outcome and complications of surgeries performed by these trainees on adult subjects is here reported. Results: Eighty-two eyes met the inclusion criteria. Male to female ratio was 1.4:1. Intraocular lenses were implanted in 80 eyes (97.5%). Visual outcome at 3 months post-operatively was good in 58 eyes (70.7%), borderline in 20 (24.4%), and poor in 4 (4.9%) subjects. The most common late post-operative complication, resulting in poor outcome was uncorrected aphakia in 2 (2.4%) eyes. Conclusion: The outcome did not meet World Health Organization (WHO) recommendations but was better than that reported for ECCE in the country. Conversion to SICS may not be difficult for competent ECCE surgeons as trainees achieved reasonable dexterity with acceptable post-operative outcome and complications profile in one week. To maximize patient safety and good outcome, a longer training period is recommended.

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Background: Hoarseness refers to a change in voice quality that can impair a patient's quality of life and is usually subject to misdiagnosis. It is sometimes a pointer to a more sinister pathology especially when it is unremitting. This study seeks to establish the pattern of hoarseness as seen at the University of Benin Teaching Hospital, Benin City, Nigeria. Patients and Methods: A prospective review of all new consecutive patients who presented with complaints of hoarseness to the Ear, Nose, and Throat Department of the University of Benin Teaching Hospital from January 2012 to September 2013. The instruments used were a proforma, laryngoscopy, and biopsy where applicable. Histopathological examination of biopsied specimens and treatment outcome were the variables. Results: A total of 75 patients, 51 (68%) males and 24 (32%) females giving M:F ratio of 2:1, were seen during the period of the study. Their age ranged from 7-78 years with a mean age of 47 years. A large proportion of the patients presented for otolaryngologic review more than 24 months after the onset of symptoms. Thirty-three (44%) patients used alcohol while 14 (18.7%) smoked cigarettes. Malignant conditions were responsible for hoarseness in 25 (33.3%) while benign 22 (29.3%) and inflammatory or infective conditions 24 (32%) and vocal cord paralysis 4 (5.3%) were also common. Conclusion: The causes of hoarseness vary from benign to malignant lesions. The observed delay in laryngoscopy portend poorer outcome for patients with malignant diseases.

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Background: The management of splenic injuries has evolved over the years. The objective of this study was to evaluate the feasibility of nonoperative management (NOM) of higher grades (grade III and IV) of splenic trauma in limited intensive care unit (ICU) settings. Patients and Methods: This prospective study was carried out in the Department of Surgery Government Medical College, Srinagar over a period of 1.5 year from January 2012 to June 2013. The study included 50 hemodynamically stable patients with computed tomography (CT) documented grade III or IV splenic trauma (30 patients with grade III and 20 patients with grade IV). Vigorous monitoring was done in general surgical ward setup during first 2-3 days of trauma consisting of hourly monitoring by the resident doctor on the 1 ^st day and 3-hourly monitoring thereafter. Results: Most common mode of trauma was road traffic accident (20, 40%) followed by fall from height (15, 30%), human violence (10, 20%), and others including animal assault (5, 10%). Ninety-four percent of our patients were managed nonoperatively without any mortality. Fourteen patients from group A (grade III) and 17 patientsfrom group B (grade IV) required blood transfusions. Ninety-three percent of the patients from group A and 45% of patients from group B were managed in the ward setting without any need for ICU setup. Children with grade III laceration showed complete resolution on CT after an average of 5.2 months and those with grade IV laceration on CT after an average of 9.3 months. Conclusion: NOM of higher grades of splenic trauma appears to be feasible in centers with limited ICU facilities, though it demands strict and continuous monitoring during initial 2-3 days.

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Background: Malignant extremity tumors are relatively common in the orthopedic and general surgery units. However there is no study that describes the pattern and outcome in our Kano north central Nigeria. The Objective of this study was to determine the pattern of malignant extremity tumors and the outcome of management. Patients and Method: All malignant extremity tumors that were managed between 1 ^st January 2008 and 31 ^st December 2012 in the Orthopedics and General Surgery units of Aminu Kano Teaching Hospital, Kano were recruited for the study. Information was extracted from records of these patients. Results: Of the 58 patients in the sturdy, 32 (55.2%) were males and 26 (44.8%) were females. The age range was 2-80 years. The mean age of the patients was 32.08 years. 41 (70.6%) patients had lower limb malignancies while 17 (29.3%) had upper limb malignancies. Soft tissue sarcoma has the highest prevalence (37.9%). Excision biopsy or wide local excision (53.4%) and amputation or disarticulation (51.7%) was the commonest surgical procedure done. Conclusion: Lower extremity malignancies are the commonest. They are commoner in males. Soft tissue sarcoma and malignant skin tumors are more common than malignant bone tumors of the extremities.

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A penetrating injury to the chest may cause a diaphragmatic rupture. Presentation can be acute or delayed. Traumatic diaphragmatic hernia (DH) usually presents with symptoms of respiratory compromise. We present a case of a middle-aged man who attended our emergency and diagnosed as acute intestinal obstruction, both clinically and radiologically. A history of stab injury over left chest 10 years back and chest X-ray showed bowel loops in left hemithorax. Diaphragmatic herniation was suspected, although there were no respiratory symptoms on presentation. On laparotomy, a rent of 4 cm × 3 cm was found in the posterolateral aspect of left hemidiaphragm, through which a part of transverse colon and omentum was herniated. The herniated contents were reduced. Closure of the diaphragm followed by loop transverse colostomy was done. The rent was surrounded all around with the ragged diaphragm, which made the possibility of congenital DH unlikely. Thus, a case of traumatic DH was finally diagnosed without respiratory symptoms. With this case we would like to highlight that delayed presentation of traumatic DH may also present with absence of respiratory symptoms.

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Carcinoids are neuroendocrine tumors and can be present anywhere in the gastrointestinal tract. These malignant tumors have relatively good prognosis after surgical resection when compared to other tumors of the gastrointestinal tract. Patients usually present with vague abdominal pain. Other rare presentations include intestinal obstruction, upper gastrointestinal bleed as hematemesis or malena, intestinal perforation, and carcinoid syndrome. Incidental finding on histopathology is another form of clinical presentation. We report three cases of carcinoid tumors of gastrointestinal tract which presented as different surgical emergencies namely, hematemesis, intra-abdominal abscess, and intestinal obstruction. Their clinical presentation, investigations, and treatment are hereby presented. Prompt evaluation and surgical intervention resulted in a good outcome.

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Background: Thymomas are rare tumors with a challenging management. After a review of the literature, we noticed the absence of a simplified decisional diagram. We aimed to present a scheme for the management of these tumors based on the experience of a Tunisian multi-disciplinary team and a review of the literature. Patients and Methods: We report a retrospective study 100 thymomas diagnosed between 1994 and 2011. We also performed an exhaustive PubMed research using the keywords: Thymoma, prognosis, management. We noticed, that the most famous studies were reported in the 1990s with most of them being a review of the literature. Results: The proposed decisional diagram is quite similar to the National Comprehensive Cancer Network (NCCN) guidelines with some particularities. These particularities consist in the recommendation of an initial surgical resection even in advances disease (stages IIIb or IVa) and the association of a radiation therapy in R1 or R2 stages I, II, and IIIa thymomas. Conclusion: This study highlights the necessity of further research performed in the field of thymoma in order to answer the unresolved question. This work seems to be necessary and helpful in daily practice of thoracic surgeons and clinicians.

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