Surgical Outpatient Department Research Articles

CLINICO-PATHOLOGICAL PROFILE OF BENIGN ANO-RECTAL DISEASES: HAEMORRHOIDS, FISSURE IN ANO, FISTULAE AT HIND INSTITUTE OF MEDICAL SCIENCES, SAFEDABAD, BARABANKI, UTTAR PRADESH, INDIA

Background: Benign anorectal diseases are frequently encountered conditions presenting to a surgical facility. However, there are limited studies on its epidemiology and clinical profile, especially from countries like India. In the present study, we made an attempt to study the clinical spectrum of different benign anorectal diseases among patients presenting to our facility. Aim and Objective: To study aetiopathogenesis and clinical presentation of Benign Ano-Rectal Diseases – i.e., Hemorrhoids, Fissures and Fistulae. Methods: It is an analytical study conducted between January 2021 to June 2022 at Hind Institute of Medical Sciences, Safedabad, Barabamki, Uttar Pradesh, India, where clinical records of all the patients presenting to surgical outpatient department or indoor patients wards with any ano-rectal condition were retrieved and a list of those presenting with benign ano-rectal conditions was made. Spectrum of benign ano-rectal conditions, their age and sex profile were noted. Results: Majority of patients with benign anorectal conditions were males. The age group of 30–40 years was most commonly affected by anorectal diseases.Pain and constipation were most common presenting complaint followed by bleeding and pus discharge. Among different benign ano-rectal conditions, fissure in anowas the most common.

A CLINICAL STUDY OF INCIDENCE OF MALIGNANCY IN SOLITARY THYROID NODULE IN A TERTIARY CARE HOSPITAL

Introduction:Thyroid nodules are common entities presenting to the surgical outpatient department. They are defined as A discrete swelling in an otherwise impalpable gland. Incidence of malignancy has been observed to be quite high in solitary thyroid nodules. Thus, they have to be evaluated properly for optimum management. Aim of the study is to identify the incidence of malignancy in solitary nodule thyroid. Materials and Methods:This study was a prospective non-randomized hospital based interventional study carried out on 50 patients who presented clinically with solitary thyroid swellings who thereby underwent surgery for the disease from August 2020 to July 2022 at the Department of General surgery of our institute. Results:There were 50 cases of clinically detected solitary thyroid nodule with female preponderance more than males. The mean age of the incidence of solitary thyroid nodule was 40.6 years. The incidence of malignancy in solitary thyroid nodule was found to be 18%. Conclusions:It is concluded from the present study that 18% of solitary thyroid nodules are malignant, with female preponderance and a mean age of solitary thyroid nodule is 40.62 years.

Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males.

Inguinal hernia repair is the most commonly performed elective surgery in Indiadraining significant healthcare resources. This observational study was conducted at a tertiary-level institute in northern India to look into the demographics, clinical profile and risk factors of inguinal hernia. This study was conducted as an observational study at the tertiary care centre of northern India, including 110 patients who had come to the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all the participants, demographic details, history and clinical examination were recorded. This was a prospective, single-centre, non-randomized, observational study. In our study, 43 patients (39%) were >50 years of age. One hundred and sevenpatients (97.27%) were males, and three (2.72%) were females. Male: Female ratio was 32:1.The preponderance of males was due to their involvement in more strenuous exercises and lifting weights and the anatomical differences between them. The main risk factor in the present study was lifting heavy weights 55%, followed by altered bowel habits 36.36% and respiratory disease (chronic obstructive airway disease). Smoking and diabetes were also associated as risk factors for the hernia. In this study, the most common side of hernia was on the right side, 63%, on the left, 33% and bilateral in 4% of patients. The indirect hernia was the most common type. Inguinal hernia is a surgical problem found commonly in the male elderly. Right-sided inguinal hernia is common, with the indirect type being more frequent. Heavy weight lifting and strenuous exercises were commonly found risk factors.

