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Biomedical subjects

B T Ugwu

Publications and source records attributed to B T Ugwu.

At least 19 recordsLinked to original sources
PubMed2003

Acalculous cholecystitis in Nigerian children.

Sixteen children with acalculous cholecystitis (AC) were treated over a 9-year period (13 male and 3 female). Their ages ranged from 8 to 18 years (median 11). Eight (50%) presented with complications (perforation 4, gangrene 2, empyema 2); 13 (80%) presented with acute AC with a duration of symptoms of 2 weeks or less while 3 (20%) presented with chronic AC with symptoms present for more than 3 months. The diagnosis was made by ultrasound except in the patients with complications, who were diagnosed at laparotomy. Salmonella typhi was cultured in the bile and blood in 2 cases and the Widal titre was significantly elevated in 4 others. One child had chronic blockage of the cystic duct by a lymph node; in 9 there was no identifiable cause. Open cholecystectomy was successfully performed in 15 cases, while 1 child was managed non-operatively. The need for early diagnosis of cholecystitis in children is obvious if the potentially life-threatening complications of perforation and gangrene are to be avoided.

Adolescent↗
PubMed2003

Testicular torsion on the Jos Plateau.

In order to determine the pattern and the factors that influenced outcome, we retrospectively studied fifty-seven patients with torsion of the testis admitted to the Jos University Teaching hospital between August 1993 and July 2001. The age ranged from 2 to 55 years with a mean of 22.7 years. Majority (79%) of the patients were in the second and third decades of life. The main suspected precipitating factors in this study were cold weather and scrotal trauma: in 28% of the cases no cause could be ascertained. Eight (14%) patients presented within 4 hours and 35 (61%) presented after 24 hours of the onset of symptoms. Both sides were equally affected. Testicular pain, retraction and scrotal swelling were the most common presenting complaints. The highest incidence 65%) occurred between November and February when the weather on the Jos plateau is coldest. At surgery, 34 (60%) patients were found to have associated congenital anomalies; in 22 (39%) patients, the testis was non-viable. There was no mortality in this series and the complications were superficial wound infection (14%), testicular atrophy (7%) and sub-fertility (16%). High index of suspicion in a patient with acute scrotum, prompt and effective surgery will improve testicular salvage.

Adolescent↗
PubMed2002

Cleft lip and palate: the Jos experience.

OBJECTIVE: To determine the pattern of occurrence of cleft lip/palate and the factors that may have influenced treatment outcome. DESIGN: Descriptive Study. SETTING: Jos University Teaching Hospital, Jos, Nigeria. SUBJECT: This study included 107 consecutive patients with cleft lip/palate managed between January 1991 and June 1997. MAIN OUTCOME MEASURES: The pattern of occurrence of cleft lip/palate, the peculiarities of the malformation in this environment as well as factors that influenced treatment outcome. RESULTS: The 107 patients were aged between one day and twenty-six years at presentation. There were three adults aged between 18 and 26 years with a mean of 22.3 years and 104 children with a mean age of 9.5 months. The male/female ratio was 1. 1:1, the anomaly was 2.4 times commoner on the left and the cleft lip alone was the most frequent mode of presentation (52%). The incidence was higher in the 3rd and 4th siblings. In 13% of these patients, there were other associated congenital anomalies such as Van der Woude's Syndrome, Down's Syndrome and congenital heart disease. Complications were noted in 16(14.9%) patients and these included dehiscence after repair in 8(7.5%) patients, oronasal fistulae in 2(1.9%), nasal speech in 4(3.7%) and hypertrophic scar in 2(1.9%). Eighty nine percent of these repairs were satisfactory to the parents of the affected children. All the adult patients were satisfied with their repair. CONCLUSION: The low incidence of this anomaly in our environment may be due to underreporting in the rural areas. Public enlightenment programs should help improve early presentation.

Abnormalities, Multiple↗
PubMed2001

Van der Woude syndrome with mental retardation: case report.

A report of a four and half-year old African patient with Van der Woude syndrome and mental retardation is reported. In addition to cleft lip/palate, hypodontia and lower lip pits; features consistent with Van der Woude syndrome, he manifested features consistent with growth and mental retardation. A genetic basis for these associated features can only be determined by detailed karyotype studies.

Abnormalities, Multiple↗
PubMed2000

Childhood intussusception: a 9-year review.

