Concepts of seroma formation and prevention in breast cancer surgery

BACKGROUND: Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast-conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined. METHOD: MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out. RESULT: The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive. CONCLUSION: Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low-pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.     

Ascites in the puerperium: a missed diagnosis of acute postpartum pancreatitis

Introduction Acute pancreatitis in pregnancy is often associated with severe morbidity. It is usually an antepartum problem occurring in late pregnancy. It rarely occurs in the postpartum period and when it does diagnosis can be difficult.Case report We report a case of unexplained ascites following ventouse delivery, diagnosed 6 weeks later as acute pancreatitis.Conclusion Although it is rare, acute pancreatitis must be considered when evaluating patients presenting with abdominal pain and/or ascites in the postpartum period. Serum amylase may not always be elevated and early recourse to CT scan will facilitate diagnosis and allow for appropriate management.     

Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students

BACKGROUND: The common self-rated depression scales are lengthy, old and do not reflect the current diagnostic classifications criteria of depressive disorders. This study aimed to validate the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. METHODS: A representative sample of university students (n=512) completed the PHQ-9 and the Beck's Depressive Inventory (BDI). They were also interviewed for clinical diagnoses of depressive disorders using the Mini International Neuropsychiatric Interview (MINI). RESULTS: The internal consistency of questions within the PHQ-9 was 0.85. The PHQ-9 had good concurrent validity with the BDI (r=0.67, P<0.001). It also had a good (r=0.894, P<0.001) one month test-retest reliability. Using the Receiver Operating Characteristic (ROC) curve, the optimal cut-off score for minor depressive disorder is 5 (sensitivity 0.897, specificity 0.989, Positive Predictive Value - PPV 0.875, Negative Predictive Value - NPV 0.981 and Overall Correct Classification - OCC rate 0.973) while for major depressive disorder only is 10 (sensitivity 0.846, specificity 0.994, PPV 0.750, NPV 0.996 and OCC rate 0.992). LIMITATIONS: The study limitations include use of a specific group in community, moderate sample size and screening for only minor and major depressive disorders while neglecting other depressive disorders. CONCLUSIONS: The PHQ-9 has good psychometric properties amongst Nigerian university students. Because of its validity, reliability, brevity and ease of administration, the PHQ-9 will be a valuable tool for estimating depression amongst college students in Nigerian community. More studies are needed to test the usefulness of the translated local language versions of this instrument amongst the community in sub-Saharan Africa.     

Serum alpha-fetoprotein level is higher in hepatitis C than hepatitis B infected chronic liver disease patients

Background:

The frequency of raised serum alpha-fetoprotein may vary in relation to hepatitis B or C infection in chronic liver disease (CLD). The study evaluated the frequency of hepatitis B and C in patients with chronic liver disease and correlated the levels of serum alpha-fetoprotein with hepatitis B and C infection in the patients.

Materials and Methods:

Eighty-six patients with CLD were recruited for the study. Fifty subjects, with no CLD were used as control. Hepatitis B surface Antigen (HBsAg) and hepatitis C antibody were determined using enzyme-linked immunosorbent assay (ELISA) technique (Human diagnostics, Germany and HCV Murex 40 Anhet laboratories, USA) while liver function tests were evaluated using express plus chemistry auto analyzer. Alpha-fetoprotein was assayed using ELECSYS 1010 auto analyser.

Results:

There were 60 males and 26 females, with a mean age of 46 + 6.5 years, while the controls were 25 males and 25 females with a mean age of 41 ± 2.5 years. Thirty-six subjects (41.7%) were seropositive for HBsAg while 24 (27.9%) were seropositive for Hepatitis C Virus (HCV) antibody. The mean alpha fetoprotein level was 359 ± 9.9 ng/mL while mean control value was 1.93 ± 0.24 ng/mL. Liver function test parameters were elevated compared with control subjects (P < 0.001). The increase in serum alpha-fetoprotein was higher (P < 0.001) in HCV than HBsAg positive patients.

Conclusion:

Serum alpha-fetoprotein level was highest in HCV compared to HBsAg positive and hepatitis negative patients with CLD.     

Antioxidant phenolics from Broussonetia papyrifera fruits

Fractionation of the EtOH extract from the fruits of Broussonetia papyrifera led to the isolation of 15 phenolic compounds (1–15). Their structures were identified using spectroscopic methods. Among these compounds, 1 and 2 are new and 3–15 were isolated from this plant for the first time. Antioxidant activities of compounds 2–15 against H₂O₂-induced injury in SY5Y cells and 1,1-diphenyl-2-picrylhydrazyl radical scavenging activities were evaluated.