The efficacy of Ksharsutra, Fistulectomy and Ligation of Intersphincteric Fistula Tract (LIFT) procedure in management of Fistula in ano a prospective observational study

BackgroundFistula in ano is always a troublesome condition for the clinician and the patients owing to its complexity, recurrences, and high morbidity since ancient times. There is no gold standard treatment modality to date documented in the literature for complex fistula in ano.Material and methodsWe enrolled 60 consecutive adult patients attending the surgical outpatient department of a tertiary care centre in India, diagnosed with complex fistula in ano. Among them, 20 each in the Ligation of intersphincteric fistula tract (LIFT), Fistulectomy andKsharsutra(Special medicated seton) group were respectively recruited randomly. A prospective observational study was conducted. The primary outcomes were postoperative recurrence and morbidity. Post-operative morbidity is measured in terms of postoperative pain, postoperative bleeding, pus discharge and post-operative incontinence. The result of the study were analysed after 6 months of follow-up by clinical examination at outpatient department and at 18 months follow up done telephonically.ResultsAt 6 months of follow-up, 2 patients (10%) had a recurrence in the Ligation of intersphincteric fistula tract procedure group, 3 patients (15%) in the fistulectomy group and 6 patients (30%) in Ksharsutra group, however 3(15%), 4(20%) and 9(45%) patients developed recurrence in Ligation of Intersphincteric fistula tract, Fistulectomy and Ksharsutra group respectively at 18 month of follow-up. The differences in the recurrence were not statistically significant.The mean Visual analogue score for postoperative pain after 24 h as well as after 48 h were statistically significant in Ligation of intersphincteric fistula tract versus Ksharsutra group (p < 0.05). The Visual analogue score for post–operative pain was also significant in the Ligation of the intersphincteric fistula tract versus the Fistulectomy group (p < 0.05). The patients treated via Fistulectomy and Ksharsutra had a higher proportion of bleeding (15%) as compared to the Ligation of intersphincteric fistula tract procedure. Postoperative morbidity was statistically significant between the Ligation of intersphincteric fistula tract versus the Ksharsutra and the Ligation of intersphincteric fistula tract versus Fistulectomy.ConclusionLigation of intersphincteric fistula tract had less postoperative morbidity compared to Fistulectomy and Ksharsutra procedure; although recurrence was less compared to other methods it was statistically not significant.

Role of Autologous Platelet Rich Plasma in the Management of Chronic Non Healing Ulcers

Background: Chronic non-healing leg ulcers are a major health problem worldwide and have great impact on personal, professional and social levels, with high cost in terms of human and material resources. The present study was conducted with an aim to demonstrate the efficacy of autologous platelet rich plasma (PRP) in chronic non-healing leg ulcers in comparison to conventional dressings. Methods: About 50 patients presenting with chronic non healing ulcers to the surgical outpatient department in a tertiary care centre over a period of one year were included in the study, of which 25 patients received autologous PRP dressings other 25 patients received conventional dressings. Ulcer measurements were taken on day 1, 15, 28 and 42 days. Results: The mean duration of healing of the ulcers was 3.9 weeks in PRP group and 6.2 weeks conventional dressing. PRP dressing group showed a reduction in ulcer size of about 45.50 percent as compared to 14.80 percent in conventional dressing group. Conclusion: Chronic non healing ulcers are often difficult to heal because they lack the necessary growth factors to maintain the healing process. Conventional therapies do not provide satisfactory healing, since these treatments are not able to provide the necessary growth factors (PDGF, EGF, VGEF etc.) which are essential for the healing process. PRP is a safe, affordable, biocompatible and simple office based procedure for the treatment of non-healing ulcers.

