Background: Abdominal injuries are common surgical emergencies in casualty units of most developing countries. This is due to the high incidence of trauma arising from increased road traffic accidents and violent crimes as a result of socioeconomic and political conflicts. The aim of this study is to evaluate the pattern and outcome of abdominal trauma in our environment and recommend ways for improving the trauma services. Patients and Methods: The case records of 46 patients admitted during a period of 2 years, just before the onset of insurgency (2010–2011) and managed in Aminu Kano Teaching Hospital were retrospectively studied for demographic characteristics, modes of injury, organs injured, treatments, and outcome. Data was collected on to Microsoft Excel 2010. Simple statistical parameters were calculated. Results: A total of 46 patients were studied; 35 (76.1%) of which had penetrating abdominal trauma (PAT) and 11 (23.9%) had blunt abdominal trauma (BAT). The male: female ratio was 8.2:1 with peak age range of 20–29 years. Stab wounds accounted for 46% and gunshot for 31% of PAT, while road traffic accidents (RTA) accounted for 82% of the BAT group. The intestine (41%), the liver (25%) are the most common organs injured in PAT, while the spleen and intestine each constituting 29% are the most frequent injured in BAT. Ninety-one percent had exploratory laparotomy, while (4) 9% were successfully managed non-operatively. The post- operative mortality rate was 16.7%. Conclusions: Abdominal trauma commonly affects the young adult males and remains a major source of morbidity and mortality in our society. Communal conflicts and road traffic accidents are the major causes. Promotion of ethno-religious harmony and road traffic education at the community level and establishment of trauma systems in hospitals will help forestall this trend.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Good measure of ability to maintain consciousness during changes in posture is what is termed orthostatic tolerance. Patients with orthostatic intolerance developed symptoms ranging from fatigue, palpitation, dizziness, to syncope on assuming erect from supine position within a short period. Orthostatic intolerance commonly complicates upper spinal cord injury (above T6). Here, we present a case of orthostatic intolerance without significant tachycardia in patient with lumbar spondylolisthesis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Midazolam is the commonest benzodiazepine used in anesthesia for premedication, induction, and maintenance of anesthesia. The popularity of midazolam in many clinical situations is because of its rapid onset, nonpainful injection, lack of venous irritation, and production of anterograde amnesia. This study was to determine whether or not immediate retrograde amnesia can be produced with intravenous midazolam and to elicit the extent of amnesia seen in adult patients given midazolam at induction. Patients and Methods: Eighty consenting American Society of Anesthesiology I and II patients between the ages of 18 and 60 years scheduled for nonmajor elective surgical procedures under general anesthesia were randomly allocated to one of four study groups: m2 (midazolam 2 mg), m5 (midazolam 5 mg), m7 (midazolam 7 mg), or m0 (normal saline). Visual recognition and recall was tested using 12 picture cards, each with an easily recognizable image. Results: Recognition and recall rates did not differ between the groups up to the time of drug injection. However, there was a deterioration in visual recall (P < 0.001), orientation in time and event recollection (P < 0.001), and mean sedation score (P < 0.001) on administration of study drug when compared with control. There was a statistically significant anterograde amnesia for pictures seen after administration of midazolam (P = 0.000). There was no evidence of retrograde amnesia (P > 0.3). Conclusion: Intravenous midazolam does not cause retrograde amnesia, however, it causes anterograde amnesia based on dose administered.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Preoperative blood transfusion, which decreases the proportion of sickle red blood cells and improves anemia, has been associated with decreased risk of perioperative complications. The aim of this study was to retrospectively review our experience in the management of adult patients with sickle cell anemia undergoing elective surgery, and to determine blood transfusion requirement and surgery-related perioperative complications. Patients and Methods: Patients were divided into two groups: Group A had top-up transfusion and Group B received a partial exchange transfusion. Four surgical procedures were analyzed: open cholecystectomy, total hip replacement, total knee replacement, and split thickness skin grafts. Postoperative complications were categorized into three groups – (1) SCD-related, (2) non-SCD-related, and (3) transfusion-related perioperative complications. Results: Twelve (12) patients received top-up transfusion before surgery (Group A) while 20 patients (Group B) received partial exchange transfusions. There were 6 (18%) postoperative complications; two occurred in group A patients who received top-up transfusion and four occurred in group B patients who had partial exchange transfusion. Sickle cell disease-related complications consisted of acute vaso-occlusive pain in two patients (6%). Four patients (12%) had episodes of postoperative fever secondary to atelectasis, urinary tract infection, and wound infection. Only one (3%) patient in group A (top up) had a mild hemolytic transfusion reaction. Conclusion: This study showed that preoperative blood transfusion was associated with a reduced risk of perioperative complications in patients with sickle cell disease who underwent low and medium-risk surgery.