Background: Systemic hypertension is a worldwide epidemic and often called a silent killer. It is the commonest cardiovascular disease among Africans, and an acknowledged potential risk factor for the development of cardiovascular diseases such as stroke, hypertensive heart disease, hypertensive heart failure, and end organ damage of the brain, eyes, and kidneys. Hypertensive heart disease results in high cardiothoracic ratio (CTR), which is evident on a chest radiograph. This study was aimed at using CTR on chest radiographs to predict the occurrence of hypertensive heart disease among hypertensive adults in Zaria. Patients and Methods: The study was carried out in the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria, using static conventional x-ray machine. Consecutive 305 hypertensive patients and equal number of normal individuals, age and sex matched (as controls), were recruited. The chest radiographs of the participants were taken according to standard technique, and required measurements such as CTR and aortic arch width were taken and documented. Results: The mean CTR for the hypertensive patients and controls were 0.52 ± 0.07 and 0.45 ± 0.04, respectively. There was significant relationship between CTR and hypertensive heart disease. Other variables such as blood pressure, age, and sex also correlated significantly with CTR. Conclusion: The CTR showed positive relationship with blood pressure and hypertensive heart disease and it could, therefore, be used to predict the occurrence of these conditions.

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Background: Preoperative anemia in surgical patients scheduled for major procedures results in poor outcomes, hence the need for full optimization of packed cell volume (PCV) before surgery. This study aims to assess preoperative PCV and category of surgery as predictors of intraoperative blood transfusion in a tertiary healthcare facility in Zaria, Nigeria. Patients and Methods: This was a retrospective study where hospital records of patient's ≥13 years undergoing elective surgeries at a tertiary hospital in Zaria over a period of 6 months were reviewed. Patients' ages, gender, preoperative PCV, category of surgery, American Society of Anesthesiologists (ASA) scores, and number of units of blood transfused intraoperatively were analyzed using SPSS 20.0. Results: There were 164 surgeries conducted during the study period. Females constituted 96 (58.5%) of the patients. The mean age and preoperative PCV were 38.9 ± 14.9 years and 36.6 ± 4.9%, respectively. The median (interquartile range) units transfused intraoperatively and ASA scores were 0 (0) and 2 (0), respectively. Spearman's correlation to compare the number of units transfused as a reference point was significant for preoperative PCV (ρ = −0.222, P = 0.004). Regression analyses using category of surgery, ASA scores, age, and preoperative PCV predicted intraoperative transfusion; F(2, 161) = 5.120, P = 0.007, adjusted R² = 0.048 with preoperative PCV and category of surgery predicting the number of units transfused (β =-0.176, P = 0.023) and (β = −0.158, P = 0.041), respectively. Conclusion: Preoperative PCV and category of surgery although important have a low ability to predict the number of blood units transfused intraoperatively.

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Uterine inversion in young girls as a complication of medical abortion is a rare obstetric emergency, and it is very difficult to diagnose. Often inversion is associated with massive hemorrhage and shock; sometimes, it can lead to maternal death. Here, we are reporting a case of 21-year-old unmarried girl who was admitted with complete uterine inversion and shock after taking treatment for medical abortion. Initially patient's vitals were stabilized by resuscitative measures, and after that she was shifted to an operation theatre for the reposition of inversion. The manual reposition of uterine inversion was attempted under general anesthesia, but it failed. Then she was planned for correction by abdominal route. Huntington procedure was done to correct uterine inversion, and 2 units of packed red blood cells (PRBC) were transfused. She was discharged on 8^th postoperative day in good condition. Early recognition and appropriate management give successful outcome in this life-threatening obstetric emergency.

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Head and neck cancers are major causes of morbidity and mortality worldwide. In India, oral cancers account for approximately 30% of all new cases annually. Ablative surgery is the main stay of treatment, followed by reconstructive surgery. In the head and neck region, there is much concern about function and structural integrity and aesthetic look, and reconstructive surgery is challenging to achieve these. Microvascular surgery revolutionized oncoplastic reconstruction, but this requires great expertise even in tertiary cancer centers and is not possible many times due to long wait or patient's condition. Hence, locoregional pedicled flap has a role to play. This article attempts to share our experience and review our current understanding about reconstruction in different subsites in the head and neck region with locoregional pedicled flaps.

