Biomedical subjects

V M Ramyil

Publications and source records attributed to V M Ramyil.

8 recordsLinked to original sources

PubMed2004

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

Causality↗

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↗

PubMed2000

Safety of daycare hernia repair in Jos, Nigeria.

OBJECTIVE: To evaluate the safety of day surgery for inguinal hernia. DESIGN: A randomised prospective study of patients presenting for elective inguinal hernia repair. SETTING: Jos University Teaching, Jos, Nigeria. SUBJECTS: One hundred and twenty one patients who completed a six-week follow up period. INTERVENTIONS: Sixty one patients had elective hernia repair as daycares while 60 patients were treated as inpatients. Forty six herniotomies and seventy five herniorrhaphies were performed under local or general anaesthesia. MAIN OUTCOME MEASURES: Early post-operative complications, including wound complications were evaluated. RESULTS: Early post-operative complications occurred in two of the 61 daycares and 15 of 60 inpatients (p=0.002). There were twelve and ten wound complications in daycares and inpatients respectively (p=0.668). There was no mortality. CONCLUSION: Outpatient elective inguinal hernia repair in carefully selected patients is relatively safe in our environment.

Adult↗

PubMed1999

Patient acceptance of outpatient treatment for inguinal hernia in Jos, Nigeria.

BACKGROUND: Patient acceptability constitutes an important component of outpatient treatment for hernias. It is essential that patients are properly selected so that only those who need admission are admitted and cared for with the limited available resources. It is also equally important that those who qualify for outpatient care are adequately informed that there is no added risk attributable to outpatient treatment and that they are free to accept or reject such treatment. OBJECTIVE: To determine the acceptability of day care treatment for inguinal hernia in our environment. DESIGN: Prospective cross sectional study. SETTING: Jos University Teaching Hospital. SUBJECTS: 121 selected patients were randomized to undergo elective inguinal hernia repair either as outpatients (61) or inpatients (60). MAIN OUTCOME MEASURES: Six weeks after operation, an assessment of patients' opinion was made as to their preferred method. RESULTS: 52 of 61 day cases and 24 of 60 inpatients preferred outpatient treatment, while two daycare patients and 36 inpatients preferred hospital admission (p < 0.001). Altogether, acceptability rate for outpatient treatment was 68.6%. CONCLUSION: in carefully selected and adequately informed patients, outpatient elective inguinal hernia repair is readily acceptable.

Adult↗

PubMed1997

alpha-receptor blockade for benign prostatic hyperplasia: uses and problems in a developing country.

OBJECTIVE: To evaluate the use and problems of alpha-receptor blockade with prazosin among patients in Nigeria with benign prostatic hyperplasia (BPH) who face a prolonged wait for a prostatectomy. PATIENTS AND METHODS: The study comprised 31 patients (mean age 64.4 years, range 55-89) facing a prolonged wait for prostatectomy: in group 1, 14 patients presented in acute urinary retention and had an indwelling urethral catheter; in group 2, six patients had indwelling catheters but removal was deemed necessary to control urinary tract infection: in group 3, 11 patients had troublesome symptoms from BPH but no retention. Some of the patients were also hypertensive. After receiving I mg of prazosin twice daily, the catheters were removed at various intervals and the effect on symptom scores and residual urine volume determined after one week and 2 months. RESULTS: Prazosin allowed the catheters to be removed, improved the symptoms of prostatism and/or controlled high blood pressure in seven, five and nine patients in each group, respectively. CONCLUSION: The use of this alpha blocker for BPH in the absence of facilities to measure urinary flow rate, intravesical pressure and serum prostate specific antigen can be justified for short periods. However, a large default rate among these patients raises additional questions about long-term safety and underlines the importance of selecting patients carefully.

Adrenergic alpha-Antagonists↗

PubMedDate not supplied

Surgical experience with management of vascular injuries.

UNLABELLED: To highlight the problems that are associated with the causes, diagnosis and management of vascular injuries. MATERIALS AND METHODS: A retrospective study of 52 cases of vascular injuries managed at the Jos University Teaching Hospital (JUTH) during a ten year period. RESULTS: The sex ratio M:F was 6:1 and the mean age at presentation was 23 years. The most common causes of vascular injuries were road traffic accidents in 44 per cent, iatrogenic 27 per cent and industrial in 13 per cent. These resulted in 50 cases (96 percent) of penetrating vascular injuries and 2 (4 percent) of blunt injury to vessels. Fifty-four percent of patients presented in shock. Active bleeding was recorded in 81 percent, pulse deficit in 65 percent and frank gangrene in 16 per cent. Aneurysms of various types occurred in 14 percent. Associated injuries were fractures in 60 percent, soft tissue injuries in 56 per cent and peripheral nerve injuries in 10 per cent. Overall, 52 arteries and 51 veins were injured, resulting in 15 lacerations, 74 complete transactions and 2 vascular blunt injuries with intimal tears and intraluminal thrombosis. Direct lateral suture of vessels was employed in 13 vessels, anastomosis in 12 vessels, graft interposition in 4 cases, ligation in 49 cases and aneurysmectomy in 3 cases. Three primary amputations were performed versus 7 secondary amputations. Hospital mortality was 16 percent and was mainly due to hypovolaemic shock, acute renal failure and sepsis.

Accidents, Occupational↗

PubMedDate not supplied

The acute scrotum: aetiology, management and early outcome-preliminary report.

BACKGROUND: Most patients with acute scrotal pain may require urgent exploration. We determined the aetiological factors, treatment and early complications in such patients. METHODS: This was a prospective study of consecutive patients presenting with the acute scrotum at Jos University Teaching Hospital, Nigeria from January 2001 to December 2002. RESULTS: Twenty-nine patients were studied with a mean age of 29.4 years (range 12 days to 80 years). Seventeen (58.6%) were 11 to 30 years old. The clinical diagnostic accuracy for testicular torsion was 75% because out of the 24 patients initially thought to have testicular torsion, 18 (62.1%), four (14.8%) and two (6.9%) had testicular torsion, epididymoorchitis and torsion of appendix testis respectively at exploration. The diagnosis in other patients was intrascrotral abscess in two (6.9%), Fournier's gangrene in one (3.4%) and haematocoele in one (3.4%). Only four (13.9%) patients presented within the first 24 hours of illness (all explored within 6 hours) and 14 (48.3%) in one to five days. Thirteen (44.6%) patients had orchidopexy while seven (24.2%) had orchidectomy as a result of testicular torsion (five) and intrascrotal abscesses (two). Testicular exploration only, with antibiotics was the treatment for patients eventually found to have epididymoorchitis, with good response. Testicular salvage rate was 72% in patients with testicular torsion. Postoperative complications observed in three patients were wound infection (two) and wound dehiscence (two). CONCLUSION: We conclude that testicular torsion is the most common cause of acute scrotum in our environment. Majority of our patients with acute scrotum present to hospital late. Health education of the public and attending physicians is required in order to reduce delay in presentation, improve diagnostic skills, testicular salvage rate and prognosis.

Acute Disease↗