Nigerian Journal of Surgery最新文献

{"title":"Postoperative Pain Management in Emergency Surgeries: A One-year Survey on Perception and Satisfaction among Surgical Patients.","authors":"AbdulGhaffar A Yunus,&nbsp;Euphemia M Ugwu,&nbsp;Yunusa Ali,&nbsp;Ganiyat Olagunju","doi":"10.4103/njs.NJS_18_19","DOIUrl":"https://doi.org/10.4103/njs.NJS_18_19","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain varies from an individual to individual. It also varies with types and extent of surgery. In general, postoperative pain is inadequately managed in most centers worldwide, especially in developing countries. Therefore, this study presents the perception and satisfaction of postoperative pain management in emergency surgeries.</p><p><strong>Methods: </strong>A 1-year prospective study of the 891 patients who underwent emergency general surgeries at Ahmadu Bello University Teaching Hospital, from January to December 2018 is hereby presented. Pain scores and patient's satisfaction toward postoperative pain management were considered at 8 and 24 h postoperatively through a predesigned questionnaire. Numeric Pain Rating Scale was used to determine pain intensity and the level of satisfaction following postoperative pain management. Student's <i>t</i>-test was used to compare the pain scores and patient's level of satisfaction of the postoperative pain management.</p><p><strong>Results: </strong>A total of 891 patients were recruited for this study, with a mean age of 36.4 ± 8.9 years with a male-to-female ratio of 1.3:1. Postoperative pain management satisfaction score for patients (98%) who had pain 8-h postoperative period was 4.8 ± 1.6. Similarly, 96.4% of the patients who had pain 24 h postoperatively scored 2.8 ± 1.7. Majority of the patients 481 (54%) were of the American Society of Anesthesiologist physical Class II. Most of the patients underwent general surgery using the technique of general anesthesia.</p><p><strong>Conclusion: </strong>This study indicated that the perception and level of patient's satisfaction regarding postoperative pain management are inadequate. The health professionals and policy makers should be aware that postoperative pain management is suboptimal, as patients still have severe postoperative pain. Therefore, the need for improved postoperative pain management.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"26 1","pages":"42-47"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/d6/NJS-26-42.PMC7041353.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37733189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Fine Needle Aspiration Cytology in Triple Assessment of Patients with Malignant Breast Lumps.","authors":"A Ugwu-Olisa Ogbuanya,&nbsp;S Nnamdi Anyanwu,&nbsp;E Festus Iyare,&nbsp;C Gregory Nwigwe","doi":"10.4103/njs.NJS_50_19","DOIUrl":"https://doi.org/10.4103/njs.NJS_50_19","url":null,"abstract":"Background: Breast cancer is the leading female malignancy in the world and now the most common cancer in Nigeria. The evaluation of patients with breast cancer requires stepwise diagnostic approach to achieve a combined diagnostic information required to make an enhanced decision on how best to approach management. The aim of this study is to evaluate the role of fine needle aspiration cytology (FNAC) in the triple assessment of patients with malignant breast lumps in our center. Patients and Methods: This is a descriptive prospective study of patients with palpable breast lumps over an eighteen-month period. The patients were sequentially subjected to FNAC and open biopsy. Those whose lumps were malignant were further evaluated. Results: There were 88 (44.9%) and 108 (55.1%) biopsy confirmed breast cancers and benign lumps, respectively. From cytology reports, there were 12 (6.1%) unsatisfactory (C1), 96 (49%) benign (C2), 8 (4.1%) atypical (C3), 10 (5.1%) suspicious of malignancy and 70 (35.7%) unequivocally malignant (C5) smears. FNAC performed better than clinical examination in the validity tests for breast malignancy. The diagnostic results for breast malignancies were 97.2% (sensitivity), 98.9% (specificity), 1.4% (false positive rate []), 2.1% (false negative rate), 98.6% (positive predictive value), 97.9% (negative predictive value), and overall diagnostic accuracy of 98.2%. Conclusion: Considering the high performance of diagnostic cytology noted above, FNAC has proved itself to be useful and significantly accurate in making diagnosis of breast cancers in our center.","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"26 1","pages":"35-41"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c7/da/NJS-26-35.PMC7041348.