Mucinous colonic adenocarcinoma in patients aged under 25 years.
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Adenocarcinoma, Mucinous↗
Biomedical subjects
J M Adotey
Publications and source records attributed to J M Adotey.
Primary malignant tumours of the small intestine.
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Adenocarcinoma↗
Incisional hernia: a review.
BACKGROUND: Otherwise known as post operative ventral hernia, incisional hernia is a common complication following abdominal surgery and is a significant cause of morbidity. This review examines incisional hernia from its historical perspective to the present. METHOD: A Literature review of the topic was carried out using manual library search of journal articles on the topic published both locally and internationally. The search also made use of intemet material from Pubmed and Medline on relevant parts of the topic. All relevant articles from the reference lists of these papers were also studied. RESULT: Incisional hernia is a common complication of abdominal surgery. Its incidence is about 1% following primary healing and increasing to about 11% with postoperative wound infection. The most consistent causative factor is wound infection and the incidence may rise to 30% after abdominal wound dehiscenece and resuture. It may be difficult to repair and a wide range of surgical procedures have been developed for such repair. The repair may be direct suture or prosthetic mesh using the open or laparoscopic technique. Prosthetic mesh has revolutionized the repair of incisional hernias. Laparoscopic repair, which was introduced in the 1990's, has been adjudged feasible, safe and as effective as the open methods of repair. Recurrence rates of up to 49% with direct suture repair have been reported. Open and laparoscopic mesh repair have recurrent rates of 0-10% and 0-9% respectively. CONCLUSION: Despite improved surgical techniques and the use of prosthetic mesh incisional herniation remains a major problem for the general surgeon.
Hernia, Abdominal↗
Ileal carcinoid.
BACKGROUND: Gastrointestinal carcinoids are ill understood, enigmatic malignancies which are extremely difficult to diagnose. In spite of their slow growth rate, they can be aggressive. The aim of this report is to present a case of ileal carcinoid which produced a complete intestinal obstruction. METHOD: The case records of a 78-year-old tailor who was treated over a period of one year and diagnosed with an ileal carcinoid and a review of literature using medline and manual library search were used. RESULT: The patient was admitted and treated conservatively on two occasions in 2004 with features of subacute intestinal obstruction. He improved on each occasion and was discharged. He was admitted for the third time in 2005 with complete intestinal obstruction which required an exploratory laparotomy. A small, hard and completely obstructing tumor was found in midileum. No synchronous tumor was detected and there was no ascites. The liver felt and looked normal. Ileal resection and end-to-end anestomosis was done. Post operative recovery was complicated by a bout of severe diarrhea which required intravenous fluid therapy. There was good wound healing and was discharged 12 days after laparotomy. He was well clinically at follow-up review one month afterdischarge. CONCLUSION: The case illustrates the difficulty in making a diagnosis of this condition before surgery.
Aged↗
The pattern of stab injuries in Port Harcourt.
All cases of stabbing reporting to the casualty Department of the University of Port Harcourt Teaching Hospital (UPTH) between 1st January 1997 and 31st December, 1997 were studied prospectively. Fifty new cases reported within the study period. Thirteen cases required admission while 37 cases were treated and discharged from the casualty department. The majority of injuries were minor and most victims were male and of these, students in the age group 21 - 30 years formed the greatest number. The most common weapon used was broken bottle and injuries involving multiple anatomic regions were in the majority. All cases requiring major surgical intervention reported within 6 hours of injury. No mortality was recorded.
Adolescent↗
Postoperative intussusception, causal or casual relationships?
