|Year : 2017 | Volume
| Issue : 1 | Page : 73-79
Abstracts of papers presented at the Nigerian Surgical Research Society Meeting Ado Ekiti, December 2016
|Date of Web Publication||8-May-2017|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstracts of papers presented at the Nigerian Surgical Research Society Meeting Ado Ekiti, December 2016. Niger J Surg 2017;23:73-9
| Erectile Dysfunction in Men With and Without Lower Urinary Tract Symptoms in Nigeria|| |
Adegun PT, Areo PA, Solomon A1, Dada SA2
Department of Surgery, Division of Urology, Ekiti State University Teaching Hospital, Departments of 1Family Medicine and 2Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
Background: A lot of attention has been given to the effect of erectile dysfunction (ED) secondary to lower urinary tract symptoms (LUTS) in recent decades as to underestimate its effect in men without LUTS. Aim: This study aimed to compare the prevalence and predictors of ED in men with and without LUTS. Methods: Three hundred and three patients had International Index of Erectile Function-15 questionnaire administered between January 2014 and June 2016. Patients with LUTS were 147 while 156 were without LUTS. Results: Mean age was 66.03 ± 9.64 and 65.78 ± 8.61 years for the cases and controls, respectively. Prevalence of ED was 73.7% and 64.6% for the case cohorts and controls, respectively. The odds ratio (OR) of ED for being currently employed was 8.08 in the case cohorts and 7.0 in the controls (P < 0.05). The OR for impaired erectile function was 12.5 for married men in the case cohorts and 6.0 in the controls (P < 0.05). The OR for impaired orgasmic function was 7.0 and 4.9 for men in the current employment in the case cohorts and controls, respectively (P < 0.05). Currently being employed had OR of 6.0 for impaired sexual desire in the case cohorts and OR of 7.0 for impaired intercourse satisfaction in the controls (P < 0.05). Finally, currently being employed men had OR of 8.7 and 9 for impaired overall satisfaction for the case cohorts and controls, respectively (P < 0.05). Conclusion: Men with and without LUTS had high prevalence of ED. Predictors of ED in both men were being married or employed.
| Enteroatmospheric Fistula And “uncomplicated” Burst Abdomen: Time For A Paradigm Shift|| |
Wuraola OK, Asowo TV1, Babalola WO, Olaogun JG, Akute OO
Department of Surgery, General Surgery Unit, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, 1Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
Background: Burst abdomen (BA) has been traditionally managed as an emergency that must be closed at the earliest available theater space. The peritoneal cavity is considered too sacred and prone to infection to be left open. When the BA is compounded by enterocutaneous fistula and worse still enteroatmospheric fistula (EAF), it presents a conundrum that has not been satisfactorily resolved till date. Aim: The study aimed to bring to light that BA as well as EAF can be managed conservatively with limited resources and the peritoneal cavity as well as the fistula can be assisted to heal themselves by open dressing. Methods: Six patients (three EAF and three “uncomplicated” BA) were treated by simple open dressing of the peritoneal cavity with normal saline PRN to clean the cavity and keep the bowel loops from desiccation. The patients were supported with cheap high protein diet of soybean powder, crayfish, and groundnuts. The source of sepsis, where possible, was removed as soon as possible. Results: The patients did well and the only mortality sustained a crushing injury at the transpyloric plane, resulting in a complete transection of the duodenojejunal junction at the ligament of Treitz. Even his wound healed well with peritoneal cover of bowel loops but succumbed to hematemesis from gastritis. Conclusion: This case series demonstrates that a BA does not demand an emergency closure and even EAF healed within 6 weeks with this method. The only complication is incisional hernia not a postmortem which may be the lot of most EAF when subjected to hasty operative interventions.