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37733187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resilient Customized Hollow Vaginal Stent for the Treatment of Vaginal Agenesis in Mayer-Rokitansky-Kuster-Hauser Syndrome.","authors":"Manu Rathee,&nbsp;Savita Rani Singhal,&nbsp;Sanju Malik,&nbsp;Gunjan Gupta","doi":"10.4103/njs.NJS_43_18","DOIUrl":"https://doi.org/10.4103/njs.NJS_43_18","url":null,"abstract":"<p><p>Vaginal agenesis is a common congenital anomaly in females and is most commonly associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome. These patients can be treated with both surgical and nonsurgical procedures. Prefabricated as well as customized vaginal stents are used for the reconstruction and maintenance of neovagina. This case report explains the fabrication of customized tissue conditioner-reinforced acrylic vaginal stent for the treatment of a 20-year-old female having vaginal agenesis associated with MRKH syndrome. This vaginal stent with resilient surface provides a relatively easy, simple, and cost-effective alternative for the treatment of vaginal agenesis. It is also associated with increased compliance and comfort to the patient.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"26 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/d1/NJS-26-88.PMC7041350.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37732530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Determining Diabetic Remission after Sleeve Gastrectomy: A Prospective Study.","authors":"Rohit Jindal,&nbsp;Mayank Gupta,&nbsp;Ashish Ahuja,&nbsp;Prabhdeep Singh Nain,&nbsp;Pranjl Sharma,&nbsp;Aayushi Aggarwal","doi":"10.4103/njs.NJS_9_19","DOIUrl":"https://doi.org/10.4103/njs.NJS_9_19","url":null,"abstract":"<p><strong>Background: </strong>An exponential rise in the prevalence of obesity and the associated type 2 diabetes mellitus (T2DM) has led to an explosion in the field of bariatric surgery worldwide. It has been proposed that laparoscopic sleeve gastrectomy (LSG) not only results in excess weight loss (EWL) but also leads to excellent glycemic control.</p><p><strong>Aims: </strong>However, not every patient benefits from the bariatric surgery. Furthermore, bariatric surgery is currently indicated based on body mass index (BMI), but BMI solely does not predict diabetes remission after the surgery. We aimed to study the outcome of LSG on the diabetic status and the factors predicting the disease remission.</p><p><strong>Subjects and methods: </strong>This prospective study was conducted on 104 obese patients having T2DM who underwent LSG. Following surgery, the clinical outcome on weight loss, BMI, and glycemic control was studied for 6 months. Various positive and negative predictors of diabetic remission after the surgery were also determined. Student's <i>t</i>-test and Chi-square tests were applied.</p><p><strong>Results: </strong>LSG resulted in significant weight loss (<i>P</i> < 0.05); the percentage of EWL was 60.75 ± 6.30 at 6 months. Furthermore, surgery resulted in 78.9% remission of diabetes with fasting blood glucose and glycated hemoglobin values at 6 months being 121.13 ± 15.25 mg/dl and 6.19% ± 0.31%, respectively. Younger and heavier patients, those with lesser disease severity and shorter duration had better chances of disease remission. Gender had no correlation with disease remission.</p><p><strong>Conclusion: </strong>LSG is a successful treatment option for T2DM and is more beneficial if offered, not as a last option, but to younger, obese patients with mild disease severity and shorter disease duration after the failure of medical treatment.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"26 1","pages":"66-71"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/25/c9/NJS-26-66.PMC7041342.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37733124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Modified Laparoscopic Technique for the Removal of Nonfragmentable Giant Gastric Trichobezoar.","authors":"Sakthivel Harikrishnan,&nbsp;Senthilkumar Perumal,&nbsp;Kanchan Sachanandani,&nbsp;M Thiruvarul,&nbsp;C Sugumar,&nbsp;Jeswanth Sathyanesan,&nbsp;P Ravichandran","doi":"10.4103/njs.NJS_20_19","DOIUrl":"https://doi.org/10.4103/njs.NJS_20_19","url":null,"abstract":"<p><p>Bezoars are usually defined as collections of nondigestible matter that most commonly accumulates in the stomach and can sometimes extend to the small bowel. Trichobezoars are a rare entity which is most commonly observed in young psychiatric females with trichotillomania and trichophagia. Here, we report a case of giant gastric trichobezoar and a novel technique of laparoscopic removal in a 16 year old female with trichophagia. The giant gastric trichobezoar weighing about half a kilogram was removed en masse laparoscopically by a novel technique. She had an uneventful postoperative recovery and was discharged after psychiatric counseling.