Manipulation of the small intestine as a cause of the increased inflammatory response after open compared with laparoscopic surgery (Br J Surg 2006; 93: 195-204).
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Cytokines↗
Biomedical subjects
A G Hill
Publications and source records attributed to A G Hill.
Secular trends in menarcheal age among Ghanaian women in Accra.
The Women's Health Study of Accra is a population-based cross-sectional survey that was conducted between March and September 2003 to assess the burden of disease in women in Accra. In addition to data relating to general health and living conditions, data on age at first menstruation was collected during the survey. A retrospective cohort analysis of the reported age at menarche was conducted using data from 2,644 women aged between 18 and 100 years. The median age of first menstruation of the entire cohort was 15.5 years and the median age of first menstruation among those aged <20 was 14.5 years. There was a statistically significant difference in median age at menstruation among the different age and socioeconomic groups. Multiple linear regression showed a significant decline of 0.2 years per decade in the mean age at menarche among Ghanaian women.
Adolescent↗
Thyroid disease in a rural Kenyan hospital.
OBJECTIVES: To review the spectrum of thyroid pathology diagnoses likely to be encountered by surgeons working in East African hospitals. DESIGN: A retrospective review of all thyroidectomies performed over a three year period. SETTING: A rural church based hospital in Kenya. SUBJECTS: Two hundred and twenty two patients who underwent thyroidectomy over a three year period at Kijabe hospital. INTERVENTIONS: A simple protocol was used to manage thyroid disease involving history, clinical examination, measurement of TSH and needle aspiration of lesions where appropriate, and excision when clinically indicated. MAIN OUTCOME MEASURES: Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. RESULTS: Two hundred and twenty thyroidectomies were performed. Overall there was a malignancy rate of 11.7% (15 papillary, 11 follicular). The commonest pathological diagnosis was multinodular goitre (47%). Graves' disease was a relatively common diagnosis in this series (13%). The mortality rate was 0.5% and the morbidity rate was 3.6%. CONCLUSION: Graves' disease is not as uncommon in rural Africa as previously thought. Malignancy is relatively common and there appears to be a change in the papillary to follicular cancer ratio perhaps reflecting widespread iodinisation of salt in Kenya.
Adenoma↗
Major salivary gland tumours in a rural Kenyan hospital.
BACKGROUND: Salivary gland tumours are not well characterised in Africa. The Kijabe Hospital Pathology Laboratory operates a pathology service utilised by twenty one church/mission hospitals and thus has accumulated data from many parts of Kenya regarding major salivary gland neoplasms. OBJECTIVE: To review the specimens in order to help understand the spectrum of the salivary gland neoplasms in Kenya. DESIGN: Data on all major salivary gland tumours examined over the study period were obtained from the Pathology department computer database. Basic information on age, tribe, pathological diagnosis and site of the tumour were available for analysis. SETTING: A rural hospital in Kenya with a pathology service serving 21 church/mission hospitals throughout Kenya. SUBJECTS: All major salivary gland neoplasms examined in the pathology laboratory over the period January 1992 to December 1999. MAIN OUTCOME MEASURES: Age, tribe, pathological diagnosis, site of specimen. RESULTS: Over the period 1992 to 1999, 135 major primary salivary gland neoplasms were examined. Amongst 103 parotid tumours, 46% were pleomorphic adenomas and 19% were monomorphic adenomas. Consistent with other studies from sub-Saharan Africa, the Warthin's tumour was rare. The commonest malignant tumour was the mucoepidermoid carcinoma comprising 14% of specimens. Thirty two submandibularneoplasms are described. The commonest tumour was the pleomorphic adenoma (78%) and the commonest malignant tumour was the mucoepidermoid carcinoma (9%). CONCLUSIONS: Compared with other African studies, these figures are similar although in Kenya there is a predominance of monomorphic adenomas. Compared with Western studies there is an increased ratio of malignant to benign tumours and Warthin's tumours are much less common in Africa.
Adenocarcinoma↗
Management of solitary thyroid nodules in rural Africa.
