Surgery- Scholarly Publications

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    Open Access
    Indications for Prostatic Biopsy – which is more useful: the Prostate Specific Antigen or the Digital Rectal Examination? – An Analysis of 431 Consecutive Prostatic Biopsies at the Lagos University Teaching Hospital
    (Lagos University Medical Society, 2004) Tijani, K.; Adetayo, F.; Osegbe, D.
    Objective: To compare the reliability of the digital rectal examination (DRE) and the serum prostate specific antigen (PSA) as an indication for prostate biopsy at the Lagos University Teaching Hospital, (LUTH) Idi-Araba, Nigeria. Patients and Methods: 42 patients were admitted for transperineal trucut biopsy of the prostate at the hospital between January 2000 to December 2001. The indication for biopsy was either an abnormal finding on DRE, serum PSA greater than 4ng/ml or both. The final histopathology report was used as the Gold standard in assessing accuracy of these two screening procedures. Results: PSA>4ng/ml (irrespective of DRE findings) had a positive predictive value (PPV) of 68.6% for prostatic cancer (Ca-P). A raised PSA. alone (i.e. with normal findings on DRE.) had a PPV of 28.6%. DRE (irrespective of PSA) had a PPV of 88.9%. When both an abnormal DRE and a raised PSA were present, the PPV was 95.2%. Conclusion: At LUTH, DRE is more reliable than the serum PSA analysis as an indication for prostate biopsy
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    Open Access
    Fine Needle Aspiration biopsy cytology in the diagnosis of prostate cancer
    (The Nigerian Medical Association, 2005) Tijani, K.H.; Adetayo, F.O; Banjo, A.; osegbe, D.N.
    Objective: To assess the efficacy of Fine Needle Aspiration Biopsy Cytology(FN ABC) in the diagnosis of prostate cancer. Patients and Methods: All patients that were admitted for transperineal core needle biopsy of the prostate were also offered trans-rectal fine needle aspiration biopsy (FNAB) as a preceding procedure. The report of the FNABC was then compared with the histopathology report from the core needle biopsy - which was used as the control. Results: 41 patients were involved in the study. All had trans¬ rectal FNAB followed by transperineal trucut needle biopsy. 33 (80.5%) of the FNAB smears were reported as adequate. The FNABC had a specificity of 100% and sensitivity of95.4% and a positive predictive value (PPV) of 100%. The average cost of the FNABC was 130 naira unlike 15,000 naira for the core needle biopsy. Conclusion: FNABC is a cheap and dependable investigation for clinical decision making. Thus, in unequivocal malignant cytology reports, FNABC is reliable in establishing a diagnosis of prostate cancer (Ca-p) and management can be confidently made without resorting to core needle biopsy.
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    Open Access
    Presentation and management outcome of childhood intussusception in Lagos: A prospective study
    (Wolters Kluwer, 2008) Bode, CO
    Background: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. Early diagnosis and effective management have reduced morbidity and mortality in developed countries. Aim: To document the presentation, management and treatment outcome of intussusceptions at the Lagos University Teaching Hospital (LUTH). Patients and Methods: One hundred seventy-four consecutive cases of this condition seen in children presenting at LUTH over a 5-year period were prospectively studied. Details of symptoms and signs, pre-hospital care, treatment, and outcome in LUTH were documented. Results: The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass were seen in 106 (61%) of the cases. One hundred thirty-five (77.6%) had been admitted and treated with antibiotics and intravenous fluids in primary healthcare centres for an average of 3 days before referral to the LUTH. The prolonged mean duration of recognizable symptoms of 3 days accounted for a 70.4% bowel resection rate. Wound infection occurred in 61 (36.1%), whereas faecal fistulae developed in six (3.6%), and burst abdomen in five (3%) cases. Seven (4.1%) patients developed incisional herniae. Overall, the mortality rate was 12.1%. Conclusion: The early symptoms of intussusception would seem to be missed by primary healthcare workers in Lagos, with consequently high morbidity and mortality. There is an urgent need to re-emphasize these symptoms to first-line healthcare providers and parents through public enlightenment campaigns.