| Awareness And Use Of Surgical Checklist Among Theater Users At Ekiti State University Teaching Hospital, Ado-Ekiti|| |
Ogunlusi JD, Yusuf MB, Popoola SO, Wuraola OK, Babalola WO, Oluwadiya KS, Ajogbasile OO1
Department of Surgery, Ekiti State University Teaching Hospital, 1Department of Nursing, Perioperative Unit, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
Background: Surgical checklist was introduced by the World Health Organization to reduce the number of surgical deaths and complications. This study was conceived after attending a Nigerian Surgical Research Society conference themed “Safety in Surgical Practice” and noting that surgical checklist was not in used in most Nigerian hospitals in general and the study center in particular. Aim: To ascertain the awareness of surgical checklist among the theater users in our hospital, determine the barriers to its implementation, and make recommendations. Methods: This is a prospective study at Ekiti State University Teaching Hospital Ado-Ekiti. Questionnaires were distributed to three groups of theater users – surgeons, anesthetists, and perioperative nurses. The responses were collated by the lead researcher, entered into Microsoft Excel spreadsheet, exported and analyzed with SPSS (IBM, Chicago). Results: Eighty-five questionnaires were distributed, seventy responses were gotten, and four were discarded due to poor filling. The studied 66 comprised 40 surgeons, 12 anesthetists, and 14 perioperative nurses. Fifty-five (83.3%) of the responders indicated awareness of the checklist, but only 12 (21.8%) correctly stated that the main objective is for patients' safety and safe surgery. Major barriers to its use include lack of training 58.2%, lack of assertiveness of staff 58.2%, and that its delays operation list 47.2%. Conclusion: The study demonstrated high level of awareness of surgical checklist in our hospital; however, this awareness is superficial as it is not reflected in the true aim of the checklist. Majority of the responders would want to be trained on checklist despite the highlighted barriers.
| Vulnerability Of Motorcycle Operators And Passengers To Injuries In Multi-Occupant Crashes|| |
Oluwadiya KS, Ojo OD, Adegbehingbe OO, Charles Mock, Popoola OS
Department of Surgery, Ekiti State University Teaching Hospital, Ado Ekiti
Introduction: The motorcycles in low- and middle-income countries are rarely ridden for recreational purposes; rather, they form an essential part of daily commuting. Consequently, most motorcycles on the roads have more than one occupant. The objective of this study is to establish the relative vulnerability of operators and passengers to injury and determine risk factors to sustaining injuries in multi-occupant motorcycle crashes. Methods: Between January 1, 2010, and December 31, 2010, and using a data collection form, we collected crash and injury data from victims of motorcycle crashes with more than one occupant at the time of the crash. Results: There were 78 multi-occupant crashes (62.4% of 125 motorcycle crashes), in which 181 persons were injured. These included 78 (43.1%) operators and 103 (56.9%) passengers. Eighteen (23.1%) of the crashes occurred on motorcycles with 3–5 occupants. While the probability of sustaining injuries was similar for passengers and operators, absolute risk reduction showed that passengers were more likely to sustain severe injuries (Injury Severity Score >15) than operators. Occupants of >2-occupant motorcycles were also significantly older and more likely to be involved in other risky behaviors such as not wearing helmet and speeding than those on >2-occupant motorcycles. In logistic regression analysis, the only significant predictor of injury was the number of occupants. Occupants of motorcycles on which there were >2-occupants were at an increased risk of sustaining injuries compared with occupants of motorcycles with only 2-occupants (odds ratio - 2.1, 95% confidence interval, 1.1–4.3). Conclusion: Passengers on multi-occupant motorcycles are more vulnerable to severe injuries than operators. The significance of the study finding to prevention is discussed.
