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Year : 2018  |  Volume : 24  |  Issue : 2  |  Page : 144-154  

Abstracts presented at NSRS meeting, Jos, December 7, 2017

Date of Web Publication14-Sep-2018

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1117-6806.241111

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How to cite this article:
. Abstracts presented at NSRS meeting, Jos, December 7, 2017. Niger J Surg 2018;24:144-54

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. Abstracts presented at NSRS meeting, Jos, December 7, 2017. Niger J Surg [serial online] 2018 [cited 2019 Jan 23];24:144-54. Available from: http://www.nigerianjsurg.com/text.asp?2018/24/2/144/241111

  Effects of Ephedrine Pretreatment on Hypotension Due to Propofol Induction Top

Onoja AA, Embu HY, Nuhu SI

Department of Anaesthesia, Jos University Teaching Hospital, Jos, Nigeria

Background: Propofol is the intravenous induction agent of choice for many anesthetists. This is because of its rapid induction and rapid recovery profile. However, the hypotension caused by propofol is a major challenge for anesthetists; this is especially so in elderly and hemodynamically unstable patients. This study attempts to evaluate the effect of ephedrine pretreatment on the hypotensive effect of intravenous induction with propofol. Methodology: Eighty-eight patients aged 18–60 years belonging to American Society of Anesthesiologists Class I or II who presented for elective surgeries under general anesthesia were recruited and assigned to two groups to receive either 2 ml of saline (Group I) or equal volume of 0.2 mg/kg ephedrine constituted in saline (Group II). Two minutes later, propofol 2.5 mg/kg was administered to all the patients. Hemodynamic variables such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate were measured before induction and every minute for 9 min after propofol induction. Data obtained were analyzed using SPSS statistical package version 20 (IBM, Chicago, USA). Results: Patients in the two groups experienced a fall in hemodynamic parameters (SBP, DBP, and MAP), but there was a greater decrease in Group I (P < 0.001) in the 2nd minute following propofol administration. The heart rate increased in the two groups. The increase in the heart rate persisted for 6 min in Group I, whereas in Group II, the heart rate remained high throughout the period of the study, but the difference between the groups was not significant. Conclusion: Pretreatment with ephedrine 0.2 mg/kg produced attenuation of hypotension associated with propofol without significant change in the heart rate.

  Estimation of Weight in Adults: A New Quick Bedside Technique Top

Kokong DD, Pam IC, Zoakah AI, DanBauchi SS, Mador ES, Mandong BM

Department of ENT Surgery, Jos University Teaching Hospital, Jos, Nigeria

Background: A considerable number of emergency drugs and procedures have a narrow therapeutic margin of safety and require knowledge of the patient's exact body weight for accurate dosaging. In critical care situations, there are often neither the means nor the time to weigh each patient before administering such medications with their associated potential lethal consequences. Aims/Objectives: The aim was to evaluate the validity, accuracy, and reliability of a new quick bedside technique for weight estimation in adults using height as compared with their actual measured weights. Study Design: The study design was of a pilot cross-sectional cohort. Setting: The study was conducted in an academic public tertiary health institution. Methods: All consecutive 500 L/600 L clinical medical students aged ≥18 years who met the inclusion criteria and who gave consent were recruited for the study on September 10, 2015, at the Lecture Hall of the College of Medicine, University Jos, Nigeria. The new technique utilizes the following formula: estimated body weight (eBW) (kg) = (N − 1) 100, where “N” is the measured height in meters. The results were subjected to statistical analysis using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). Results: The cohort sample size was 55.5% of the adult undergraduate students of the class with 86 males and 36 females (male:female = 2.4:1). Age range was 21 –38 years, height range was 1.55 m–1.95 m, with the range 1.60 m–1.64 m having the highest frequency (n = 34, 27.9%). Actual body weight (ABW) range was 48.0–91.0 kg, mean was 65.3 ± 9.7 kg, and standard error (SE) was 2.0, while eBW range was 55–95 kg, mean was 69.1 ± 8.4 kg, and SE was 1.5. Actual BMI (ABMI) range was 16.6–29.8 kg/m2 while the estimated BMI (eBMI) range was 23.0–25.0 kg/m2. Based on BMI classification for ABW, we obtained a positive predictive value of 94.7% for normal eBW and 95.5% for overweight eBW, while a 100% negative predictive value for all classes of obesity [Table 2]. The association between variables was modeled in correlation statistics: the Pearson's correlation coefficient at 99% confidence interval (CI) was r = +1, P = 0.000 which is strongly significant [Table 3]a and b], while linear regression analysis yielded a coefficient of determination (r2) = +1 at 95% CI (P = 0.000) which is strongly significant with a regression equation of y = 4.877x + 51.92. For estimating accuracy, 86.1% of the participants fell within the ± 10% acceptable permissible estimate error (APEE) margin implying a “good agreement” between the two measures of weight estimation [Table 5]. Furthermore, convergent validity of the estimate was established by the Bland–Altman's plot [Figure 4] which depicts a considerable proportion of the estimates to have fallen within the ±10% APEE and lies within the accep[table 95]% CI, while the weighted Kappa statistics for both the ABMI and eBMI displayed in [Table 6] yielded a weighted kappa statistics value of 0.618 at 95% CI that signifies a “good agreement.” Conclusion: The formula, eBW (kg) = 100 (N − 1), could be employed as a quick bedside method of weight estimation in adult patients >1.00 m tall presenting as emergencies/the critically ill. This could be of value in ATLS protocol.

  Lower Limb Surgery as Three Nights' Stay Procedure Using Epidural Analgesia: A Prospective Study Top

Olakulehin OA, Akanbi OO, Otiti TA, Olanipekun OO, Oladele OS, Folami EO

Department of Orthopaedics, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Nigeria