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"26 1","pages":"84-87"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/74/NJS-26-84.PMC7041354.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37733127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Unusual Case of Biliary Stent Migration in Sacrum.","authors":"Anant Sadanand Ramani,&nbsp;Sudip Mandrekar,&nbsp;Dattaprasad Samant,&nbsp;Francisco Noronha","doi":"10.4103/njs.NJS_28_18","DOIUrl":"https://doi.org/10.4103/njs.NJS_28_18","url":null,"abstract":"<p><p>The common bile duct stenting has been a common endoscopic procedure practiced worldwide for the treatment of benign or malignant bile duct obstruction. Although the procedure has shown a very low morbidity, it is not free from complications. Stent migration has been a common late complication seen in 10% of cases presenting with various manifestations depending on the site of impaction. Here, we present a rare case of distal stent migration with impaction in the sacral foramina due to perforation through sigmoid diverticula with review of literature.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"25 1","pages":"104-106"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/04/3c/NJS-25-104.PMC6452759.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37347879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular Fireworks Injuries in Eastern Nigeria: A 3-Year Review.","authors":"Akunne Ijeoma Apakama,&nbsp;Cosmas C Anajekwu","doi":"10.4103/njs.NJS_29_15","DOIUrl":"https://doi.org/10.4103/njs.NJS_29_15","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study is to determine the incidence and types of ocular injuries caused by fireworks in patients seen at Guinness Eye Centre Onitsha and their effects on vision.</p><p><strong>Methods: </strong>This was a 3-year retrospective study evaluating case files of patients with ocular fireworks injuries seen at Guinness Eye Centre Onitsha during the Christmas and New Year festivities (2010-2012). Information was extracted into a pro forma and analyzed using Excel, AutoSum, and calculators.</p><p><strong>Results: </strong>Subconjunctival hemorrhage, corneal lacerations, and hyphema were the most common injuries seen. Patients had multiple ocular pathologies, and the left eye was affected in 62.5% of cases. Bystanders accounted for 75% of those with ocular fireworks injuries. All were males. Half of the affected eyes went blind.</p><p><strong>Conclusion: </strong>Fireworks injuries constituted only 5.1%, 0%, and 10% of ocular injuries in 2010, 2011, and 2012, respectively, with devastating consequence of blindness in 50% of affected eyes.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"25 1","pages":"42-44"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ee/06/NJS-25-42.PMC6452755.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37173239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rare Breast Malignancy Subtypes: A Cytological, Histological, and Immunohistochemical Correlation.","authors":"Manmeet Kaur,&nbsp;Kanwardeep Kaur Tiwana,&nbsp;Nisha Singla","doi":"10.4103/njs.NJS_27_18","DOIUrl":"https://doi.org/10.4103/njs.NJS_27_18","url":null,"abstract":"<p><strong>Background: </strong>Breast malignancies encompass various subtypes which differ in their clinical presentations, outcomes, and response to the treatment regimens. Thus, a proper histological diagnosis and a special mention of the rare histologic subtypes are required to formulate clear recommendations of their treatment protocols.</p><p><strong>Materials and methods: </strong>This is a 1-year retrospective study highlighting the rarely encountered subtypes on the mastectomy specimens received.</p><p><strong>Results: </strong>We encountered only 11 rare cases out of the total 153 mastectomy specimens received. The rare subtypes were as follows mucinous cystadenocarcinoma (0.6%), mucinous carcinoma (0.6%), dermatofibrosarcoma protuberans (0.6%), Squamous cell carcinoma (0.6%), papillary carcinoma (2.6%), medullary carcinoma (0.6%), and malignant mesenchymal tumor (1.3%).</p><p><strong>Conclusion: </strong>Our data suggest that these variants are distinct clinicopathological entities with a unique hormonal receptor status. Scant information is available on the rare breast tumor subtypes.