Female genital mutilation and obstetric outcome.
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Africa↗
Biomedical subjects
N Eke
Publications and source records attributed to N Eke.
Chronic pyonephrosis associated with renal neovascularisation.
The spectrum of renal tract infections is wide. When the kidney has been severely damaged, the radiological findings may suggest a malignancy. To report a case of chronic pyonephrosis, which even at exploration appeared to be a malignancy. The case record of the patient as well as the literature were reviewed and reported. A 25 year-old woman presented with a 5-year history of left lumbar pain, urinary frequency and intermittent total haematuria. The intravenous urography showed non-function in the left kidney harbouring a calculus. Treatment was delayed for poor finances. At laparotomy a huge renal mass invading the colonic mesentery and showing neovascularisation was removed. The final diagnosis was chronic pyonephrosis. She recovered from postoperative septicaemia. Neovascularisation is a feature of malignant disease mediated by angiogenesis factors. These factors are probably present in chronic inflammation. It is suggested that for nephrectomy, prophylactic antibiotics should be used. There is also a need for histopathological examination of every specimen removed at operation.
Adult↗
Nephrectomy at the University of Port Harcourt Teaching Hospital: a ten-year experience.
The case records of patients who had nephrectomy from 1989 to 1998 were retrieved. Data extracted for analysis included age, sex, clinical features, indications for nephrectomy, post-operative complications and histological findings. Thirty-four unilateral nephrectomies in 21 males and 13 females were done. The patients were aged between 1.5 to 75 years. The predominant presenting features were abdominal pain (76.5%), abdominal mass (70.6%), haematuria (61.8%) and weight loss (47.1%). Diagnostic investigations were intravenous urography and renal ultrasound scan. The major indications for renal exploration included non-functioning kidney and renal mass suspected to be carcinoma. The histopathological findings included renal malignancy 23 (67.6%), hydronephrosis 6 (17.6%) and renal infections 3 (8.8%). The male/female ratio in nephrectomy for malignancy was 1:1.09. Renal trauma was the indication in only one patient. Non-functioning kidneys on intravenous urography (IVU) occurred in both malignant and infective lesions. Hypertension was found in 9 patients preoperatively. It resolved in 7 patients after operation. The histological finding in one kidney differed from what was assumed at operation. Follow-up USS showed compensatory hypertrophy in the remaining kidneys. Post-operative sepsis occurred in 4 patients. One of these was a retroperitoneal abscess. Two patients with huge tumours died on the operating table. Two died from sepsis. Four patients died from metastatic disease within two years after operation. Malignancies constituted the commonest indication for and commonest cause of mortality in nephrectomy. Antibiotics prophylaxis is advocated. All nephrectomy specimens should be subjected to histopathological examination.
Adolescent↗
Extrauterine translocated contraceptive device: a presentation of five cases and revisit of the enigmatic issues of iatrogenic perforation and migration.
Translocation of an intrauterine contraceptive device to an extrauterine site in the peritoneal cavity is an uncommon complication. In cases reported in literature, the timing of extrauterine presentation and the distant sites of translocation often raise the issue of whether iatrogenic uterine perforation or migration of the device was responsible. We present and discuss five referred cases of the extrauterine device inserted in centres outside the University of Port Harcourt Teaching Hospital. The indication for insertion of the intrauterine contraceptive device in the patients (mean age 25.6 years) was contraception in four patients and adhesiolysis for Asherman's syndrome in the fifth. The most common presenting symptom was inability to feel the device's string (in three patients). Four of the patients presented within one month of the insertion. Three of the five translocated intraperitoneal devices were recovered by laparotomy and the forth by laparoscopy. The fifth patient, pregnant, defaulted with the device still retained. We are of the opinion that primary iatrogenic uterine perforation occurs occasionally. Other possible translocatory mechanisms include spontaneous uterine contractions, urinary bladder contractions, gut peristalsis and movement of peritoneal fluid.
Adult↗
Fracture of the penis.
