Transurethral prostatectomy in human immunodeficiency virus-infected patients, morbidity and surgical risks in a developing economy

Human immunodeficiency virus (HIV) infection is increasing world-wide and highly active antiretroviral treatment (HAAT) is allowing afflicted individuals to live near normal life span and acquire surgical diseases of the aged as in the unaffected population. This pose occupational hazards to operating surgeons especially in tropical Africa where the seroprevalence is so high that seroconversion in the medical staff contaminated with the virus is estimated to be as much as 15 times (per annum) more than what obtains in developed. A 63-year old man was admitted to our Hospital with urethral catheter in situ and having failed medical therapy, he opted for transurethral prostatectomy (TURP) which was done without any post-operative complication. He was known to be afflicted with human immunodeficiency virus and on treatment for 3 years. He also had a large but reducible inguinoscrotal hernia for 4 years attributed to lower urinary tract obstruction. He had a Lichtenstein repair of right inguinoscrotal hernia which was complicated by small hematoma that was evacuated. The risk of transmission and surgical morbidity during transurethral prostatectomy could be minimized by adequate universal precaution, pre-testing of all consented patients and wise selection of patients that would benefit from such surgical therapy.

Krukenberg's tumour

BACKGROUND

Krukenburg's tumour, a metastatic cancer to the ovary can pose difficulties in early diagnosis. The paucity of reports from our environment coupled with the difficulties we encountered makes it imperative that we report this case.

METHODS

We present a 32-year-old lady who presented with mucoid and bloody diarrhoea associated with menstrual irregularity, weight loss and lower abdominal pains 2 years after surgical treatment for gastric cancer. Literature on Krukenburg's tumour was also reviewed.

RESULTS

While serum level of CEA was found to be elevated and colonoscopy showed an ulcerated mass obliterating the lumen of the sigmoid colon, abdominal CT scan revealed bilateral adnexal masses. The histology of the colonic lesion showed signet ring carcinoma while the enlarged ovaries turned out to have evidence of metastatic adenocarcinoma.

CONCLUSION

Early diagnosis of KT can be difficult. Periodic surveillance is, therefore, essential especially in those who have had a gastrointestinal malignancy.

Giant and complicated subcutaneous lipoma of the neck

BACKGROUND

Although lipomas around the head and neck region are not uncommon, giant lipomas around the neck are rare.

OBJECTIVE

To report the case of a long standing giant lipoma of the neck which was managed easily by simple surgical excision.

CASE REPORT

A case of giant subcutaneous lipoma of the neck is reported in a 70 year old woman who presented with dragging sensation and bleeding from the site of pressure ulceration as the major complaint. The patient was evaluated and definitive diagnosis was arrived at using Fine Needle Aspiration Cytology (FNAC). She had a successful Surgical excision and was subsequently discharged but never came back for follow up.

CONCLUSION

Lipoma should always be considered in the differential diagnosis of pedunculated lesions around the neck.

Non-cirrhotic portal vein thrombosis, an uncommon cause of portal hypertension - a case report

Most cases of portal hypertension follow chronic liver disease (cirrhosis) while non cirrhotic causes are occasionally seen. A case of portal hypertension secondary to non-cirrhotic portal vein thrombosis is reported. The patient was managed at the Aminu Kano Teaching Hospital Kano, Nigeria in the year 2006. She presented with recurrent massive upper gastrointestinal bleeding and was resuscitated, followed by clinical, radiological and endoscopic evaluation. She had massive splenomegaly and grade four oesophageal varices with evidence of recent bleed. There were, however, no other stigmata of chronic liver disease or portal hypertension. Abdominal computed tomography scan confirmed portal vein thrombosis. Splenectomy and ligation of short gastric veins was performed and the patient has not had any repeat episode of haematemesis or malaena six months post surgery.

Post transplant Kaposi's sarcoma among Nigerians: a report of two cases

With the establishment of kidney transplant centres in Nigeria and increase in the number of kidney transplant recipients returning home for follow up after successful transplant abroad, an increasing number of patients with post transplant complications are likely to be seen. There is the need for physicians vested with the care of these patients to be aware of the post transplant complications so that early diagnosis and effective treatment can be instituted so as to save both the patient and the allograft. Two out of seventeen renal transplant recipients followed up in our unit had post renal transplant Kaposi's sarcoma. Both were successfully treated with withdrawal of cyclosporin, reduction of other immunosuppressives and introduction of low dose Mycophenolate Mofetil (MMF). One had a course of radiotherapy followed by weekly intravenous vincristine and the other only had vincristine with complete remission of the lesions in both patients. Post transplant Kaposi's sarcoma occurs in Nigerian transplant patients and this report highlights the need for increased awareness and high index of suspicion of post transplant Kaposi's sarcoma among kidney transplant recipients.

Typhoid enteric perforation in north western Nigeria

BACKGROUND

Typhoid perforation is the most important surgical complication of typhoid enteritis and is associated with high morbidity and mortality.

AIMS AND OBJECTIVES

To determine the pattern and outcome of management of typhoid perforation in Aminu Kano University Teaching Hospital, Kano.

METHOD

A retrospective Analysis of patients treated for typhoid perforation over a 6-year period.

RESULTS

There were 47 patients: 35 males and 12 females, ratio 2.9 to 1. The patients were aged 4 years to 58 years (mean 18.9 years). Typhoid perforation occurred all the year round with a peak prevalence in September; Six (12.8%) patients perforated in the first week, 29 (61.7%) second week, and 12 (25.5%) third week, of illness. Single perforation was found in 91.5% of cases, and two to three perforations in 8.5%. Surgical treatment was by simple closure in 72.3%, wedge resection in 8.5%, ileal resection in 17.1% and right hemi-colectomy in 2.1%. Of the 41 survivors (87.2%), wound infection was the most common postoperative complication in 44.7% of cases. The mortality rate was 12.8% mostly due to overwhelming sepsis.

CONCLUSION

Typhoid perforation requiring surgical intervention is still endemic in our subregion, and emphasis should be on preventive measures such as safe drinking water and appropriate sewage disposal, and typhoid vaccination.

Histopathological review of prostatic diseases in Kano, Nigeria

Diseases of the prostate are common causes of morbidity in adult males and show wide geographical and ethnic variations in incidence and mortality worldwide. It is in the light of this that records of prostatic biopsies were reviewed in retrospect at the Aminu Kano Teaching Hospital, Kano and Murtala Mohammed Hospital Kano over a 4-year period in order to determine the histological pattern and age distribution of the various prostatic lesions. Three hundred and three prostatic lesions constituting 7.4% of all surgical biopsy specimens received were studied. Two hundred and thirty five (77.6%) of these were cases of BPH while prostatic cancer accounted for 22.4% of cases. The ratio of benign to malignant prostatic disease was 3:5:1. Chronic non-specific prostatitis, acute prostatitis, schistosomiasis and tuberculosis were present in 22.8%, 3.3%, 0.7% of the total number of cases respectively. The mean age of BPH patients was 63.7 years, and 88% of them had a glandulostromal histological pattern. Majority (64.2%) of the prostate cancers were well-differentiated adenocarcinoma and the mean age was 67.1 years. The findings confirm earlier observations that prostatic diseases are common causes of morbidity in our environment, and early diagnosis and treatment remain key measures in reducing mortality. The practice of 5-region biopsy is advocated to improve detection of clinical prostate cancer.