Perforated gastric ulcer is one of the most life-threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59-year-old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology-related factors influencing the decision-making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient- and healthcare-related factors should also be considered.

Objective: The objective of this study was to assess the efficacy of tamsulosin and finasteride monotherapies, and their combination in men with benign prostatic hyperplasia (BPH). Materials and Methods: This is a prospective single-blind randomized study of ninety men with BPH who were managed using drugs. The International Prostate Symptom Score (IPSS), peak urinary flow rate, and prostate volume were measured as parameters for assessment at the beginning, 3 months, and 6 months of the study. Results: The mean age of patients was 61.65 with a range of 44–81 years. There was a progressive and sustained improvement in the IPSS score in all patient groups with mean decrease at 3 months of 7.24 (42.59%), 7.60 (41.85%), and 7.24 (40.61%) and at 6 months of 8.14 (47.88%), 10.33 (56.88%), and 11.1 (62.25%) in the tamsulosin, finasteride, and combination groups, respectively. There was an increase in peak urinary flow rate in all groups with mean increase at 3 months of 0.98, 0.05, and 3.55 (ml/s) and at 6 months of 4.11, 0.87, and 3.74 (ml/s) in the tamsulosin, finasteride, and combination groups, respectively. There was a reduction in the prostate volume in the finasteride and combination groups at 6 months of 6.8 and 6.32 cm³, respectively, while the tamsulosin group recorded an increase. Conclusion: At the end of 6 months, tamsulosin monotherapy and combination therapy appear to be equally effective in the treatment of lower urinary tract symptoms BPH while finasteride monotherapy appears to be the least effective. Bothersome, side effects were more in patients taking finasteride alone or as combination therapy.

Introduction: Pancreatic trauma is a rare entity occurring in 0.2% of patients with blunt trauma abdomen. Once the diagnosis is made, the management of patients is dependent on multiple variables. Conservative management, suture repair, drainage, and resection have been utilized with varying degree of success. This study is aimed to evaluate the management of patients with pancreatic trauma. Materials and Methods: This was a prospective study done in the Department of Surgery in Dayanand Medical College and Hospital where forty hemodynamically stable patients diagnosed to have pancreatic trauma on contrast-enhanced computed tomography abdomen were included in the study. Results: Out of forty patients taken in this study, 38 were male and two were female with age ranging from 3 to 50 years. Road traffic accident was the most common cause of pancreatic injury. Pancreatic injuries were graded according to the American Association for Surgery in Trauma scale. Twelve patients had Grade I and II injuries. Grade III was the most common injury occurring in 14 patients. Twenty-four patients underwent surgical management. Mortality rate was 45% and it was in direct correlation with the severity of injury. Conclusion: Grade I and II pancreatic injury can be managed conservatively depending upon the hemodynamic status of the patient. Grade III and IV injuries have a better prognosis if managed surgically.

Objectives: The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Patients and Methods: We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006–2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. Results: The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8–53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. Conclusion: Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.

Context: Oncosurgery is an emerging branch with the set goals of prolonging the life and ensuring the best possible quality of life to the surviving patient. The use of harmonic scalpel has proved to be beneficial in a variety of surgeries but its role in breast surgery is still controversial. Aims: We conducted this study to compare the intraoperative and postoperative outcomes in modified radical mastectomy using harmonic scalpel versus electrocautery. Subjects and Methods: Fifty female patients with confirmed diagnosis of breast carcinoma and planned for modified radical mastectomy were taken up for surgery. Twenty-five patients were operated using harmonic scalpel (Group A) and another 25 were operated using unipolar cautery (Group B). Results: The mean operative time was significantly longer with harmonic scalpel when compared to that with electrocautery (140.40 ± 29.96 vs. 99.80 ± 24.00 min, P< 0.001). The smaller amount of drainage content (431.60 ± 145.94 vs. 594.20 ± 278.63, P = 0.013) and intraoperative blood loss (426.00 ± 76.54 vs. 502.00 ± 104.56, P = 0.005) in the group operated with the ultrasound harmonic scalpel was statistically significant. There was no significant difference between the groups with regard to drain duration (5.24 ± 0.97, P = 0.127), seroma (12% vs. 16%, P = 0.684), hematoma (4% vs. 4%, P = 1.000), wound infection (24% vs. 32%, P = 0.529), flap necrosis (8% vs. 28%, P = 0.066), pain intensity (measured on visual analog scale) (5.08 ± 1.29 vs. 5.20 ± 1.68, P = 0.778), and lymphedema (4% vs. 8%, P = 0.552). The length of hospital stay could not be compared effectively because all the patients were discharged on the 10^th or 11^th postoperative day. The cost of the equipment used in the electrocautery group was almost negligible as compared to the harmonic group. Conclusions: The use of harmonic scalpel versus electrocautery is somewhat advantageous but not cost-effective.