PROSPECTIVE DESCRIPTIVE STUDY OF NON-THYROIDAL NECK SWELLINGS IN WESTERN INDIAN POPULATION

Background. Nonthyroidal neck swellings are common and cause diagnostic challenges. This study highlights various diagnosis associated with non-thyroidal neck swellings and their management challenges. Objective. This pilot study highlights the various diagnosis associated with nonthyroidal neck swellings and their management challenges. The clinical spectrum of two most common aetiology of nonthyroidal neck swelling: tubercular cervical lymphadenopathy and lymphomas, are also compared. Methods. This prospective study was conducted in a tertiary care teaching hospital from 01 Jun 2018 to 31 Dec 2019. The first 100 nonthyroidal neck swellings presented to the surgical outpatient department were included and assessed clinically, radiologically and histopathologically. Comparison was carried out between the first two common diagnosis of tubercular cervical lymphadenitis and lymphoma. Continuous variables were analysed using Student’s t-test and categorical data were analysed using the Chi square test. A statistical p value &lt;0.05 was taken as significant. Results. There were 73 lymph node swellings and 27 non-lymph node swellings in the study. The most common diagnosis was tubercular cervical lymphadenitis (n=38) and lymphoma (n=17). The mean volume of lymph nodes in the lymphoma group (38.72±22.12 cm3) was significantly bigger than in the tuberculosis group (9.44±5.99 cm3) P=0.00001. The mean age (33.81±11.8 years) of tubercular patients was significantly less than the lymphoma (52.38±25.3 years) with P=0.000167. The clinical diagnosis was nearly accurate in 85% of cases. However, in 15 cases clinical diagnosis was changed after fine needle aspiration cytology. Conclusions. Ultrasonography and fine needle aspiration cytology are very useful adjunct in arriving at a definite diagnosis of a lymph node swelling in neck. Tubercular cervical lymphadenopathy and lymphoma were two major diagnosis. Tubercular cervical lymphadenopathy is significantly different from lymphomas in terms of early age of presentation and smaller size at the time of presentation.

The quality of life of patients with coronary artery disease before and after coronary artery bypass graft

Heart is one of the vital organs in the human body which is a durable organ and efficient pump. The human heart works tirelessly from the moment of formation and it begins beating until the moment it stops. On an average life time, the human heart beats more than twenty two and half billion times without taking rest. The heart beats continuously and unlike other muscles of the body, it cannot stop to rest when tired and worn from work. Research Approach: This study adopted a non experimental descriptive and comparative survey approach.The study was conducted at the cardio thoracic surgical out patient department of one of the selected hospital at Sahdol.The population comprised of all patients with coronary artery bypass graft attending the cardio thoracic surgical outpatient department of the selected hospital at Sahdol at the time of the study.The sample consisted of 75 patients with coronary artery bypass graft based on the criteria for sample selection. Non probability convenient sampling technique was adopted for the selection of sample. 64 samples (85.3%) were able to carry out the household activities such as cooking, washing the cloth, sweeping, grinding, ironing, gardening, minor repairing work at home moderately well and 11(14.7%) were able to perform these activities very well before surgery. However after the surgery the percentage of samples who performed the household activities very well increased by 5.3%.cBefore surgery 59 samples (78.7%) showed good interest in reading newspaper and watching TV. However after surgery this number reduced to 51, a reduction of 10.7%. that majority of the samples (84-94.7%) had good social well being before surgery. However after surgery the samples showed moderate quality of life in social wellbeing. Statistically there was no significant difference between the mean score of personal and household activities ( t-0.239 and 0.054,df=74,p&amp;#60;0.0 ) before and after surgery and there was significant difference between the mean score of outdoor and other activities (t-3.17and3.8,df=74,p&amp;#60;0.01 ) before and after surgery. The study concludes that the quality of life of patients who had undergone coronary artery bypass graft was better before surgery but after surgery the quality of life was better in physical well being whereas psychological and social wellbeing was reduced.

