Background: Pyometra is a gynecological emergency in cervical cancer patients receiving radiotherapy because it can be complicated by perforation, sepsis, and death. It can delay initiation and continuation of treatment. For certain select patients who may not be able to undergo drainage of the lesion under anesthesia via cervical dilatation and drainage, ultrasound-guided percutaneous drainage is a good alternative. We report the successes recorded in using an alternative route for pyometra drainage in cervical cancer patients on radiotherapy when the conventional examination under anesthesia and cervical drainage was not possible. Patients and Methods: Following institutional ethical approval, a prospective study was conducted from January 2014 to January 2016 on selected patients referred from the radio-oncology unit of Ahmadu Bello University Teaching Hospital, Zaria to the Gynecologic Oncology Unit with pyometra complicating advanced cervical cancer on radiotherapy. Initial attempts at cervical dilatation and drainage under anesthesia were unsuccessful necessitating this approach of percutaneous drainage under ultrasound guidance with mild sedation after obtaining informed consent. Results: Six patients were managed with a mean age of 58.5 years, who were diagnosed with advanced cervical cancers clinical stages 2B to 3A on radiotherapy. An average of 200 ml of pus was drained, and culture revealed mixed infections with predominant anaerobes strongly sensitive to metronidazole. There was recurrence in 1 case (16.7%) after 1 month of follow-up requiring a repeat procedure. Conclusion: The procedure is relatively cheap, safe, and effective in selected patients.

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Background: Congenital adrenal hyperplasia (CAH) is a disorder wherein female babies are born with masculinized external genitalia characterized by hyperpigmented or fused labioscrotal tissue, a urogenital sinus, and clitoromegaly. Feminizing genitoplasty (clitoroplasty, labioplasty, and vaginoplasty) is necessary to make the patient consistent with gender identity and to ensure adequate sexual function in pubertal age. Patients and Method: We performed feminizing genitoplasty in which reduction clitoroplasty was done by a ventral approach in 6 patients of CAH, with a mean age of 3.8 years. Excessive erectile tissue was excised by giving incisions into Buck's fascia at 8 and 4 o'clock position on the clitoral shaft and Byar's flaps created from the degloved clitoral shaft were used for labial and vaginal reconstruction. The glans clitoris was left as such and anchored to proximal 1–1.5 cm clitoral shaft. Results: All patients had good cosmetic female appearance of external genitalia. In 5 patients, the clitoroplasty was done along with labioplasty and vaginal introitus exteriorization. However, in 1 patient, the vaginal confluence into urogenital sinus was high and hence only clitoral reduction as well as labioplasty was done and the urogenital sinus opening was left as such. The maximum follow-up is up to 6 years with good result. Conclusion: The reduction clitoroplasty by present approach of 8 and 4 o'clock incision into the Buck's fascia is a good option for clitoral girth and length reduction as it preserves approximately two-third of Buck's fascia with intact neuromuscular bundle and glans. Postoperatively, patients have good vascularity and sensation of the glans clitoris and acceptable cosmetic outcome. However, the long-term results are difficult to comment as no patient of the present study achieved puberty.

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Cancer cells are in situ or invasive depending upon whether they have invaded basement membrane or not. Ductal carcinoma in situ (DCIS) signifies in situ growth in the ductal system of the breast. Screening mammography has revolutionized the screening and diagnosis of this clinically occult disease. Diagnosis may be further improved by ultrasonography and magnetic resonance imaging in selected cases. Suspicious area in the breast is subjected to fine needle aspiration cytology (FNAC). The drawback of this simple procedure (FNAC) is that basement membrane cannot be assessed, and hence, image-guided, core needle biopsy or tru-cut biopsy is used to overcome this drawback. After confirmation of the diagnosis, DCIS may be treated by breast conservation or mastectomy and/or radiation. This paper discusses the various challenges encountered at every step in this clinically occult disease during screening, diagnosis, and treatment. Means and ways are highlighted to overcome the challenges.

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Background: Perforation peritonitis is one of the most commonly encountered surgical emergencies across the world. In developing countries, gastrointestinal perforations have very high morbidity and mortality rates, irrespective of the type of operative procedure performed. The aim of the present study was to evaluate and find out various determinants for safe outcome in gastrointestinal perforation in terms of decreased morbidity and mortality and applying Clavien–Dindo classification for postoperative complications for evaluating the outcome. Patients and Methods: A nonrandomized retrospective study with collected data from 350 patients with gastrointestinal perforations was conducted over a period of 3 years. Data from various preoperative and operative factors, surgical technique, and complications were recorded. The output was measured as better and worse, as per the classification proposed by Clavien–Dindo. Results: The study enrolled 350 patients with a male:female ratio of 3.3:1; 58% of the patients were <40 years of age. The most common etiologies of perforation peritonitis were peptic perforation (duodenal 42%, gastric 8%), small bowel perforation (jejunum 3.14%, ileal 26.28%), appendicular perforation (10%), and cecum and colon constituting 4.85% each. The incidence of major complications was wound infections 18%, respiratory complications 16.57%, burst abdomen 5.14%, leak 4%, and septicemia 7.14%. Overall mortality was 10.85%. High mortality was observed in ileal perforation. Conclusion: Preoperative comorbidities, operative techniques, and postoperative complications in this setting are associated with morbidity and mortality. Proper screening on admission should be done to identify premorbid illness, and with the use of some recommendations in surgical technique we can achieve safe outcome of gastrointestinal perforations. The Clavien–Dindo classification can be adapted to assess the severity of postoperative complications following gastrointestinal perforations.