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Background: Breast lesions are more prevalent in the present population. Eighty percent (80%) of lesions are benign. No clinical examination or investigation is accurate in the detection of benign breast disease (BBD). Accuracy of diagnosis increases when clinical examination, ultrasonography (USG) breast, and fine-needle aspiration cytology (FNAC)/histopathological examination (HPE) are combined. The objective of this study was to compare the role of clinical examination, USG/mammography, and HPE study in the diagnosis of BBDs. Patients and Methods: Consecutive female patients presented with breast diseases to the Department of Surgery, SVS Medical College and Hospital, Mahabubnagar, Telangana, India, between October 2013 and September 2015. Detailed history of the patient was noted to find out the reasonable risk factor. Clinical examination was done followed by USG/mammography of the breast and FNAC/HPE. Results: On analysis of our study, it was found that the incidence of benign breast lumps was found to be more in the age group of 21–30 years. One hundred and twenty cases were studied, of which 99 cases (82.5%) complained of lump in the breast. This was closely followed by pain (9 cases, 7.5%) and discharge from nipple (5 cases, 4.2%). Most of the lumps (65.8%) were <3 cm. Fibroadenomas cases (63.3%) were the commonest. Left-sided lesions were more (59 cases, 49.7%). Most of the lesions were solitary (113 cases, 94.17%). FNAC/HPE was done in all the cases and was diagnostic. USG could clearly suggest if the lesion was cystic or solid but further typing of the lesion had limitations, even though fibroadenoma would be diagnosed accurately. Conclusion: The accuracy of BBD diagnosis increases when all the three modes, i.e. clinical examination, imaging, and FNAC/HPE are employed. Triple assessment may avoid many unnecessary surgeries for benign lesion.

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Well-differentiated neuroendocrine tumors of the midgut are generally known as midgut carcinoids. These endocrine tumors have characteristic clinicopathological features with majority elaborating serotonin, present at an advanced age, and are frequently associated with carcinoid syndrome. We report an autopsy case of low-grade (G1) midgut carcinoid tumor presenting as carcinoid syndrome in a 64-year-old patient who presented with abdominal distension, diarrhea, body pain, and vomiting. Autopsy findings show a yellow tan tumor in the distal ileum measuring 0.5 × 0.5 × 0.1 cm. Histology shows tumor to be carcinoid and strongly positive for immunohistochemical markers chromogranin and cytokeratin and negative for S-100 protein.

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Orbitocranial penetrating injuries usually present dramatically with the stump of the penetrating object in the wound though occult cases have been reported in which the injury appeared trivial without outward evidence of the penetrating object. We present a child who fell on a pencil and underwent a craniotomy for retrieval of the transorbitocranial penetrating foreign body. A joint neurosurgical and neuroophthalmic evaluation were used in the management. Neuroimaging included computed tomography scan and ocular ultrasound with or without magnetic resonance imaging. In addition, a high index of suspicion is required in seemingly trivial periorbital trauma to prevent devastating and life-threatening complications. Public education on the dangers of children holding potentially harmful schooling and household objects during play is also emphasized.

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Urolithiasis is a common urological condition and an important affliction of the urinary tract; however, urethral calculi account for a small fraction of stones in the entire urinary tract. The dual occurrence of a vesicourethral collar stud calculus and a bulbar urethral diverticula calculus is exceptionally rare. We report the case of a 50-year-old man who presented with lower urinary tract symptoms that culminated into acute urine retention, which was relieved by suprapubic cystostomy after a failed attempt at urethral catheterization. His pelvic X-ray revealed vesicourethral collar stud and bulbar urethral calculi. There was no urethral stricture on retrograde urethrogram. The patient underwent cystolithotomy, urethrolithotomy, diverticulectomy, and urethroplasty. He was treated for suprapubic surgical site infection during the postoperative period. His voiding remained normal on removal of urethral catheter and he had no lower urinary tract symptoms at the last follow-up. Collar stud vesicourethral calculus coexisting with bulbar urethral diverticular calculus is rare. Appropriate patient work-up followed by cystolithotomy, urethrolithotomy, diverticulectomy with urethroplasty alleviates lower urinary tract symptoms.

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