Background: Pain is a major cause of disability and prolonged hospital stay. Prolonged hospital stay is associated with social dysfunction, loss of man-hours, and other complications. This becomes worse in elderly patients who will not tolerate prolonged bed stay and longer period of immobility. Lower limb surgeries are often performed following trauma and are associated with significant postoperative pain. Objectives: This study was conducted to answer whether combined epidural/opioid analgesia provides better postoperative pain control, improved mobilization, and decreased length of hospital stay in patients undergoing lower limb surgery as compared to opioid only. Methods: Patients admitted and operated for lower limb surgery over a 2-year period at a private orthopedic center were enrolled. The patients were randomized equally into two groups: those who received combined epidural and opioid (EG) and opioid only (OG) as postoperative mode of analgesia. Plain Marcaine was used as epidural agent and pentazocine was used as opioid of choice in the study. All procedures were performed under subarachnoid block. The mean opioid requirement over the first 48 h postoperation, time of commencement of mobilization from postoperation, pain score at admission and 48 h postoperation, time of readiness for discharge, and mean hospital stay in days were compared between the two groups. Results: Sixty patients were enrolled into the study. The mean age of patients in EG and OG was comparable (47.7 ± 4.3 vs. 49.2 ± 3.8, P = 0.1576). Femoral fractures constituted the major indication for surgery in EG and OG groups (60.0% vs. 63.3%). The mean pain scores at admission in EG and OG groups were comparable (8.4 ± 0.8 vs. 8.1 ± 1.1, P = 0.2319). The mean pain score at 48 h postoperation was lower in EG (2.3 ± 0.3 vs. 5.7 ± 1.4, P < 0.001). Mean opioid requirement in EG was lower than that of OG (84 ± 27.6 vs. 186 ± 34.1, P < 0.001). Patients in EG tolerated mobilization earlier (2.5 ± 1.2 vs. 4.4 ± 1.8 days postoperation, P = 0.0131). Mean hospital stay in EG was lower than that of OG (3.3 ± 0.8 vs. 6.2 ± 0.2.0). No analgesic-related complication was recorded in both groups. Conclusion: Epidural analgesia is beneficial in patients undergoing lower limb surgery and we suggest routine use of it in patients without contraindication to such mode of analgesia.

  Ethno-pathological Profile of Nasal Polyps: Seven Years' Experience in Federal Teaching Hospital, Gombe, Nigeria Top

Abdulmajid Y, Ali A, Lawan A, Yusuf M, Kabilis L

Department of ENT Surgery, College of Medical Sciences, Federal Teaching Hospital Gombe, Gombe State University, Gombe State, Nigeria

Background: Nasal polyps is a trivial disease to the ear, nose, and throat (ENT) surgeons as the diagnosis is easy to make by anterior rhinoscopy and endoscopy, and its treatment consists of conservative and/or surgical intervention. The incidence is often noted to be 1%–4% of the population, with higher rates among patients with asthma, cystic fibrosis, and allergic fungal disease and with least among patients with chronic rhinosinusitis. There appears to be at an increased incidence with rising age and male gender (peak age: 50 years and older, male:female ratio: 2:1) Aim: The aim of this study is to evaluate the ethnic, clinical, and pathological pattern of patients with nasal polyps, seen in ENT department, Federal Teaching Hospital, Gombe. Materials and Methods: This was a retrospective study of all patients seen in ENT department, Federal Teaching Hospital, Gombe, with the diagnosis of nasal polyps, between October 2010 and September 2017. The patients' biodata, clinical presentation, and histopathological patterns were all studied. Results: A total of 159 patients were seen within this period of study, with age range of 1 month (1/12) to 70 years and mean age of 29.7 years. Majority of the patients were in the age groups of 20–39 years (46.5%), with the least among those aged 60–69 years (3.1%). There were 62 (39%) males and 97 (61%) females with a male:female ratio of 1:1.6. Fifty-five (34.6%) patients were Fulanis, 20 (12.6%) were Tangale, 13 (8.2%) were Hausas, 11 (6.9%) were Kanuri, 10 (6.3%) were Bolawa, 7 (4.4%) were Tera, 5 (3.1%) were Babur, 5 (3.1%) were Bura, 4 (2.5%) were Waja, and 28 (17.6) were other different tribes with least percentages. Forty-three (27.0%) patients were homemakers, 33 (20.8%) were students, 15 (9.4%) were civil servants, 11 (6.9%) were traders, and 6 (3.8%) were farmers. The main presenting symptoms were nasal blockage and rhinorrhea (94.3%), and about 60% of complaints were of intranasal growth. It was bilateral in 28 (17.6%), right sided in 58 (36.5%), and left sided in 73 (45.9%) patients. The most common clinical diagnosis was simple nasal polyps in 151 (94.97%) and antrochoanal polyps in 8 (5.03%) patients. Forty-three (27.04%) patients have associated chronic rhinosinusitis, 14 (8.8%) have allergic rhinosinusitis, 2 (1.3%) have HIV infection, and 1 (0.6%) have asthma. Seventy-two (45.3%) had surgeries (nasal clearance and/or nasal polypectomy with bilateral intranasal antrostomy in patients with associated rhinosinusitis). Histopathological reports of patients who had surgery mainly inflammatory polyps 39 (54.2%), 6 (8.3%) were benign polyps, 5 (6.9%) were hemangiomas, 5 (6.9%) were papillomas, 2 (2.8%) were malignant masses. Recurrence was found in only 4 (2.5%) patients. Conclusion: Nasal polyps was found to be more common among the Fulanis in our environment, with peak age of occurrence in the second and third decades of life and more common among homemakers. Most of the patients have associated rhinosinusitis as the only identifiable risk factor, while asthma was found in only one patient. The main presenting symptoms were nasal blockage and rhinorrhea, with majority of the patients having simple inflammatory polyps as their histological diagnosis in our environment. Surgical intervention is still the best modality of treatment, thus the need for early diagnosis and management by the ENT surgeons.

  Prognostic Characteristics of Nasopharyngeal Cancers in Native Africans Top

Kokong DD, Adoga AA, Ma'an ND, Nimkur LT, Yabak CJ, Yaro JP, Dauda AM, Adamu AG

Department of ENT Surgery, College of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau state, Nigeria