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    Open Access
    Penile Fasciocutaneous Flap Urethoplasty. Recent Experience and Challenges in a sub-Saharan African Teaching Hospital
    (Elsevier, 2009-10) Tijani, K.; Adesanya, A.; Ogo, C.E.; Osegbe, D.
    OBJECTIVE: To evaluate penile fasciocutaneous flap urethroplasty for complex anterior urethral strictures in circumcised West African men. METHODS: Between January 2002 and December 2006, 26 patients with anterior urethral strictures underwent penile fasciocutaneous flap urethroplasty (PFU), using a modification of the technique described by Quartey (Quartey JKM. J Urol. 1985;134:474-475). Of these patients, 21 had dorsal onlay patches and 5 had tubularize patches. Average follow-up was 19 months. RESULTS: There was a 100% immediate success rate with the dorsal onlay group. No recurrence was seen in all patients available for follow-up at 30 months. The tubularized flap had an immediate success of 80% but at 30 months it was only 40%. Troublesome postvoid dribbling was completely eliminated and complications were minor and few, which included 1 case of distal superficial dorsal penile skin loss, 1 case of urethrocutaneous fistula, and 2 cases of postvoid dribbling all of which were managed conservatively. CONCLUSIONS: PFU when used as a dorsal onlay gives excellent results at least in the immediate and intermediate periods in black West African population. A multiracial study to compare the effect of skin color on the short- and long-term outcome of PFU is also suggested
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    Open Access
    Emergency surgical services in a sub-Saharan African country: can we meet the needs
    (EuroJournals Publishing incorp, 2010) mofikoya, B.O; Enweluzo, G; Tijani, K.H; Ogunleye, E; kanu, O.
    Objectives: To determine the broad demographics and morbidity of patients utilizing the emergency surgical services at a public tertiary hospital in Lagos, identify major bottle necks to prompt service delivery, and determine patient outcomes. Methods: Authors and trained assistants collected data with aid of a simple proforma was designed to collect basic demographic data, patient socioeconomic group, injury–presentation interval in trauma cases, diagnoses of the patients seen, the presentation-intervention interval, emergency room mortality, outcomes and percentage of patients who experienced service failures. Results: 3426 patients were seen at the accident and emergency, surgery section between July 2003 and August 2006. Of the 3307 studied 1422 (43%) patients presented on account of injuries. Male: female ratio was 4: 1. Peak age group was 31-40 years. Injury–presentation time was more than 24 hours in 82% of cases seen. 96%(n= 3175) of patients had surgical intervention times of greater than 6 hours. Slow response times at the Laboratories and X ray centers delayed the intervention in most the cases. Service failure occurred in 40%(n= 1332) of cases. 214 (6.4%) cases of emergency room deaths occurred during the study period. 43% of the patients seen had surgical intervention 29% were admitted, the rest were treated and discharged. Conclusion: Tertiary referral facilities who receive surgical emergencies should ensure provision of smooth patient flow pathways to minimize morbidity and mortality.
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    Open Access
    Excision and end-to-end anastomotic urethroplasty in the management of post-traumatic urethral stricture disease: experience and challenges in a Nigerian teaching hospital.
    (National postgraduate Medical College, 2010) Tijani, K.H.; Ogo, C.N.; Adeyomoye, A.O.
    AIMS AND OBJECTIVES: The study aims to assess the outcome of excision and end-to-end anastomotic urethroplasty in the management of post traumatic urethral stricture in at one of the teaching hospitals in Nigeria. MATERIALS AND METHODS: All cases of post traumatic urethral stricture disease managed by excision and end to end anastomosis between January 2000 and December 2006 were retrospectively studied. The data collected included the patients age, cause of stricture, location, length and the outcome of surgery. RESULTS: A total of 47 patients excision and end to end anastomotic urethroplasty were carried out during the period. Twenty patients (42.6%) had bulbar stricture and 27 (57.4%) had pelvic fracture urethral distraction stricture involving the posterior urethra. There was a 100% success rate in the 20 patients with bulbar urethral stricture at a minimum follow up of 1 year while the success rate for the 27 patients with posterior urethral stricture was 70.4%. Complications included one case each of perineal wound infection and of urethrocutaneous fistula which were managed conservatively. CONCLUSION: Excision and end to end anastomotic urethroplasty gives excellent results for the treatment of short segment post traumatic bulbar strictures and should be used as the primary treatment for such strictures.
