Journal of the West African College of Surgeons最新文献

{"title":"Management of Distal Femur Unicondylar Fractures by Calcaneal Buttress Plating: A Prospective Interventional Study.","authors":"Dheeraj D Shekar,&nbsp;Ramesh Chand Meena,&nbsp;Shyoji Lal Sharma,&nbsp;Krishnapriya T Vijayan,&nbsp;Sachin Nayak,&nbsp;Anushrey Singhal","doi":"10.4103/jwas.jwas_23_23","DOIUrl":"10.4103/jwas.jwas_23_23","url":null,"abstract":"<p><strong>Background: </strong>Unicondylar fracture of distal femur accounts for less than 1% of all femoral fractures. As conservative methods have shown substandard results, traditional surgical treatment includes open reduction and internal fixation by Herbert screws, cannulated screws, and conventional lateral locking plates. Though screw fixation has excellent results over long run, there is literature documenting the loosening and loss of articular congruency in elderly patients and in comminuted fracture patterns. Also, the traditional locking plates are precontoured to fit the lateral condyle, whereas there is no specific implant to fix the medial condylar fractures. The merit of the calcaneal plating is that it is easily moldable and can be used for either of the sides irrespective of fracture pattern.</p><p><strong>Objectives: </strong>This study aimed to evaluate the clinical outcome of calcaneal plate (D-shape) fixation in distal femur unicondylar fractures.</p><p><strong>Materials and methods: </strong>A total of 30 patients were studied, who met the inclusion criteria and consented to the surgery. After appropriate investigations, these patients were treated with calcaneal plating and were followed up postoperatively at 2 weeks, 1 month, 3 months, and 6 months for clinical evaluation.</p><p><strong>Results: </strong>There was a gradual increase in the range of motion (ROM) with subsequent follow-ups. The overall mean ROM evaluated at 6 months was 108.46° ± 28.27° with <i>P</i> < 0.001 and was a statistically significant outcome. Also, the mean ROM for sagittal split fractures (~120°) was comparatively more than the coronally split fractures (~90°). The functional outcome assessed by Neer scoring showed excellent and satisfactory results in 24 (80%) patients, whereas the remaining six (20%) patients had poor results. None of the patients had nonunion, infection, or implant failure.</p><p><strong>Conclusion: </strong>With no specific implant for isolated unicondylar fractures, the use of calcaneal plate in our study has shown promising results probably due to its low profile design reducing the soft-tissue irritation and wide area of bone coverage by the plate offering regions of intermittent fixation due to its spanning design, thereby promoting periosteal preservation and ultimately fracture union.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/69/JWACS-13-59.PMC10395845.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929712","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":"Spectrum of Oral and Maxillofacial Tissue Biopsies at the Foremost Tertiary Institution in The Gambia: A Retrospective Review.","authors":"Ousman Leigh,&nbsp;Akindayo Olufunto Akinyamoju,&nbsp;Gabriel O Ogun,&nbsp;Victoria Nwebuni Okoje","doi":"10.4103/jwas.jwas_168_22","DOIUrl":"10.4103/jwas.jwas_168_22","url":null,"abstract":"<p><strong>Introduction: </strong>Sub-Saharan Africa has a heavy burden of oral diseases and cancers. Also, there is a dearth of published records of oral pathology services in The Gambia. Therefore, this review aimed to determine the prevalence of biopsied oral and maxillofacial lesions in order to ascertain the uptake of oral histopathology services at the foremost tertiary institution in The Gambia.</p><p><strong>Materials and methods: </strong>This was a retrospective study performed at the Pathology Department of Edward Francis Small Teaching Hospital. Reports of all oral and maxillofacial biopsies submitted for the period 2012 to 2021 were reviewed and data were extracted. Descriptive analysis was done using SPSS software, version 26.