| Clinical Predictors Of Colorectal Carcinoma In A Low-Resource Country: Results Of A Colonoscopy-Based Study|| |
African Research Group in Oncology, Obafemi Awolowo University Teaching Hospital, Ile Ife
Background: Colorectal cancer (CRC) is becoming a major public health issue in most low-income country as the incidence continues to rise. The survival is strongly related to stage at diagnosis as 5-year survival for early-stage CRC is >90%, compared with 10% for widespread cancer at diagnosis. Population-based CRC screening programs and early diagnosis strategies in symptomatic patients are two strategies that are widely used to improve CRC prognosis and to optimize the health resources consumed. Population-based screening may not be feasible in a low-income country like Nigeria for several reasons. To explore the symptom-based surveillance, we conducted a multicenter colonoscopy-based screening of patients with rectal bleeding with a view of diagnosing CRC early. Patients and Methods: Consecutive patients with rectal bleeding age of 45 years and above who had colonoscopy done at Obafemi Awolowo University Teaching Hospitals, Ile-Ife, University College Hospital (UCH), Ibadan, and University of Ilorin Teaching Hospital (UITH), Ilorin, were recruited to the study. Statistical analysis was carried out using SAS 9.4 and R 3.3.1. Results: At the end of the study, 362 colonoscopies were performed in all the participating centers. Two hundred and seventeen (60.0%) cases who were performed at OAUTHC served as training data and 145 (40.0%) cases who were performed at the other two institutions (UCH and UITH) were used for validation. The source of bleeding in the majority of the patients was hemorrhoids (120 [33.1%]), followed by diverticulosis (81 (22.4%]) and CRC (65 (18.0%]). On multivariate analysis, change in bowel habit and weight loss within 6 months were highly significant for both the training and validation set (odds ratio = 7.074 and 12.769; confidence interval = 3.574, 14.000 and 4.602, 35.430, respectively). The c-index for the model for training and validation set is 0.823 and 0.875, respectively. Conclusion: Presence of weight loss and change in bowel habit in patients with rectal bleeding predict the occurrence of CRC in Nigeria. We therefore recommend that patients with this symptoms complex should be referred for colonoscopy.
| Poor Responses To Patients' Deteriorating Physiological Parameters In A Sub-Saharan African Hospital: Role Of Modified Early Warning Scoring System And Rapid Response System|| |
Akanbi OO, Olakulehin OA, Adeoti ML, Onilede DA, Idowu NA, Olanipekun OO
Ladoke Akintola University Teaching Hospital, Osogbo
“An ounce of prevention is worth a pound of cure”
Background: Most of the adverse events in hospitalized patients are often preceded by documented progressive deterioration of physiological parameters without appropriate response. Modified Early Warning Score (MEWS) is a simple physiological bedside score that was developed to help in early recognition of patient at risk of deterioration and assist in timely response, as optimal patients' care required the triad of early recognition, timeliness of response, and competency of the attending clinicians. Objectives: This study was conducted to (1) document and determine response of health-care workers to physiological parameters 72 h preceding death among dead patients (2) to sensitize and convince the nurses and doctors about this simple scoring system. Methods: We reviewed the case notes of 264 patients discharged alive and 243 dead patients in the Ladoke Akintola University of Technology, Ogbomoso. Patients >18 years and obstetrics and gynecological patients were excluded. The patients' vital signs were extracted from the case notes and were used to calculate mean MEWS for each patient over 72 h preceding outcome. MEWS of >6 was considered as critical value for higher level of care. Other relevant data obtained include nurses' and doctors' responses to vital signs as documented in the case notes, duration in minutes between house officers' responses and consultants' inputs. Results: One hundred and fourteen (79.72%) of 143 patients with MEWS of seven and above were classified to be critically ill and were managed in general wards. The mean MEWS among the patients discharged alive was statistically significantly lower than the dead patients (2.74 ± 0.67 vs. 8.06 ± 2.56, P< 0.001). The mean MEWS for pulse rate (0.2 ± 0.63 vs. 2.1 ± 1.03 P< 0.001) and respiratory rate (1.2 ± 0.51 vs. 2.3 ± 0.675, P< 0.001) was statistically significantly lower for the patients discharged alive. The main reason for calling attention of clinicians to deteriorating patients was gasping in 52.6% of cases. The responses of house officers when called upon to review critically ill patients were to inform registrars in 44.03% of cases. There was a mean delay of 131 (±66.28) min between house officers' review and consultants' inputs. Conclusion: Our study showed delay in recognition of patients at risk of deterioration and significant delay in decision-making process; we thus suggest the use of MEWS at least once a day and introduction of rapid response system.