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    Open Access
    Survey of teaching, research and conference experiences of paediatric surgical trainees in Nigeria
    (MedKnow, 2011) Ademuyiwa, AO; Ameh, EA; Bode, CO; Adejuyigbe, O
    Aim: To determine the teaching methods used by residents in paediatric surgery in Nigeria and their exposure to research and conferences. Materials and methods: A structured questionnaire was administered to trainees in paediatric surgery in Nigeria seeking information regarding different teaching methods used, frequency of use, involvement in research and participation in conferences. Results: There were 11 respondents (91.6%) of 12 questionnaires that were distributed. All of them were training in accredited teaching hospitals in Nigeria. All of them had been involved in teaching medical students. Ten residents were involved in teaching in wards/bedside two times or more in a week and all were involved in teaching at the clinics. Only one resident used audiovisual aid at least once a week to teach students. Eight trainees used tutorial or seminar group discussion as a teaching tool once a week. Four trainees had not used written essay as a way of teaching students while five had never given students lectures in a classroom before. All the respondents had participated in retrospective research while nine had been involved in prospective research. Nine residents had attended conferences nationally while two had attended international conferences. Six trainees presented a paper or more at national conferences while one presented at an international conference. Conclusion: Trainees in paediatric surgery in Nigeria are significantly involved in the teaching of undergraduate medical students and clinical research. This should be encouraged and further enhanced by motivating the trainees to attend international conferences.
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    Open Access
    Kidney preservation protocol for management of emphysematous pyelonephritis: Treatment modalities and follow-up
    (Elsevier, 2011) El-Nahas, A.; Shokeir, A.A; Eziyi, A.K; Barakat, A.; Tijani, K.H.
    Objectives: To present treatments for kidney preservation in the management of emphysematous pyelonephritis (EPN), and to evaluate the functional outcome of preserved kidneys during the follow-up. Patients and methods: The computerized files of patients with EPN from 2000 to 2010 were reviewed. After initial resuscitation, ultrasonography-guided percutaneous tubes were placed for drainage of infected fluid and gas. A radio-isotopic renal scan was done after stabilization of the patients’ condition. Preservation of the affected kidney was attempted when the differential function was >10%. A renal isotopic scan was taken during the follow-up to evaluate renographic changes in preserved kidneys. Results: The study included 33 kidneys in 30 consecutive patients (mean age 51.7 years, SD 10.9). Kidney preservation was applicable for 23 kidneys (20 patients). Preservation methods included percutaneous nephrostomy for 12, percutaneous tube drain for two and conservative treatment for nine kidneys (six patients). Nephrectomy was performed for 10 kidneys (emergency in three and delayed in seven). The frequency of post-treatment septic shock after kidney preservation (10%) was significantly lower than after nephrectomy (20%, P = 0.005). The overall mortality rate was 7% (two patients). The follow-up was completed for 13 patients with 15 preserved kidneys for a mean duration of 21 months. During the follow-up, differential renographic clearance of the affected kidney was stable in 13 of 15 while two kidneys showed improvement. Conclusions: Kidney preservation should be the primary goal in the treatment of EPN when the differential renal clearance is >10%. It was associated with fewer complications than nephrectomy and the follow-up showed a favourable functional outcome of the preserved kidneys.
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    Open Access
    Seasonal Frequency in Esophageal Atresia/Tracheo-Esophageal Fistula: Is there an Environmental Etiology?
    (2011) Bode, C; Ademuyiwa, A; Ikhisemojie, S
    Background: Esophageal Atresia and Tracheo-Esophageal Fistula (EA/TEF) occurs sporadically and its eti-ology is poorly understood. We observed six cases of EA/TEF within three weeks of October 2007 at the Lagos University Teaching Hospital (LUTH), Nigeria. Aims: To analyze the monthly trends of presentation of EA/TEF at the LUTH from 2002-7, test the hypothesis that the October figures were not due to chance and correlate data with known local disease patterns. Setting: Lagos University Teaching Hospital, Nigeria. Patients, Materials, Method: A retrospective analysis of all EA/TEFs managed at the LUTH within stated period. Results: 25 babies with EA/TEF presented over the period. 10 (40%) were seen in the month of Oc-tober, 5 (20%) occurred in May while the rest were spread over the rest of the months. Chi-square analysis confirmed that the EA/TEF cases occurred significantly more frequently in October (P < 0.001) and this ob-servation was unlikely due to chance. Conclusions: There seems to be a seasonal variation in the occurrence of EA/TEF in Lagos, with a significantly higher frequency in the month of October. 96% of mothers of ba-bies with EA/TEF lived in low socioeconomic parts of Lagos. This study highlights the possibility of local viral etiology of EA/TEF.