Predisposing Factors of Diabetic Foot Amputation among the Diabetic Patients in a Tertiary Care Hospital

Background and Aim: Diabetic patients have a 15 to 20 time’s higher risk of amputation than non-diabetic patients.In literature, many factors have been mentioned which affect diabetic foot prevalence and its treatment amongdiabetic patients. Present study was directed to recognize those factors. Identification of those factors would helpto bring down the financial burden over patients and healthcare centers.Material and Methods: Present cross-sectional study was conducted among the diabetic (diabetes type Ⅱ) patients whocame with problems relevant with diabetic foot in the surgical outpatient department of tertiary care institute of India for theduration of 6 months. Three hundred Patients were categorized into two categories based on the treatment advised to them.One category of patients was treated through amputation whereas, other category of patients was treated with antibiotics andwound dressings. A self-structured questionnaire was built to collect the required data from patients. Chi-square was appliedto identify any association.Results: From the total of 300 patients 78 (26%) were advised amputation, whereas, 22 (74%) patients weremanaged conservatively. The correlation between diabetic foot amputation and various factors which includedgender, socioeconomic status, diet modification, blood sugar monitoring, life style, therapy type, smoking(p=0.02), ischemic heart disease, peripheral neuropathy and peripheral arterial disease (p=0.001) was statisticallysignificant.Conclusion: The incidence of foot amputation was high among the patients who had male gender, lowereducational status, lower socioeconomic status, longer duration of diabetes, no diet change, no proper blood sugarmonitoring, sedentary type of life style, inadequate therapy, poor compliance with treatment, history of smoking,hypertension, ischemic heart disease, stroke, peripheral neuropathy, and peripheral arterial disease and thesefactors were correlated with incidence of diabetic foot amputation significantly except duration of diabetes.

Open Inguinal Hernia Repair Utilizing a Prolene Mesh (Lichtenstein’s Operation): Study in Tertiary Care Hospital in Bangladesh

Background: One of the most common surgeries is inguinal hernia repair. The best procedure for inguinal hernia repair is still debatable. Open Lichtenstein tension-free mesh repair (LMR) is one of the most popular open procedures with good outcome. Objective: To assess the open inguinal hernia repair using a Prolene mesh (Lichtenstein's procedure). Materials and Methods: The observational study was carried out at the Department of General Surgery in Kushtia Medical College Hospital. 60 consecutive adult patients seen in the surgical outpatient department with inguinal hernias were scheduled for elective mesh repair. Patients below 18 years, emergency cases, and immuno-compromised patients were excluded. All patients were informed of the use of the mesh and informed consent was sought and obtained pre-op. Patients were not charged for the mesh and were promised free care in case of recurrence. Results: Hernias were discovered in 31(51.7%) of the patients, 45 (75.0%) of whom had direct hernias, with a mean duration of 2.30.5 years. 28 patients (46.7%) required a hospital stay of 2-4 days. Surgical complications following two groups of patients (3.3%) suffered urinary retention, while 6 (10.0%) patients developed Haematoma. At the 4-week checkpoint, 19(31.7%) of the patients reported sensory loss, 1 (1.7%), seroma, 1 (1.7%), discomfort, and 1 (1.7%), recurrence. Conclusion: In conclusion, the majority of hernia was discovered to be Direct and ASA Grade I. Haematoma and urine retention were discovered as postoperative consequences. Four weeks later, there was sensory loss, seroma, discomfort, and recurrence.

An Assessment of Door to Consultation Time in Outpatient Department (OPD) of a Tertiary Care Cardiac Hospital: A Clinical Quality Improvement Project (QIP)

Objective: To assess door to consultation time in cardiac OPD of a tertiary care hospital and to recommend strategies to reduce patients waiting time.&#x0D; Study Design: Cross sectional study&#x0D; Place and Duration of Study: Surgical Out-Patient Department, Armed Force Institute of Cardiology, National Institute AFIC/NIHD, Rawalpindi Pakistan, from Aug 2020 to Sep 2020.&#x0D; Methodology: This quality improvement project (QIP) was conducted for a period of 4 weeks from 15th, Aug-15th, Sep 2020 in the surgical out-patient department of Armed Force Institute of Cardiology, National Institute/National Institute of Heart Disease (AFIC/NIHD). Time for registration, waiting time pre-consultation and consultation times were recorded on a patient survey proforma. A non-probability consecutive sampling technique was used to recruit study participants.&#x0D; Results: Data was collected from a total of 278 respondents. The results showed that 142(51%) participants had the total door to consultation time of 30 minutes and 86(31%) participants had the door to consultation time of 30-60 minutes 86(31%), respondents reported the actual consultation time to be 11-20 minutes and an equal percentage of participants 86(31%) responded that it was 6-10 minutes. Sixty-six percent 183(66%) participants reported that the doctors were aware of theirmedical history which helped in shorter consultation time.&#x0D; Conclusion: In this QIP we concluded that patients who had shorter waiting time lead to a significantly shorter door to consultation time. A few areas of concern identified in the QIP of note were; less number of registration counters and patients presenting on same day without appointments. Recommendations were made to reduce waiting times in outpatient department (OPD) which would in turn increase patient satisfaction.