</p><p><strong>Results: </strong>Total number of biopsy reports was 158 representing 0.02% over the study period. The mean age of patients was 34.3 ± 19.7 years, the 3rd decade was the peak age of presentation and male-to-female ratio was 1:1.6. Majority (65/41.1%) of the cases were benign neoplastic lesions, and the mandible was the most (21/13.3%) common site of biopsy. Reactive lesions were the predominant (34/21.5%) group and squamous cell carcinoma had the highest (24/15.3%) number of lesions while odontogenic tumours constituted six cases only (3.8%).</p><p><strong>Conclusion: </strong>The findings of this study showed low uptake of oral histopathology services while biopsied oral and maxillofacial lesions were prevalent in female patients in the third decade of life. Also, the mandible was the most affected site whereas benign neoplastic diagnoses were most common. However, this study recorded a higher proportion of malignancies than some previous studies.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/4b/JWACS-13-1.PMC10395849.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935789","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":"Evaluation of Pattern of Lesions Depicted on Brain Computed Tomography Scan of Patients Presenting with Stroke in Zaria, Nigeria.","authors":"Mubarak Zubair Abdullahi,&nbsp;Halima Mono Mohammad,&nbsp;Suleiman Lawal,&nbsp;Muhammad Zaria Ibrahim,&nbsp;Nafisa Bello,&nbsp;Ibrahim Aliyu,&nbsp;Rasheed Mono Muhammad","doi":"10.4103/jwas.jwas_256_22","DOIUrl":"10.4103/jwas.jwas_256_22","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a major public health problem worldwide and it is the third leading cause of death in industrialized countries and ranks among the five most common causes of hospital deaths in adults in Africa. Accurate stroke diagnosis has a high significance for patient's outcome. Computed tomography (CT) brain scan is the imaging of choice for patients presenting to the emergency department with stroke.</p><p><strong>Aim and objectives: </strong>The study aimed at evaluating the pattern of lesion depicted on CT brain of patients presenting with stroke in ABUTH, Zaria.</p><p><strong>Materials and methods: </strong>A prospective review of CT findings in 155 patients who presented in the Radiology Department of Ahmadu Bello University Teaching Hospital (ABUTH) with clinical diagnosis of stroke was undertaken over a period of six months (from October 2017 to April 2018)..</p><p><strong>Results: </strong>Of the 155 patients seen within the period under review, 88 (56.8%) were males while 67 (43.2%) were females. Age range was 11-90 years (mean 56, standard deviation (SD) 16, 44(28.4%) of patients were in the age group of 61-70 years. Ninety six patients (61.9%) had ischaemic stroke, 27(17.4%) had hemorrhagic stroke, eight (5.2%) was stroke mimic, six patients (3.9%) mixed lesions (ie both ischaemic and haemorrhagic). Eighteen patients (11.6%) had normal brain CT findings. The region most affected by stroke was the parietal region 52(38%).</p><p><strong>Conclusion: </strong>Ischaemic stroke is the most common form of stroke in this study.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ce/81/JWACS-13-16.PMC10395855.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9935786","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":"Reduction Mammoplasty for Macromastia: Our Experience Using the Inferior Pedicle with Inverted-T Skin Resection.","authors":"Simon Jekat Yiltok,&nbsp;Akintunde J Akintayo,&nbsp;Christopher Y Karago,&nbsp;Joshua D Choji,&nbsp;Babangida Sankey,&nbsp;Enye Agada,&nbsp;Atarang A Dafong,&nbsp;Anthony S Ezekiel,&nbsp;Kusu Samuel Orkar","doi":"10.4103/jwas.jwas_30_23","DOIUrl":"10.4103/jwas.jwas_30_23","url":null,"abstract":"<p><strong>Introduction: </strong>Macromastia is a major reason why women seek for breast reduction especially when there are symptoms. Breast reduction is an uncommon procedure in our environment and this is a report of our experience with inferior pedicle with an inverted-T skin resection.