OBJECTIVES: To review a simple protocol for the management of solitary thyroid nodules and to document the spectrum of pathological diagnoses associated with this condition. DESIGN: A retrospective review of all solitary solid thyroid nodules excised over a three-year period from 1st January 1999 to 31st December 2001. SETTING: A rural church-based hospital in Kenya. SUBJECTS: All patients undergoing thyroidectomy for solitary solid thyroid nodule over a three-year period at Kijabe Hospital. INTERVENTIONS: A simple protocol was used to manage this condition involving history, clinical examination, needle aspiration of the lesion, and excision when clinically indicated. MAIN OUTCOME MEASURES: Clinical diagnosis, tribe, operation performed, pathology, and complications of surgery. RESULTS: Eighty-one operations were performed for a solitary thyroid nodule. The most common operations were lobectomy and isthmusectomy. There were two complications--a neck haematoma that required surgery and one recurrent laryngeal nerve injury. The commonest pathological diagnosis was multinodular goitre (42%). There was a 16% malignancy rate with eight papillary carcinomas, five follicular carcinomas, and one hurthle cell carcinoma. CONCLUSIONS: The simple protocol described gives good results in a rural African hospital. Solitary solid thyroid nodules should be routinely excised due to the 16% malignancy rate in this condition. There is a possibility that there is a shift in the ratio of papillary to follicular carcinomas compared to older African studies and this would be an interesting area for further study.
Adenocarcinoma, Follicular↗
Suprapubic transvesical prostatectomy in a rural Kenyan hospital.
OBJECTIVE: To evaluate the effectiveness, safety and complications of suprapubic transvesical prostatectomy in a rural Kenyan hospital. DESIGN: A prospective audit of suprapubic transvesical prostatectomy. SETTING: Africa Inland Church, Kijabe Hospital, Kijabe, Kenya. SUBJECTS: One hundred and six men with lower urinary tract obstruction, clinically due to benign prostatic hyperplasia, undergoing suprapubic transvesical prostatectomy. INTERVENTIONS: Suprapubic prostatectomy. MAIN OUTCOME MEASURES: Age, presentation, comorbidity, type of anaesthesia, pathology, bladder irrigation time, Foley time, post-operative stay, complications-mortality, blood transfusion rate, return to theatre for bleeding, incontinence, urine leak, urinary retention. RESULTS: One hundred and six men entered the study with a mean age of 72.8 years. Seventy eight per cent were in retention and 25% had significant medical problems. Spinal anaesthesia was used in 94%. The mean prostate weight was 70.4 g and 11% had carcinoma. The Foley's catheter was removed at a mean of 4.2 days after surgery and the mean post-operative stay was 6.0 days. The 30 day mortality was 0.9%, the blood transfusion rate was 4.7%, the return to theatre for bleeding rate was 0.9% and 4.7% of patients developed a urine leak. CONCLUSION: Suprapubic transvesical prostatectomy, performed under spinal anaesthetic, by general surgeons in rural Kenya, is a safe and effective way of managing benign prostatic hyperplasia and its complications.
Aged↗
Management of perforated duodenal ulcer in a resource poor environment.
BACKGROUND: The majority of literature on the management of perforated duodenal ulcer comes from the west. However, this is not necessarily appropriate in the developing world where perforated ulcers occur in younger patients, there is a strong association with cigarette smoking, and presentation is often delayed. OBJECTIVE: An attempt to guide management of perforated duodenal ulcer in the developing world using the best evidence available. DATA SOURCES: Review of the literature on perforated ulcers and retrospective chart review of cases from a rural African hospital. STUDY SELECTION: Relevant studies from the western and developing world literature. DATA EXTRACTION: Med-line search. DATA SYNTHESIS: Assessment of relevance to clinical management of perforated duodenal ulcers in the developing world. CONCLUSIONS: Due to recognition of Helicobacter pylori (HP) as a causative agent in duodenal ulcer disease many western surgeons are questioning the need for definitive ulcer surgery in the acute management of perforated duodenal ulceration. This philosophy may not be appropriate in the developing world due to poor HP eradication rates, conditions fostering re-infection with HP, problems with patient compliance in taking medications, and difficulties with follow-up. It is suggested that selected patients, without preoperative risk factors, are offered definitive surgery but those at any risk of postoperative mortality be treated with conservative surgery and treatment for HP. These patients will have to be followed closely to check ulcer healing. Attention will also need to be paid to stopping smoking.
Adult↗
Acute appendicitis in a Kenyan rural hospital.