Prospective Evaluation of the Quality of Life of Patients after Surgical Treatment of Rectal Cancer: A 12-Month Cohort Observation.

This study constitutes a prospective, three-stage evaluation of quality of life among patients receiving surgical treatment for colorectal cancer depending on the type of surgery performed (open anterior resection, laparoscopic anterior resection, abdominoperineal resection, or Hartmann’s procedure). The study included 82 patients treated at the Surgical Oncology Outpatient Department of the Oncology Center in Bydgoszcz from June 2019 to August 2021. The study tools consisted of diagnostic surveys and analyses of medical records. The standardized study tools were the surveys EORTC QLQ-C30 and QLQ-CR29. In addition, a proprietary questionnaire was developed to collect demographic data. Quality of life was measured at three time-points: the day before the surgery and 6 and 12 months post-surgery. Statistically significant differences (p < 0.05) were observed in the domains of role functioning (III, p = 0.030), body image (II, p < 0.001; III, p < 0.001), sexual functioning (II, p = 0.037), buttocks/anal area/rectum pain (III, p = 0.031), and embarrassment (II, p = 0.022; III, p = 0.010). Statistically significant differences in the functional and symptom scale scores were also observed within each group at different stages of cancer treatment. As shown by our study, the quality of life of patients treated for colorectal cancer is determined not only by the operating technique but also by sociodemographic and clinical factors. The use of minimally invasive surgical techniques enables patients to return to their social roles more quickly and improves their self-assessment of body image.

Resilience process in individuals with colorectal cancer: a qualitative study.

Resilience is a positive outcome in giving individuals strength to adapt to cancer and have better various aspects of health-related quality of life. However, research focusing on resilience in relation to colorectal cancer (CRC) is limited. Therefore, the aim of this study was to explore the process of resilience in individuals with CRC. Sixteen individuals diagnosed with stage Ι to III CRC within the last five years were recruited from a CRC surgical outpatient department in a medical center in Northern Taiwan. Semi-structured interviews were used to explore the resilience process of living with CRC. Recorded interviews were transcribed verbatim and were analyzed using modified grounded theory. Resilience is a dynamic three-phase process, including impact of CRC, adaptation or maladaptation following CRC, and growth from CRC experience. Resilience strategies (i.e., attitude adjustment, developing personal strategies to conquer CRC and side effects, setting new goals in life, and viewing death as a normal process), avoidance behaviors, and passive waiting strategy were shown across the resilience process. All individuals showed negative impacts during CRC diagnosis and treatments, but some individuals used the resilience strategies in helping to promote positive adjustment and redirect to develop their resilience process. Furthermore, resilient and maladaptive individuals may change the situation depending on which strategies are used and on the progression of CRC because resilience is dynamic. Oncology clinicians should help individuals use resilience strategies to smoothly go through the resilience process.