Background: Nasopharyngeal cancers (NPCs) have been reported by scholars around the globe as the most invasive lethal malignant disease that ever afflicted the human race. Objective: The objective of this study was to critically appraise the prognostic characteristics of NPCs in African natives. Study Design: This was a retrospective study. Setting: This study was conducted at an academic public tertiary hospital. Methods: All files of histopathologically confirmed cases of nasopharyngeal carcinomas managed in our health institution over an 8-year period, May 1, 2009–April 30, 2017, were retrieved using the ICD-10 version 10 standard codes and were analyzed. Results: Thirty cases that met the inclusion criteria were studied which accounted for 27.0% – the most common being head-and-neck malignancy and the 3rd general body squamous cancer with 9.3%. The male:female ratio was 1.7:1 with an age range of 18–69 years and mean of 52.2 ± 19.1 kg. There was a bimodal age distribution, the first peak was the third decade of life, while the second peak was the seventh decade of life. Sinonasal malignancies were the second most common with 24.3%, then metastatic neck disease the third with 20.7%. Highest referral was from secondary health centers with 6 (20.0%), and then general surgeons with 5 (18.7%) and general practitioners with 4 (13.3%) cases. On lifestyle, 22 (73.3%) smoked cigarettes and/or consumed alcohol. For cigarette smoking, minimum pack-years was 2.25 years, maximum pack-years was 31.5 years, and mean pack-years was 14.7 years ± 8.4 years. Combined cigarette smoking/alcohol consumption was seen in 6 (20.0%) cases with mean duration of 8.1 ± 11 years (all males), while 8 (26.7%) consumed only alcohol, predominantly males – 6 (20.0%). There was no clear history of consumption of ungutted fish. Mode of presentation included cervical masses 20 (66.7%) in which 65.0% had N3 disease, then rhinologic 15 (50.0%), and otologic 13 (43.3%), the 1st, 2nd, and 3rd in that order of frequency. Twenty-three (76.7%) presented after 18 months of symptoms and 2 (6.7%) had HIV as causally related comorbidity. The NPCs were as follows: World Health Organization (WHO) Type I-nil, WHO Type II-40.0%, and WHO Type III-60.0%. There was no Epstein–Barr virus isolation and serologic and immunological assay. Concerning treatment, 4 (13.3%) had radiotherapy alone with Cobalt-60 external beam, while only one had concurrent chemoradiation. Follow-up visits were dismal as 21 (70.0%) never returned, 4 (13.3%) visited for 2 months, while only 1 (3.3%) visited regularly for 6 months while 4 (13.3%) requested for discharge on diagnosis. Morbidity was observed in 5 (16.7%), while mortality rate was difficult to ascertain due to poor follow-up as all were referred for further care elsewhere 800 km away. Conclusion: Strategy for funding on early detection through biomarkers' assay, improvement on cancer care infrastructure, and introduction of intensity-modulated radiation therapy alongside free cancer care would reduce the morbidity/mortality associated with NPC in this region which are majorly from late presentation and prohibitive cost of care.

  Tracheostomy: The Dynamics of Indications in an Old Procedure Top

Kokong DD, Yaro PJ, Embu HY, Nimkur LT, Iduh AA, Okwori ET, Adoga AS, Binitie OP

Department of ENT Surgery, College of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau state, Nigeria

Background: Securing a surgical airway remains one of the fundamental components of critical care medicine as an obstructed airway for more than 3 min is not compatible with life. Purpose: The purpose of the study was critical appraisal of the dynamics of the indications for tracheostomy in our environment. Study Design: This was a retrospective study. Methods: Clinical details of patients who had tracheostomy over a 3-year period were analyzed; January 1, 2012–December 31, 2014. Results: We studied 41 tracheostomy cases of the 235 ear, nose, and throat (ENT) operations, constituting 17.4% of ENT operations. The male:female ratio was 2.2:1 and mean age was 33.2 years ± 20.3. The relief of upper airway obstruction (n = 30, 73.2%) was the main indication of which tumors accounted for 50% (n = 15, 36.6%). Ventilatory support was the next main indication (n = 9, 22.0%). Of this, 4 (9.8%) represented 1.6% of the intubation-developed laryngotracheal stenosis. Cut throat and infective causes were among the main indications, with a tie (n = 4, 9.8%). Twenty-nine (70.7%) were successfully decannulated. The study recorded 12.2% complications while perioperative mortality was 4.9%. Conclusion: Indications for elective tracheostomy are well established; however, an algorithm on the indications and timing for a surgical airway in emergency cannot be drawn due to the multiplicity of variables and the inapplicability in the context of life-threatening critical emergency.

  Ranula: Current Concept of Pathophysiologic Basis and Surgical Management Options Top

Kokong DD, Iduh AA, Chukwu IS, Mugu JG, Nuhu SI, Sule AZ

Department of ENT Surgery, College of Medicine, University of Jos and Jos University Teaching Hospital, Jos, Plateau state, Nigeria

Background: There is no consensus opinion on a definitive surgical management option for ranulas to curtail recurrence, largely from the existing gap in knowledge on the pathophysiologic basis. Aim: The aim is to highlight the current scientific basis of ranula development that informed the preferred surgical approach. Design: This was a retrospective cohort study. Setting: This study was conducted at a public tertiary academic health institution. Methods: A 7-year 7 month's study of ranulas surgically managed at our tertiary health institution was undertaken, June 1, 2008–December 31, 2015, from case files retrieved utilizing the ICD-10 version 10 standard codes. Results: Twelve cases, representing 0.4% and 1.2% of all institutional and ear, nose, and throat operations, respectively, were managed for ranulas with a male:female ratio of 1:1. Their ages ranged from 5/12 to 39 years, mean of 18.5 years and prevalent in the third decade of life. Main presentation in the under-fives was related to airway and feeding compromise, while in adults, with cosmetic facial appearance. Ranulas in adults were plunging (n = 8, 58.3%), left sided save for one with male:female ratio of 2:1. All were unilateral with R:L = 1:2. Treatment included aspiration (n = 2, 16.7%) with 100% recurrence, intra/extraoral excision of ranula only (n = 4, 33.3%) with recurrence rate of 50% (n = 2, 16.7%), while marsupialization in children (n = 1, 8.3%) had no recurrence. Similarly, transcervical approach (n = 5, 41.7%) with excision of both the ranula/sublingual salivary gland recorded zero recurrence. Recurrence was the main complication (n = 4, 33.3%). Conclusion: With the current knowledge on the pathophysiologic basis, extirpation of both the sublingual salivary gland and the ranula by a specialist surgeon is key for a successful outcome.