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    Open Access
    HIV Seropositivity among Paediatric Surgical Patients at the Lagos University Teaching Hospital: What Risk to the Surgeon
    (2011) Bode, C; Ademuyiwa, A; Ikhisemojie, S; Elebute, O
    Background: Although much concern has been expressed about the occupational risk posed to surgeons by the HIV pandemic infection, the paediatric age group is often seen as less likely to harbor the disease. Aim: To determine the HIV infection rate among children presenting for surgical operations at the Lagos University Teaching Hospital (LUTH), Lagos. Materials, patients and method: Blood was taken from 1000 consecutive children referred to LUTH for surgical conditions and tested for HIV sero-positivity using the Western blot method. Consenting parents of sero-positive patients were also tested. Result: Five children tested positive for HIV, giving an overall infection rate of 0.5%. Four mothers and three consenting fathers were also positive. In one child, none of the parents was positive and he was suspected to have developed the disease from a previous blood transfusion prior to presentation in LUTH. This possibly resulted from transfusion of infected blood during its window period. Conclusion: Although the HIV infection rate of 0.5% in paediatric surgical group in Lagos is low, surgeons should vigilantly apply universal precautions to prevent needle-stick injuries while the rate of HIV infection should be periodically monitored to determine the trend.
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    Open Access
    Carcinoma of the penis: experience from the Lagos University Teaching Hospital Lagos, Nigeria
    (Lagos University Medical Society, 2011-01) Ajekigbe, A.; Anunuobi, C.; Tijani, K.
    BACKGROUND: Carcinoma of penis is rare in countries where neonatal mate circumcision is the tradition and in Nigeria it is a common practice amongst almost all the tribes. OBJECTIVE: This is to document the prevalence, age distribution, site and histologic types of penile carcinoma at the Lagos University Teaching Hospital Idi-Araba over a 20 year period. METHODS: Cases of the penile carcinoma recorded in the surgical pathology register of the Department of Morbid Anatomy, the Cancer Registry and the Medical Records Department of the Lagos University Teaching Hospital over a twenty year period were reviewed. Information extracted included the age, site of lesion, and histopathologic type. The histopathology slides were reexamined to confirm the diagnosis and to grade the lesion. The data was analyzed using simple statistical methods. RESULTS: There were 7 cases of carcinoma of the penis accounting for 1.9% of malignant lesions of the male genital tracts in LUTH, 3 (42.85%) of which were on the shaft of the penis. The ages of the patients ranged from 42-79 years with a mean of 52.2 years, majority (42.92) of the cases were inthe 5th decade. All the cases were well differentiated squamous cell carcinomas. CONCLUSION: Carcinoma of the penis is rare in Lagos, Nigeria. This may be attributed to the common practice of neonatal male circumcision in Nigeria.
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    Open Access
    Iatrogenic ureteric injuries in a Nigerian teaching hospital-experience in the last decade
    (kenyan medical Association, 2011-09) Tijani, K.H.; Onwuzurigbo, K.; Ojewola, R.W.; Afolabi, B.B.; Akanmu, N.O.
