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BACTERIOLOGY OF CHRONIC MAXILLARY SINUSITIS AT KEI (JYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the bacteriology and antibiotic sensitivity of the bacterial isolates inchronic maxillary sinusitis patients seen at the Kenyatta Natic nal Hospital.Design: Cross-sectional studySetting: Kenyatta National Hospital, ENT department.Subjects and methods: Seventy-three patients had bilateral s ntral washout done and thelavage submitted for culture and anti-microbial sensitivity bet1 veen January and June 19%.Results: Antral lavage yielded secretions in 63% of patients but bacteria were cultured inonly 28.8% of the specimens. The isolates included Strept~coccus pileumonk (22.2%),Staphyloccocus albus (18.5 % ), Staphyloccocus aureus (1 1.1 % )a ~d Enterobactericiae (1 1.1 % ).Anaerobic bacteria were cultured in 22.2% of the specim,:ns. Of the commonly usedantibiotics, there was high sensitivity to erythromycin, cefaclroxyl, chloramphenicol andamoxicillin and poor sensitivity to ampicillin, cotrimoxazole i ud perfloxacin.Conclusion: The bacteriology of chronic maxillary sinusitis at Lenyatta National Hospital isgenerally similar to that found elsewhere. The bacteria are susct :ptible to relatively affordableantibiotics like amoxicillin, erythromycin and cefadroxyl
REVERSE SURAL ISLAND FLAP IN COVERAGE OF DEFECTS LOWER THIRD OF LEG: A SERIES OF NINE CASES
No full textThe distally based sural island flap was first described by Masquelet, et al, in 1992. It is a skinisland flap supplied by the vascular axis of the sural nerve. The aim of this paper is to demonstratethat it can be applied in coverage of difficult wound in the lower third of the leg. We treated ninepatients with nine distally based sural island flaps. All the flaps survived, most of the flaps hadvenous congestion. The largest flap was 10 x 8 cm and Doppler was used in only one flap. Thistechnique is easy and quick to execute without sacrificing major arteries
CEREBRAL VENOUS SINUS THROMBOSIS: A REPORT OF TWO CASES
No full textCerebral venous sinus thrombosis is an uncommon yet potentially life threatening condition which is often under-diagnosed or misdiagnosed because of the variability of the clinical signs and symptoms. The imaging findings are often subtle thus the need for a high index of suspicion. The superior sagittal and transverse sinuses are the most frequently involved. The correct diagnosis of cerebral venous thrombosis relies on neuroimaging studies. The two cases reported highlight the fact that the radiologistmay be the first clinician to suspect and diagnose this condition. This ultimately affects prognosis as early diagnosis and treatment reduces morbidity and mortality
CHRONIC MYELOID LEUKAEMIA AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
Get PDFObjective: To determine the clinical and haematological factors associated with treatmentand outcome of chronic myeloid leukaemia (CML) at Kenyatta National Hospital.Design: Retrospective survey of patients treated for chronic myeloid leukaemia.Setting: Kenyatta National hospital, Nairobi, Kenya, between April 1990 and August 2000.Subjects: Patients with chronic myeloid leukaemia.Results: One hundred and four patients, 55 males and 49 females, age range 10-72 yearswith a median age of 35 years. Treatment with busulphan getting less popular in favourof hydroxyurea. Median follow-up 20 months with none of the clinical and haematologicalparameters impacting significantly on duration of follow-up.Conclusion: CML occurs at a younger age-group in Kenya, and none of the clinicalor haematological parameters appears to impact on follow-up duration
ANOMALIES OF THE RENAL, PHRENIC AND SUPRARENAL ARTERIES: CASE REPORT
No full textABSTRACTThis is a case where multiple anomalies of the posterior abdominal wall arteries werefound. These were accessory renal, a pre-hilar division of the renal, a unilateral originof the inferior phrenic artery from the renal and aberrant suprarenal arteries. Theaccessory renal and the pre-hilar branch of the renal resembled polar arteries thatsupplied the upper and lower poles and similar segments of both kidneys.INTRODUCTIONVariations in the number of the renal arteriesand their position with respect to the renal veins arecommon; and so are the variations of the suprarenalarteries (1). Accessory renal arteries are commonlyderived from the renal, abdominal aorta, commoniliac and superior mesenteric arteries. Rarely theyoriginate from the external iliac, lumber, spermatic,ovarian, inferior mesenteric, superior suprarenal,inferior phrenic, right colic, subcostal, contralateralrenal, splenic and the thoracic aorta (2-4).Usually a single inferior