| Prehospital Care And The Use Of First Aid Box: Survey Of Doctors And Nurses Perception And Practices In Ekiti State|| |
Etonyeaku AC, Ogundipe KO, Abiyere H, Omotola CA, Olaogun J
Department of Surgery, Obafemi Awolowo University Teaching Hospital, Ile Ife
Background: Prehospital care of crash victims reduces trauma death. Doctors and nurses can provide some prehospital care using first aid boxes (FABs). Aim: To ascertain knowledge, availability, and use of FAB by doctors and nurses, and factors mitigating crash site care. Methods: A confidential, self-administered questionnaire evaluating among other things, such as demographics, ownership, and use of the FAB, was administered on nurses and doctors, fifty each, from two tertiary hospitals in Ekiti state, Nigeria. Data generated were analyzed using the SPSS 20.0 version (IBM, Chicago) for frequencies and inferential statistics. Results: There were 193 respondents comprising 93 (48.2) doctors and 100 (57.8%) nurses; 110 (57%) males and 83 (43%) females. Most respondents (179; 92.7%) drive; 19 (9.8%) respondents do not own a vehicle. Furthermore, 124 (64.2%) respondents had witnessed a vehicular crash, but only 82 (42.5%) have been involved in one. Most respondents (136; 70.5%) had managed crash victims, but only 74 (38.3%) had ever done so at crash site. Time constraints 19 (n = 119), no equipment 20 (n = 119), and perceived legal issues 20 (n = 119) were major reasons for not stopping at crash site. Only 17 (8.8%) respondents have FAB, compared to 150 (77.7%), 151 (78.2%), and 169 (87.6%) who possess vehicular fire extinguisher, caution signs, and drivers' license, respectively. Majority of them (160) believed that prehospital care should involve rescue/extrication, resuscitation/stabilization, and transfer of victims to hospital. Perceived factors mitigating crash site care were lack of ambulance services (27), bad road network (25), dearth of paramedics (23), lack of equipment (21), or a combination of these (113). Conclusion: Most doctors and nurses do not possess FAB in their vehicles. They often do not offer crash-site care.
| Motorcycle-Related Facial Bone Fractures In Ado-Ekiti, Nigeria: A Survey Of Pattern Of Presentation And Care|| |
Obimakinde OS, Olajuyin OA1, Rabiu TB2, Olanrewaju OA3
Department of Dentistry, Ekiti State University Teaching Hospital, 1Department of Ear, Nose and Throat Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, 2Department of Surgery, LAUTECH Teaching Hospital, Osogbo, 3Department of Family Dentistry, Lagos State University Teaching Hospital, Lagos, Nigeria
Background: Although earlier reports indicated that significant proportion of facial injuries attributed to road traffic mishaps are caused by motorcycle-related crashes, there is limited information on clinical and epidemiologic characteristics of such injuries. Aim: We sought to study the pattern of motorcycle related facial bone fractures in Ado-Ekiti, a suburban population in Southwestern Nigeria. Methods: Data on patients' sociodemographics, pattern of presentation, type(s) of fracture, patient status, injury mechanism, level of consciousness, and treatment offered were collected and analyzed. Result: Of the 208 people who sustained motorcycle-related facial injuries during the study period, 151 patients aged 7–59 years had facial bone fracture. A male preponderance of 121 (M:F = 4:1) was observed and the injured patients were predominantly motorcyclists (64.8%, n = 98). A total of 194 fractures were reviewed and the mandible (58.8%, n = 114) was more commonly affected than the midface (41.2%, n = 80). The predominant site on the mandible was the body (31.6%) while zygoma (32.5%) was the most affected part of the midface. Patient's status was found to have a significant relationship with loss of consciousness (P = 0.015). Of the 194 facial fractures managed definitively, only 42.3% had open reduction and internal fixation. Conclusion: Facial bone fractures occur in a significant proportion of motorcycle-related crashes and motorcyclists are predominantly affected. In addition, a larger proportion of commuters rarely wear crash helmet which would have offered protection. Continual advocacy on preventive measures and enforcement of road safety regulations are advised.