Sixty-four consecutive cases of intussusception in 48 infants and 16 older children managed at Jos University Teaching Hospital between January 1990 and December 1998 are reviewed. The age range was between 3 months and 15 years (mean 2.2 years) and the male to female ratio was 3.6:1. The quartet of abdominal pain, bloody mucoid stools, abdominal mass and palpable rectal mass was present in 70% compared with the classical triad (abdominal pain, bloody mucoid stools and abdominal mass) which occurred in only 32%. All the children had surgery. In 26 (41%) of the children, no associated cause was found, in three polyps formed the lead point and in five children a buried appendicectomy stump formed the lead point. In 30 (47%) other children, mesenteric lymphadenopathy and inflamed Peyer's patches were noted. Ileo-colic intussusception occurred in 32 (50%) children. Manual reduction was successful in 67%. Bowel resection for gangrene, irreducibility and an iatrogenic colonic tear was done in 30% of patients. Two (3%) had spontaneous reductions. There were four deaths. The commonest complications were wound infection and adhesive intestinal obstruction.

Adolescent↗
PubMed2000

Chronic osteomyelitis in patients with sickle cell disease.

OBJECTIVE: To determine the baseline pattern and audit management modalities of chronic osteomyelitis in patients with sickle cell disease. DESIGN: A retrospective study. SETTING: Jos University Teaching Hospital, Jos, Nigeria from August 1993 to July 1997. PATIENTS: Twenty four patients with concomitant chronic sickle cell disease. INTERVENTIONS: Fifteen patients had operations; eleven had sequestrectomy and curettage while four had incision and drainage. Eight patients were treated with antibiotics alone and one patient refused surgery. MAIN OUTCOME MEASURES: The demographic data of patients, aetiological agents, culture and sensitivity patterns, aetiopathogenesis, treatment modalities and outcome were analysed. RESULTS: Twenty four (36.9%) out of 65 patients who had chronic osteomyelitis also had sickle cell disease. Male:female ratio was 1.2:1. The peak age incidence (37.5%) was in the first decade of life. Seventy five per cent of infections were haematogenous. The most frequently isolated organism was Staphylococcus aureus (58.8%) while the rest were Gram negative organisms. There was no case of Salmonella osteomyelitis. The most sensitive antibiotics were gentamicin and the third generation cephalosporins. Twelve patients (50%) had good results while eight (33.3%) were still undergoing treatment. Complications recorded were persistent discharging sinuses in two cases, recurrence of symptoms in one and pathological fracture with non-union in one patient. CONCLUSION: Though the incidence of Gram negative organisms in causation of chronic osteomyelitis in patients who have sickle cell disease is high (41.2%), Salmonella osteomyelitis may be related to endemicity of the organism in a given locality.

Adolescent↗
PubMed1999

One-stage procedure in the management of acute sigmoid volvulus.

In a descriptive prospective study, twenty-seven patients with sigmoid volvulus and three with ileosigmoid knotting had primary resection of the redundant sigmoid colon with immediate anastomosis after intraoperative antegrade colonic irrigation. There was no clinical anastomotic leak nor mortality in any of our patients. Superficial wound infection occurred in four patients (13.3%). Intraoperative colonic irrigation time ranged between 25 to 50 minutes with a volume of saline/Hartmann's required to achieve a clean colon ranging between 1.5 to 5.0 litres. The duration of hospital stay ranged between 7 and 14 days. The result of this study suggests that resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage is safe provided the patient is reasonably fit.

Adult↗
PubMed1999

Spinal injuries in the Plateau State, Nigeria.

OBJECTIVE: To highlight the epidemiology, management and outcome of spinal cord injuries (SCI) in the Plateau State of Nigeria. DESIGN: A retrospective study involving case note analysis of all patients with SCI admitted into the hospital. SETTING: The study was carried out at the Jos University Teaching Hospital to cover January 1984 and December, 1997. SUBJECTS: Sixty eight cases of SCI were studied. INTERVENTIONS: Patients were managed by conservative and operative interventions especially in cervical subluxations involving C5 on C6. MAIN OUTCOME MEASURES: Neurological function was assessed employing Frankel scale. RESULTS: There was an increased hospital incidence for SCI between 1994 and 1997. Means age of presentation was 30 years and sex ratio M:F was 10:1. Vehicular accidents accounting for 49 per cent of SCIs and collapsed tunnels (26 per cent) were the two common causes. Fracture dislocation of the spine (unstable) occurred in 52 per cent and flexion wedge fractures (stable) in 14 per cent. Ten per cent of patients had no neural deficits at presentation, 21 per cent had partial cord lesions and 69 per cent complete cord lesions. Hospital mortality was 26 per cent. The four patients subjected to posterior spinal fusion, (Frankel A to E) including 8 other patients that were conservatively managed. CONCLUSION: Centres for spinal injuries should be established incorporating hospital wards, theatres, gymnasia, nursing units, occupational therapy units, activity centres and workshops. These centres will generate comprehensive data on morbidity and morality needed for future planning.

Adolescent↗
PubMed1999

Cordylobia anthropophaga mastitis mimicking breast cancer: case report.