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Background: The provision of safe anesthesia in developing countries is often challenging due to multiple health systems and infrastructural challenges. We explored the suitability and reliability of the Universal Anaesthesia Machine (UAM) in Northern Nigeria. Patients and Methods: Over an 18-month period from 1^st June 2012 to 30^th November 2013, Nurse anesthetists and biomedical technicians were trained on the use, maintenance, and installation of the UAM in the study facilities. Patients requiring general anesthesia (GA) were then randomly assigned to the UAM or other forms of GA. Availability, ease of ues ans safety were monitored. Results: A total of 1562 patients had anesthesia administered with 54.8% using UAM. Cesarean section due to obstructed labor was the most common indication. There was no malfunctioning of the UAM and its use was preferred over other forms of GA. Complications were less than with other form of GA provided by the same staff. Conclusion: The UAM is suitable for health facilities with limited equipment and manpower. It has the potential to improve access to surgery and emergency obstetric care as it can be safely used by non-physician anesthetists.

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Ureterocele is a congenital saccular dilatation of the terminal portion of the ureter within the urinary bladder. It is an uncommon cause of urinary tract obstruction in the young patient and one of the more challenging anomalies to the urologists. Ureterocele poses a diagnostic and therapeutic dilemma as it manifests a wide spectrum of perplexing clinical symptoms. We report a case of single system ureterocele in a patient presenting with acute severe transformation of recurrent loin pain.

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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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Posterior urethral valves are tissue leaflets fanning distally from the prostatic urethra to the external urinary sphincter. It is the most common obstructive uropathy leading to childhood renal failure. It constitutes a clinical spectrum ranging from severe forms to milder forms. When obstruction can be overcome by detrusor contraction, it may remain silent until later life

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Background: Cancer and human immunodeficiency virus (HIV) infections are commonly associated diseases, particularly in subsaharan Africa. The objective of this study was to evaluate the clinical and pathological characteristics of cancer patients with background HIV infection. Patients and Methods: This study was a retrospective study carried out between July 2006 and June 2013, at the radiotherapy and oncology department of Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. One hundred and two (102) histologically confirmed cancer patients were diagnosed to be HIV seropositive, of which 88 patients' folders were retrieved for retrospective analysis. Patients' clinical and laboratory information was documented during each visit and were analyzed using Epi Info software version 3.4.1; 2007 edition. Results: Out of the 88 patients studied, the male-to-female ratio was 1:2; median age was 40 years and age range was 23–65 years. Only 27 patients were housewives and 7 were students. Primary education and above was attained by 71 patients, and there was no formal education in 15 patients. Cancer-related symptoms were the indication for HIV screening in 45 patients and ill-health in another 43 patients. Source of HIV infection was attributed to heterosexuality and blood transfusion in 76 and 4 patients, respectively. Using enzyme-linked immunosorbent assay, HIV-1 was seen in 37 patients, 1 patient had HIV-2, and 10 patients had HIV-1 and 2 seropositivity. Type of HIV was unspecified in 40 patients. Cervical cancer was the most common cancer (29) followed by Kaposi's sarcoma (23). Ocular cancer accounted for 12 out of 16 head and neck cancers. Most patients (70) presented with locally advanced disease and 16 patients with metastatic disease. The mean CD4 count was 323 and 402 cells/μl at presentation and 6 weeks after treatment, respectively. Only 44 patients were on highly active antiretroviral therapy at presentation. Only 24 patients had surgery; combination of chemotherapy and radiotherapy were given to 33 patients. No definitive treatment was given to 21 patients. Conclusion: Cervical cancer and Kaposi's sarcoma were the most common malignancies seen with an underlying HIV infection.

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Intestinal-type villous adenomas are rare in the genitourinary tract. Among genitourinary tract, the most common location is urinary bladder followed by urethra, prostate, vagina, and vulva. Only few cases of villous adenoma of renal pelvis have been reported so far in the literature. We present a case of villous adenoma of the kidney presenting as muconephrosis with nonfunctioning kidney, along with renal stone, which was one of the largest muconephrotic kidney with villous adenoma removed.

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