| Interpreting Vital Sign Values Among Nurses In A Teaching Hospital In Southwestern Nigeria: A Call To Bridge The Gap|| |
Akanbi Olusola Olateju, Adeoti Moses Layiwola, Onilede David Adekunle, Olakulehin Olawale Adebayo, Olanipekun Olusegun Olaolu, Akinloye Tayewo Adebisi
Ladoke Akintola University Teaching Hospital, Osogbo
Background: This study was borne out of the findings from our previous study on poor response to patients' deteriorating physiological parameters at our center in Sub-Saharan African hospital that revealed that there was documented evidence of abnormal vital signs without appropriate clinical responses. Objective: This study thus investigated the knowledge and how nurses respond to vital signs values. Methods: This prospective questionnaire-based study was carried out in Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso. Questionnaires were sent out to nurses (respondents) until eighty completed questionnaires were gotten after editing for completeness. Relevant data related to vital signs and its interpretation and Modified Early Warning Score (MEWS) were obtained. Results: The age range of the respondents was 22–56 years, with a mean age of 36.4 (±5.27) years. Only 19 (23.75%) of the nurses got the correct values of normal range for all the vital signs and oxygen saturation (SpO2). Seven (8.75%) of the respondents knew that pulse rate is the earliest vital sign to change that may suggest patients deterioration while 44 (67.5%), 6 (7.5%), and 13 (16.25%) of the respondents believed that blood pressure, respiratory rate where the earliest vital sign to change, and SpO2, respectively. Fifty-nine (73.75%) out of the eighty respondents believed that SpO2 is very reliable in assessing respiratory functions, and 63 (78.73%) respondents will not consider supplemental oxygen support until SpO2 falls below 90%. Five (6.25%) out of the eighty respondents were able to identify correctly all patients at risk of adverse events based on vital signs, SpO2, and level of consciousness. None of the respondents had heard about MEWS system. Sixty-seven (83.75%) of the respondents rated themselves to have either excellent or good knowledge of vital signs and its interpretation. However, only 9 (11.25%) of the respondents have overall good comprehensive knowledge of vital signs. Conclusion: Our study revealed that majority of the respondents have poor comprehensive knowledge about vital signs and its interpretations. We suggest that clinicians should individualize patients and make an attempt to document value of vital signs that required clinicians' attention and need to use MEWS in our hospitals.
| Knowledge of Newly Qualified Doctors on Pain Management in Southwestern Nigeria: A lesson for Medical Education|| |
Olakulehin Olawale Adebayo, Akanbi Olusola Olateju, Adeoti Moses Layiwola, Onilede David Adekunle, Akinloye Tayewo Adebisi, Olanipekun Olusegun Olaolu
Ladoke Akintola University Teaching Hospital, Osogbo
Background: Pain is the most common complaint of patients visiting hospitals and leading cause of disability. Several studies have implicated the Siamese twins of lack of adequate knowledge on pain management and poor attitude of the health-care professionals as major contributing factors to poor pain control in the hospitals. Objective: This study investigates how are newly qualified doctors equipped with knowledge surrounding management of pain. Methods: This study was carried out in Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, and Bowen University Teaching Hospital, Ogbomoso. The study enrolled newly qualified doctors who were appointed for the post of internship training. The enrolled doctors were asked to fill a pretested paper-based pro forma questionnaires within 2 weeks of resumption into their respective units to obtain relevant data. Results: A total of 129 respondents were enrolled. The mean age of the respondent was 26.90 (±3.859) years. Majority 106 (82.17%) of the respondents believed that analgesia should be avoided in neonate. One hundred and twenty-six (97.67%) of the respondents believed that analgesia should be withheld in patients with acute abdomen until definitive clinical diagnosis is made. One hundred and seventeen (90.69%) respondents believed that opioid analgesia is better avoided in patients with chronic pain such as cancer pain so as to avoid the risk of addiction. However, only seven (5.42%) respondents claimed to have seen cases of opioid addiction. One hundred and twenty-one (93.79%) of the respondents were unable to differentiate between tolerance and physical dependence from psychological and behavioral dependence. The entire respondent would deny or withdraw opioid analgesia in patients with hypothetical clinical scenario of physical dependency following tolerance to opioid analgesia. Seventy-two (55.81%) of the respondents would combine narcotics with narcotics antagonist. Only 23 (17.82%) of the respondents know one or other methods of rating pain; however, none of the respondents have ever rated pain before. Nineteen of the respondents claimed to have previous lecture on pain management; however, none of them has ever been assessed on pain management to test their adequacy of knowledge while in school in any form. Conclusion: Our study revealed deficit of knowledge of newly qualified doctors on pain management. We thus recommend that the stakeholders who are involved in medical student training and postgraduate residency training should take into cognizance this aspect of patients care.