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Breast lump in women is a common clinical condition encountered in day-to-day surgical practice and needs thorough evaluation. This study is focused on co-relation between axillary lymph nodal status and the size of the breast tumor through clinical, radioimaging, and pathological studies. The axillary lymph node study also helps to differentiate benign from malignant breast lumps. Patients and Methods: This study was carried out in the Department of Surgery, Great Eastern Medical School (GEMS) Hospital, Ragolu, Srikakulam, Andhra Pradesh, India. A total of 45 patients were selected for the study from among admitted cases to the Department of Surgery through clinical assessment, laboratory investigations, and ultrasound findings. After confirming the diagnosis of breast malignancy by fine needle aspiration cytology and Trucut biopsy in few cases, the patient had undergone operative intervention. Later, the specimens were sent for histopathological study. Results: Breast malignancy was found more commonly among female patients of 45–64 years of age with an incidence of 66% in present studies. Lump in the breast was the common presenting feature in all patients. Ultrasound findings and Trucut biopsy have shown high sensitivity and specificity up to 97–99%. Conclusion: The present study concludes that for the tumor size <10 mm, axillary lymph node dissection may not be needed. Larger the size of the tumor, the more probability of lymph nodal metastasis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Systemic lupus erythromatosus (SLE), is an autoimmune disease characterized by autoreactive T cells and polyclonal activation of B cells. SLE is a rare disease in tropical Africa and its association with thrombocytopenia has not been reported in the English literature. This is a case of a 37-year-old female civil servant with SLE complicated by refractory thrombocytopenia and successfully managed with splenectomy. Splenectomy in the management of thrombocytopenia associated with SLE in Africans as in other regions of the world is indicated in cases refractory to other treatment options.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Esophageal perforation is a rare but dreadful surgical emergency. The main etiology is iatrogenic trauma, mostly related to endoscopic instrumentation. The treatment is controversial; however, surgery remains the mainstay. In this article, 3 cases of instrumental perforation of esophagus are described. In all cases, diagnosis was based on clinical, radiographic, and endoscopic findings. The first case was a 4-year-old girl with a corrosive stricture of esophagus who received 8 sessions of dilatation over 1 year; the last session resulted in perforation. Unfortunately, she was not referred to thoracic surgery at once but kept in gastroenterology department for several days, and hence, empyema developed. Conservative treatment was employed first followed by elective gastric pull-up via laparotomy and left neck incision 3 months later. She regained normal swallowing of fluid and semisolid food but developed a chronic neck sinus that required few drainage operations. The second case was of a 54-year-old man with dysphagia and a normal esophagus who developed perforation during rigid esophagoscopy. The perforation was immediately detected and an urgent primary repair was performed via left thoracotomy. The third case was of a 24-year-old man with persistent achalasia cardia despite 2 trans-abdominal esophagomyotomies. Perforation occurred during second session of pneumatic balloon dilatation but was directly referred to a thoracic surgeon who performed an urgent esophagectomy. All patients survived. We conclude that a good outcome of this potentially fatal condition is possible with early diagnosis and intervention provided by an expert surgical team.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: The lifetime risk of acute appendicitis is 7-14%. Incidental appendectomy is defined as the removal of a clinically normal appendix during non-appendiceal surgery. Guidelines have tried to determine candidates for incidental appendectomy, but the practice continues to attract controversies. This paper presents our observation after appendectomy performed during oesophageal bypass/replacement procedures for treatment of dysphagia. Patients and Method: The histology results of all who underwent oesophageal bypass/replacement patients for the treatment of dysphagia was trace from the patient's hospital records and histopathology register. Results: A total of 28 patients underwent oesophageal bypass /replacement procedure between 2008 – 2015, during which 25 had incidental appendectomy. We were able to retrieve the histology of only 7 patients (3 males and 4 females). Of these, one male had a normal appendix another had lymphoid hyperplasia. Four patients had acute recurrent appendicitis (3 females with corrosive stricture and one male with HIV associated inflammatory stricture). Conclusions: There is a high incidence of incidental appendicitis in patients with dysphagia justifying the need for incidental appendectomy as prophylaxis against future exploration which may put the conduit in harm's way.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]