    Background: Ureteric injury is one of the most serious complications of any abdominal or pelvic surgery with significant morbidity. The medico-legal consequences are also becoming areas of concern in our environment. Traditionally abdominal hysterectomy was responsible for most cases. While recent reports from the west have however indicated a change in the pattern of these iatrogenic injuries with urological endoscopy being the major source, recent literature from the sub-Saharan Africa is relatively sparse, with the few ones available also indicating a change in pattern however of a different variety with a high incidence of injuries arising from gynaecological, non-hysterectomy causes. Objectives: To determine the incidence, pattern of presentation and outcome managements of iatrogenic ureteric injuries in our centre. Design: A retrospective descriptive study. Setting: Lagos University Teaching Hospital, Lagos, Nigeria. Subjects: Twenty patients managed for iatrogenic ureteric injuries between January 2000 and June 2010. Results: A total of 20 patients were managed for 24 iatrogenic injuries. Total abdominal hysterectomy was responsible for 15 (75%) of the patients. Six patients had the injury from the referring hospital in four of whom the gynaecological operations were performed by general practitioners (GP). Twelve patients developed injury after operation in our centre. Excessive intra-operative bleeding and emergency surgery in critically ill patients referred by the GP or traditional birth attendants were the most common predisposing factors. All but one patient had open surgical intervention. All patients with delayed diagnosis were operated immediately they were fit for anaesthesia irrespective of the time of injury. Outcome was satisfactory in all patients who had surgical intervention. There was one mortality which occurred in one patient who presented late and died before surgical intervention. Conclusion: Total abdominal hysterectomy still accounts for most cases of iatrogenic ureteric injuries in our environment. Open surgical intervention gives satisfactory results in all cases. Early surgical intervention is necessary to prevent morbidity and mortality.
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    Open Access
    Prevalence Of Prostate Cancer Among Nigerians With Intermediate Total Prostate Specific Antigen Levels (4-10ng/Ml): Experience At Lagos University Teaching Hospital, Nigeria
    (ISPUB, 2012) Ezenwa, E.V.; Tijani, K.H.; Jeje, E.A.; Ogunjimi, M.A.
    Prostate cancer is a common clinical condition among adult males world wide1 ; its prevalence in the intermediate total PSA values (4-10ng/ml) has not been assessed among Nigerians. This study was carried out to determine the prevalence of prostate cancer among patients with intermediate total PSA values seen in Lagos University Teaching Hospital (LUTH), a tertiary hospital located in Nigeria. A total number of 105 patients aged 50years and above with total PSA values within the intermediate PSA range (4-10ng/ml) and normal findings of the prostate on digital examination seen from January 2010 to December 2010 were recruited for the study. These patients had no features suggestive of metastasis on clinical examination. All the patients subsequently had free PSA assay and trans-rectal guided six core biopsy of the prostate. The mean age of the patients studied was 64.4years (SD=1.6) with mean total PSA value of 6.6ng/ml (SD=1.7). One hundred patients (95.1%) presented with lower urinary tract symptoms. The prostate cancer rate following analysis of biopsy specimen was 13.3 % ( 14 patients) with most patients (78.6%) within 61-70 year old bracket. The histology was adenocarcinoma in all the patients; Gleason scores 5-7 predominating. We therefore concluded that the prevalence of prostate cancer among Nigerian males with intermediate total PSA and palpably benign prostate gland from this study is 13.3%. Awareness of the prevalence of prostate cancer in this range should be created among Nigerians, as this will help improve the overall management of prostate cancer patients in this category.
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    Open Access
    Non-trauma related paediatric abdominal surgical emergencies in Lagos, Nigeria: Epidemiology and indicators of survival
    (2012) Ademuyiwa, AO; Bode, CO; Adesanya, OA; Elebute, OA
    Background: Pediatric surgical emergencies are associated with higher morbidity and mortality. The aim of this study is to describe the epidemiology of non-trauma related pediatric abdominal surgical emergencies in our centre and determine the indicators for survival in a cohort of patients. Patients and Methods: A retrospective study of children aged 1 day to 15 years who presented with non-trauma related abdominal emergencies at the Lagos University Teaching Hospital (LUTH). Results: There were 129 children. The median age at presentation was 5 months (range: 1 day-15 years). There were 104 males and 25 females. Sixty-four (49.6%) patients presented within 48 hours of the onset of the symptoms while 65 (50.4%) presented after 48 hours. Intestinal obstruction is the commonest indication for pediatric emergency surgery in our centre accounting for 76 patients (58.9%). Appendicitis is the second most common indication for emergency surgery with 13 patients (10.1%). Thirteen patients (10.1%) had postoperative complications. There were 13 deaths in all (10.1% mortality rate). Eleven out of 43 (25.6%) neonates died compared with 2 (2.3%) out of 86 patients in the other age groups (P=0.002). Seven out of 107 (6.5%) patients that had surgery within 72 hours died while 5/22 (22.7%) patients died who had surgery after 72 hours (P=0.003). There were 4 mortalities (28.6%) among patients with postoperative complications compared with 9 (7.8%) mortalities among 116 patients without any postoperative complications (Pp=0.001). Conclusion: Intestinal obstruction is the commonest pediatric surgical emergency seen in LUTH. Neonatal age, admission to surgery intervention time >72 hours, and severe postoperative complications are associated with high mortality.
