Day case endourology in surgical outpatient clinic at Ibadan: A 5 year review

ObjectiveTo review our day case endourological practice over a five-year period.Subjects and methodsData was obtained from the endourology day case register and these were analysed using simple statistical methods. Caudal anaesthesia and intravenous sedatives were used for the procedures.ResultsA total of 559 patients underwent endoscopic procedures as day cases. Their ages ranged from 10 to 88 years, with a male to female ratio of 4 to 1. Four hundred and thirty eight (78.4%) were diagnostic and 121 (21.6%) were therapeutic. The main diagnostic procedures were urethrocystoscopy (n = 222), and cystoscopy alone (n = 116), cystoscopy and biopsy (n = 46) while the therapeutic procedures were direct visual internal urethrotomy (n = 86), endoscopic cystolitholapaxy (n = 10), and rigid retrograde endoscopic realignment (n = 7) for posterior urethral injury. The main anaesthesia was caudal block in 472 patients and topical 2% xylocaine jelly with sedation in 86 patients.ConclusionsThere is a steady increase in therapeutic day case endourology. Caudal anaesthesia provides effective pain free procedure to the patient. Surgical trainees can benefit by learning the technique of caudal block anaesthesia.     

Field and laboratory findings of the first incursion of the Asian H5N1 highly pathogenic avian influenza virus in Africa.

In mid-January 2006 an outbreak of avian influenza in domestic birds was recorded in Kaduna State, Nigeria. The virus responsible for the outbreak was characterized as a highly pathogenic avian influenza H5N1 (A/chicken/Nigeria/641/06), belonging to the Qinghai lineage. The index case occurred on a farm containing mixed avian species including free-range birds. Clinical signs and mortality were observed in chickens, geese and ostriches. The present paper describes the clinical, pathological and virological findings of this outbreak.     

Rapid antigen detection in the diagnosis of highly pathogenic avian influenza (H5N1) virus in Nigeria

Highly pathogenic avian influenza (AI) is an infectious disease of agroeconomic and public health importance. The outbreak that occurred in Nigeria (2006–2008) was devastating to the poultry industry and raised public health concerns. In the course of its control, rapid laboratory confirmation of suspected cases in poultry was essential for prompt mobilization of control logistics for depopulation and decontamination of affected premises. Commercial rapid test kit was evaluated in the diagnosis of highly pathogenic AI (HPAI) as a preliminary to virus isolation. Between 2006 and 2007, 382 cases were tested out of which 149 were positive by rapid antigen detection. Virus isolation yielded 171 positive cases. The relative diagnostic sensitivity of Anigen Rapid AIV Ag test was 84.3% (95% confidence interval [CI], 78.1–88.9%), whereas the relative diagnostic specificity was 97.7% (95% CI, 94.2–99.1%). Rapid antigen detection is a useful technique for prompt diagnosis of HPAI for early detection and containment.     

School performance of Nigerian adolescents with epilepsy

PURPOSE: The study assessed the school performance of Nigerian adolescents with epilepsy compared with healthy controls and examined the variables correlating with their academic difficulties. METHODS: The school grades of adolescents with epilepsy aged 12 to 18 years (n = 73) over the past academic year were compared with the grades of their classmates of the same age and gender. Risk factors possibly associated with school performance, such as adolescent variables (age, gender, perceived stigma, attitude toward epilepsy, and psychopathology), seizure variables (age at onset of illness, years of illness, types of seizures, and frequency of seizures per month), drug variables [types of antiepileptic drugs (AEDs), number of AEDs and side effects of AEDs], and family variables (family's socioeconomic status, family functioning, caretakers' psychopathology, and caretakers' perceived stigma) were assessed. RESULTS: The mean school grades of adolescents with epilepsy are significantly lower than are those of their healthy controls (p < 0.001) in all the subjects. The variables that significantly predict poor school performance in adolescents with epilepsy include psychopathology in the caretaker (p < 0.001), adolescents' perceived poor family functioning (p = 0.002), adolescents' attitude toward the illness (p = 0.001), adolescents' felt stigma (p = 0.002), externalizing symptoms in the adolescents (p = 0.004), and duration of illness (p = 0.024). CONCLUSIONS: The determinants of poor school performance in adolescents with epilepsy in Nigeria are multivariate, with psychosocial factors most important. These should be noted for early identification and screening of those children at greatest risk for academic failure and the greatest need for appropriate educational remediation services.     