  Usefulness of Modified Alvarado Score in the Diagnosis of Acute Appendicitis in Adults in University of Benin Teaching Hospital, Benin City Top

Osemwegie O, Osime CO, Odigie VI

Department of Surgery, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria

Background: Making an accurate diagnosis of acute appendicitis in patients presenting with right iliac fossa pain is a surgical/clinical challenge. Negative appendicectomy exposes the patient to the risk of surgery and anesthesia with possible complications. Modified Alvarado score has been reported to be an easy diagnostic tool in patients suspected of having acute appendicitis. This study was done to highlight the usefulness of the scoring system in making a diagnosis of acute appendicitis among adults at University of Benin Teaching Hospital. Methods: It was a 12-month prospective study of patients who presented with right iliac fossa pain at the University of Benin Teaching Hospital. The patients were divided into Group A (modified Alvarado score) and Group B (clinically assessed). Group B patients were used as control. The second Group A patients were subdivided into A1, A2, and A3 patients. Group A1 patients had scores of 4 and below, Group A2 patients had a score of 5–7, and Group A3 patients had scores of 8 and above. All the appendix specimens were subjected to histologic confirmation. Results: A total of 124 patients were studied, with 62 patients in each group. The age range was 21–30 years. The mean age was 25.4 ± 9.1 and 27.0 ± 9.5 years for Groups A and B, respectively (P = 0.589). Male-to-female ratio was 1:2.3. All patients in Group A and B had appendicectomy, fifty patients in Group A had histologically confirmed appendicitis to 38 patients in Group B. The difference was statistically significant. Sensitivity was 96.0% and specificity was 66.7% at cutoff of 4. Specificity was 100% at a score of 8–10 for Group A patients. The negative appendicectomy rates were 38.7% (Group B) and 19.4% (Group A). Conclusion: This study shows that modified Alvarado score is useful in making diagnosis of acute appendicitis. It decreases the rate of negative appendicectomy. Recommendations: The use of modified Alvarado score is recommended for the diagnosis of acute appendicitis in University of Benin Teaching Hospital. Patients with a score of >4 may be subjected to appendicectomy.

  Using Trauma Registry to Describe the Epidemiology of Childhood Trauma Top

Shitta AH, Dung ED, Shilong DJ, Ode MD, Isichei WM, Peter SD, Ojo EO, Ozoilo K, Chirdan LB

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: Trauma is a major cause of morbidity and mortality globally. Pediatric trauma is increase due to violence, negligence, and road traffic accidents. Trauma registry as part of trauma system is not well developed in low- and middle-income countries. Objective: The objective was to describe the etiologic spectrum, treatment, and outcome of pediatric trauma at the Jos University Teaching Hospital, a major referral center in North Central Nigeria, using data from our recently established hospital trauma registry. Methods: A 1-year prospective analysis of data on childhood trauma from our trauma registry was conducted. Results: There were 168 pediatric trauma patients with ages ranging from 3 months to 17 years (mean = 8.5 years). There were 103 (61.3%) males and 65 (38.75%) females with a male-to-female ratio of 1.6:1. Road traffic collisions 78 (47.5%), falls from heights 32 (19.1%), and burns 26 (15.5%) were the main source of injuries, while stabs and equipment-related accidents were seen in 11 (6.5%) patients apiece. Most patients (135 [80.4%]) were transported to hospital in private cars, 37 (22%) by public transport, 6 (3.6%) by law enforcement agents, and none by ambulance services. Injuries involving the head in 94 (56.0%) patients, extremities in 37 (22%), chest in 10 (6.0%), and 9 in (5.4%) abdomen were recorded. About half (51 [50.5%]) required minimal intervention, while 38 (37.6%) had debridement. One hundred and thirty-three patients (89.3%) were treated and discharged home, 6 (4%) left hospital against medical advice, and 9 (6%) mortalities were recorded. Conclusion: Data from our trauma registry showed that pediatric trauma is a major cause of morbidity and mortality in children.

  Surgeon-performed Colonoscopy: A Prospective Audit Top

Ismaila BO, Sule AZ

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: Colonoscopy is not generally available in Nigeria. Lack of equipment and expertise as well as cost of procedure contributes to unavailability. While there are arguments elsewhere about which specialty should perform colonoscopy based on audit results, audits of colonoscopy in Nigeria are few. More audits in Nigeria are needed and specialty-based audits may provide answers to both quality of colonoscopy and the expertise of the specialties that provide the service in the country. Objective: The objective was to audit the performance of colonoscopy by a surgeon. Methods: Prospective audit of colonoscopy was performed by a surgeon in a Nigerian hospital over a 4-year period. Results: Two hundred and fifty-two patients underwent colonoscopy by the surgeon during this period. Mean age was 49.5 years (range: 7–90 years). Only 21.4% of colonoscopies had therapeutic procedures (polypectomies). Colonoscopy findings included polyps in 56 patients (22.2%) and colorectal tumors in 29 patients (11.5%). Four patients (1.6%) had both tumors and polyps, while diverticuli was detected in 21 patients (8.3%). Two patients (0.8%) had ulcerative colitis. The most common lesion seen was hemorrhoids (29.8%). Adjusted cecal intubation rate was 89.3%. Overall adenoma detection rate was 23.8%. There were no complications associated with the procedures. Conclusion: A surgeon can perform colonoscopy effectively in developing countries such as Nigeria.

  A Rare Case Report of Recurrent Sinonasal Neurofibroma in a Hiv-positive Woman Top

Abdulmajid Y, Ali A, Lawan A, Yusuf M, Kabilis L

Department of ENT Surgery, College of Medical Sciences, Federal Teaching Hospital Gombe, Gombe State University, Gombe State, Nigeria

Background/Objectives: Neurofibroma is a benign nerve sheath tumor in the peripheral nervous system. In 90% of cases, they are found as stand-alone tumors, while the remainder are found in persons with neurofibromatosis Type I, an autosomal dominant genetically inherited disease. Neurofibroma is very uncommon in the sinonasal tract, with only few cases reported in literature. Neurofibroma of the sinonasal tract occurs in a middle-aged patient without a gender predilection, usually with nonspecific symptoms present for a long duration. Objectives: The aim of this study is to report a rare case of recurrent sinonasal neurofibroma in a 45-year-old HIV-positive woman on highly active antiretroviral therapies. The report is aimed at discussing the clinical presentation, histopathologic features of sinonasal neurofibroma, and how it recurs over time. Methodology: An incidental histopathological finding of neurofibroma in one of the patients with recurrent sinonasal mass, with previous histopathological diagnosis of neurofibroma, was chosen for this case report. Report: The first presentation of this patient was at the age of 33 years with complaints of bilateral nasal blockage and rhinorrhea. Anterior rhinoscopy showed a polypoidal mass in the right nasal cavity with grossly engorged left inferior turbinate. She had nasal examination under anesthesia, nasal clearance, left partial turbinectomy, and bilateral intranasal antrostomy. Intraoperative findings revealed polypoid fleshy mass arising from the ethmoid region and a polypoid right antral mucosa. Histopathological examination of the sinonasal masses was in keeping with neurofibroma. She was placed on antibiotics, decongestants, and analgesics postoperatively. The patient was lost to follow-up till after 12 years when she presented with a progressive swelling on the right medial canthus, loss of vision on the right, nasal blockage, mouth breathing, epistaxis, and ear fullness. Physical examination and anterior rhinoscopy revealed right opaque cornea, cystic mass in the right medial canthus, widened nasal bridge, and polypoidal masses occupying both nasal cavities. Computed tomography (CT) scan was requested, but the patient could not afford because of financial constraints. X-ray of sinuses was done which showed thickening of both maxillary antra, with soft-tissue masses obliterating the nasal cavities. She had Lynch–Howard operation which revealed fleshy masses occupying the nasal cavities, with right ethmoidal mass discharging purulent effluent. Histopathological report of the sinonasal masses showed features in keeping with cellular neurofibroma. She was placed on cefuroxime, chymotrypsin, and analgesics postoperatively. She is presently on follow-up with no other complaints. Conclusion: Sinonasal neurofibroma is a rare benign peripheral nerve sheath tumor that could mimic any other form of sinonasal mass, but histopathological examination of the mass is essential for its diagnosis. Recurrence may occur due to either persistence of risk factor or failure to remove the mass completely from the sinonasal tract. CT scan is crucial in determining the extent of the mass and to rule out extracranial and intracranial extension of the mass.