</p><p><strong>Materials and methods: </strong>This is a report of breast reductions using the inferior pedicle with an inverted-T skin resection approach that were carried out between 2004 and 2022. The information that was retrieved from the case notes were age, marital status, parity, last child birth, family history of breast enlargement, presenting features, height, weight, the weight of tissue excised, and complications. The data obtained were then entered into the SPSS version 25 (IBM Corp.) software and analysed.</p><p><strong>Results: </strong>Seventeen women were managed with an age range of 16-50 years and a mean of 31.06 ± 9.66 years. The most common features at presentation were heavy weight around the chest, backache, shoulder pain, no appropriate brassiere with low self-esteem and self-confidence. Ten had skin changes and recurrent rashes over the breast, whereas four complained of grooves with skin changes. The weight of excised breast tissue ranged from 0.2 to 5.5 kg with an average of 2.18 ± 1.28 kg for the right and 2.05 ± 1.00 kg for the left breast. All except one patient had blood transfusion. The common complications were delayed wound healing (47%) followed by partial wound dehiscence (17.6%), and flap necrosis (11.8%). Except for those with flap necrosis the wounds healed with some having broad scars.</p><p><strong>Conclusions: </strong>Patients for breast reduction are mainly due to the symptoms and signs with the associated large breast. The inferior pedicle with inverted-T skin resection is a valuable technique with a very good outcome. To improve access to breast reduction, there is the need to enhance awareness through advocacy using women groups and health education.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/44/JWACS-13-77.PMC10395857.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9938909","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":"Acute Intestinal Obstruction: A 1-Year Prospective Audit into Causes.","authors":"Isaac Assam Udo,&nbsp;Odionyeme Ugochukwu","doi":"10.4103/jwas.jwas_213_22","DOIUrl":"10.4103/jwas.jwas_213_22","url":null,"abstract":"<p><strong>Background: </strong>Intestinal obstruction is a common general surgical emergency with high morbidity and mortality. Its aetiology varies widely between and within geographic regions, with gender, age, and time. Obstructed inguinal hernia is still considered the most common cause of intestinal obstruction in Sub-Saharan Africa and other low-income countries, but its incidence appears to be on the decrease as other causes of intestinal obstruction become more common in a particular society.</p><p><strong>Aim: </strong>To examine the spectrum of causes of intestinal obstruction in a tertiary hospital in southern Nigeria and compare the results with earlier studies in the region and Nigeria.</p><p><strong>Materials and methods: </strong>A cross sectional, single-hospital study of adults diagnosed with and having clinical and radiological features of acute intestinal obstruction.</p><p><strong>Results: </strong>Seventy patients were enrolled in the study, comprising of 35 (50%) males and 35 (50%) females, M:F = 1:1. The mean patient age was 44.8 years. Two peak age incidences of intestinal obstruction were observed in the 36-45 and 56-65 years age groups. Post-operative adhesion 13 (18.5%), obstructed external abdominal hernia 13 (18.5%), colonic cancer 11 (16%), and intussusception seven (10%) were the primary causes of intestinal obstruction. Obstructed inguinal hernia was commonly encountered in males while adhesions and colonic cancers were common in females.</p><p><strong>Conclusion: </strong>Obstructed external abdominal hernias and post-operative adhesion are at par as the main primary causes of intestinal obstruction. Colon cancer and intussusception are increasingly causing more obstructions.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/69/JWACS-13-6.PMC10395853.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9941421","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":"Association of Cervical Spine Magnetic Resonance Imaging Abnormalities with Chronic Neck Pain in Southern Nigeria.","authors":"Oghenetejiri Denise Ogholoh,&nbsp;Amenaghawon Precious Bemigho-Odonmeta,&nbsp;Omuvwie Igberhi Orhrohoro,&nbsp;Joyce Ekeme Ikubor,&nbsp;Bukunmi Michael Idowu,&nbsp;Besiginwa Harrison Tsebi,&nbsp;Nicholas Kogha,&nbsp;Nkem Nnenna Nwafor,&nbsp;Anthony Osayomwanbor Ogbeide","doi":"10.4103/jwas.jwas_11_23","DOIUrl":"10.4103/jwas.jwas_11_23","url":null,"abstract":"<p><strong>Objective: </strong>This study was done to evaluate the relationship between cervical spine magnetic resonance imaging (MRI) findings and clinical features in adults with chronic neck pain (NP) at our tertiary hospital.