Bilateral nephron sparing surgeries for multiple renal angiomyolipomas in Bourneville’s disease

Introduction Angiomyolipomas are the most common renal lesions in tuberous sclerosis complex. When symptomatic, the treatment includes nephron sparing surgery. This is especially challenging when the lesions are bilateral, large and multiple. Case-History A 22-year-old lady with bilateral multiple large symptomatic renal angiomyolipomas associated with other manifestations of tuberous sclerosis was managed with partial nephrectomies on either side. At 30 months of follow-up, the patient has normal renal functions and no evidence of recurrence. Discussion Intervention for renal angiomyolipomas is indicated in symptomatic tumors larger than four centimetres. Selective arterial embolisation is the therapeutic modality of choice in such cases. However, in bilateral cases when angioembolisation may not always be feasible, nephron sparing surgery maybe considered. Nephron sparing surgery of both kidneys for angiomyolipomas in association with tuberous sclerosis has only been sparingly reported in literature.     

Successful surgical correction of true diphallia, scrotal duplication, and associated hypospadias

A 1-year-old child with complete duplication of penis presented with continuous dribbling of urine. Examination revealed hypospadias of 1 penis and a duplicated scrotum with 2 normal testes. Cystourethrogram revealed a single bladder with a normal urethra in the dorsally placed phallus and ectopic insertion into the bladder of the ventral urethra. Abnormality was corrected by excision of the ventrally located penis bearing the ectopic urethra. The preputial skin of this ventral penis was used to repair the hypospadias of the dorsal penis. The case is being reported in view of its rarity and the successful surgical correction.     

The discovery of a multi-resistant Staphylococcus haemolyticus clone in the hospital and community environment in south western Nigeria

Among clinically significant isolates of coagulase negative staphylococci, Staphylococcus haemolyticus is ranked second after Staphylococcus epidermidis. It has been associated with septicemia in newborns and various infections in persons with compromised host defenses and implanted foreign bodies. The existence of a multi-resistant Staphylococcus haemolyticus clone was discovered during a study on patients with skin and soft tissue infections at two local health clinics and in a referral hospital in South Western Nigeria. The clonal nature of these strains was determined by antibiotic susceptibility profile and pulsed field gel electrophoresis. This represents the first report of what appears to be a hospital-acquired and transmitted Staphylococcus haemolyticus clone in South Western Nigeria. Careful infection control measures and strain typing are urgently needed to understand species epidemiology and to limit the spread of multi-resistant strains within and beyond healthcare facilities.     

Alteration of subcellular and cellular expression patterns of cyclin B1 in renal cell carcinoma is significantly related to clinical progression and survival of patients

Cyclin B1, identified as a regulator of late cell cycle, is involved in the development and progression of a variety of human malignancies. To clarify the role of cyclin B1 in the pathogenesis and prognosis of renal cell carcinoma (RCC), protein expression was compared with clinicopathological characteristics of patients as well as the long-term survival after surgical therapy. Expression analysis was carried out by immunohistochemistry and tissue microarray analysis. The microarrays that represented the primary tumors, their invasion front and normal peritumoral renal parenchyma contained 753 tissue cores obtained from 251 randomly selected nephrectomy specimens. Immunopositivity within the primary tumors was significantly associated with tumor stage (pT) (p < 0.01), lymph node status (pN) (p < 0.01) as well as the presence of systemic metastatic disease (p = 0.01). Subcellular expression in the cytoplasm of tumor cells significantly correlated with pT (p = 0.02) and pN (p = 0.03). When peritumoral tissue samples exhibited a relative amount of <10% of positively reacting epithelial cells, cyclin B positivity was identified to predict long-term survival of patients in univariate analysis (p < 0.01) whereas borderline significance was observed in multivariate statistical analysis (p = 0.05). Increased intratumoral cyclin B1 positivity and aberrant localization of signals within the cytoplasm of tumor cells is positively correlated with the tendency towards tumor progression, indicating the significant role of cyclin B1 in the development and pathogenesis of RCC. The result of uni- and multivariate statistical analysis suggests the prognostic value of cyclin B1 for RCC patients.