Background: Childhood pyogenic septic arthritis and its associated musculoskeletal morbidity is an important health concern in developing countries. Its pattern of presentation that varies from and within subregions has implications on the early recognition, treatment, and outcome. The aim of this study was to determine the pattern and outcome of childhood septic arthritis in our environment. Materials and Methods: This was a retrospective study of all the children seen with pyogenic septic arthritis in Federal Teaching Hospital Abakaliki between January 2005 and December 2015. Results: Childhood septic arthritis accounted for 44 (83%) of the 53 patients seen with pyogenic septic arthritis. Female to male ratio was 1:1.75 and the mean age was 5.7 ± 0.73 years. Eight patients (18.2%) had polyarticular involvements. The right shoulder was significantly more involved than the left and the left hip more than right. Overall, there was a preponderance of onset of symptoms in the dry season. Children from the rural areas accounted for 85.7% of those with the onset of symptom in rainy season. Delayed presentation >6 days (in 68.2% of patients) was related to age (P < 0.042), and health seeking behavior (P < 0.036). Staphylococcus aureus was the commonest causative organism. Seventy-seven percent (77%) underwent open arthrotomy. Anemia, septic shock, and joint stiffness were three top complications observed. Mortality rate was 2.3%, and cause of death was overwhelming sepsis. Conclusion: In our setting, pyogenic septic arthritis is predominantly a childhood health problem and children under 5 years of age are the most vulnerable. Delayed presentation, an important factor in morbidity and mortality associated with septic arthritis was common among the patients, calls for a public enlightenment program on the importance of early presentation.

Context: Prostate cancer (PCa) is frequently diagnosed at advanced stages in Nigeria. Aims: To determine the screen detected PCa prevalence in a suburban community and explore any relationships between prostate-specific antigen (PSA) and anthropometric measurements. Settings and Design: Nsukka is a town and local government area (LGA) in Southeast Nigeria in Enugu State. Towns that share a common border with Nsukka are Edem Ani, Alor-uno, Opi, Orba, and Ede-Oballa. Nsukka LGA has an area of 1810 km² and a population of 309,633 at the 2006 census. All consecutive responders who met the inclusion criteria were recruited. Subjects and Methods: A screening outreach was conducted in one location in Nsukka. PSA testing and digital rectal examinations were performed. Height and weight were measured and body mass index (BMI) was calculated. Statistical Analysis Used: Results were subjected to statistical analysis using SPSS 20 (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY, USA). Categorical data were analyzed using the Chi-square test, with significance level set at P< 0.05. Pearson's correlation was conducted for interval data (P < 0.05). Results: One-hundred and sixty men met the inclusion criteria and were screened. Age range was 40–81 years; PSA range was 1.20–33.9 ng/ml. Digital rectal examinations (DREs) was abnormal in 17 men. Median BMI was 27.49. A Pearson's correlation coefficient showed a significant correlation between age and PSA, r = 0.127; P ≤ 0.05, and DRE findings and PSA, r = 0.178; P ≤ 0.05. There was no significant correlation between height and PSA, r = −0.99; P = 0.211; weight and PSA, r = −0. 81 P = 0.308; and BMI and PSA, r = −0.066; P = 0.407. 8/21 men consented to prostate biopsy with three positive, giving a screen detected PCa prevalence of 1.875%. Conclusions: Screen detected PCa prevalence in high this population and efforts to improve early detection may be of value in improving treatment outcomes.