To Evaluate the Management of Epididymo-Orchitis at Tertiary Care Hospital

Introduction: Epididymo-orchitis is common condition in scrotum found in surgical practice. It is commonly seen in young males. It can occur at any age. The common age is between 2nd to 4th decades of life. Its duration of illness is 6 weeks in acute condition and 12 weeks in in chronic conditions. It mostly occurs associated with sexually transmitted diseases. Chlamydia trachomatis and Neisseria gonorrhea are the common causative organisms. After age 40, the common organisms causing this disease are Escherichia Coli and Coliform bacteria found on G.I.T. There are also other causes of this disease. It is mostly managed conservatively but it can be operated it the condition develops complications. Even Orchidectomy is also done in some conditions. Objective: To evaluate the management options in epididymo-orchitis . Material methods: This is a cross sectional study done at surgical Unit 1 of Peoples Medical Hospital (PMCH) Nawabshah. The duration of study was one year from 10th August 2019 to 9th July 2020. All the patients were admitted through Surgical out Patient Department (SOPD) and emergency department of Peoples Medical College Hospital (PMCH) Nawabshah. Approval of study was taken from Ethical committee. Detailed history and thorough clinical examination was done. Routine investigations were done apart from viral markers including HIV. Urine DR and Culture ,Ultrasound of Scrotum and CT Scan were done. Management was planned accordingly. Results: Total 65 patients were included in this study. Of them, 20 (31%) had left sided pathology, 40 (61%) had right sided and 5(8%) had bilateral. Testicular abscess formation was seen in 8 (12.3%) patients. In 2 (3.07%) patients, testicular infarction was noted. 1 (1.5%) patient became infertile due to bilateral involvement. 3 (4.6%) patients had developed psychosis. Conclusion: It is concluded that most of the patients were treated conservatively and in a few patients, incision drainage and orchidectomy was performed. Keywords: Epididymo-orchitis. Neiserria Gononrhea, E.Coli, Incision Drainage, Orchidectomy.

Clinical Profile and Evaluation of Outcomes of Symptomatic Gallstone Disease in the Senior Citizen Population.

BackgroundThere is a heavy burden of gallstone disease on the world’s population. The incidence and severity of symptomatic cholelithiasis increase with age. There is often a delay in presentation, leading to complicated disease, diagnostic delay, and increased morbidity. There is a paucity of studies on the presentation and management of cholelithiasis in elderly persons from the western part of India. This study aimed to observe the spectrum of presentation and management of symptomatic cholelithiasis in senior citizens.Objectives The primary objective of this study was to describe the presentation, diagnosis and intraoperative findings of symptomatic gallstone disease (GSD) in patients aged over 60 years. The secondary objectives of this study were to find the association of GSD with age, sex, and comorbidities, including diabetes mellitus, hypertension, and thyroid disorders.MethodsAll patients above the age of 60 years presenting to the surgical outpatient and emergency departments from January 2020 to July 2021 with symptomatic GSD were included. Details of history, physical examination, blood investigations, and imaging of the abdomen (ultrasonography and Magnetic Resonance Cholangiopancreaticography, when indicated) were recorded. Patients were managed as per the advice of the treating consultant. Details of management and outcomes, including hospital stay, mortality, and morbidity, were noted. The descriptive data were organised into tables and percentages. The significance of various data and relationships between various variables was analysed using the Pearson chi-square test, Fischer exact test and scatter plots.ResultsA total of 76 patients were evaluated in this study, of which 73.7% were female. The mean age was 70.8 ± 1.7 years. The majority of patients (63.2%) were admitted through the outpatient department (OPD). The most common presenting complaint was abdominal pain (96.1%). Clinical jaundice was noted in 9.2%. Complicated Gall Stone Disease (GSD) was found more commonly in the female population (57.1%). Complicated GSD was more commonly found in patients with diabetes (p=0.075) and hypothyroidism (p=0.057). No association of age with intraoperative complications was noted (p = 0.446).ConclusionSenior citizens can present with both complicated and uncomplicated GSD. GSD, in the presence of hypothyroidism or diabetes mellitus, presents in a much more complicated form. Early surgical intervention in form of laparoscopic cholecystectomy can be beneficial to the patient if diagnosed with symptomatic gallstones. Patients of this age group need not be over investigated if a benign pathology is suspected.