  Lumbar Epidural Gouty Tophi with A Catastrophic End Top

Binitie OP, Shilong, DJ, Nwibo EO, Olajide OS, Ningi BA, Enyikwola OJ, Ayuba MD, Ochigbo JA

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Gout and pseudogout are the most common crystal-induced arthropathies. Gout is caused by monosodium urate monohydrate crystals. The occurrence of gouty tophus in the spine has been reported in a limited number of cases. In our report, we present the case of a 49-year-old man who presented with 6 months' history of low back pain which radiated to both thighs. His magnetic resonance imaging showed an epidural L4/L5 mass causing thecal compression. He had laminectomy and excision of the mass with a surprising histological diagnosis of gouty tophi. Unfortunately, he could not live to see the histology report.

  Finding Community Navigators for Women with Suspected Breast Cancer: Are Community Health Workers Knowledgeable Enough for the Job? Top

Akanbi OO, Adeoti ML, Oguntola AS, Idris OL, Adejumobi MO, Akinloye AT

Department of Surgery, Ladoke Akintola University of Technology, Teaching Hospital, Osogbo, Osun State, Nigeria

Background: Breast cancer is the recognized cause of mortality among women globally, and most cases are due to delay in presentation, resulting from misconceptions about breast cancer. Integration of breast cancer education into community health education can reduce such misconceptions. Community health workers (CHWs) play a major role in community health education. A previous study has suggested the use of CHW as patients' navigators, as their work are mainly in the community and expected to have a better understanding of sociocultural context in which health-care services are rendered. Objectives: We assessed the background knowledge, attitude, and perception of CHW about breast cancer and extent of training required prior to utilizing them as navigators for patients with breast symptoms. Methods: The study enrolled CHW as target group and noneducated women (NEW) as control group. Face-to-face interview was conducted to obtain relevant data about breast cancer and the results were compared. P value was set at 0.05. Results: Eighty-one CHWs and 95 NEWs were enrolled. The mean age was 31.1 (±3.7) years in CHW vs. 37.6 (±1.1) in NEW. Participants' knowledge about breast cancer revealed that 82.7% of CHW and 83.2% of NEW scored <50% (P = 0.9018). Majority of the CHW (90.1%) and NEW (91.6%) believed that breast cancer is not curable medically (P = 0.9428). None of the participants was able to list up to three correct risk factors for breast cancer. Majority of CHW (88.9%) and NEW (92.6%) have negative attitude toward breast cancer (P = 0.5500). On the participants' advice for patients with breast symptoms, 36% of CHW and 47.4% of NEW would refer patients to doctors (P = 0.0777). Seventy-five (92.6%) of the CHW would agree to voluntarily attend seminar on breast health and be willing to disseminate such information compared to 8 (8.4%) of the NEW who held similar view (P < 0.001). Conclusion: The obvious poor knowledge and a number of misconceptions about breast cancer among CHW call for urgent need to target this group as part of routine breast health education program prior to utilizing them as community navigators in a culturally sensitive, community-based cancer education program.

  Pattern of Breast Diseases in Gombe Top

Mba EL

Department of Surgery, Federal Teaching Hospital, Gombe, Nigeria

Background: Breast disease is a very common disease in general surgery. The clinical pattern in Gombe is not known. Objective: This study is to determine the clinical pattern of breast diseases in Federal Teaching Hospital, Gombe (FTHG). Methods: It is a retrospective study done in FTHG between January 2015 and August 2017. The records of all patients who presented with breast diseases were reviewed. Their age, sex, site of lesion, and diagnosis were analyzed. Results: The number of patients were 475 comprising 461 (97.5%) females and 12 (2.5%) males with female-male ratio of 38:1 (the sex of two patients was not stated). The age range was 18–98 years with most of the patients in their second and third decades. The right-sided lesions were 51.5%, 44.7% were on the left, while 3.9% were bilateral. The diagnosis of 113 patients was not stated and they were excluded. The breast cancer patients were the most common, accounting for 77.7%, while fibroadenoma accounted for 17%. Mastitis/abscess constituted 3.6% and gynecomastia made up 1.8%. Discussion: Breast cancer was the most common breast disease in this study, unlike other studies where benign breast disease, fibroadenoma in particular, was the most common. This could be due to the hospital data or lack of awareness in this region. Breast disease is predominantly seen in females and in the second and third decades of life, but there is no site predilection. Conclusion: Malignant breast diseases are more common than benign breast diseases in FTHG. Whatever the reason may be, a more pragmatic and drastic measure is needed in breast cancer prevention and early detection, especially in North East Nigeria.

  Audit of Breast Cancer in the University of Benin Teaching Hospital (2011–2015) Top

Irowa OO, Momoh MI, Ohanaka C, Osime CO, Odigie VI

Department of Surgery, University of Benin Teaching Hospital, Benin City, Nigeria

Background: Breast cancer is a contemporary surgical disease in low-resource countries. Presentation is late, affecting more females. Knowledge of the disease is poor. Aims/Objectives: The aims of this study are to highlight the demography of breast cancer, stages of presentation, bed occupancy, and mortality arising from breast cancer. Its objective is to awaken us to the urgent need to initiate measures that will in the long term ensure early presentation of patient with breast cancer to our facility. Methods: All patients seen and treated in the surgical ward of University of Benin Teaching Hospital were studied over a 5-year period. Patient demographics, bed occupancy, and mortality were reviewed. Results: An average of 724 patients were admitted yearly into the ward, with breast cancer admissions constituting 28% (204). This clearly showed that for every three patients admitted, 1 will be a breast cancer patient. The mean age is 55 years with a range of 19–85 years. Majority of the patients were in their fourth and fifth decades of life (56.3%). Stage 3 was the most common stage of presentation constituting 69.2% of the total number of breast cancer patients. The mortality was 42 deaths/year and 18% (8) were from breast cancer, ratio being approximately 5:1. Conclusion: Breast cancer patients constitute a very high percentage of patients admitted with the background that other patients with other surgical pathologies are admitted in the same designated area in our environment. Their late presentation largely accounts for the high mortality seen in this study.