Postoperative intussusception (POI) is a recognised but uncommon condition. Primary intussusception has been reported several times from Africa, but there are only two reports of postoperative intussusception. A literature review on POI was performed by searching the Medline between 1966 and 1998 together with relevant references in publications on the subject. Postoperative intussusception occurs within a month of an operation. It differs from primary intussusception. No specific aetiology has been found. Predisposing factors based on disorder of peristalsis have been proposed. At risk are patients with prolonged postoperative ileus after prolonged surgery with extensive dissection or after a postoperative regimen of radiation and/or chemotherapy. The diagnosis requires a high index of suspicion. Contrast radiology is not reliable in the diagnosis. The preferred treatment is operative reduction, but resection may be indicated. There are no reports of recurrence after surgical treatment. Preventive measures include gentle handling and avoidance of drying of intestines at operation. The paucity of reports from Africa may mean that the diagnosis is being overlooked.
Adult↗
Informed consent: how informed are patients?
BACKGROUND: By casual interaction with patients our impression was that patients lacked adequate knowledge about their ailments and surgical treatment. There is now increasing educational exposure and legal awareness in the society. AIM: To reassess the extent of the practice of "informed consent" expose failures if any, and make appropriate recommendation. METHODS: A written questionnaire, randomly distributed to patients, sought to find out to what extent patients admitted into the University of Port Harcourt Teaching Hospital (UPTH) were adequately informed about their ailments and the implications of surgical treatment. RESULTS: One hundred and fifty patients were randomly recruited into the study and all responded to the questionnaire. Majority of the patients (75%) knew their diagnoses. Most patients (63%) did not know the problems that could be associated with their surgery while 75% did not know the complications of anaesthesia. CONCLUSION: There is need for a closer interaction in communication between patients and their surgeons. This will facilitate the participation of patients in decisions on treatment options and consequently help to maintain a satisfactory standard of practice and reduce litigation following an unfavourable outcome of surgical treatment.
Adult↗
Attitudes to, knowledge and practice of breast self-examination (BSE) in Port Harcourt.
BACKGROUND: Many of the cases of carcinoma of the breast we find in our clinic are advanced, sometimes with fungation. We believe that if women in Port Harcourt are knowledgeable about breast self-examination (BSE) and practise it, this scenario may not be so. AIM: The study is intended to highlight the extent of their knowledge vis-à-vis their practice of BSE. METHOD: A written questionnaire was distributed to 200 women from different walks of life in Port Harcourt to assess their attitudes to, knowledge and practice of BSE. Their responses were then collated and analyzed. RESULTS: Ninety-eight percent of the respondents had formal education, majority having obtained tertiary education. Eighty-five point five percent of them had heard of BSE but 39.0% practised BSE only occasionally, while 24.0% did not practise it at all. Among 76 health workers who participated in the study, 60.0% of doctors and 53.7% of nurses practised BSE only occasionally. Only one doctor could describe how to perform BSE correctly. The news media, nurses and physicians were the commonest sources of information on BSE. CONCLUSION: Most women in Port Harcourt, though aware of BSE and its usefulness never practise it. Those who care to practise it are ignorant of how to correctly do it. There is need for a vigorous health education programme on this subject for our women. It is hoped that this will help to reduce the morbidity and mortality associated with carcinoma of the breast.
Adult↗
Anorectal disorders requiring surgical treatment in the University of Port Harcourt Teaching Hospital, Port Harcourt.
BACKGROUND: The prevalence of anorectal disorders requiring surgical treatment has not been previously documented in the University of Port Harcourt Teaching Hospital (UPTH). AIM: To find out which of the anorectal disorders were most commonly managed surgically in the UPTH from January 1 1998 to December 31 2002. METHODS: The case notes and theatre records of all anorectal conditions treated surgically were studied retrospectively. They were analysed with respect to age, sex, type of lesion, duration of pathology before surgery, surgical treatment performed, hospital stay, complications and outcome. RESULTS: Seventy patients were so treated. Males outnumbered females in a ratio of 1.2:1. The commonest age groups treated were in the first, third and fourth decades of life. The commonest conditions treated were haemorrhoid, fissure-in-ano, imperforate anus and fistula-in-ano. Apart from imperforate anus cases, the mean duration of symptoms before surgery was 18 1/2 months. Open haemorrhoidectomy, lateral internal sphincterotomy and fistulotomy/fistulectomy were themain procedures performed. The procedures for imperforate anus varied from simple serial anal dilatation to perineal pull through operations. Main complication encountered was post hemorrhoidectomy anal stenosis. The mean hospital stay was 16.9 days. Mortality rate was 1.4%. CONCLUSION: Haemorrhoid, fissure-in-ano, imperforate anus and fistula-in-ano were the commonest conditions treated surgically in UPTH over the 5 year period.
