From the Breast to the Finger - A Case Report of Acrometastasis

BACKGROUND

Acrometastasis is an unusual presentation that is associated with a poor prognosis.

SUMMARY OF CASE

We report a case of an advanced breast cancer in a Nigerian woman, with clinical, radiological and histopathological features of lung, brain, and distal phalanx metastases. We report this case to highlight the need to have a high index of suspicion for acrometastasis as well as to emphasize the effect and challenges of managing metastatic breast cancer in a low-income country.

CONCLUSION

Breast cancer metastasis to the bones of the hand is a rare condition and associated with poor prognosis.

Awareness and Knowledge of Breast Cancer and Breast Examination amongst Undergraduate Students. Mixed Method Approach

INTRODUCTION

Breast cancer is the most common cause of cancer death amongst women, and the stage at presentation has been found to be an important prognostic index. The study aims to assess breast cancer awareness, including breast cancer education and knowledge of breast self-examination, among undergraduate students with the hope of improving their knowledge of breast cancer.

METHODS

The study used the mixed method approach, to evaluate during breast cancer awareness month. All consenting participants completed a pre-test questionnaire before a breast health seminar, after which the post-test questionnaire was filled out. Consenting participants also had clinical breast examinations performed on them. The data were analyzed using IBM SPSS version 24.

RESULTS

One hundred and thirteen participants filled out the pre-test questionnaire while 127 participants filled out the post-test. There was a significant change following the seminar. About 87.9% of respondents knew about breast cancer but had poor knowledge of the predisposing factors (11.3%). Most participants (94.3%) knew about self-breast examination (SBE), however, only 46% examined themselves in the past with only 21% aware of the correct timing for SBE. Clinical breast exams were conducted on 80 participants, six (7.5%) breast lumps were found and two had excision biopsies with histopathology diagnosis of fibroadenoma.

CONCLUSION

Breast education is important, as knowledge about breast cancer is still low, even among undergraduate students. Continuous breast education should be encouraged.

Audit of Preoperative Fasting for Elective General Surgeries in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria

BACKGROUND

Despite overwhelming evidence in favour of a relaxed fasting protocol, the traditional practice of keeping patients nil per oral from midnight before the day of surgery for all elective operations still appears to hold sway in many practices.

METHODS

A prospective study to evaluate the pattern of preoperative fasting among patients undergoing elective general surgical operations in the Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was conducted between June and December 2020. Data obtained was analysed using the IBM SPSS Statistics for Windows, version 24, and presented as descriptive statistics in the form of frequencies and percentages.

RESULTS

The mean prescribed fasting duration was 11.2 ± 2.4 hours. The mean actual fasting duration of 17.6 ± 13.1 hours was significantly longer than the mean prescribed fasting duration (p= <0.001). Eighty-nine percent of patients fasted for >12 hours before their surgical operations. Bowel surgeries had the longest actual fasting duration of 34.9 ± 27.5 hours, while ventral hernia repairs and superficial mass excisions had the shortest duration of 13.5 ± 0.7 hours. Surgeries performed after noon had the longest actual fasting duration compared to those performed before noon (21.5 ± 18.7 hours vs. 15.6 ± 8.6 hours). Ninety percent of respondents reported hunger score of>4 while fasting.

CONCLUSION

Preoperative fasting duration in our surgical unit remains long and conventional. The potential implications of this practice on patients' physiological status and surgical outcomes are strong enough to motivate a change.

Effectiveness of Triclosan Coated Suture for Subcutaneous Wound Closure in Preventing Surgical Site Infection following Mesh Repair of Inguinal Hernia: A Pilot Study

BACKGROUND

The role of prophylactic antibiotics in mesh repair of inguinal hernia is controversial and often based on institutional policies. Surgical site infection rate from earlier studies in Nigeria justifies the continued use of prophylactic antibiotics during hernia repair. With increased use of antibiotics comes the challenge of antibiotic resistance and toxicity. The use of antimicrobial coated suture may help avoid these challenges but its efficacy needs to be tested.

OBJECTIVE

To compare Triclosan coated suture with intravenous antibiotics for the repair of inguinal hernia with mesh.