OBJECTIVES: The literature on appendicitis in Africa is almost all derived from urban teaching hospitals. As most of Africa's people are from rural areas, we sought to review our experience from a rural hospital in Kenya. DESIGN: Retrospective chart review. SETTING: A rural Kenyan church hospital. SUBJECTS: One hundred and twelve cases of acute appendicitis presenting at Kijabe Hospital over a five year period were reviewed. INTERVENTION: Appendicectomy. MAIN OUTCOME MEASURES: Sex, age, pre-hospital delay, operative findings, wound infection, post-operative length of stay. RESULTS: The male to female ratio was 1.8:1. The median age was 29 (4-71 years). Median prehospital delays were one day (normal appendix), one and a half days (simple appendicitis), three days (perforated appendix) and six and a half days (appendical abscess). Operative findings were 14% normal appendix, 42% simple appendicitis, 22% perforated, 21% abscess. Overall wound infection rate was 22%; ranging from 11% for simple appendicitis to 46% for an appendiceal abscess. The mean post-operative length of stay was nine and a half days. CONCLUSIONS: Acute appendicitis in rural Kenya is similar to patterns reported in urban African centres. The main difference from western data is the high complicated appendicitis rate which is most likely related to prolonged pre-hospital delay.
Acute Disease↗
Initiators and propagators of the metabolic response to injury.
Injury produces tissue hypoperfusion and subsequent reperfusion, afferent neural activity, and immune and vascular endothelial activation. These, in turn, set up a cascade of events coordinated by the central nervous system and at the level of individual tissues such as the liver, gut, and skeletal muscle. They are mediated by a complex array of neutrophil and macrophage products. The changes result in hypermetabolism, lypolysis, lysis of skeletal muscle and visceral protein, and expanded extracellular fluid with consequent organ failure.
Animals↗
Decline of mortality in children in rural Gambia: the influence of village-level primary health care.
Using data from a longitudinal study conducted in 40 villages by the UK MRC in the North Bank Division of The Gambia beginning in late 1981, we examined infant and child mortality over a 15-year period for a population of about 17 000 people. Comparisons are drawn between villages with and without PHC. The extra facilities in the PHC villages include: a paid Community Health Nurse for about every 5 villages, a Village Health Worker and a trained Traditional Birth Attendant. Maternal and child health services with a vaccination programme are accessible to residents in both PHC and non-PHC villages. The data indicate that there has been a marked improvement in infant and under-five mortality in both sets of villages. Following the establishment of the PHC system in 1983, infant mortality dropped from 134/1000 in 1982-83 to 69/1000 in 1992-94 in the PHC villages and from 155/1000 to 91/1000 in the non-PHC villages over the same period. Between 1982 and 83 and 1992-94, the death rates for children aged 1-4 fell from 42/1000 to 28/1000 in the PHC villages and from 45/1000 to 38/1000 in the non-PHC villages. Since 1994, when supervision of the PHC system has weakened, infant mortality rates in the PHC villages have risen to 89/1000 in 1994-96. The rates in the non-PHC villages fell to 78/1000 for this period. The under-five mortality rates in both sets of villages have converged to 34/1000 for 1994-96. When the PHC programme was well supported in the 1980s, we saw significantly lower mortality rates for the 1-4-year-olds. These differences disappeared when support for PHC was reduced after 1994. The differential effects on infant mortality are less clear cut.
Child, Preschool↗
Separate lives, different interests: male and female reproduction in the Gambia.
We report the initial findings of a research programme on the fertility and reproductive health of both men and women in rural Gambia. The reproductive experiences of men and women in the population studied were very different. During the period 1993-97, the total fertility rates were 12.0 for men and 6.8 for women. For men fertility began later, reached higher levels and continued into older ages than for women. Through serial and polygynous marriages, men were able to extend their reproduction beyond what would be possible with one woman. Of the married men interviewed, 40% were married polygynously. Men's fertility preferences indicated that they recognized their reproductive potentials to be greater than those of their individual wives. On average, married men desired 15.2 children for themselves and 7.3 for each wife. In this polygynous population the means available for attaining reproductive goals were different for the two sexes, depending on the separate lives and different interests of men and women.
Adolescent↗
Improvements in childhood mortality in The Gambia.
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Child, Preschool↗
Metabolic response to injury.