  Breast Cancer Management Outcome in Jos Top

Misauno MA, Mandong BM, Isichei MW, Ale AF, Ayuba MD, Ugwu BT

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: Breast cancer is the most common malignancy seen in Nigerian women with 64.6 cases/100,000 reported annually in some treatment centers. The disease in Nigerian women tends to run an aggressive cause for yet unidentified reason unknown. Most patients present late and have the highest cancer mortality in women. We analyzed the outcome of breast cancer patients managed at selected hospitals in Jos, plateau state. Methods: Preliminary report of data was collected on breast cancer patients managed at Jos University Teaching Hospital, FOMAS hospitals, MEENA, SOTERIA, Faith Alive Foundation Hospital, and DeConsultant Laboratory in Jos from January 2015 till date. Data were analyzed using Epi-Info version 3.5.3 (IBM, Chicago) and Microsoft Excel while thematic analysis was done for qualitative data. Results: There were 290 cases, the mean age of the study population was 46.1 ± 9.6 years, there were 289 (99.66%) females and 1 (0.04%) male; 63 (21.72%) had left-sided tumors, 43 (14.83%) were on the right, while 4 (0.01%) had bilateral involvement. Case stage distribution is as follows: T0/T1 – none, T2 – 11 (3.79%), T3 – 19 (6.55%), T4 – 65 (22.41%), and Tx – 7 (2.41%) (came with pathology reports) and invasive ductal carcinoma was seen in 105 (36.21%) and ILC in 5 cases (4%). Comorbidities high blood pressure-8, anaemia-4, diabetes mellitus-2 (0.69%), HIV-2 (0.69%). Immunohistochemistry was done in 44 patients (40%) and of these, triple negative − 16 (5.52%), triple positive − 7 (2.41%), ER+/PR+ – 11 (3.79%), ER+ – 6 (2.07%), PR+ – 1 (0.34%), and Her2+ – 3 (1.03%). Only 53 (18.28%) patients completed prescribed chemotherapy, 21 (7.24%) were not eligible for chemotherapy, while 37 (12.76%) could not afford chemotherapy. Chemotherapy regimen was as follows: CAF – 31 (10.69%), TAXANES – 12 (4.14%), VAC-P – 7 (2.41%), and CMF – 3 (1.03%). Hormonal therapy was as follows: tamoxifen 25 (8.62%), exemestane 3 (1.03%), and arimidex 6 (2.07%). Simple mastectomy was done in 63 cases (21.72%), quadrantectomy in 10 (3.45%), surgery was declined in 3 (1.03%), and cases not eligible for surgery accounted for 34 (11.72%). Outcome was as follows: 71 (24.48%) were alive, 11 (3.79%) lost to follow-up, and 28 (9.66%) dead. Conclusion: Most of the study population presented late, mainly at Stages III and IV Manchester staging, but a good percentage are still alive. There is a need to evaluate individual patients managed with a view to obtain the best practices that have better outcome.

  Assessment of Serum Insulin and C-peptide Levels among Breast Cancer Patients and Healthy Controls at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria Top

Agbo SP, Etuk EB1

Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, 1Department of Surgery, University of Uyo Teaching Hospital, Uyo, Nigeria

Carbohydrate diets have long been known to influence breast cancer risk by increasing the plasma levels of glucose and insulin. Raised plasma insulin may cause breast tissue carcinogenesis by directly stimulating insulin receptors leading to increased levels of the insulin-like growth factor-1 which has been found to have strong proliferative and antiapoptotic effects on breast tissues. This was a cross-sectional study, in which all consecutive patients aged between 20 and 80 years with confirmed diagnosis of breast cancer at the surgical clinic of the Usmanu Danfodiyo University Teaching Hospital, Sokoto, were selected. Healthy women in the same age range were selected as controls. Serum levels of insulin and C-peptide, a marker of insulin secretion, were assayed. Hyperinsulinemia was defined as a fasting insulin level of ≥10 μU/Ml. A total of 76 patients were seen comprising 38 cases and 38 controls. The mean ages of cases and controls were 40.0 years and 30.0 years, respectively. All the patients were females. The mean (±standard deviation) serum insulin level for cases and controls was 18.3 (±10.2) and 2.6 μIU (±1.2)/mL, respectively, while the mean serum C-peptide level was 3.8 and 1.2nG/mL, respectively. The association of hyperinsulinemia with breast cancer was assessed using conditional logistic regression. There was a significant association of hyperinsulinemia (odds ratio = 10.44, confidence interval (13.95, 20.67), P value = 0.021) with breast cancer. The finding shows that hyperinsulinemia is a significant predictor of breast cancer risk in women from Sokoto, Nigeria.

  Evaluation of Breastlight Examination Among Women in South Western Nigeria: A Preliminary Report Top

Akanbi OA, Oguntola AS, Adeoti ML, Akinloye TA, Ajayi IA, Aderounmu AOA

Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Osun State, Nigeria

Background: Survival rate of breast cancer is poor in Nigeria due to delayed presentation, diagnosis, and treatment. The benefits of early diagnosis and treatment include higher chance of cure among others. Previous studies have shown that breast cancer can be detected by translumination of red-light ray through the breast tissue and an area with high vascularity such as a cancer focus would cast “shadow” due to absorption of red light by hemoglobin. Few studies have been conducted to assess the usefulness of breastlight (BLIE) examination among dark-skinned population as previous clinical trials were mainly on Caucasians and the authors are not aware of any such study in Nigeria. Objective: The objective was to present our experience with BLIE examination usage in South Western Nigeria. Methods: Female patients attending general surgery clinic at our teaching hospital and a private breast clinic were prospectively enrolled between July and October 2017. The patients were made to undergo clinical breast examination and reexamined using Breast-I device, a form of BLIE examination device. The findings were then compared and also compared with the final histological diagnosis. Results: A total of thirty patients were included and 58 breasts were examined. Twenty-one patients presented with breast complaint, of which 13 (61.9%) complained of nonpainful lumps. The mean age of patients was 45.23 (±7.661) years. Clinical examination detected 23 lesions and this rose to 27 following light examination (17.39% increment). Fourteen out of the 16 BLIE-positive findings were histologically confirmed to be malignant (true positive, 87.5%), while 1 out of 42 benign findings were histologically confirmed to be malignant (false negative, 2.38%). The true negative and false positives were 97.61% and 12.5%, respectively. The device has a sensitivity and specificity of 93.3% and 95.34%, respectively, and an accuracy of 94.82% in detecting breast cancer. Conclusion: The preliminary findings indicate that BLIE examination is simple to perform without breast compression and risk of radiation and it findings will suggest to user the need for further examinations or referral and can serve as a complementary tool in routine breast self-examination and clinical breast examination.