Harmonic Scalpel Hemorrhoidectomy—Open versus Closed: A Comparative Study

Background Hemorrhoids are one of the frequent presenting complaints in the surgical outpatient department of any hospital. Multiple options are available for the treatment of these based on the grade. Recently, there are many varieties of energy devices being tried for hemorrhoidectomy to decrease the postoperative pain and achieve better hemostasis intraoperatively. This study represented an effort to compare open versus closed method of harmonic scalpel hemorrhoidectomy to determine the differences in terms of operative time, hospital stay, postoperative bleeding, pain, and other complications. Method A total of 40 patients, 20 each in open and closed method harmonic scalpel hemorrhoidectomy, were followed up for 6 weeks postoperatively. Early and late outcomes were compared. Incontinence if any was measured with Vaizey incontinence score. Result There was significant prolonging of operative time in closed method (30.25 ± 5.49 vs. 22.0 ± 4.70). Postoperative pain was significantly more in open method group compared with closed on days 1, 3, 7, and 21. There was no significant difference between groups in terms of hospital stay, postoperative bleeding, and complications. Conclusion Leaving mucosa open after hemorrhoidal tissue excision is comparable to closed in terms of safety complication and is cost effective in terms of operative times and utility of suture materials at the expense of need for analgesics.

Burn Injuries in Kumasi: A Ten-Year Review

Objective: To document the clinical and epidemiological features; and the outcome of management of patients with burn injuries at Komfo Anokye Teaching Hospital in Kumasi, Ghana, from January 2003 to December 2012. Patients and Methods: Data on all burn patients managed within the study period were retrieved from the records of the Burns Intensive Care Unit (BICU), theatre and Surgical Outpatient Department (SOPD) and analyzed. Data included name, age, sex, cause ofburn, medical and surgical treatment given, post burn complications and the outcome of the treatment.Results: 1361 patients were treated for burn injuries and their complications at KATH, comprising 707 males and 654 females (M: F = 1.08:1). Ages ranged from 0.25 to 92 years; mean 15.5 (SD 14.1) years, median 11.9 years. About 77% of the patients wereaged 20 years or less; 45% were children aged 10 years or younger. The highest annual admission was 172 patients in 2005; the lowest 104 in 2007. Scalds comprised 60% of the injuries, hot water accounting for 45%. Dry heat was responsible for 37% of the burninjuries. Chemical burns accounted for 28 (2%) injuries which led to loss of vision in two cases and one death; all of which were through assault. Electrical burns accounted for 12 (0.9%) of the injuries and led to six limb amputations and three deaths, all of them workersof electricity companies. A total of 162 patients died of burn injuries, giving an overall mortality of 11.9%. The highest annual mortality of 32 (29%) occurred in 2008, which coincided with 4 major burn disasters. Perioperative deaths occurred in four epileptic patients.Conclusion: Though injuries from hot liquids account for most admissions for burns at KATH, significant morbidity and mortality also result from dry heat. Electrical and chemical burns and epilepsy are increasingly becoming responsible for most burn morbidity.

Malignant Skin Tumours in Kumasi: A Five Year Review

Introduction: Ultraviolet radiation is the primary aetiological agent in malignant melanoma (MM), squamous cell carcinoma (SCC) and basal cell carcinoma (BCC). Its effect on carcinogenesis can be influenced by endogenous and exogenous factors.Objective: To document the clinical and epidemiological features of patients presenting with malignant skin tumours at Komfo Anokye Teaching Hospital (KATH), from January 2009 to December 2013.Patients and Methods: Records of patients treated for malignant skin tumours at KATH were retrieved from the surgical out-patient department and theatre records and analysed.Results: 38 patients comprising 16 males and 22 females were treated for malignant skin disease from January 2009 to December 2013. Their ages ranged from 12 to 84 years (mean 48.4, SD=20.2). Predominant lesions were SCC (17 cases), MM (12 cases), and dermatofibrosarcoma protuberans (DFSP), (four cases). SCC were located on the scalp (eight cases), lower limbs (six cases), upper limb (two cases) and trunk (one). All MM lesions were located on the foot. DFSP lesions were found on the leg (one case), trunk (one case), and shoulders (two cases). Basosquamous carcinoma (BSC) was found on the trunk of an albino. All patients were treated surgically (48 procedures); three SCC patients had radiotherapy; one MM patient had chemotherapy.Conclusion: SCC, MM and DFSP were the main malignant skin tumours managed. Chronic wounds, scars and skin bleaching were the exogenous factors; whilst albinism and xeroderma pigmentosum were the endogenous factors identified. For prevention, earlycase detection, adequate treatment of wounds and sun avoidance are advocated.