Adolescent↗
HIV positive patients and the surgeon.
BACKGROUND: Guidelines for the surgical treatment of HIV infected patients are lacking in Nigeria. The Social stigma of the infection and fears of contracting the disease discourage healthcare providers from treating the patients. OBJECTIVE: To present cases treated by surgeons and thereby stimulate interest on the need to offer these patients needed treatment. METHODS: A written questionnaire was sent to surgeons based in the University of Port Harcourt Teaching Hospital who have operated on patients known preoperativly to have HIV. Information sought included age, gender, indication for surgery, operation done, outcome of operation, indication for HIV test and information given to the patient after the test. RESULTS: a total of 26 HIV infected patients received surgical treatment in private and company clinics and there were 18 females and 8 males aged between 8 and 48 years. Most of these were in the 2nd to 4th decades. The operations were elective, emergency or urgent. Pregnancy-related indications predominated. Three patients volunteered their status. One when told she was HIV positive declined a planned right nephrectomy for hypernephroma. Nineteen patiens were discharged from hospital well. Three patients and parents of two were informed by the surgeons that they were HIV positive preoperatively. Five patients died postoperatively. CONCLUSION: There is need to promote awareness on the obligation of suregeons to offer these patients surgical treatment. A protocol and adequate facilities for prophylaxis for health care workers exposed to infection from patients should be established in Nigeria.
Adult↗
Pattern of surgical acute abdomen in the University of Port Harcourt Teaching Hospital.
This paper presents a retrospective study on 279 cases of surgical acute abdomen seen and treated at the University of Port Harcourt Teaching Hospital over a period of about 2 1/2 years, September 1983-February 1986. The majority of the patients were in the second and third decades of life. Acute appendicitis and obstructed hernias were the commonest causes of surgical acute abdomen, while abdominal pain and vomiting were the commonest symptoms. Only two patients in the series had acute pancreatitis. The overall mortality was 13.3%.
Abdomen, Acute↗
External intestinal fistulae in Port Harcourt.
Twenty cases of established external faecal fistulae treated at the University of Port Harcourt Teaching Hospital (UPTH) over an eight year period were studied to find out the peculiar characteristics of this problem in this part of Nigeria. The male/female ratio was 3:1 Surgical complications constituted the commonest cause of fistula formation (65%). 80% of the patients were referred to the UPTH from peripheral hospitals and clinics. All patients were initially treated conservatively by nutritional build up, correction of fluid and electrolytes, control of infection and, where necessary, blood transfusion. 15% of fistulae closed spontaneously on conservative treatment while 55% required surgery for a successful outcome. The overall mortality was 25%.
Adolescent↗
Colostomy--the Port Harcourt experience.
Over the 7 years period from January 1986 to December 1992, 36 colostomies were performed at the University of Port Harcourt Teaching Hospital (UPTH). The indications for the procedure were classified under congenital, traumatic, neoplastic and miscellaneous groups. Imperforate anus and Hirschsprungs disease, under the congenital group, formed the commonest indication (19 cases); traumatic conditions followed with 9 cases, carcinoma of the rectum comprised 5 cases while there were 3 cases in the miscellaneous group--made up of 2 sigmoid volvulus and one of stercoral perforation of the sigmoid colon. 27 of the colostomies were loop transverse, 6 absolute defunctioning transverse and 3 terminal Permanent). The peculiar problems encountered with this procedure are also highlighted.
Adolescent↗