BACKGROUND: Sporadic reports of penile fracture give the impression of a rare trauma. The value of diagnostic investigations is doubtful and treatment options are controversial. METHODS: A Medline search from January 1966 to July 2001 using the terms 'fracture of penis', 'penile trauma' and 'coital injuries' was used to identify full texts of publications on fracture of the penis. Full texts of relevant references from these publications were also identified. Data extracted for review included authors, country and year of publication, number of cases in each report, aetiology, clinical features, investigations, treatment and outcome. RESULTS: In 183 publications 1331 cases were reported between January 1935 and July 2001. Most reports were from the Mediterranean region. The commonest causes were coitus and penile manipulations, especially masturbation. Most patients were in their fourth decade. Clinical features included sudden penile pain, detumescence, voiding difficulties, and penile swelling and deviation. Diagnosis was made mainly on clinical grounds. Associated injuries included urethral rupture. Predisposing factors included excessive force at coitus or manipulation, fibrosclerosis of the tunica albuginea and chronic urethritis. Most authors advocated early surgical repair using absorbable sutures. Complications of the injury included coital difficulty, urethral fistula, penile plaque and erectile dysfunction. CONCLUSION: Penile fracture is not rare. Radiological investigations are expensive and may delay treatment. Current management favours early surgical exploration to prevent complications.
Adolescent↗
Urological complications of coitus.
OBJECTIVE: To ascertain the urological complications of coitus, as the proximity of the lower urinary tract to the organs of coitus exposes the tract to coital trauma. MATERIALS AND METHODS: Medline was searched from 1966 to 2000 to identify reports on coital injuries. Publications and relevant references were retrieved. Those reporting urological complications were selected for analysis. RESULTS: In all, 1454 cases of reported coital injuries were reviewed; 790 occurred in men while 664 occurred in women, mainly in the genital area. Physical urological complications were more common in men than in women. The injuries were often sustained during voluntary coitus, but one penile fracture was sustained during an attempted rape. The presentations included penile swellings and deviations, haemorrhage, erectile dysfunction and urinary incontinence. Complications included vesicovaginal fistulae, bladder and cavernosal ruptures, and urinary tract infections. Rare complications included isolated rupture of the penile vasculature. Major risk factors included penovaginal disproportion, excessive force at coitus, urethral coitus, fellatio and anal intercourse. Urethral injuries were the commonest complications; in men these were associated with 10-38% of penile fractures. The treatments included cold compress and anti-inflammatory agents in contusions, repairs of lacerations, closure of fistulae and urethral and vaginal reconstruction. The results of treatment were essentially good. Recurrent penile fractures were reported. CONCLUSION: Coitus, although pleasurable, may be risky. The complications have been termed 'faux pas' implying that they are preventable. While the ultimate prevention is abstinence, this is an unrealistic prescription. Therefore, efforts are necessary to identify risk factors to enable preventive strategies.
Coitus↗
Collaboration in urological practice in the new millennium.
The aim of this paper is to highlight areas in which urologists collaborate with other healthcare practitioners and to identify further areas of beneficial collaboration. A review of the literature using Medline search and the authors clinical experience. There is close collaboration with the radiologists in urological investigations and embolization of tumours, aspiration of cysts and abscesses as well as obtaining biopsy specimens. Cross referral of patients occurs between urologists, gynaecologists, oncologists and radiotherapists. Technological advances enabling different specialist to master certain procedures like ultrasonography and laser surgery should make collaboration obligatory and mandatory. Collaboration also occurs with orthopaedic, paediatric and plastic surgeons, proctologists and specialist nurses involved in urological treatments. Sometimes, there have been competition and conflicts with the above specialists, especially the gynaecologist in the treatment of urogenital fistulae. Close co-operation among healthcare practitioners will improve the standard of practice to the benefit of the patient as well as to promote healthier work atmosphere in health care delivery. Conflict and competition are diversionary, costly and unnecessary. The urologist appears best placed to lead the way in collaborative clinical practice in this millennium.
Cooperative Behavior↗
Postoperative tension pneumoperitoneum in an infant.
A 9-week-old boy developed massive postoperative abdominal distension following a Fredet-Ramstedt pyloromyotomy for hypertrophic pyloric stenosis. A plain abdominal X-ray film was suggestive of a tension pneumoperitoneum. Passage of a cannula into the peritoneal space resulted in forceful expulsion of air, resulting in relief of the distension, which recurred after a few hours. At laparotomy, the tension pneumoperitoneum was due to a pyloric fistula at the proximal end of the pyloromyotomy, although a mucosal breach at the first operation had been at the distal end. Closure of the fistula resulted in complete resolution. A limited review of the literature is undertaken.
Humans↗
Symptomatic spinal cord involvement in prostate cancer.
