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Splenic abscess in Jos
AT Kidmas, GO Igun, PO Obekpa, AA Anele
Nigerian Journal of Surgical Research , 2003,
Abstract: Background: Splenic abscess is an uncommon surgical condition that constitute 0.14-0.7% of necropsy specimen. Delayed or missed diagnosis may result in a fatal outcome. Method: A retrospective study of patients with splenic abscess treated at Jos University Teaching Hospital over a ten-year period. Results: Eight patients were managed. There were 2 males and 6 females aged between 18 and 65 years (median age 31 years). Duration of symptoms ranged between 2 to 16 days with a median of 7 days. The main clinical features were fever, left hypochondriac pain and tender splenomegaly occurring in 87.5%, 100% and 87.5% respectively. Abscess cavity was solitary in seven cases. All except one patient had antibiotics and splenectomy. The commonest organism cultured was staphylococcus aureus, 5 of 7 cultures (71.4%). Postoperative complication included wound infection two, acute pancreatitis one and over- whelming post splenectomy infection (OPSI) in one. There was one mortality (12.5%). Conclusion: Prompt diagnosis and treatment based on a high index of suspicion will reduce the high morbidity associated with this rare disease. It is hoped that as appropriate skill and imaging techniques become more available in developing countries, more splenic abscess patients will be managed by percutaneus drainage especially that solitary abscess cavity seems dominant in our environment. (Nig J Surg Res 2003; 27 - 31
Mass casualty management: Jos University Teaching Hospital experience
HC Nwadiaro, D Iya, SJ Yiltok, AT Kidmas
West African Journal of Medicine , 2003,
Abstract: Three experiences of management of mass casualties in Jos University Teaching Hospital were analysed. Classification into minor, moderate and major mass casualties was done using multiple criteria of number of casualties, number of doctors required to contain the situation, number of nurses and paramedical staff, degree of distruption of hospital services and time required to handle the immediate stabilisation of the casualties. The classification recognises a category called “regional disaster” and attempts to enunciate a principle of initiation, mobilisation and co-ordination of management of such disasters among hospitals and human and material resources within the region. It is envisaged that coalescence of “regional disaster preparedness” would from the bedrock of national ambulance services system.
Typhoid intestinal perforation in North Central Nigeria
BT Ugwu, SJ Yiltok, AT Kidmas, AS Opaluwa
West African Journal of Medicine , 2005,
Abstract: Background: Typhoid intestinal perforation is a surgical problem with severe morbidity and high mortality in North Central Nigeria. Patients and Methods: In order to determine the pattern and the prognostic indices, we studied 101 patients with typhoid intestinal perforation managed over a ten-year period Results: Children constituted 49% of the cases and majority(78%) of the patients were in the low socio-economic strata. The incidence peaked to 67% between November and March – the dry season in Nigeria. The male/female ratio was 1.9:1 with a mean age of 19 years and a mean hospitalization period of 18 days. There were 167 perforations; four involved the large bowel and appendix, and in 72.2% cases, the perforation was single. The mortality rate was 13.9%, affected mostly children and significantly worsened by prolonged perforation-surgery interval > 72 hours, jaundice, convulsion, ASA V, faecal peritonitis and re-exploration for early intra-peritoneal complications. Morbidity rate was 65.3% and significantly affected more children than adults and associated with perforation-surgery interval of between 24 and 72 hours, haematochezia and multiple perforations. Moribund patients fared better when operated upon under local anaesthesia with adequate analgesia. The least traumatic but effective surgical procedure that could seal the perforations and keep the peritoneum clean gave the best results. Children who survived up to 5 days and adults who survived up to 10 days after surgery had better chances of survival. Conclusion: The most significant prognostic factor is late presentation which prolongs perforation-surgery interval and the other complication and mortality indices are directly influenced by it.
Male breast malignancy in Jos University Teaching Hospital
AT Kidmas, BT Ugwu, AN Manasseh, D Iya, AS Opaluwa
West African Journal of Medicine , 2005,
Abstract: Background: Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. Patients and Methods: A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.) Results: A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality. Conclusion: MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.
Delayed presentation of blunt traumatic diaphragmatic hernia: A case report
AT Kidmas, D Iya, ES Isamade, E Ekedigwe
Nigerian Journal of Surgical Research , 2005,
Abstract: Blunt traumatic diaphragmatic rupture is an uncommon but severe problem that is usually seen in poly-traumatized patients. Diagnosis is often difficult resulting in delayed presentation and increased morbidity. We report a case of blunt traumatic diaphragmatic hernia in a 39-year-old man presenting 10 years after the initial abdomino-thoracic injury sustained in a road traffic accident. He had herniation of the spleen and stomach. Through a left thoracotomy, the herniated organs were reduced and diaphragmatic defect closed with interrupted nylon sutures. A high index of suspicion would minimize the morbidity and mortality associated with delayed diagnosis.