A case of furuncular myiasis of the breast due to infestation by the larva of Cordylobia anthropophaga in a young lady is presented. Some of the physical presentations of Cordylobia anthropophaga mastitis are similar to those of carcinoma of the breast. High index of suspicion in endemic areas, including patients who had visited such areas, the characteristic intense itching of the affected breast, the use of the magnifying hand lens and subsequent extraction of the offending maggots are the invaluable aids to diagnosis and treatment. The ulcer left on the breast after extraction of the maggot should be biopsied and the associated ill defined mass and skin changes must be seen to resolve completely before carcinoma of the breast can be safely ruled out. The various methods of extraction and the preventive measures are highlighted. Though furuncular myiasis has been reported to involve every part of domestic animals, this is the first reported case in literature involving the human breast.

Adult↗
PubMed1999

Comparative study of conservative resection and radical operation for thyroid carcinomas.

OBJECTIVE: To compare mortality and morbidity in management of thyroid cancers by total lobectomy (C-R) and near-total thyroidectomy (R-O) and to relate pathological subtype to prognosis. DESIGN: A retrospective study of patients with thyroid cancers that were managed during an eleven-year period. SETTING: Jos University Teaching Hospital, Nigeria. SUBJECTS: A total of 44 patients who underwent C-R (n = 26) and R-O (n = 18) were studied. INTERVENTION: A total of 509 goitrous specimens including the excised thyroid cancers were histopathologically studied. MAIN OUTCOME MEASURES: Cases were analysed for mortality and morbidity data in the two groups during a partial follow-up period of two years. RESULTS: Mortality figures for C-R was 4% versus 11 for R-O. Postoperative haemorrhage occurred in 14% for C-R versus six for R-O. Similarly, bilateral vocal cord paralysis occurred in 11% versus 22; voice changes in 11% versus 33, transitory hypoparathyroidism 8% versus 50, local recurrence in 18% versus eleven. Hypothyroidism occurred in all patients undergoing R-O and stitch granuloma in 11% of patients in C-R group versus six for R-O. Follicular carcinoma constituted 59% of the total number thyroid cancers with papillary cancer constituting 35%. CONCLUSION: C-R is recommended as the operation of choice for thyroid cancers.

Adenocarcinoma, Follicular↗
PubMed1998

Single-layer closure for typhoid perforations of the small intestine: case report.

The case of a 13-year old girl who presented with generalised peritonitis, septic shock and laboratory features of perforated typhoid enteritis is presented. At laparotomy 25 perforations involving the distal jejunum and the entire ileum were noted with extensive peritoneal soilage. The perforations were successfully closed in single layer using vicryl (polyglactin 910) sutures and the peritoneum thoroughly lavaged. The patient has been followed up for thirty months with only minimal complications. We believe that single layer closure of extensive multiple typhoid perforations in a poor risk patient when weighed against resection and anastomosis with the possibility of short bowel syndrome is safer, quicker and more effective as long as the procedure is undertaken after adequate resuscitation and under appropriate antibiotic cover.

Adolescent↗
PubMed1998

Fracture of the penis--a rare injury on the Jos Plateau, Nigeria.

A case of a 37 years old veterinary surgeon who sustained right sided fracture of the base of the penis during masturbation is presented. He was seen more than 48 hours after his injury with the typical painful swelling, angulation and tenderness at the fracture site. The tear was promptly repaired using the Laubscher's subcoronal sleeve technique. He regained his ability to achieve erection on the third post operative day. This is a rare injury on the Jos Plateau--being the only documented case in 11 years in this tertiary health facility and so we consider it necessary to highlight salient points in the diagnosis and treatment. Psychotherapy was found very useful in this patient in order to wean his off masturbation especially during the immediate post operative period. His short term follow up has been uneventful; he is now able to achieve normal and straight erection and sexual intercourse without pain--a view corroborated by his wife.

Adult↗
PubMed1997

Management of childhood splenic trauma--the Jos experience.

We studied retrospectively 22 children who were managed for splenic injuries at Jos University Teaching Hospital between September 1988 and October 1995. Sixteen were males and six were females (M:F = 2.7:1) with their ages between five and 15 years and a mean of 10.3 years. Eleven were knocked down by vehicles while crossing the freeway, playing or hawking goods; seven fell from slippery mango trees after a downpour of rain while two were passengers in a vehicle that was involved in a head-on collision and another two were kicked in the abdomen as a result of assault. All had surgery. Four sustained Uphadhyaya and Simpson's Type 1 injuries while six sustained Type IV injuries. Twelve had total splenectomy, seven had total splenectomy with heterotopic autotransplantation of splenic wafers while three had splenorrhaphy augmented with omentoplasty. An average of 1.5 units of blood per patient were transfused. There was only one death. Considering that the majority (18) of these children sustained their splenic injuries while crossing the freeway (playing or hawking goods) and from falls from mango trees after the rains, we believe that there are preventable causes. Mandatory primary and junior secondary school education as well as legislature against child labour will help keep these children safe out of harm's way and thus drastically reduce the incidence of childhood splenic injuries in our environment.

