Urethral fibrosis with pyonephrosis in a patient with situs inversus totalis: a case report

BACKGROUND

Cases of a case of situs inversus totalis are very rare and therefore when encountered, they are likely to be missed or poorly managed.

OBJECTIVE

To present a case of situs inversus totalis with a view to creating more awareness about this rare clinical entity.

PATIENT AND METHOD

The patient, a 22 year old boy was referred from a private clinic after a failed and complicated attempted appendicectomy carried out by a general medical practitioner. The patient was admitted, resuscitated and had investigations done. Some of the investigations done were abdominal ultrasound scan, computerized axial tomography scan, a chest x ray, complete blood count, urinalysis and electrolyte and urea.

RESULTS

Investigations showed features of situs inversus totalis. There was also bilateral hydronephrosis, worse on the right side. The patient also had features of renal failure. He died after three days on admission. Autopsy finding confirmed bilateral pyonephrosis which was worse on the right side. There was associated urethral fibrosis. Cause of death was urethral fibrosis resulting in obstructive uropathy, pyonephrosis and renal failure.

CONCLUSION

Situs inverses totalis is rare but can psented in diverse ways and thus the diagnosis may be missed and the patient wrongly managed. A high index of clinical suspicion is required if we the diagnosis is to be made early and wrong treatments avoided.

Anthropometric predictors of elevated prostate specific antigen among rural and urban Nigerians: a population-based study

BACKGROUND

Obesity has been associated with incidence and mortality of carcinoma of the prostate (CaP), but the relationship of BMI to CaP risk remains controversial across populations.

OBJECTIVE

To describe the anthropometric correlates of elevated prostate specific antigen in Nigeria, a low-incidence region for CaP that currently reports rising incidence.

SUBJECTS AND METHODS

Weight, height and skin fold thickness were measured for men, aged 40 years and older. Waist-to-hip ratio (WHR) and body mass index (BMI) were computed. Prostate specific antigen (PSA) status and prostate size were determined. Mean anthropometric indices were compared across groups using Student's t-test, association between anthropometry and PSA was by Spearman's correlation, and mean PSA was tested for linearity across tertiles of anthropometry. Prediction of elevated PSA was determined by multivariate logistic regression controlling for age and prostate size.

RESULTS

Of 350 consecutive men contacted, 281(80.3%) completed the survey, mean age 56.9(13.5) years, and elevated PSA prevalence 31(11.0 %). WHR was 0.92 for rural and urban men, BMI (22.9 vs 24.7, p<0.002, and skin fold thickness was lower for rural men. PSA correlated directly with age, r=0.360, p<0.0001 and negatively with height, r=-0.136, p<0.023. WHR remained a significant predictor of elevated PSA,[OR 3.04 (95% CI 1.13 - 8.15)], after adjusting for age and enlarged prostate.

CONCLUSION

Central adiposity may be a more important predictor of elevated PSA than BMI in this population. There is need to investigate the role of hormonal, metabolic, and genetic correlates of central adiposity in carcinoma of the prostate risk in this population.

Case-control study of risk factors for breast cancer in Nigerian women: a pilot study

OBJECTIVE

To evaluate the risk factors for breast cancer among women in Midwestern and Southeastern Nigeria.

DESIGN

A case control study.

SETTING

University of Benin Teaching hospital, Benin City and University of Port Harcourt Teaching Hospital, Port Harcourt in Nigeria.

SUBJECTS

Fifty one women with diagnosis of breast cancer and their age- and sex matched controls were included in the study.

INTERVENTIONS

Data was collected during a 30 minute period after obtaining written informed consent using interviewer-administered questionnaires.

RESULTS

Parity > 4 (OR = 0.50, 95% Cl 0.17, 1.46) and duration of breast feeding > 60 months (OR = 0.58, 95% Cl 0.23, 1.48) were associated with reduced risk of breast cancer while birth order > 3 (OR = I.50, 95% Cl 0.25, 8.98), age at first full term pregnancy>20 years (OR = 2.50, 95% Cl 0.78, 7.97) and longer duration of reproductive period (OR = 1.25, 95% Cl 0.34, 4.66) were associated with increased risk of breast cancer.

CONCLUSION

The study has shown that high parity and long duration of breastfeeding are associated with reduced risk while high birth order and late age at first full-term pregnancy are associated with increased risk of breast cancer.

Clinicopathological study of carcinoma of the breast in Benin City

Morbidity and mortality from breast cancer have continued to be a source of concern to surgeons in many countries. Over a period of 10 years--January 1987 to December 1996--117 patients presented with carcinoma of the breast at the University of Benin Teaching Hospital in Benin City, Nigeria. The case files of 77 patients were available and were analysed retrospectively. There were 75 females and 2 males. Sixty seven per cent of the female patients had large and grossly advanced lesions. Most of them were multiparous and they practiced prolonged breastfeeding. Seventy eight per cent of the patients delayed for over 3 months before presenting to the hospital. The five-year survival was 8.7%. We conclude that carcinoma of the breast is common in this community and that most of the patients present late to the hospital.