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    Open Access
    Clinical and proctosigmoidoscopic findings in patients with anorectal sepsis in a private health facility in Lagos, Nigeria
    (Nigerian Quarterly Journal of Hospital Medicine, 2012) Jeje, E.A; Mofikoya, B.O; Osunkoya, S.A; Olajide, T.O; Osinowo, A.O
    Background: Anorectal sepsis is a distressing condition which is sometimes inadequatelytreated. Objectives: To determine the clinical and prostosigmoidoscopic findings in patients with anorectal sepsis seen by the authors over a 5 year period as well as identifying the commonly performed procedures. Method: A review of all the records of patients seen by the authors over a 5 year period was carried out. The demographic pattern was determined including the age, sex, mode of presentation, and associated co-morbidities. The detailed perianal and protosigmoidoscopic findings were also noted Results: 45 males and 10 females were seen during the study period. The mean age incidence was 43.4 years. The commonest mode of presentation was perianal discharge and pain in over 85% of the patients seen. The low anal fistula was the commonest pathology on proctosigmoidoscopy while abscesses and external haemorrhoids were the other commonly occurring lesions found . Fistulotomy was the most commonly perfomed procedure while diabetes was the most common comorbidity. Conclusion: Anorectal sepsis most commonly affects males in the fifth decade of life. Thorough evaluation and adequate operative treatment appear to result in satisfactory early outcome.
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    Open Access
    Differential diagnosis and management of giant fibroadenoma: Comparing excision with reduction mammoplasty incision and excision with inframammary incision
    (Journal of Plastic Surgery and Hand Surgery, 2012) Ugburo, A.O; Olajide, T.O; Mofikoya, B.O; Fadeyibi, I.O; Osinowo, A.O; Lawal, A.O
    Giant fibroadenoma (GFA) may present with breast asymmetry and can be excised with an inframammary incision (IFI) or reduction mammoplasty incision (RMI). This study investigated the clinical presentation and compared excision with the IFI and RMI. All patients with benign breast tumours greater than 5 cm underwent core needle biopsy and a histopathological diagnosis. All confirmed GFA had their clinical details documented and randomised into two groups for excision with an IFI or RMI. Twenty-two patients were studied. The age range was 12–46 years, mean 21.18 ± 2.22 years. The patients were divided into two groups: a juvenile group (n = 16) (73%) aged 12–18 years, mean age 14.06 ± 0.42 years, and a perimenopausal group (n = 5) aged 28–46 years. The juvenile group showed cyclic increases in breast size monthly with menstruation while the perimenopausal showed an initial slow growth of 6–24 months followed by a rapid growth. Fifteen patients (68%) had excision biopsy with IMI and seven patients with RMI. Seven of the patients treated with IFI had minimal preoperative asymmetry and satisfactory aesthetic outcome. Among the patients with severe preoperative asymmetry treated with IFI (n = 8) and RMI (n = 7), those treated with IFI had persistent postoperative skin redundancy and asymmetry, which was not found in those treated with RMI. In conclusion, for patients with significant asymmetry, excision with the IFI was associated with persistent asymmetry while excision with RMI was associated with restoration of symmetry.
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    Open Access
    The value of percentage free prostate specific antigen (PSA) in the detection of prostate cancer among patients with intermediate levels of total PSA (4.0–10.0 ng/mL) in Nigeria
    (Elsevier, 2012) Ezenwa, E.V.; Tijani, K.H.; Jeje, E.A.; Soriyan, O.O.; Ogunjimi, M.A.