Adolescent↗
PubMedDate not supplied

Marfan's syndrome presenting with abdominal aortic aneurysm: a case for vigilance.

We present the case of a 16-year old student with Marfan's syndrome and abdominal aortic aneurysm who presented with a diagnostic conundrum. He presented with a three months history of progressive painful left upper abdominal mass and back pain. It became severe in the last two weeks before presentation and was associated with constipation. This mass was thought to be of splenic origin but the initial ultrasound suggested a pancreatic pseudocyst. Review of his previous hospital record revealed that he had been treated for severe myopia which started at infancy. Another opthalmic review at our centre revealed bilateral ectopia lentis. He had no cardiac signs and no family history of cardiovascular diseases. He is the 6th of 8 siblings, all the family members are alive and healthy except one sibling who died at 7 months. The diagnosis of abdominal aortic aneurysm was only made at laparotomy and confirmed by on-table aortogram. He had excision of the aneurysmal sac and replacement with on-lay dacron tube graft. He died on the 4th post-operative day. A diagnosis of abdominal aortic aneurysm was not made at initial presentation because of the rarity of this condition in our environment and incompetence of the ultrasonographer. Aortic aneurysm in Marfan's syndrome is commonly found in the thoracic part of the aorta, however in this case, it is abdominal. A high index of suspicion is necessary to avoid missing this pathology, therefore the need for vigilance.

Adolescent↗
PubMedDate not supplied

Typhoid intestinal perforation in north central Nigeria.

BACKGROUND: Typhoid intestinal perforation is a surgical problem with severe morbidity and high mortality in North Central Nigeria. PATIENTS AND METHODS: In order to determine the pattern and the prognostic indices, we studied 101 patients with typhoid intestinal perforation managed over a ten-year period RESULTS: Children constituted 49% of the cases and majority (78%) of the patients were in the low socio-economic strata. The incidence peaked to 67% between November and March - the dry season in Nigeria. The male/female ratio was 1.9:1 with a mean age of 19 years and a mean hospitalization period of 18 days. There were 167 perforations; four involved the large bowel and appendix, and in 72.2% cases, the perforation was single. The mortality rate was 13.9%, affected mostly children and significantly worsened by prolonged perforation-surgery interval > 72 hours, jaundice, convulsion, ASA V, faecal peritonitis and re-exploration for early intra-peritoneal complications. Morbidity rate was 65.3% and significantly affected more children than adults and associated with perforation-surgery interval of between 24 and 72 hours, haematochezia and multiple perforations. Moribund patients fared better when operated upon under local anaesthesia with adequate analgesia. The least traumatic but effective surgical procedure that could seal the perforations and keep the peritoneum clean gave the best results. Children who survived up to 5 days and adults who survived up to 10 days after surgery had better chances of survival. CONCLUSION: The most significant prognostic factor is late presentation which prolongs perforation-surgery interval and the other complication and mortality indices are directly influenced by it.

Adolescent↗
PubMedDate not supplied

Male breast malignancy in Jos University Teaching Hospital.

BACKGROUND: Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. PATIENTS AND METHODS: A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.) RESULTS: A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality. CONCLUSION: MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.

Adolescent↗
PubMedDate not supplied

Clinicopathological features and molecular markers of breast cancer in Jos, Nigeria.

BACKGROUND: Several studies have suggested that breast cancer in black women is associated with aggressive features and poor survival. This study examines molecular markers along with clinical stage and pathological grade in breast cancer material from Jos, Nigeria. STUDY DESIGN: The histological diagnoses of 178 consecutive Nigerian patients with breast cancer were retrieved from their hospital records. A subset of 36 patients was staged and their tumours typed and graded. Immunohistochemical staining of sections from paraffin wax embedded tissues from these cases for the expression of oestrogen receptor (ER), progesterone receptor (PGR), Human ERBB2 (or HER2/neu), p53 and cyclin D1 (CCND1) was carried out using the avidin biotin complex (ABC) procedure. RESULTS: A majority of the cases were invasive ductal carcinoma (92.7%), high grade (grade 3, 70.6%) and of late clinical stage (stages III and IV, 58.3%). Only 25% and 27.8% of cases expressed ER and PGR respectively. The ERBB2 and CCND1 antigens were expressed in 25%, and 5.7% of cases respectively. The p53 protein was the most frequently expressed in this study (47.2% of cases). High grade tumours were significantly more likely to be ER and PGR negative (P = 0.006 and P = 0.002 respectively). CONLCLUSION: There is predominance of high grade, invasive ductal carcinomas which are likely to be ER and PGR negative but p53 positive. These features suggest a biologically aggressive form of breast cancer in Nigerian women with the possibility of poor response to both hormonal therapy and chemotherapy.

Adolescent↗