One-stage resection of acute sigmoid volvulus.
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Acute Disease↗
Biomedical subjects
S B Naaeder
Publications and source records attributed to S B Naaeder.
Cancer of the colon and rectum in Ghana: a 5-year prospective study.
A prospective study of 134 patients who presented to a teaching hospital in Ghana for the first time with colorectal cancer between January 1987 and December 1991 is reported. The mean number of new patients per year was nearly three times that of a decade ago. The disease afflicts both sexes equally and the age of highest incidence is in the seventh and eighth decades. Some 65 patients had colonic cancer and 69 rectal lesions. Most patients presented with advanced disease and only four of 109 in whom disease was staged (3.7 per cent) had Dukes A tumours. Right-sided cancer of the colon was more common than that of the left. The importance of rectal examination is emphasized by the finding that 78 per cent of rectal tumours were within reach of the examining finger. 'Curative' resection was possible in 60 per cent of patients with colonic cancer but in only 36 per cent of those with rectal tumours. The postoperative mortality rate of patients who underwent laparotomy was 13.6 per cent and in those who had resection 5.5 per cent. Long-term follow-up was poor. These results emphasize the need for accurate data collection on colorectal carcinoma, public education on the importance of early diagnosis and follow-up after treatment. These findings also call for a study of the epidemiology and aetiology of colorectal cancer in Ghana.
Adult↗
Changing pattern of intestinal obstruction in Accra, Ghana.
BACKGROUND/AIMS: Over the past 50 years acute intestinal obstruction has remained among the commonest causes of the acute abdomen, along with peritonitis, appendicitis and gastrointestinal perforations. However several observers have noticed over the past 2 decades a shift in the etiological spectrum. The study aims at ascertaining the precise nature of the change. METHODOLOGY: Published data on intestinal obstruction from the Korle Bu Teaching Hospital over the past 50 years were reviewed, as the consistent report format permitted ready comparison of the series. Emphasis was placed on clinical features, established cause and resulting complications. RESULTS: The case load of intestinal obstruction has dwindled over the past 3 decades, accounting for 0.7% of all hospital admissions compared with 1.4% 30 years earlier. External hernias together with adhesive bands still constitute the bulk of presenting cases, but the proportions have changed with strangulated hernias accounting for 59.8% instead of 77.6%. The change has paralleled a rise in elective hernia day case surgery. The incidence of intussusception has almost doubled (7.4% from 4.0%) and it still afflicts the very young. Colonic neoplasms have been commoner over the past 2 decades although the incidence (3.3%) falls short of Western figures. Overall mortality has remained unchanged at 9.4% and this has been associated with a rise in resection rates to 18.3%. CONCLUSIONS: The patterns of intestinal obstruction have been much influenced by changing attitudes regarding elective hernia surgery and evolving financial policies.
Acute Disease↗
Clinical spectrum of acute abdominal pain in Accra, Ghana.
In a 12-month prospective study 370 patients with acute abdominal pain were admitted to a single surgical unit of a large teaching hospital. The most common diagnoses were appendicitis (23.5 percent), Non-specific abdominal pain (NSAP) (21.4 percent), acute intestinal obstruction (10.8 percent), gynaecological causes (9.5 percent, and peptic ulcer (9.2 percent). Emergency operations were performed in 146 patients (39.5 percent). Appendicectomy was the commonest operation (77 cases or 52.7 percent) and there was a high incidence of complicated appendicitis (41.6 percent). Eleven patients (3.0 percent) died within 30 days of admission (8 postoperative and 3 non-operative deaths). The clinical spectrum of the acute abdomen in this study shows that surgeons in developing countries are not facing surgical challenges similar to those of their counterparts in developed countries and the most important diagnostic distinction surgeons in both localities have to make is that between acute appendicitis and non-specific abdominal pain.
Abdominal Pain↗
Human pentastomiasis: a case report.
We report a case of human pentastomiasis in a 55-year-old farmer whose diagnosis was made incidentally during laparotomy on account of a mechanical small intestinal obstruction caused by adhesions. Encysted parasites and degenerative granulomas were found in the omentum and in the subserosal layer of the small intestine. These parasites were diagnosed as Armillifer armillatus larvae. The patient made an uneventful recovery after the operation and was discharged. He is being followed up.
Animals↗
Changing pattern of acute intestinal obstruction in Accra.
Five hundred and fifty-two cases of intestinal obstruction were seen over a two year period, January 1987 to December 1988. Strangulated external hernias and adhesions still remain the most common causes of intestinal obstruction in Accra, but there has been a change in their relative incidence with external hernias falling to 59.8 per cent and adhesive obstruction increasing to 21.0 per cent. There has been no change in the overall mortality and mortality from inguinal hernia which are still 9.4 per cent and 4.9 per cent respectively. However, there has been a significant improvement in mortality rate from volvulus and a slight improvement in mortality from adhesive obstruction even though the overall resection rate has increased from 12.7 per cent to 17.6 per cent.