  Deep Neck Space Infections: Scope, Dangers, and Predictors of Outcome in an Emerging Economy Top

Kokong DD, Adoga AA, Akhiwu BI, Agbara R, Mugu JG, Embu HY, Ramyil VM

Department of ENT Surgery, College of Medicine, University of Jos and Jos University Teaching Hospital, Plateau State, Nigeria

Objective: The objective was to study the scope, dangers, and predictors of outcome of deep neck space infections (DNSI) in our setting. Study Design: The study design is of retrospective cohort. Setting: The study was conducted at a public academic tertiary hospital. Methods: Case files retrieved utilizing ICD-10 version 10 codes that met the inclusion criteria for DNSI from January 1, 2012, to June 30, 2016, were analyzed. Results: Thirty-three cases of DNSI with a male:female ratio of 1.75:1 were studied. Age range was 6 months–82 years with mean of 35.3 ± 26.0 years [Figure 1]. In this, 60.6% presented early (≤7 days) while 39.4% presented late (i.e., after 7 days). The submandibular space predominated (n = 20, 60.6%) then the space of gillette (n = 5, 15.2%) [Figure 2]. Major source was odontogenic (n = 19, 57.6%) with 57.9%, 26.3%, and 15.8% for the 1st, 2nd, and 3rd mandibular molars, respectively, which tend to be extensive. We recorded a case that extended to the coccyx. Almost half had causally associated comorbidity (n = 15, 45.5%); predominantly anemia (n = 8, 24.2%) [Figure 3]. Parenteral ceftriaxone/augmentin with metronidazole was instituted for 24–48 h before surgical intervention, of which 33.3% were delayed interventions. All had Intensive Care Unit management which improved the outcome. Morbidity and mortality rates were 24.2% and 15.2%, respectively, with the latter often following upper airway obstruction from Ludwig's angina in 80% of which three-fifth expired before surgical intervention from late presentation. Conclusion: Extensive DNSIs with their attendant morbidity and mortality remain frequent in our environment. Early diagnosis and early identification of predictors of outcome with prompt intervention are key to satisfactory results.

  Laparoscopic-assisted Colostomies for Advanced Colorectal Cancers in a North Central Nigerian Hospital: A Report of a Pilot Study Top

Adeyeye AA, Onjefu SO1, Lawal B1, Aremu IA1

Department of Surgery, Bowen University, Iwo, Osun State,1 Department of Surgery, University of Ilorin Teaching Hospital, Kwara State, Nigeria

Study Background: Fecal diversion through colostomies is an important component of the surgical treatment for advanced colorectal cancers. These stomas are usually created through the open surgical approach. There are very few reports of minimally invasive, laparoscopic-assisted colostomies (LACs) in our setting. The aim of this study is to prospectively evaluate the intraoperative and early postoperative outcomes of laparoscopic colostomies for colorectal cancers. Methodology: Patients requiring fecal diversion as the primary modality of surgical treatment for locally advanced colorectal cancer were offered a 2-port LAC between April 2017 and October 2017. The demographics, indication for surgery, type of stoma, operative results, early postoperative outcomes, and time to initiation of adjuvant chemotherapy were noted. These were compared with a retrospective cohort of patients who had an open colostomy as the only form of initial surgical therapy. Results: A total of 12 patients had LAC during the study period. These were compared with a retrospective cohort of 22 patients who had open colostomy for colorectal cancer. The most common indications in the laparoscopic group (LG) were fecal incontinence (41.7%) and malignant internal fistula (33.3%), while that of the open group (OG) was bowel obstruction (77.3%). The effective operative time (63 min vs. 77 min; P = 0.18) and the American Society of Anesthesiologists score (3 vs. 3; P = 0.33) were similar in both groups. The average estimated blood loss was less in the LG (40 ml vs. 150 ml; P = 0.0007). There was no conversion to open surgery in the LG. Stoma complications were more in the OG (27.3% vs. 8.3%; P = 0.002). Initiation of postoperative oral intake (1 day vs. 4 days; P = 0.05) and average duration of postoperative hospital stay (2.5 days vs. 10 days; P = 0.001) were shorter in the LG. Adjuvant chemotherapy commenced earlier in the LG compared to the OG (9 days vs. 42 days; P = 0.0001). There was no mortality recorded in the LG while the OG recorded a 4.5% perioperative mortality rate. Conclusion: LAC is associated with better operative outcomes, faster recovery, shorter hospital stay, and earlier initiation of adjuvant therapy when compared to open colostomy. Minimally invasive stoma creation may be considered in properly selected patients where the skills and facilities for laparoscopy are available. A randomized controlled trial may be required for robust comparison between both surgical approaches.

  A Modified Open Primary Laparoscopic Surgery Port Placement Through Umbilical Tube Top

Ismaila BO, Omolabake B, Akims SM, Alayande BT, Ajulo AA, Iorbo A, Omofuma IO, Wina FM, Okoko EJ

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

Background: A safe reliable technique for primary trochar introduction is important for laparoscopic surgery. In resource-constrained settings where there is a paucity of needed equipment and cost is prohibitive, a method utilizing fewer instruments will be useful. Aim: This study aimed to describe a method of primary trochar introduction that utilizes any available port. Methods: A supra- or infra-umbilical incision is made into an everted tubular umbilicus and the linear alba is cut, after which a port is inserted using the trochar as a guide. Trochar is withdrawn while the cannula is pushed in. Results: One hundred and two patients had primary port insertions with no significant gas leaks. Mean age of patients was 32 years (range: 1 year–75 years), 68% were female. Conclusion: This is a simple and reliable way of primary port insertion and access was gained easily in different age groups and umbilicus types.