OBJECTIVE: To outline the modern understanding of the aetiology of the metabolic response to injury. DATA RESOURCES: Review of the relevant literature of the twentieth century. STUDY SELECTION: Papers were selected for their relevance to the topic. Preference was for relevant animal and human studies. DATA EXTRACTION AND SYNTHESIS: Relevant papers were obtained through MEDLINE search strategies. Papers were read and analysed for accuracy of methodology, statistics, and application to the review in hand. The review also relied heavily on the author's own work. CONCLUSION: Cytokines are central to the metabolic response to injury and that understanding of their compartmentalisation in critical illness could lead to new therapeutic strategies. The complexity of the system is recognised and suggestions are made for the practising surgeon.
Critical Illness↗
Improvements in childhood mortality in the Gambia.
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Adolescent↗
Metabolic response to severe injury.
BACKGROUND: Severe injury is associated with a complex sequence of metabolic events. The accurate quantification of these changes and a developing understanding of their aetiology has been the product of much work by researchers over the past 60 years. An understanding of these phenomena is vital to the practising surgeon because of the plethora of new metabolic modulators threatening to become part of clinical practice. METHODS: This review describes the clinical picture of the metabolic response to severe injury and then outlines modern understanding of the underlying processes. RESULTS AND CONCLUSION: The need for further research before introduction of new technologies is emphasized.
Adipose Tissue↗
Cellular potassium depletion predisposes to hypokalaemia after oral sodium phosphate.
BACKGROUND: Oral sodium phosphate has become an attractive alternative to polyethylene glycol for colonic cleansing preparatory to elective colorectal surgery. Its use, however, has been associated with hypokalaemia. The authors of the present study tested the hypothesis that patients with cellular depletion of potassium are at significant risk for hypokalaemia with oral sodium phosphate bowel preparation. METHODS: In 23 patients, total body potassium was measured by whole-body counting and intracellular water volume was measured by bioimpedance analysis before oral sodium phosphate bowel preparation. Patients were divided into those whose serum potassium fell to 3.5 mmol/L or lower (Group 1) and those whose did not after sodium phosphate treatment (Group 2). RESULTS: The fall in serum potassium concentration over the period of oral sodium phosphate administration was significantly negatively correlated with intracellular potassium concentration measured prior to administration (r = -0.65, P = 0.0009). In Group 1, serum potassium concentration fell from 4.1+/-0.1 (standard error of the mean (SEM)) mmol/L to 3.2+/-0.1 mmol/L (P < 0.0001) while in Group 2 there was no significant change in this concentration (4.0+/-0.1 vs 3.9+/-0.1 mmol/L) as a result of sodium phosphate treatment. Intracellular potassium concentration prior to administration of sodium phosphate was significantly lower in Group 1 (117+/-9 mmol/L vs 143+/-7 mmol/L, P < 0.05). CONCLUSIONS: Caution should be exercised when treating patients with oral sodium phosphate who are considered to be cellularly depleted of potassium. These patients are at risk of hypokalaemia after this treatment.
Administration, Oral↗
Metabolic responses to interleukin-1: centrally and peripherally mediated.
OBJECTIVE: The purpose of this study was to differentiate between the catabolic effects of interleukin-1 (IL-1) when infused into the central nervous system or into the periphery. SUMMARY BACKGROUND DATA: After injury and infection, IL-1 has been found in the central nervous system. Chronic intracerebrovascular infusion of IL-1 produces protein catabolism, anorexia, and fever. However, IL-1 may act directly on liver and bone marrow to elicit metabolic responses. Although IL-1 is thought to be involved in a number of metabolic responses associated with injury-inflammation, the sites of action are unclear. METHODS: Rats were implanted with chronic infusion pumps and received diluent or three doses of IL-1 infused subcutaneously for 6 days, and a variety of response variables were measured. In a second study, doses were adjusted so that similar systemic catabolic responses were obtained from peripheral and intracerebroventricular infusion of IL-1. The acute-phase responses then were compared in the two groups of animals receiving IL-1 by different routes. RESULT: Subcutaneously infused IL-1 elicited catabolic responses in a dose-response manner. Similar catabolic responses were achieved by infusing one tenth of the dose of IL-1 given subcutaneously into the central nervous system. Although similar systemic responses (protein catabolism, anorexia, fever, and weight loss) were observed with both routes of infusion, the subcutaneous infusion produced a much greater lymphocytosis, elevation in acute-phase reactants, and fall in serum iron and albumin. CONCLUSIONS: The IL-1 appears to have different effects depending on the site of production and site of action. Regionalization of signal proteins such as IL-1 should be taken into consideration when devising specific anticytokine treatment strategies.
Animals↗
Perfusion standards and guidelines.
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Accreditation↗