| Effectiveness Of Modified Simple Retropubic Prostatectomy In Perioperative Hemostasis|| |
Patrick Temi Adegun, Julius Gbenga Olaogun1, PeterOlufemi Areo, Emmanuel Abidemi Omonisi2, Julius Olusanmi Esho
Department of Surgery, Division of Urology, Ekiti State University, 1Department of Surgery, Division of General Surgery, Ekiti State University, 2Department of Anatomic Pathology, Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria
Background: Excessive bleeding is a major challenge of open prostatectomy. Aim: To determine the effectiveness of vertical mattress closure of lateral edges of capsulotomy on the perioperative hemostasis in modified simple retropubic prostatectomy. Methods: This was a prospective study conducted between March 2015 and August 2016. Thirty-three patients with benign prostatic obstruction had retropubic prostatectomy with vertical mattress closure of the edges of prostatic capsule at Ekiti State University Teaching Hospital, Ado-Ekiti. This was compared with what was obtained in the preceding 18 months in the facility by the same surgeons. The weight of prostatic tissue excised and the number of pints of blood transfused perioperatively were recorded. Results: The age range of patients was 46–86 years while the mean age was 68 years. The prostate volume was between 60 and 263 g, with an average of 112.1 g. Average operating time was 111 min (±21.6), with the longest time being 2 h and 45 min while the shortest time being 1 h. Mean duration of urethral catheterization was 5.79 days. The mean intraoperative blood loss was 572.12 ml compared with 697.53 ml in the preceding 18 months. However, 9.1% of the patients had (intraoperative) blood transfusion compared to 22.2% of 27 patients who did not have vertical closure in the preceding 18 months. There was no mortality. Conclusions: Application of vertical mattress closure to the lateral edges of the capsule during prostatectomy improves hemostasis with reduced rate of intraoperative blood transfusion.
| Most Important Cause Of Road Traffic Crashes: Road Users' Perspectives|| |
Oluwadiya KS, Popoola SO1, Onyemaechi NOC1, Kortor JN1, Denen-Akaa P1, Mohammad H1
Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State, 1Department of Surgery, Benue State University Teaching Hospital, Makurdi/Federal Medical Centre, Makurdi, Benue State, Nigeria
Background: Every day, more than three thousand persons die, and another 136,000 are injured on the world's roads. These traffic crashes are the product of several factors which can be distilled into three elements of road traffic system, namely, the vehicle, the road user, and the road infrastructure. Most drivers believe they are better than at driving than other drivers. Objectives: The purpose of this study is to determine the most important causes of road crashes in Nigeria from drivers' perspectives. Knowing this can help policymakers determine the focus of driver education. Methods: Using a pro forma containing among other queries, the question “In your opinion, what is the single most important cause of accidents on the roads?” we interviewed 600 randomly selected drivers in Makurdi, Benue State. Results: Bad roads were believed to be the most important cause by 290 (48.3%) respondents, driver factors by 158 (26.3%) respondents, vehicle factors by 51 (8.5%) respondents, and poor law enforcement by 101 (16.8%) respondents. While motorcycle riders felt that both bad roads and driver factors were equally responsible for road crashes (40.6% each), and all other road users gave the lion share to bad roads. Conclusion: The belief of drivers regarding road crashes is contrary to established facts which hold human factors responsible for greater than two-thirds of all road crashes. The findings here may encourage complacency among drivers leading to overconfidence and increased crash proneness.