phrenic artery arisesfrom the abdominal aorta on each side of the body.They might originate by a common trunk from theaorta, the celiac trunk or independently from thesame sources. The inferior phrenic may arise fromthe renal, left gastric, superior mesenteric, suprarenal;or rarely from the hepatic artery (5-9).The suprarenal glands are supplied by multiplebranches from the inferior phrenic, aorta and renalarteries from above downwards (10). Rare originsfrom the ureteral and gondal arteries have beendescribed (11).MATERIALS AND METHODSThe findings belong to a single male German cadaverduring routine dissection in the dissection room(AnatomyDepartment, College of Medicine, K.F.U., Dammam). Thesubject was about 50 years old and had an average bodyweight and height. He seemed to have no injuries and therewere no wounds, ulcers and or scratches on the surfaceof the skin. His face, eyes, nose and mouth were normaland there were no other congenital abnormalities apartfrom those mentioned above. The cause of death could bedue to pulmonary edema or pneumonia as the right lunglooked dark black and showed multiple infracts and clots.RESULTSOn the right side: The renal artery trifurcated into threebranches: an upper inferior phrenic artery, a middle prehilarbranch and a lower renal artery proper(Figure 1). The inferior phrenic artery passed upwardson the right psoas muscle to the under surface of theright dome of diaphragm. During its course it gavemultiple aberrant inferior suprarenal arteries.The pre-hilar branch divided into upper and lowerbranches in front of the hilum of the right kidney. Theupper branch entered the upper pole of the kidney whilethe lower branch passed downwards in front of the renalartery to the lower pole of the kidney. It terminatedinto two branches that entered the lower pole of thekidney. The renal artery itself divided into threeterminal branches at the hilum of the kidney
CONGENITAL SYPHILIS IN AN IMMUNOCOMPROMISED NEONATE:CASE REPORT
No full textSUMMARYSyphilis is a notifiable and preventable disease, congenital syphilis more so. Consequently,attention has been recently focused on prenatal diagnosis of foetal syphilis by the useof ultrasonography apart from the conventional serologic screening. Congenital syphilishas not been reported from the Kingdom of Lesotho. We report the case of a 3.0kgmale neonate with florid joint and bone lesions of congenital syphilis associated withHIV infection seen at the Queen Elizabeth II Hospital, Maseru, Kingdom of Lesotho.Co-existing HIV infection influences the clinical manifestation of syphilis, the progressionof neurosyphilis and the response to standard therapy. The baby had the recommendedstandard treatment with good response and he was followed-up for a period of twelvemonths with serologic screening and radiographic evaluation
Pattern of alcohol consumption among commercial road transport workers in a semi-urban community in South Western Nigeria
No full textObjectives: To determine prevalence and pattern of alcohol use, evaluate the level of awareness of the harmful consequences of drinking, and determine the relationship between alcohol use and some selected factors among commercial road transport workers.Design: Cross-sectional survey.Setting: All the five motor parks spread over Ile-Ife, a semi-urban community in south western Nigeria.Results: out of the 403 transport workers, 400 (99.3%) agreed to participate in the study. The questionnaire of one respondent was rejected. The current prevalence rate of alcohol use was 67.2%. Forty seven percent were ‘heavy’ users; 15.3% ‘moderate’ users and 37.7% were occasionalor ‘mild’ users. All the users were engaged in the use of commonly available alcoholic beverages in the vicinity of the motor parks. Majority of the respondents (74.5%) reported drinking after work; 13.5% in the mornings; 10.1% when off-duty and 1.9%, during work. Frustrations that are associated with their work topped the list of reasons adduced for drinking. Belonging to lower age groups was significantly associated with current drinking (X2 = 17.46, df = 3, p<0.001). The proportions of respondents with unsatisfactory level of awareness regarding the association of current drinking with road traffic accidents, and with physical complications were high.Conclusion: Current alcohol use and use in a hazardous manner is an important public health problem among commercial road transport workers in Nigeria. There is an urgent need to modify existing legislations or enact new laws on ‘driving under the influence’ of alcohol, and enforce them
OPEN SIMPLE PROSTATECTOMY AND BLOOD TRANSFUSION IN NAIROBI