  Primary Carcinoma of the Gall Bladder in Northern Nigeria: Case Series and a Short Review of the English Literature in Africa Top

Dauda MM, Daniyan M, Liman AM, Ukwenya YA

Departments of Surgery and Pathology, A.B.U. Teaching Hospital, Zaria

Introduction: Incidence of primary gall bladder carcinoma is largely unknown and there has been no previous report from northern Nigeria in the English literature. Although there are some reports from southern Nigeria, the frequency is probably overexaggerated when compared to the overall very low incidence all over the world. In the last 50 years, we have seen only three cases of primary carcinoma of the gall bladder in Zaria, all of them within the last 3 years. Study Design: This is a case series of three patients seen over the last 3 years and a short review of cases reported from other institutions around Africa in the English literature. Results: Three patients, comprised of two females and one male, were managed for gall bladder carcinoma over the last 3 years. They were aged 58 years, 70 years, and 76 years, respectively. All the three were diagnosed as cholelithiasis while one of them presented with cholangitis. They were all adenocarcinoma. Conclusion: While delay in presentation is a major factor contributing to poor outcome in most of these patients, the initial diagnosis of cholelithiasis by sonologist remains a serious problem.

  Restoring Gastrointestinal Continuity with Surgical Staplers; Early Experience from Two North Central Nigerian Hospitals Top

Adeyeye AA, Fasiku OK1, Onjefu SO1, Lawal B1, Aremu IA1

Department of Surgery, Bowen University, Iwo, Osun state, 1Department of Surgery, University of Ilorin Teaching Hospital, Kwara state, Nigeria

Study Background: Surgical staplers are known to be an acceptable alternative in creating gastrointestinal anastomosis. Hand-sewn suture techniques, however, remain the main method of restoring gastrointestinal continuity in Nigeria. The objective was to prospectively review the outcomes of an initial experience with intestinal staplers in two North Central Nigerian hospitals. Methodology: Consecutive patients who had gastrointestinal anastomosis with staplers were prospectively reviewed between August 2015 and March 2017. The following were evaluated: demographics, indication for surgery, procedure performed, anastomosis created, and postoperative outcomes. Results: A total of 17 patients had stapled restoration of gastrointestinal continuity during the study period. There were ten males and seven females. Their ages ranged between 20 and 82 (mean 43) years. The following anastomoses were created: 7 (41.1%) colo-rectal, 2 (11.8%) each of esophago-gastric, gastro-jejunal, and ileo-ileal, and 1 (5.9%) each of duodeno-jejunal, colo-colic, ileo-rectal, and colo-anal. The indications included four (23.6%) gastric cancers, three (17.6%) colorectal cancers, three (17.6%) sigmoid volvulus, and two (11.8%) ileal perforations. One (5.9%) patient each had small bowel tumor, rectal prolapse, colonic trauma, recto-vesical fistula, and colonic diverticulosis. The mean duration of surgery was 118 ± 32 min and mean duration of postoperative stay was 9 ± 2.9 days. A complication rate of 17.6% was recorded at a median follow-up of 11 months. There were no anastomotic bleeds or leaks. There was an unplanned proximal diversion rate of 11.8%. Conclusion: Stapled gastrointestinal anastomosis is technically feasible with favorable outcomes in a resource-poor setting like ours. Its adoption may improve surgical outcomes, especially when creating difficult gastrointestinal anastomosis.

  Prophylactic Use of Ephedrine and its Effect on Pain from Propofol Administration Top

Onoja AA, Embu HY, Nuhu SI

Department of Anaesthesia, Jos University Teaching Hospital, Jos, Nigeria

Background: Pain during intravenous propofol injection is a great source of discomfort to patients. This tends to make this anesthetic agent unpopular with patients and may discourage them accepting its use in future anesthetics. Several methods of preventing this pain have been tried with varying degrees of success. This study aims to evaluate the effect of prophylactic use of ephedrine in attenuating the pain associated with intravenous propofol injection. Methodology: Eighty-eight patients were recruited and assigned into two different groups to receive either 2 ml of saline (Group I) or equal volume of 0.2 mg/kg ephedrine constituted in saline (Group II). Two minutes later, propofol 2.5 mg/kg was administered to both groups of patients in four aliquots over 2 min. Pain was assessed using the verbal rating scale. Data obtained were subjected to analysis using version 20 of SPSS statistical package (IBM, Chicago, USA). Results: Group I patients (control) had an incidence of pain of 54.5% compared to Group II patients (ephedrine) who had a pain incidence of 29.5% (P > 0.05). There was also a greater decrease in oxygen saturation in Group I patients compared with Group II (P < 0.001). Conclusion: 0.2 mg/kg of ephedrine produced attenuation of pain resulting from intravenous induction with propofol. This was though not statistically significant.

  Therapeutic Endoscopy with Limited Resources in Jos: The Road Less Traveled Top

Ismaila BO, Adighije PF, Alayande BT, Ajulo AA

Department of Surgery, Jos University Teaching Hospital, Jos, Plateau State, Nigeria

There are increasing reports on endoscopy in Nigeria. However, most of these reports are on diagnostic endoscopy. Therapeutic endoscopy provides a unique minimally invasive way of tackling diseases of the gastrointestinal tract with potentially low morbidity and mortality. However, therapeutic endoscopy requires more skill and equipment than diagnostic endoscopy. These skills and especially equipment are generally are not available in Nigeria.

This study evaluates the spectrum and outcomes of therapeutic gastrointestinal endoscopy performed by a surgeon as well as innovations to ensure quality service. Methods: Prospective database which captured therapeutic endoscopic procedures and methods was utilized to ensure successful outcomes. Results: Out of 85 therapeutic endoscopies in seventy patients, 29 were in upper gastrointestinal tract. Only 28 (32.9%) were female. These included variceal treatment, dilatations, stent insertions, and polypectomies. The mean age was 50 years. Apart from the endoscopic equipment, some accessory equipment were essential for therapeutic endoscopy. There was no morbidity or mortality. Conclusion: Therapeutic endoscopy with limited resources can be performed safely, but requires utilizing little available equipment in innovative ways.


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Effects of Ephed...
Estimation of We...
Lower Limb Surge...
Prognostic Chara...
Tracheostomy: Th...
Ranula: Current ...
Usefulness of Mo...
Using Trauma Reg...
A Rare Case Repo...
Lumbar Epidural ...
Finding Communit...
Pattern of Breas...
Audit of Breast ...
Breast Cancer Ma...
Assessment of Se...
Evaluation of Br...
Deep Neck Space ...
A Modified Open ...
Primary Carcinom...
Restoring Gastro...
Prophylactic Use...
Therapeutic Endo...

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