Background: Condylar resorption as a cause of relapse after orthognathic surgery is well known. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and resorption. This study was done to appraise the condylar changes along with the form and function following orthognathic surgery, as well as to assess what factors may have contributed to the problems. Methodology: A diagnosis of progressive condylar resorption (PCR) was made by comparison of preoperative and postoperative radiographs (cephalometric radiograms), as well as clinical evaluations. The radiographs were taken for each patient preoperatively and postoperatively, which include immediately after osteotomy, at 6 months and 24 months. Additional radiographs were taken when required. Then, preoperative and postoperative tracings were compared at 24 months postoperatively. Results and Conclusion: It can be concluded from this study that females of relative low age (<18 years) appeared to be a high-risk factor for the occurrence of condylar alteration including PCR. A steep mandibular plane angle, the low facial height ratio (post/ant), and magnitude of surgery were also significantly related to the occurrence of condylar alteration, but the multivariance regression showed that these parameters had only limited value.

Background: Severe hip pain with associated significant functional limitation is the major indication for total hip replacement, a rewarding and gratifying procedure. However, significant blood loss can occur in the intra- and post-operative periods, posing a major challenge and necessitating prompt restoration of circulating blood volume to minimize morbidity and mortality. The aim of this study was to evaluate blood loss after primary total hip replacement, and to determine the effect of surgical time on blood loss. Patients and Methods: A prospective study of blood loss after total hip arthroplasty in 41 patients. All cases were primary total hip arthroplasty done by one surgeon. Intra- and post-operative blood losses were recorded in two groups of patients (surgical time <2 h and surgical time >2 h), and the effect of these on blood loss was evaluated. Results: The mean intra- and post-operative blood losses were 1222.7 ml and 574.3 ml, respectively. These showed a strong positive correlation with total blood loss (r = 0.790, P< 0.001 and r = 0.517, P< 0.001). Higher intra- and post-operative blood losses were recorded in patients with surgical time >2 h, with a significant difference on postoperative days 2 and 3 (P = 0.003 and P = 0.014, respectively). Conclusion: Blood loss in total hip replacement is an important factor and may be influenced by a shorter surgical time.

Introduction: Civilian penetrating gunshot injuries to the neurocranium are no longer uncommon in Nigeria. Such injuries are however poorly reported. They are associated with poor outcome and, at close range, are frequently fatal, especially when inflicted by high-velocity weapons. Prompt transfer to neurosurgical service and urgent intervention may improve outcome in those that are not mortally wounded. Materials and Methods: Fifty-two patients with civilian penetrating gunshot wounds seen over a 10-year period (2004–2014) at the University of Nigeria Teaching Hospital and Memfys Hospital for Neurosurgery Enugu were reviewed retrospectively, and their data were analyzed to evaluate factors that impacted on outcome. Only patients with clinical and imaging evidence of cranial gunshot injuries who reached hospital alive were included in the study. The overall mortality and Glasgow outcome score were analyzed. Results: Fifty-two patients with isolated civilian penetrating gunshot wounds were identified (M:F = 7.7:1); mean (standard deviation) age was 32.8 (11.9) years. There was a high correlation (0.983) between the sex of the patients and the outcome. The overall mortality was 30.8%, whereas the mortality for patients with postresuscitation Glasgow coma scale (GCS) score ≤8 was 57%, as against 12.9% in those in whom postresuscitation GCS was >8; meaning that 87.1% of patients in whom postresuscitation GCS was >8 survived. Thirty-one patients (59.6%) had papillary abnormalities. Majority of patients with monohemispheric lesions survived while all those with diencephalic, transventricular, and posterior fossa involvement had 100% mortality. Conclusions: Admitting GCS and bullet trajectory were predictive of outcome.

Introduction: Acute pancreatitis is inflammatory process of the pancreas associated with local and systemic complications. At present, there are lots of scores (such as Ransons, APACHE II, bedside index for severity in acute pancreatitis) that help us in predicting severity at the time of admission but these are time consuming or require complex calculation and are costly. Material and Methods: PANC3 Scoring System is one of the better systems because the three criteria used (hematocrit, body mass index, and pleural effusion) are simple, easy to assess, readily available, and economic. In this prospective study, 100 cases were evaluated to see the prospects of PANC3 scoring in predicting the severity of acute pancreatitis as decided by modified Marshals score. Results: The results showed that PANC3 score had a 96.43% specificity, 75% sensitivity, 80% positive predictive value, and 95.29% negative predictive value. Conclusion: Hence, the PANC3 score is a cost-effective, promising score that helps in predicting the severity of acute pancreatitis leading to prompt treatment and early referral to higher center.