Outcome of traditional bone setting in the Middle belt of Nigeria
HC Nwadiaro, PO Nwadiaro, AT Kidmas, KN Ozoilo
Nigerian Journal of Surgical Research , 2006,
Abstract: Background: This hospital based study was designed to elucidate the outcome of Traditional Bone Setting (TBS) practice in four states of the middle belt of Nigeria, via complications presenting in select hospitals. Methods: A combination of retrospective and prospective study of complications arising from traditional bone setting in Plateau and Nasarawa States and southern parts of the Kaduna and Bauchi States was undertaken. Results: Fifteen patients were retrospectively studied in the one year period between December 1999 and November 2000 inclusive, while seventy-six patients were recruited into a 1 year prospective study (January 2001 to December 2001). There were sixty-nine males and twenty-two females giving a male: female ratio of 3.1:1. The most frequently encountered patients were children in the first decade of life (34.1%), while the 3rd and 4th decades accounted for 20.9% and 18.7% respectively. 61.5% of the study population were residents in Jos, Plateau State, and 19.8% were admitted from Nasarawa State. 12.1% came from Kaduna State while 6.6% were recruited from Bauchi State. The study population cut across all social strata with a preponderance of illiterates, children and primary school certificate holders. The presenting injuries clustered around femur, tibia and fibula, humerus and forearm with 19.61 each. These were followed by dislocations of hip, elbow and shoulders (15.2%). The presentation of complications included non union (13.1%), mal union (21.5%), volkman’s ischaemic contractures and compartment syndrome (8.4%), infections (24.4%), stiffness/ankylosis (15.9%) and gangrene (8.4%) among others. Eight two orthopaedic interventions were carried out ranging from minor procedures to open reduction and internal fixations (15.9%), amputations (7.3%) and arthroplasties (4.9%). Five portalities were recorded giving a mortality rate of (5.5%). Conclusion: 91 complications with 5 mortalities, largely avoidable in two years calls for a serious look at traditional bone setting practice in the Middle Belt of Nigeria. We recommend that other zones undertake similar studies so that a national picture would emerge and policy dialogue initiated.
Long survival ( 21 years) after portoenterostomy for biliary atresia: A case report and review of complications
AM Tabari, AT Kidmas, AO Ogunseyinde, AA Samaila
Nigerian Journal of Surgical Research , 2006,
Abstract: Long term survival for decades after portoenterostomy (Kasai procedure) for biliary atresia is rare and the association of portoenterostomy with liver cirrhosis is well known. Not much attention was given in the evaluation of the imaging features of cirrhosis caused by portoenterostomy as received by other known usual causes of cirrhosis. We presented a case of a Nigerian with confirmed biliary atresia at birth, that suvived portoenterostomy performed at two months of age for 21years. The cirrhotic presentation at imaging was that of prominent volume redistribution with less parenchymal changes in the liver. The long term survival and the type of cirrhotic presentation on imaging in this case is worthy of note for the record.
Epidemiology of Accident Deaths in Jos, Nigeria (1996-2000)
Mandong B,Madaki J. K. A.,Mohammed A,Kidmas A
Annals of African Medicine , 2006,
Abstract: Background: Accidents are common events in our society and have contributed significantly to causes of morbidity and mortality in most hospitals. In our environment accidents are fast becoming the commonest cause of death. Only few cases of these accidents are reported to the corona for investigation. Methods: Records of deaths from January 1996- December 2000 reported to the corona for autopsies from two major Hospitals in Jos city were analyzed. Those related to accidents were retrieved and studied. Information from the Police regarding causes of accidents was also extracted. Data on the deceased such as age, sex, and nature of injury were also collated. Police reports on the contributing factors to accidents were also analysed. Results: A total of 270 cases of deaths were reported to the corona for autopsies out of which 122 (45%) were accident deaths. One hundred and three (86%) cases were males while 19 cases were females. Two-thirds of deaths (60%) were in the productive age group of 21— 40 years. Multiple fractures long bones without head injury accounted for 37.7% of deaths, followed by head/upper spinal injuries 24.6%, crushed body injuries 22%, while, intra-abdominal organ injuries which accounted for 15.6%. Analysis of types of accidents showed that vehicle, motorcycle, airplane crash and pedestrian accidents accounted for 59.8%, 20.5%, 10.7% and 9.0% respectively. Information from the Police on motor vehicle accidents, records showed that 50% of the accidental events were due to dangerous driving under the influence of alcohol. Conclusion: Accident death in our environment appears to affect mostly men in the productive and reproductive age groups. However measures that regulate vehicle speed on the road and alcohol intake by drivers may reduce more than half of such deaths.
Digital rectal examination for prostate cancer: Attitude and experience of final year medical students
NK Dakum, VM Ramyil, S Abgo, E Ogwuche, BS Makama, AT Kidmas
Nigerian Journal of Clinical Practice , 2007,
Abstract: Objective: Prostate cancer which tends to take an aggressive course in black populations can be detected by digital rectal examination (DRE). There are concerns however that medical students are not acquiring the necessary DRE skills. We therefore studied their experience and attitude towards DRE for prostate cancer to assist us make any necessary adjustments in training. Methods: This was a self-administered questionnaire based study of final year medical students two months to graduation carried out at the Jos University Teaching Hospital, location for clinical studies of the Medical Faculty of the University of Jos. Results: There were 100 students in the study, with a male: female ratio of 3.6:1. The ages ranged from 24 to 35 with a mean of 28 years. Fifty-one percent and 94% agreed they had been taught DRE in class and on the ward/clinic respectively. Almost half (45%) had never performed a DRE and 43% performed it only1-2 times. Sixty-two percent of the students had never confidently palpated a prostate; while 30% had palpated it 1 – 2 times. Eighty-six percent and 7% respectively have never felt a clinically malignant prostate or felt it 1 – 2 times. There was no statistically significant difference in the number of DREs performed by sex or age (p> 0.05). On supervision 43% were never supervised to do DRE while 23% were supervised all the time. Ninety-five percent believed DRE is an essential requirement for a medical practitioner and 96% believed they should have the skills before graduating. Only 36%, however, believed their teachers have been supportive, teaching them DRE (p value= .033). Ninety percent agreed that DRE is useful for screening for prostate cancer. The major reason for not performing DRE more than half the time was the student not feeling competent (54%). Conclusion: Students have received adequate teaching on DRE, have the right attitude and perspective, have adequate knowledge on DRE findings suggestive of prostate cancer but have not translated this knowledge into practice. This is mainly due to the students not feeling competent. Teachers need to intensify practical supervision to enable medical students acquire the necessary experience during clinical training.
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