</p><p><strong>Materials and methods: </strong>This was a prospective cross-sectional study of the cervical spine MRI of 90 adult patients with chronic NP. The clinical history, biodata, and cervical spine MRI findings were analysed. Statistical tests were considered significant at <i>P</i> ≤ 0.05.</p><p><strong>Results: </strong>The mean age of the participants was 54.72 (13.51) years (range = 28-79 years). There were 52 (58%) males and 38 (42%) females. Cervical disc desiccation and disc herniation were the most prevalent MRI findings. C4/C5 and C5/C6 disc levels were most commonly affected. Disc height reduction correlated with shoulder pain (<i>r</i> = 0.23, <i>P</i> = 0.030), unsteady gait (<i>r</i> = 0.27, <i>P</i> = 0.010), and lower limb weakness (<i>r</i> = 0.23, <i>P</i> = 0.029). Vertebral collapse correlated with shoulder pain (<i>r</i> = 0.22, <i>P</i> = 0.036), upper limbs burning sensation (<i>r</i> = 0.33, <i>P</i> = 0.001), and loss of dexterity (<i>r</i> = 0.22, <i>P</i> = 0.037). Spondylolisthesis correlated significantly with unsteady gait (<i>r</i> = 0.34, <i>P</i> = 0.001), dizziness/vertigo (<i>r</i> = 0.29, <i>P</i> = 0.005), painful neck movement (<i>r</i> = 0.32, <i>P</i> = 0.002), loss of dexterity (<i>r</i> = 0.37, <i>P</i> < 0.001) and sphincteric dysfunction (<i>r</i> = 0.23, <i>P</i> = 0.031). Modic changes correlated with loss of dexterity (<i>r</i> = 0.39, <i>P</i> < 0.001) and upper limbs burning sensation (<i>r</i> = 0.21, <i>P</i> = 0.048). Cervical canal stenosis did not correlate significantly with any symptom.</p><p><strong>Conclusion: </strong>Cervical disc disease (C4/C5 and C5/C6 levels) was the most prevalent finding on MRI. Disc height reduction, vertebral collapse, spondylolisthesis, and Modic changes correlated with various clinical symptoms.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/49/JWACS-13-48.PMC10395864.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9938907","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":"Immunohistochemical Expression of E-Cadherin and β-Catenin in Oral Squamous Cell Carcinoma.","authors":"Akindayo Olufunto Akinyamoju,&nbsp;Ahmed Oluwatoyin Lawal,&nbsp;Akinyele Olumuyiwa Adisa,&nbsp;Bukola Folasade Adeyemi,&nbsp;Bamidele Kolude","doi":"10.4103/jwas.jwas_1_23","DOIUrl":"10.4103/jwas.jwas_1_23","url":null,"abstract":"<p><strong>Background: </strong>The E-cadherin/β-catenin protein complexes are actively involved in the epithelial-to-mesenchymal transition. Alterations in cadherin or catenin expression or function, play important roles in the development of invasive or metastatic phenotypes of cancers.</p><p><strong>Objectives: </strong>The aim of this study was to assess the expression of E-cadherin and β-catenin in oral squamous cell carcinoma (OSCC) patients and to compare this with their clinico-pathological parameters.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study to assess the immunohistochemical expression of E-cadherin and β-catenin in 41 cases of OSCC. Data were analyzed using version 26 of SPSS software. Qualitative data were compared using chi-square statistics. Quantitative data were summarized using mean, standard deviation, and confidence interval and compared using a one-way analysis of variance test. The level of significance was set at <i>P</i> < 0.05.</p><p><strong>Results: </strong>Overall, 95.1% of the cases had positive membrane expression for E-cadherin, while cytoplasmic staining was seen in 90.2% cases. Positive nuclear staining was seen in 46.3% cases. There was a decrease in the percentage of cytoplasmic and nuclear expression of E-cadherin as the OSCC became more poorly differentiated (χ² = 13.96, <i>P</i> = 0.016). Also, a decrease in the percentage of nuclear expression of β-catenin in poorly differentiated cases was seen. However, no statistically significant difference was seen in the expression of β-catenin between the different histologic grades (χ² = 4.8, <i>P</i> = 0.4).