Biomedical subjects

R C Echem

Publications and source records attributed to R C Echem.

7 recordsLinked to original sources

PubMed2004

Chronic pyonephrosis associated with renal neovascularisation.

The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.

Adult↗

PubMed2003

Nephrectomy at the University of Port Harcourt Teaching Hospital: a ten-year experience.

The case records of patients who had nephrectomy from 1989 to 1998 were retrieved. Data extracted for analysis included age, sex, clinical features, indications for nephrectomy, post-operative complications and histological findings. Thirty-four unilateral nephrectomies in 21 males and 13 females were done. The patients were aged between 1.5 to 75 years. The predominant presenting features were abdominal pain (76.5%), abdominal mass (70.6%), haematuria (61.8%) and weight loss (47.1%). Diagnostic investigations were intravenous urography and renal ultrasound scan. The major indications for renal exploration included non-functioning kidney and renal mass suspected to be carcinoma. The histopathological findings included renal malignancy 23 (67.6%), hydronephrosis 6 (17.6%) and renal infections 3 (8.8%). The male/female ratio in nephrectomy for malignancy was 1:1.09. Renal trauma was the indication in only one patient. Non-functioning kidneys on intravenous urography (IVU) occurred in both malignant and infective lesions. Hypertension was found in 9 patients preoperatively. It resolved in 7 patients after operation. The histological finding in one kidney differed from what was assumed at operation. Follow-up USS showed compensatory hypertrophy in the remaining kidneys. Post-operative sepsis occurred in 4 patients. One of these was a retroperitoneal abscess. Two patients with huge tumours died on the operating table. Two died from sepsis. Four patients died from metastatic disease within two years after operation. Malignancies constituted the commonest indication for and commonest cause of mortality in nephrectomy. Antibiotics prophylaxis is advocated. All nephrectomy specimens should be subjected to histopathological examination.

Adolescent↗

PubMedDate not supplied

A simple lithotomy device for children.

BACKGROUND: The position of the patient is important for good access during surgery. The aim of this paper is to present a simple lithotomy device for children. METHOD: We present a simple easy-to-construct and affordable lithotomy device utilizing locally available materials for paediatricpatients. RESULTS: A simple, cheap and easy-to-construct lithotomy device for children has been used in our centre. It is also easy to sterilize and very durable. No complication has been noticed so far that is attributable to the lithotomy device. It has been used for Swenson's procedure for Hirschsprung's disease, and rectal biopsy. CONCLUSION: The affordability of the device will save hospital administrators and the country great cost while still being effective. The device is being recommended for use in developing countries where paediatric operating tables are not available.

Child↗

PubMedDate not supplied

Slow, gradual external fixator distraction in acquired ankle and foot contracture.

BACKGROUND: External fixators have been noted to have a place in the orthopaedic management of problems involving the ankle and foot. We here report a case of ankle and foot contracture managed by soft tissue release and slow, gradual external fixator distraction. METHOD: A case report of a patient with acquired ankle and foot contracture and discussion of relevant literature. RESULTS: A 9-year old female presented to our out-patient clinic with features of right ankle and foot contracture following treatment by traditional bone setters 6 years earlier. The contracture was fixed at 30 degrees. She had soft tissue release and slow, gradual external fixator distraction which corrected the foot to a plantigrade position. Subsequently she had skin grafting for the skin defect. After removal of the external fixator she was placed on a below knee cast and commenced weight bearing. The cast was removed after three weeks and the patient has continued to bear weight on a plantigrade foot. CONCLUSION: External fixators have a definite place in contracture release and should be widely utilized.

Ankle Injuries↗

PubMedDate not supplied

Fournier's gangrene in Nigeria: a review of 21 consecutive patients.

A review of 21 consecutive cases of Fournier's gangrene seen at the University of Port Harcourt Teaching Hospital (UPTH) in the period 1994-1998 is presented. All the patients were males with an average age of 43.4 years. Most of the patients had a predisposing factor. There was a low incidence of pre-existing medical conditions. The commonest organisms isolated were of the enterobacteria group. All the patients were treated with antibiotics, surgical debridement and frequent wound dressings with hypertonic saline, hydrogen peroxide and Eusol. In 71.4% of the cases, the wounds healed by secondary intention. The mortality was 9.5%. The deaths occurred in the older age group. We recommend surgical debridement of necrotic tissues as they present and suggest that the surgical procedures be minimal as scrotal wounds heal satisfactorily.

Adult↗

PubMedDate not supplied

Renal cell carcinoma presenting as a scalp swelling.

BACKGROUND: Renal cell carcinoma occasionally presents in an unusual manner. AIM: To report the rare presentation of renal cell carcinoma as a scalp swelling. METHOD: The case record of a patient with renal cell carcinoma and the literature on the disease were reviewed. RESULT: A 42-year old woman presented with a scalp swelling. Haematuria was missed at the first visit until she volunteered it on a subsequent visit. Investigations suggested renal cell carcinoma. This was confirmed following a right nephrectomy. The scalp lesion was a metastasis extending through the skull into the intracranial compartment. She was not given any systemic drugs because none was available. She survived until she was lost to follow up. CONCLUSION: Haematuria remains an important symptom of renal cell cancer and should be elicited during systemic enquiry.

Adult↗

PubMedDate not supplied

Conservative management of tuberculous spondylitis in a developing country.

BACKGROUND: Tuberculous spondylitis is a significant health burden in the Third world. Tuberculosis and its complications are on the increase because of the HIV/AIDS challenge. The aim of this study was to review the patients managed for tuberculous spondylitis at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. METHODS: This was a retrospective study of patients seen at the University of Port Harcourt Teaching Hospital between January 1999 and December 2002 with tuberculosis of the spine. Patients case notes were reviewed after collating out-and-in-patient records. Analysis was done using multiway frequency tables. RESULTS: There were 16 males and 18 females, with a ratio of 1:1.1. Their ages ranged from 3.3 to 82 years with an average of 31.1. Peak ages of occurrence were the 3rd and 4th decades. Eighteen patients (52.9%) presented within the first 6 months of symptoms. The most frequent presenting symptoms were back pain, weight loss, difficulty with walking, low grade fever, and night sweats. The most frequent signs were gibbus and lower limb paralysis. The most common association was pulmonary tuberculous (32.4%). The thoracic spine was mostly affected, followed by the lumbar spine. Wedge collapse of the vertebrae was the common radiological finding. Twenty two patients had multilevel affection. Twenty patients (71%) had a lymphocyte differential of more than 45%, 87% had erythrocyte sedimentation rate of over 20 mm/hr. Westergren, and Mantoux test was positive in 55 percent of the patients. Twelve patients had outpatient treatment and 22 had in-patient treatment. Duration of hospital stay ranged from 7 to 157 days with an average of 62.6 days. All the patients had standard combination antituberculosis therapy. No patient had surgery for tuberculous spondylitis. Outcome of treatment was good (68.2%). Follow up was poor with a high default rate. There were 3 mortalities (8.8%). CONCLUSION: Diagnostic delays partly due to lack of experience makes a high index of suspicion necessary to make a diagnosis. Outcome utilizing conservative methods of treatment is good.

Adolescent↗