| Pattern Of Visceral Metastasis From Breast Cancer Patients In Zaria Northwestern Nigeria|| |
Abur PP, Odigie VI, Yusufu LMD, Gana SG, Bashiru Aminu
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
Background: Visceral metastasis from breast cancer usually results in high tumor burden with poor prognosis. Aim: To document the pattern, treatment, and outcome of breast cancer patients with visceral metastasis in our hospital. Patients and Methods: This was a 5-year prospective study of breast cancer patients with visceral metastasis from January 2009 to December 2013. All patients had routine investigations including liver function test, chest X-ray, and abdominopelvic ultrasound. Computed tomography scan was done as indicated. Information documented included patients bio-data, histology, site of visceral metastasis, treatment, and outcome. Results: Two hundred and fourteen patients had visceral metastasis (19.7%). Their age ranged 15–83 years. Female: male ratio was 17:1. One hundred and fifty-nine (74.3%) had metastases at presentation while 55% (25.7%) after surgery. Eighty-four (39.4%) had metastasis to the lungs. Thirty-nine (18.3%) had metastasis to the liver. Fifty-eight (27%) had metastasis to two or more visceral organs. One hundred and thirty-eight (64.5%) had invasive ductal carcinoma while 26 (12.2%) were invasive lobular carcinoma. One hundred and eighty-one (84.6%) patients had chemotherapy, one hundred and fifty-eight (73.8%) had hormonal therapy, while 103 (49.1%) had surgery. The mortality at 3-year follow-up was 58.4%. Conclusion: The lungs and liver were the main sites of visceral metastasis from this study. There was a direct relationship with size of tumor at presentation and subsequent development of visceral metastases. Early presentation will reduce the incidence of visceral metastasis and the high mortality associated with it.
| Giant Breast Abscess – Definition, Classification, Contributing Factors, And Its Psychosocial Aspects|| |
Department of Surgery, Delta State University Teaching Hospital, Oghara, Nigeria
Background: Giant breast abscess has not been previously defined in the world literature. This may be due to the rarity of this condition. The terms large and extremely large breast abscesses have been variously used in the literature without standard definitions till date. This paper defines giant breast abscess, classifies, and presents the factors contributing to its development and the psychosocial aspects of this disease. Definition: Giant breast abscess is here defined as a breast abscess containing >2 L of pus. It is acute when it presents within 6 weeks, acute-on-chronic when it presents between 6 weeks and 6 months, and chronic when it presents after 6 months from the period of onset. Methods: A prospective study of patients with giant breast abscesses between 2002 and 2015 in both urban and rural practice in Nigeria and Sierra Leone was reviewed and analyzed using a simple frequency distribution. Results: Fifteen patients with giant breast abscesses were reviewed. All were females. Age range was 34–58 years. Mean age was 44 (±7.46 standard deviation) years. All the patients (100.00%) had unilateral giant breast abscesses. The left breast was affected in nine patients (60.00%). One patient (6.67%) presented as an acute case (within 6 weeks), 1 (6.67%) as acute-on-chronic (between 6 weeks and 6 months), and 13 (86.67%) as chronic (after 6 months of onset). Two patients (13.33%) presented in urban formal hospital settings while 13 (86.67%) presented during free rural healthcare delivery programs. One (6.67%) was a breastfeeding mother while 14 (93.33%) were not. Ten (66.67%) had their abscesses located in the upper outer quadrant, and 5 (33.33%) were central. The main reason for delayed presentation was fear of death from surgical incision in 12 (80.00%) patients. All the patients (100.00%) had some form of self-medication or the other and 11 patients (73.33%) had sort alternative medical or faith-based therapy before presentation. Large disproportionate breast size and subsequent loss of self-esteem, poor socialization habits due to continuous ridicule from sexual partner, and peers informed presentation in all the patients (100.00%). Conclusion: Giant breast abscess is a salient surgical condition with its attendant psychosocial problems that require the physicians' support. Open drainage is advocated because of the multilocular complex nature of this disease entity. Awareness creation among women, particularly in the rural communities, is encouraged.