Background: Procedure-related and patient-related factors influence the prognosis of dental implants to a major extent. Hence, we aimed to evaluate and analyze various systemic factors in patients receiving dental implants. Materials and Methods: Fifty-one patients were included in the study, in which a total of 110 dental implants were placed. Complete examination of the subjects was done before and after placement of dental implants. Implant surgery was planned, and osseointegrated dental implants were placed in the subjects. Postoperative evaluation of the dental implant patients was done after 3 weeks. Anxiety levels were determined using State-Trait Anxiety Inventory (STAI) questionnaire on the surgery day and after 1 week of surgery. The participant describes how they feel at the moment by responding to twenty items as follows: (1) absolutely not, (2) slightly, (3) somewhat, or (4) very much. All the results were recorded and statistical analyzed by SPSS software. Results: Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. Female patients' mean age was 50.18 years while male patients' mean age was 52.71 years, with statistically nonsignificant difference between them. Functional rehabilitation was the main purpose of choosing dental implants in more than 90% of the subjects. Diameter of 3.75 mm was the shortest implants to be placed in the present study, whereas in terms of length, 8.5 mm was the shortest length of dental implant used in the present study. Tooth area in which maximum implants were placed in our study was 36 tooth region. Maximum implants were placed in Type II bone quality (n = 38). Implants installed in the mandible were clamped more efficiently than implants placed in the maxilla (P < 0.001). The difference of average STAI-State subscore before and after the surgery was statistically significant (P < 0.05; significant). Conclusion: Mandibular dental implants show more clamping (torque) than maxillary dental implants.

Excision of multiple fibroadenomas (MF) in separate breast quadrants presents difficulties of number and location of incision(s) and extent of tissue dissection and may be associated with more complications and poorer cosmetic outcome. This is a report of excision of MF in multiple quadrants of the breast using a modification of subcutaneous dissection technique dubbed the circumareolar incision and subdermal tunneling (CAST) dissection. After exposure of the superficial fascia with circumareolar incision, subdermal cone-wise dissection was made to allow mobilization of the segment bearing the lump(s). The lump(s) were enucleated and removed. MF were removed from four breasts in three young unmarried females. The first patient had multiple adenomas removed from three quadrants of both breasts: 14 on the right and six on the left. The second patient had excision of three lumps in three separate quadrants, and the third patient had excision of two lumps in two separate quadrants. All patients had edema and bruising. One breast had wound infection and dehiscence. There were no skin necrosis, no nipple loss, and no breast distortion. All ensuing scars were camouflaged. CAST dissection was used for excision of MF in multiple quadrants of the breast with preservation of excellent cosmetic outcome of a single circumareolar incision.

It is unusual but not uncommon for foreign bodies to be missed at bronchoscopy. This case report highlights the importance of the clinical history in the diagnosis of aspirated foreign bodies and the usefulness of chest imaging modalities. A 6-year-old boy presented with recurrent breathlessness and cough of 2 months. He was said to have aspirated the base cap of a pen at about the time symptoms started. He had two sessions of rigid bronchoscopy and a session of flexible bronchoscopy at three different hospitals. He had an initial rigid bronchoscopy which failed to show the foreign body (FB). A chest computerized tomographic scan demonstrated the FB, which was retrieved at combined flexible/rigid bronchoscopy. Although rigid bronchoscopy is the gold standard for managing airway foreign bodies, there remains a false negative rate for this procedure and where necessary, appropriate imaging may compliment rigid bronchoscopy, especially where there is some confusion.

Gastrointestinal stromal tumours (GIST) are rare tumours arising from mesenchyme of gastrointestinal tract and overexpress C-kit protein. Mainly seen in stomach and small bowel. Mesenteric GIST are rarely reported as they constitute less than 1% of total GIST. We here report such a rare case of GIST arising from mesentery of small bowel and presenting as acute abdomen. Good surgical clearance ensures good survival whereas incomplete resection results in a high incidence of recurrences with distant metastasis.