Congenital peritoneal encapsulation of small intestine: a case report

Congenital peritonel encapsulation of the small intestine is a rare malformation. It is associated with clinical features which may cause diagnostic difficulties and more often it is recognised only at exploratory laparotomy. We present a case in a 15 year old female, who was treated and she had a good result. Embryological explanation for the pathology is also considered. It is a disease entity which should be recognised, especially when encountered at laparotomy and treated appropriately.

Management of enterocutaneous fistulae in Benin City Nigeria

We report a prospective study of 17 cases of enterocutaneous fistulae managed at the University of Benin Teaching Hospital, Benin City, Nigeria between June 1992 and June 1999. All the cases were iatrogenic in origin and all age groups (6 weeks to 68 years, mean 27) were represented. There were 10 males and 7 females. Emergency surgery for acute appendicitis and intestinal obstruction were the commonest causes. Management should be conservative initially but surgery should be resorted to if there is no significant improvement, particularly in circumstances where facilities for total parenteral nutrition are not available. A literature review has been carried out and measures to prevent the development of enterocutaneous fistula are outlined.

A five year review of splenic injuries in the University of Benin Teaching Hospital, Benin City, Nigeria

Splenic injuries are common and require emergency treatment. Efforts are now geared towards splenic conservation by way of splenorrhaphy. Thirty cases of splenic injuries seen at the University of Benin Teaching Hospital, Benin City, Nigeria between June 1992 and June 1997 were evaluated with a view to assessing the pattern of injuries and the management with respect particularly to splenic conservation. Males accounted for 66.6% of cases and the age range was 3-57 years (mean 20.8). Road traffic accident was the leading cause (63.3%) of injury. Splenic injuries were graded in severity from grades one to five based on the organ injury scaling. Injuries in 3(10%) cases were Grade 1, 5(17%) Grade 2, 7(23%) Grade 3, 4(20%) Grade 4 and 9(30%) Grade 5. Because majority of the splenic injuries were severe only four (13.3%) in Grades 1 and 2 had salvage operation of splenorrhaphy. All the other patients had splenectomy. Splenic conservation has been little practiced but could be encouraged by the more experienced surgeons having more interest in preserving splenic functions.

Incidence of hypo-parathyroidism following thyroidectomy in a prospective study of 108 consecutive African patients

In a prospective study of 108 consecutive African patients in the University of Benin Teaching Hospital undergoing thyroidectomy over the period 1986-1990, one patient had overt hypoparathyroidism while six others presented with the latent form, giving an overall incidence of 6.5 pc. Hypoparathyroidism was associated with large adherent goitres involving extensive dissection. Routine post-operative serum calcium is advocated so as not to miss latent hypoparathyroidism. Identification of the parathyroids with preservation of the blood supply should be carefully observed so as to minimise the incidence of hypoparathyroidism.

Prevention and treatment of early postoperative deep vein thrombosis in africans: a Nigerian experience with dihydroergotamine mesylate

Post-operative deep vein thrombosis is regarded as rare among Africans, even though there are no known specific factors existing in the African population which either increase or decrease the incidence of deep vein thrombosis in the surgical patient. But by using human fibrinogen labeled with radioactive iodine (125I), despite its limitations in detecting thrombi proximal to the femoral veins, we were able to demonstrate those which were still at the subclinical stage of the disease process apart from overt cases of deep vein thrombosis (DVT). Whereas, miniheparinization and treatment with Dextran 70 may be better, accepted methods of prophylaxis in the immediate post-operative days, in 38 consecutive post-operative cases studied, we were able to show the benefits of dihydroergotamine mesylate in the prevention of deep vein thrombosis among Nigerians. It was also shown that since DVT may occur in the femoral segments without a concomitant involvement of the calf veins, assertions based only on data obtained from clinical examinations of the calf for evidence of DVT are bound to be understatements of the true incidence.

Post-operative deep vein thrombosis incidence in Nigerians

In 450 consecutive Nigerian patients aged 20 and above undergoing elective surgery, the incidence of post-operative deep vein thrombosis using clinical methods was 2.2 per cent. Of these 333 were men and 5 had deep vein thrombosis giving an incidence of 1.5 per cent while 117 were females and 5 had deep thrombosis giving an incidence of 4.3 per cent. This figure is low and appears to agree with the current opinion that post operative deep vein thrombosis is comparatively rare in Africans. This is in contrast to the view expressed by Nwokolo and Ikoku (1967) that thromboembolic disease is more common in Nigeria than in East and Central Africa.