Comparative study of Vac dressing with moist gauze dressing in the treatment of diabetic foot ulcer in tertiary care center

Background: Diabetic foot ulcers are one of the most commonly encountered cases in any surgical out-patient department. Causes of leg ulcers vary from traumatic, diabetic, chronic venous insufficiency, trophic, hypertensive, and so on. Objectives: To evaluate the safety and clinical efficacy of negative pressure wound therapy compared with moist gauze dressings to treat foot ulcer wounds. Methods: Patients presenting with leg ulcers to the department of general surgery, VMKVC hospital. 40 randomly selected patients will be assigned to the study group based on their willingness for undergoing topical negative pressure dressing and 40 patients to the moist gauze dressing, control group. Results: Most of the ulcer (46%) got healed by secondary intention through VAC. dressing. Treating DFU with VAC therapy results in a better graft take rate (p=0.05) when compared to standard wound care. There is a statistically significant association found between interventions and the area of the ulcer on day 21.Among the study participants according to day 1 ulcer state 16% had healthy granulation tissue, 14% had necrotic granulation tissue, and 50% had their tissue with pale granulation.

Breast Cancer in Relation to Gynecological Risk Factors Among Women in Southeast Nigeria

Background: Breast cancer is a highly heterogeneous disease that is developed by mutual impact of genetic risk factors and environmental factors. Identification of these factors may enhance the ability to prevent the disease by permitting better-focused health education and other preventive strategies. Objectives: The objective of the study is to determine the association between breast cancer and gynecological risk factors. Methodology: One hundred and twenty consenting females who were referred from the Surgical Outpatient Department and underwent mammography in the Radiology Department of Nnamdi Azikiwe University Teaching Hospital, Nnewi, from 2018 to 2020. Women who were 40 years and above as well as those below 40 years with positive family history of breast cancer presenting with palpable breast mass were included in the study. Results: The mean age was 47.36 ± 10.67 years and the most frequent age range was 41–50 years while the least frequency fell in the above 70 years of age group. Women with age of menarche at 11–13 years had higher association with breast cancer than those whose menarche occurred at later age. Those who attained menopause at a later age had higher association with breast cancer. Women whose age at first confinement was 25 years or less had higher association too. Further, higher incidence of breast cancer was recorded in women with parity &gt;3. Conclusion: No significant statistical difference was found between these gynecological risk factors as well as body mass index and breast cancer.

Acute Postoperative Visual Loss Due to Occipital Arteriovenous Malformation Rupture During Anesthesia

&lt;p&gt;We report a case of occipital arteriovenous malformation (AVM) rupture during anaesthesia, causing postoperative visual loss in a 43-year-old man with American Society of Anesthesiologist class I. He was scheduled for an operation for the correction of right index deformity. He was a healthy, middle-sized man without any previous systemic disease. He had sustained a cutting injury to the right index finger 1 year ago and had undergone microsurgery. As he was unsatisfied with the surgical results, he was arranged for another correction surgery. After the 2-h surgery, he recovered from anaesthesia, but complained of a mild headache over the occipital region. He left the post-operative recovery room thereafter and was discharged the next day. Three days later, he came to our surgical outpatient department for follow-up. He complained of blurred vision since the surgery. The ophthalmologist found left-sided homonymous visual field loss with incomplete hemianopia. He was referred to the neurological section and after a series of examinations including brain computed tomography, the diagnosis of AVM rupture in the right occipital region was confirmed.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;