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"25 1","pages":"70-75"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/93/50/NJS-25-70.PMC6452754.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37334783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological Changes in Gallbladder Mucosa Associated with Cholelithiasis: A Prospective Study.","authors":"Amandeep Singh,&nbsp;Guramritpal Singh,&nbsp;Kanwardeep Kaur,&nbsp;Gagandeep Goyal,&nbsp;Girish Saini,&nbsp;Deepika Sharma","doi":"10.4103/njs.NJS_15_18","DOIUrl":"https://doi.org/10.4103/njs.NJS_15_18","url":null,"abstract":"<p><strong>Background and aims: </strong>Cholelithiasis is known to produce diverse histopathological changes in the gallbladder mucosa. In the present study, we aimed to find the correlation between various gallstone characteristics (i.e., number, size, and morphological type) with the type of mucosal response in gallbladder mucosa (i.e., inflammation, hyperplasia, metaplasia, and carcinoma).</p><p><strong>Methods: </strong>The present study was conducted prospectively on 100 patients undergoing cholecystectomy for symptomatic cholecystitis. Gallstones were assessed for various parameters, i.e., number, size, and morphological type. Gallbladder mucosa was subjected to histopathological examination. Sections were taken from body, fundus, and neck of gallbladder.</p><p><strong>Results: </strong>Of 100 cases, maximum type was of mixed stones (54%) and was multiple in number (46%). However, gallstone type and number are nonsignificant variables to produce precancerous lesions (i.e., hyperplasia and metaplasia). Statistically significant results were obtained while comparing the mucosal response with gallstone size (<i>P</i> = 0.012).</p><p><strong>Conclusion: </strong>As the gallstone size increases, the response in gallbladder mucosa changes from cholecystitis, hyperplasia, and metaplasia to carcinoma. Gallstone type and number are nonsignificant variables to produce precancerous lesions.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"25 1","pages":"21-25"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/42/84/NJS-25-21.PMC6452760.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37173235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern of Extremity Arterial Injury and Outcome of Repair in Southwest, Nigeria.","authors":"Uvie Ufuoma Onakpoya,&nbsp;Joel Oghenevware Eyekpegha,&nbsp;Akinwumi Ogunrombi,&nbsp;Akumbu Sylva Ohuche,&nbsp;Temitope Olumuyiwa Ojo","doi":"10.4103/njs.NJS_18_18","DOIUrl":"https://doi.org/10.4103/njs.NJS_18_18","url":null,"abstract":"<p><strong>Background: </strong>Extremity arterial injuries are an important cause of loss of life/limb after trauma. Early intervention is important for the good outcome.</p><p><strong>Objectives: </strong>The objective of this study is to review the pattern of presentation and study the factors that influences the outcome of extremity arterial injuries in our hospital.</p><p><strong>Patients and methods: </strong>This is a retrospective study of all patients with injuries to the extremity arteries requiring surgical intervention from July 2007 to June 2015. Data obtained included biodata, ischemic time, arteries involved, surgical intervention, and outcomes and analyzed using SPSS version 22.</p><p><strong>Setting: </strong>Our hospital is the main referral hospital for vascular trauma serving four adjoining states in Nigeria and is linked to major cities by at least 3 Trunk-A federal roads.</p><p><strong>Subjects: </strong>The subjects are patients who were managed in our cardiovascular surgical unit for the study duration (July 2007-June 2015) who had extremity arterial injuries.</p><p><strong>Results: </strong>A total of 36 patients presenting with 40 arterial injuries in 37 limbs were studied. The mean age was 28.4 ± 10.3 years with male preponderance (88.9%). Gunshot injuries were the most common cause of arterial injuries (37.8%), followed by assault (27%). The mean time from injury to presentation for acute injuries was 20.4 h but 23 of the patients (63.8%) presented to the accident and emergency department within 12 h of injury. A limb salvage rate of 64.9% was achieved though ischemic times of ≥12 h were associated with poor outcomes.</p><p><strong>Conclusion: </strong>Prolonged ischemic time is associated with poor outcomes. Efforts should be put in place to reduce the limb ischemic times.</p>","PeriodicalId":30399,"journal":{"name":"Nigerian Journal of Surgery","volume":"25 1","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a5/ed/NJS-25-85.PMC6452751.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37334786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}