</p><p><strong>Conclusion: </strong>This study shows a reduction in the expression of E-cadherin and β-catenin as OSCC becomes less differentiated.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/24/2b/JWACS-13-43.PMC10395847.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9941416","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":"Evaluation of the Effects of Peritonsillar Infiltration of Tramadol-Ketamine Combination Versus Tramadol Alone on Posttonsillectomy Pain in Children.","authors":"Samuel Isaiah Nuhu, Daniel Francis Atteh, Henry Yammoh Embu, Erdoo Suckie Isamade, Daniel Damasau Kokong, Nuhu Danle Ma'an, Kefas Thomas Malau, Yohanna Musa Usman","doi":"10.4103/jwas.jwas_31_23","DOIUrl":"10.4103/jwas.jwas_31_23","url":null,"abstract":"<p><strong>Introduction: </strong>Tonsillectomy is associated with significant pain and post-operative pain control is often unsatisfactory. This study sought to evaluate the effect of peritonsillar infiltration of tramadol-ketamine combination, tramadol alone and ketamine alone on post-tonsillectomy pain in children.</p><p><strong>Patients and methods: </strong>A randomized double-blinded interventional study involving 90 patients aged 3-15 years of American society of anesthesiologists I or II physical status scheduled for elective adenoidectomy, tonsillectomy or adenotonsillectomy at JUTH was conducted. Patients were randomized into one of three groups: group I received tramadol 2mg/kg, group II received ketamine 1mg/kg plus tramadol 2mg/kg and group III received ketamine 1mg/kg only all made up to 2mls with normal saline and 1ml given per tonsillar bed. All patients had standard general anaesthesia with endotracheal intubation and monitoring. Data was analyzed using Epi-info version 7.1.5 with p £ 0.05.</p><p><strong>Result: </strong>The analysis of data showed that the mean ages of the participants in group I, II and III were 5.70±2.00, 5.69±3.22 and 4.47±2.01 years respectively (p-value=0.091). Group II had significantly lower pain scores, longer time to first request of analgesia, earlier oral intake and discharge from the hospital compared to the group that received either tramadol or ketamine alone. Minimal side effects were noted across all the groups in the study.</p><p><strong>Conclusion: </strong>Peri-tonsillar infiltration of tramadol-ketamine combination immediately after tonsillectomy (but before extubation of patients) significantly decreased post-tonsillectomy pain without increasing the incidence of side effects compared to tramadol or ketamine alone in children undergoing adenotonsillectomy.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/11/f3/JWACS-13-84.PMC10395861.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929717","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":"Challenges and Prospects of Laser Haemorrhoidoplasty in a Low Resource Setting: The LUTH Experience.","authors":"Thomas Olagboyega Olajide,&nbsp;Olanrewaju Samuel Balogun,&nbsp;Christopher O Bode,&nbsp;Oluwole Ayoola Atoyebi","doi":"10.4103/jwas.jwas_42_23","DOIUrl":"10.4103/jwas.jwas_42_23","url":null,"abstract":"<p><strong>Background: </strong>Haemorrhoids are the most common condition of the anal canal causing significant disability. Traditional excisional haemorrhoidectomy and its various modifications, while effective, may be attended by severe postoperative pain and other complications. Laser haemorrhoidoplasty is reported to be effective with fewer complications and shorter hospital stay.</p><p><strong>Objectives: </strong>The aim of this study was to report the outcome of intrahaemorrhoidal coagulation with 1470-nm diode laser at the Lagos University Teaching Hospital.</p><p><strong>Patients and methods: </strong>The procedures were performed with a radially emitting laser fibre from Biolitec AG-CeramOptec (Bonn, Germany). The duration of symptoms, grade of the haemorrhoids, duration of the procedures, and postoperative complications were evaluated.