Abdominal Neoplasms↗
Amputation of the lower limb in Korle-Bu Teaching Hospital, Accra.
With the increasing life expectancy of our population, peripheral vascular disease will soon become a major problem in our society. The incidence of neoplasia affecting the lower limbs is reported to be on the increase in Africa. The increased activity of our herbal colleagues has brought in its wake large numbers of patients with disastrous complications of cellulitis. The lack of sophisticated methods of diagnosis and treatment coupled with the ignorance of our people and late presentation mean that many limbs that could be salvaged will continue to be lost. We, as health workers, can lessen the emotional and social burden of these unfortunate patients by ensuring their early and rapid integration back into their communities.
Adolescent↗
Effect of acute dietary fibre supplementation on colonic pH in healthy volunteers.
Dietary fibre and undigested starch are fermented to short chain fatty acids by colonic bacteria with acidification of the colon. It has been suggested that acidification of the colon by these fatty acids inhibits bacterial metabolism, but this concept has been disputed. The aim of this study was to investigate the short term effect of a dietary fibre load on colonic metabolism. Colonic pH and breath hydrogen was measured in healthy omnivorous British male volunteers following ingestion, in turn and at weekly intervals, of 15g lactulose, wheat bran biscuits, oat bran biscuits and ispaghula husk. All the test meals caused a reduction in caecal pH and an increase in breath hydrogen production. The changes were greatest with lactulose. Lactulose and wheat bran caused acidification of the right and left colon whereas oat bran and ispaghula husk caused acidification of mainly the right colon. An inverse correlation between right colonic pH and breath hydrogen was observed in only the oat bran study. This study has demonstrated the ability of dietary fibre to lower right colonic pH and to increase breath hydrogen excretion. The changes were greater with soluble fibre than with insoluble fibre but the change in luminal pH was persistent all round the colon with insoluble fibre.
Adult↗
Effect of chronic dietary fibre supplementation on colonic pH in healthy volunteers.
Dietary fibre supplementations studies to evaluate the effect of dietary fibre on colonic and faecal pH have relied on the use of the unabsorbed disaccharide and osmotic laxative lactulose. We studied the effect of chronic dietary fibre supplementation on colonic pH in healthy British volunteers who consumed a normal mixed diet but who consumed a normal mixed diet but who were asked to double their daily intake of dietary fibre from their usual fibre sources. The median dietary fibre intake of the 5 male volunteers was 17.5 g/day. This was doubled to 34.4 g/day. The pH in all the parts of the colon decreased progressively during the period of study, being lowest at the end of two weeks of fibre supplementation. The pH returned to the presupplementation values within two weeks of cessation of fibre supplementation. This study has shown that the effect of dietary fibre on colonic pH is short-lived and therefore its use for dietary intervention in large bowel diseases should be indefinite.
Adult↗
Acute appendicitis and dietary fibre intake.
It has been postulated that acute appendicitis is the first serious disease to emerge with the adoption of fibre-depleted diets. The incidence of acute appendicitis is rising in Africa and this has been attributed to socio-economic advancement and the adoption of low residue diets. The aim of this study was to determine whether income levels and the level of dietary fibre intake play any role in the rising incidence of acute appendicitis in Ghana. Between June and November 1997 patients aged 13 years and above with acute appendicitis were studied. Their monthly net income levels or those of their parents if they were minors were ascertained and a dietary fibre questionnaire completed on each patient in order to assess his or her dietary fibre intake. The clinical details of each patient were recorded on a proforma. One hundred and seventy-three patients, 128 males and 45 females, mean age 29.2 (range 13-75) years were studied. 14 percent presented within 6 h, 46.8 percent within 24 h and 41.6 percent after 2 or more days. 53.2 percent had acute appendicitis and 42.8 percent presented with complicated appendicitis. The appendix was normal in 4.0 percent. Two patients died (1.2 percent). 61.3 percent of patients were low income earners and 38.7 percent were high income earners. The overall dietary fibre intake was 39.4 g per day with no significant difference in fibre consumption between low income earners (39.0 g/day) and high income earners (43.5 g/day). We conclude that dietary fibre may not be the important factor in acute appendicitis and other luminal and/or morphological factors may be predisposing factors.
Acute Disease↗
Multiple primary carcinomas of the gastrointestinal tract.
A case of multiple primary Carcinomas of the gastrointestinal tract is reported in a man presenting with Carcinomas of the rectum and oesophagus.
Adenocarcinoma, Papillary↗