    Objectives: To assess the value of percentage free prostate-specific antigen (%fPSA) in the detection of prostate cancer among Nigerian men with an intermediate total PSA level (4–10 ng/mL), and to show if the optimum threshold for biopsy is different from Caucasian values when the widely used (six-core, digitally directed) prostate biopsy protocol in Nigerians is applied. Patients and methods: The study included 105 patients aged >50 years, with a palpably benign prostate gland and intermediate levels of total PSA (4–10 ng/mL). These patients had a free PSA assay and a transrectal digitally directed six-core biopsy of the prostate. The %fPSA was calculated and the optimum threshold value for detecting prostate cancer was determined. Results: The mean (SD) age of the patients was 64.4 (6.6) years and their mean (SD) total PSA level was 6.6 (1.7) ng/mL. Of these men 14 (13.3%) had cancer of the prostatedetected by the prostate biopsy. The %fPSA level related directly to sensitivity values but inversely to the specificity and the positive predictive values. The best threshold of %fPSA for detecting cancer in these men was <40%, with a sensitivity of 100%, specificity of 93.4% and a positive predictive value of 70% (P<0.05). Conclusions: In evaluating Nigerian patients with a palpably benign prostate gland and within the intermediate total PSA range, when digitally directed biopsy protocol is adopted, a %fPSA threshold of <40% will detect significant percentage of those with prostate cancer, with a minimal number of unnecessary biopsies. This value differs from that reported in western studies in which transrectal ultrasonography- directed biopsy was used
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    Open Access
    Diverticular disease of the colon presenting with rectal bleeding in an elderly African: a case report
    (Nigeria Journal of Medical Imaging & Radiation Therapy, 2012) Irurhe, N.K; Awosanya, G.O.G; Olajide, T.O
    Objective: To re-emphasize the role of radiological evaluation in the diagnosis of diverticular disease. Result: Multiple outpouching were seen in descending and sigmoid colon in double contrast barium enema films. Conclusion: The important role of radiological evaluation in the diagnosis of diverticular disease was confirmed using barium enema study.
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    Open Access
    Surgically Correctable Morbidity from Male Circumcision: Indications for Specialist Surgical Care in Lagos
    (Nigerian Journal of Surgery, 2012-07) Ademuyiwa, AO; Ojewola, RW; Elebute, OA; Jeje, EA; Bode, CO
    Aim/Objective: To determine the pattern of morbidity and outcome among patients referred to the Pediatric Surgery Unit of the Lagos University Teaching Hospital (LUTH) following circumcision. Materials and Methods: A retrospective descriptive study of all patients with complications of circumcision who were managed in LUTH between 2008 and 2010. Results: There were 36 patients. The age range was between 2 days and 9 years (median-3 months). Fifteen cases (42.9%) were due to urethro‑cutaneous fistula while there were six cases (16.7%) of post-circumcision bleeding. There were four cases (11.1%) each of partial penile amputation and buried penis. There were also cases of meatal stenosis, penile implantation cyst and glanulo‑preputial skin bridge. With respect to the treatment offered, eleven (30.6%) patients had urethroplasty for the urethro‑cutaneous fistulae while seven (19.4%) patients had penile refashioning for the buried penis and penile amputation. Appropriate surgical treatments were performed for the other complications. Conclusion: Urethrocutaneous fistula and penile amputation are the commonest complications of circumcision for which referral is made to LUTH. The treatment outcome was satisfactory. Health education and legislation to ensure the procedure is performed by qualified medical and paramedical staff may reduce the morbidity.
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    Open Access
    Intravesical Migration of a Failed and Forgotten Intrauterine Contraceptive Device after 20 years of Insertion - A case report
    (MedKnow, 2012-07-01) Jeje, E.A.; Ojewola, R.W.; Atoyebi, O.A.
    Intrauterine contraceptive device (IUCD) is a commonly utilized reversible contraceptive technique especially in the developing world. Though effective, it is not immune to complications. Migration of the device is a rare but serious complication which may be symptomatic or asymptomatic. We report a case of a 45yr old woman who had IUCD inserted 20 years earlier and had forgotten about it since she subsequently had three full term pregnancies leading to successful vaginal deliveries. The forgotten IUCD was discovered incidentally during evaluation of the woman for haematuria as it had migrated to the wall of the bladder. The case is reported to increase index of suspicion as detailed clinical history is important in evaluating cases of haematuria.