</p><p><strong>Results: </strong>Eleven patients had laser haemorrhoidoplasty. There were seven males and four females. The age range was 23-71 years, with a median age of 47 years and an interquartile range (IQR) of 28-57 years. Duration of surgery ranged from 20 to 90 min, with a median of 33 min and IQR of 25-53 min. Postoperative pain was mild in eight patients and moderate in three. Ten patients were discharged as day cases and one 3 days later due to spinal anaesthesia-related headache and acute urinary retention. One patient later had an anal ulcer probably due to too much energy delivered during the procedure, this was managed conservatively. There was no postoperative wound infection, anal incontinence, anal stenosis, subcutaneous abscess, and fistula or recurrence.</p><p><strong>Conclusion: </strong>The advantages of laser haemorrhoidoplasty make it a readily acceptable form of treatment for haemorrhoids in our setting.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/d6/JWACS-13-96.PMC10395859.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9938902","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 Diagnostic Accuracy of Prostate-Specific Antigen and Digital Rectal Examination in the Diagnosis of Prostate Cancer at the University of Benin Teaching Hospital.","authors":"Ehiremhen Ozah,&nbsp;Dele Eradebamwen Imasogie","doi":"10.4103/jwas.jwas_32_23","DOIUrl":"10.4103/jwas.jwas_32_23","url":null,"abstract":"<p><strong>Objectives: </strong>To assess and compare the diagnostic accuracy of prostate-specific antigen (PSA) and digital rectal examination (DRE) in the diagnosis of prostate cancer.</p><p><strong>Materials and methods: </strong>It was a prospective, comparative study carried out over a period of 14 months at the University of Benin Teaching Hospital, Benin City. It involved male patients ≥50 years who presented at the urology clinic with lower urinary tract symptoms (due to prostatic disease), PSA > 4 ng/mL and or abnormal DRE findings. They had serum total PSA determined. Patients were recruited for prostate biopsy and samples sent for histopathological assessment. Histopathology was determined by a histopathologist dedicated to the study. Using a researcher-administered, structured proforma, data were collected, collated and subjected to statistical analysis for assessment and comparative analysis of the diagnostic accuracy of PSA and DRE.</p><p><strong>Results: </strong>The study involved 94 patients; they were all Nigerians. The age range of the study population was 50-85 years, with a mean age of 70.4 ± 8.6 years. Most (89.4%) of the patients were exposed to formal education. PSA of the study population ranged between 2.5 and 840 ng/mL. For patients with carcinoma of the prostate (CaP), median PSA value was 79.2 ng/mL, whereas patients with benign prostatic disease had a median PSA value of 16.0 ng/mL. The difference in median PSA value between the two groups was statistically significant (<i>P</i> < 0.001). In this study, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of PSA was 97.2%, 12.1%, 40.7%, 87.5% and 44.7%, respectively. However, a sensitivity, specificity, PPV, NPV and diagnostic accuracy of DRE was 88.9%, 70.7%, 65.3%, 91.1% and 77.7%, respectively. Combination of PSA and DRE had sensitivity, specificity, PPV, NPV and diagnostic accuracy of 91.7%, 91.4%, 86.8%, 94.6% and 91.5%, respectively. In this study, 36 (38.3%) patients had CaP whereas 57 (60.6%) patients had benign prostatic disease and 1 (1.1%) patient had high-grade prostatic intraepithelial neoplasia.</p><p><strong>Conclusion: </strong>The study revealed a low specificity, high sensitivity and low diagnostic accuracy of PSA in diagnosis of CaP. However, sensitivity, specificity, and diagnostic accuracy of DRE were high but not sufficient in diagnosis of CaP. A combination of PSA and DRE had a higher sensitivity, specificity and diagnostic accuracy in diagnosis of prostate cancer.</p>","PeriodicalId":73993,"journal":{"name":"Journal of the West African College of Surgeons","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9c/31/JWACS-13-91.PMC10395850.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929715","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}