No full textABSTRACTBackground: Open simple prostatectomy has long been associated with large bloodlosses; hence allogeneic blood transfusion in this procedure is a standard practiceworld over. A review of literature suggests significant association between perioperativeblood loss accompanying open simple prostatectomy and certain patientfactors.. The shortage of blood and blood products in our blood transfusion centresas well as the alarming risks of transfusion reactions and disease disseminationdemanded a review of these factors with the aim of reducing morbidity associatedwith peri-operative blood loss and blood transfusion.Objectives: To assess blood loss, determine blood transfusion rate, and define someof the factors associated with peri-operative blood loss and blood transfusion in opensimple prostatectomy.Design : A prospective cohort study.Settings: The urology units of Kenyatta National Hospital, Kenya.Results: Ninety five patients who underwent open simple prostatectomy for benignprostatic hyperplasia were enrolled into the study. Their median age was 70 years(Range 50 to 97). The mean decrease in haemoglobin concentration, which was themain indicator of peri-operative blood loss, was 2.1g/dl (± 1.4). The peri-operativeblood transfusion rate was 36.8%. Twenty four (68.6%) of the patients who receivedeither one or two units of blood had a pre-operative haemoglobin level above 13.5g/dl and a post-operative haemoglobin level above 11.5g/dl, while 11 (31.4%) hadsevere peri-operative bleeding, that necessitated immediate surgical re-intervention.A total of 68 units of blood was transfused, 42 (61.8%) allogeneic and 26 (38.2%)autollogous blood. The post-operative median hospitalisation time was eight days(Range 4 to 35). There were two (2.1%) post-operative deaths and both patients hadintractable intra- and post-operative bleeding, massive blood transfusion anddisseminated intravascular coagulopathy. The factors that were significantlyassociated with peri-operative blood loss and blood transfusion in open simpleprostatectomy were patient’s aged above 70 years, pre-operative use of acetylsalicylateor warfarin sodium, pre-operative systolic blood pressure above 140mmHg,general anaesthesia, Freyer’s (transvesical) technique and the weight of resectedprostatic tissue above 70 grams.Conclusion: Open simple prostatectomy performed under spinal anaesthesia usingMillin’s (retropubic) technique is associated with minimal blood loss. The perioperativeblood transfusion rate was 36.8%
WANDERING SPLEEN: CASE REPORT
No full textWandering spleens are rare clinical entities found more commonly in women aged 20-40 years. We report one such case found in a 24-year-old nulliparous woman who presented with low abdominal pains of sudden onset and splenomegaly. An emergency abdominal CT scan showed an enlarged spleen located in the right lumbar region and extending into the pelvis. There was a long splenic pedicle containing tortuous vessels. A review of literature and the postulated aetiological factors and associationsare discussed
MANAGEMENT OF “WATERING-CAN” PERINEUM
No full textObjectives: To review the management of watering-can perineum (WCP) in a Nigerian centre andto outline challenges of its management.Design: A retrospective review of cases of watering-can perineum over a seven-year period.Setting: Usmanu Danfodiyo University Teaching Hospital, Sokoto, a Nigerian tertiary health centre.Subjects: Forty one patients with the diagnosis of watering-can perineum managed from January1997 to December, 2003.Results: There were 41 cases of watering-can perineum. The mean age at presentation was 46.0 years(range: 7 to 80). Characteristically, all the patients had long standing neglected urethral stricture.Eighteen (43.9%) presented with single active fistulae while eight (19.5%) had more than four (9.8%)active external openings. Fistulae were located in the perineum (58.5%), scrotum (41.6%), penis(14.6%), penoscrotal junction (9.8%) and thigh (49%). The strictures were post inflammatory in 73%of patients. Bulbar strictures constituted 63.4% of cases. At presentation, patients were in generalplanned for initial suprapubic cystostomy (SPC) followed by assessment of stricture and finallyurethroplasty in six months. Patients who could not afford urethroplasty were offered dilatation.The immediate outcome of urethroplasty was satisfactory in 70.6% of patients.Conclusion: Watering-can perineum was a common sequel of long standing neglected inflammatoryurethral stricture. SPC followed by urethroplasty gave the best results. Prevention and adequatetreatment of urethritis, prompt treatment of urethral stricture, and affordable and accessiblereconstructive urologic service are recommended to reduce the incidence of WCP and sufferingof the patients