METHODS

Patients with uncomplicated inguinal hernia undergoing mesh repair were randomized to either have intravenous antibiotics administered for prophylaxis or to have wound closure with Triclosan coated Vicryl 2/0 suture. Post operatively, wound infection rates were compared between the two groups. Follow up was for 1 year.

RESULTS

We studied 49 patients with 59 hernias with a mean age of 53 years. Hernias were solitary in 75% of cases, the majority of which were right sided, while 25% were bilateral. There were 25 patients with 32 hernias in the Intravenous antibiotic group (Group A) and 24 patients with 27 hernias in the Triclosan suture group (Group B). Wound grades were similar between the two groups with one patient in the Triclosan group confirmed to have wound infection (4.2%) and none in the Intravenous antibiotics group (p=0.27). Wound infection was of the superficial type which resolved with wound care within 1 month.

CONCLUSION

Triclosan coated suture may be safely used as an alternative to intravenous antibiotics for the mesh repair of inguinal hernia. Further studies are required to validate this finding.

Feasibility study for a randomized clinical trial of bupivacaine, lidocaine with adrenaline, or placebo wound infiltration to reduce postoperative pain after laparoscopic cholecystectomy

Background

Short‐term pain relief can be achieved by local anaesthetic infiltration of port sites at the end of laparoscopic surgery. This study aimed to assess feasibility of performing an RCT to evaluate short‐term postoperative analgesia after laparoscopic surgery in Nigeria using two local anaesthetics for port‐site infiltration versus saline placebo.

Methods

This was a placebo‐controlled, patient‐ and outcome assessor‐blinded, external feasibility RCT. Patients undergoing elective laparoscopic cholecystectomy for symptomatic ultrasound‐proven gallstones were randomized into three groups: lidocaine with adrenaline (epinephrine), bupivacaine or saline control. The feasibility of recruitment, compliance with randomized treatment allocation, and completion of pain and nausea outcome measures were evaluated. Pain was assessed at 2, 6, 12 and 24 h after surgery using a 0–10‐point numerical rating scale (NRS) and a four‐point verbal rating scale. Nausea was assessed using NRS at the same time points. Clinical outcomes were assessed only in patients who received the correct randomized treatment allocation.

Results

Of 79 patients screened for eligibility, 69 were consented and randomized (23 per group). Overall, compliance with randomized treatment allocation was achieved in 64 patients (93 per cent). All pain and nausea assessments were completed in these 64 patients. On the NRS, most patients had moderate to severe pain at 2 h (39 of 64, 61 per cent), which gradually reduced. Only six patients (9 per cent) had moderate to severe pain at 24 h.

Conclusion

Recruitment, compliance with the randomized allocation, and completion of pain outcome measures were satisfactory. This study demonstrates the feasibility of conducting a surgical RCT in a resource‐limited setting. Registration number: ISRCTN 17667918 (https://www.isrctn.com).

Use of commercial mesh for hernia repair in a low resource setting: experience after 500 cases

BACKGROUND

The use of mesh has revolutionized the management of hernias in many parts of the world. There is, however, limited experience on its use in sub-Saharan Africa. This study describes a single hospital experience after 500 cases of mesh hernia repairs in a sub-Saharan African country.

METHODS

We reviewed the records of the first 500 cases of abdominal wall hernia operations performed using commercial mesh since year 2007. Socio-demographic characteristics, hernia type, method of repair and outcome data were analyzed and presented as descriptive statistics.

RESULTS

The first 500 cases of mesh hernia repairs were performed between 2007 and 2017 during which a total of 1,175 hernia operations were carried out, mesh repair accounting for 42.5% of the total. There was a progressive rise in the uptake of mesh repairs over time, with mesh repairs overtaking tissue based repairs in the last few years of the review. Inguinal hernia was by far the commonest indication for mesh use (80.4%), followed by incisional hernia (9%). Polypropylene mesh was the most common type of mesh used in about 96.2% of cases. Overall, there were seven recurrences (1.4%) at a mean follow-up period of 15.3 months (1-108 months) CONCLUSION: In spite of resource limitations, the use of mesh for hernia repairs continues to rise and has overtaken tissue-based repairs in a sub-Saharan African setting. Results show good outcomes justifying continued use.