The literature on spinal cord involvement in prostate cancer is reviewed by searching the Medline from 1965 to 1997 and references in publications on the subject. The objective was to identify the clinical characteristics and treatment modalities of the disease. Prostate cancer is the leading cause of metastatic spinal cord disease in men. The tumour reaches the spinal column mainly by the venous route. The frequency of involvement in decreasing order is thoracic spine, lumbar spine and cervical spine. The tumour usually exerts compression of the cord from the extradural space. However, intradural and intramedullary metastases have devastating effects. The patients have other neurological and urological symptoms prior to the onset of paraplegia. But in some, spinal cord compression may be the first symptom of prostate cancer. Plain X-rays may suffice in diagnosis but MRI is the single most valuable investigation for anatomic definition or localization of spinal cord secondaries. All forms of treatment are palliative. Treatment options, singly or in combination, include hormonal manipulation, radiotherapy and laminectomy each often with high dose corticosteroids. Recurrence of symptoms after an initial relief with hormonal manipulation signifies escape of the tumour from endocrine control and portends a poor prognosis.
Humans↗
Learning and evaluation in medical education.
An educational experience is a complex event, which involves four distinct common places: learner, curriculum, milieu and teacher. Medical education is a unique form of educational experience. The learner is almost always an adult. The teacher is not necessarily trained to teach. Because of rapid changes in knowledge it is very dynamic. Life-long learning and evaluation are mandatory, for the student as well as the medical practitioner. This communication highlights some issues concerning learning and evaluation, as applicable to medical education, including the concept of learning by objectives, learning approaches, study strategies, learning methods; the purposes of evaluation, self-evaluation and common assessment methods. This is intended to create some awareness, in the medical student, resident or medical teacher of the need to begin to learn how to learn and demystify evaluation.
Education, Medical↗
Female genital mutilation: what can be done?
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Africa↗
Fournier's gangrene: a review of 1726 cases.
BACKGROUND: Although there is much consensus, certain controversies exist regarding the management of Fournier's gangrene. METHOD: Publications in English on Fournier's gangrene from January 1950 to September 1999 were obtained through the Medline database and relevant reference lists in publications. It was possible to identify 1726 cases for study. Data extracted for review included country of reported cases, number of patients in each report and relevant clinical features. RESULTS: Fournier's gangrene occurs worldwide. However, its definition has generated considerable controversy as efforts are made to refine the original description in the light of increasingly understood aetiological factors. Attempts to classify the disease into primary and secondary forms have not been successful. The basic pathological process, necrotizing fasciitis, has been identified in the perineum of women and children, although the disease afflicts the male more often than the female. Most reported cases have occurred in the USA and Canada. The major sources of sepsis are the local skin, colon, anus and rectum, and the lower urinary tract. Colonic, anal and rectal sources carry the worst prognosis. Diabetes mellitus is important in aetiological terms. Rare causes include vasectomy and circumcision. Investigations are essential to define the cause of an episode but not for the diagnosis of the disease. Early aggressive treatment of Fournier's gangrene and underlying conditions is essential. Hyperbaric oxygen and honey are treatment modalities yet to be universally adopted. Risk of death, 16 per cent overall in this series, is related to the patient's condition at presentation. CONCLUSION: Controversies over the definition of Fournier's gangrene persist but these do not affect the treatment options. The diagnosis is made on clinical grounds. The occurrence of the disease in women is under-reported and may go unrecognized by some clinicians. Some treatment options, such as hyperbaric oxygenation and radical excision, remain controversial.
Age Distribution↗
Intramural haemorrhage of the colon.
Two cases of acute abdominal crisis due to intramural haemorrhage of the colon are presented with a review of the literature. One was a 10-year-old Nigerian boy; the haemorrhage occurred in the caecum and ascending colon. The other was a 69-year-old Caucasian woman with a haemorrhage in the colonic splenic flexure and descending colon. Both had a one-stage resection with anastomosis. The child survived; the woman died two days after the operation. The preoperative diagnosis of bleeding colonic lesions remains difficult especially when facilities for investigation are scarce. It is re-emphasized that in patients with acute abdomen it is not necessary to insist on accurate preoperative diagnosis before offering appropriate treatment.
Abdomen, Acute↗
Genital self-mutilation: there is no method in this madness.
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Amputation, Surgical↗
Carcinoma of the cervix presenting with post-defecation vaginal bleeding.
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Journal Article↗
Major surgical complications from minor urological procedures.
Some urological procedures are regarded as minor or simple. As a result, these may be delegated to trainee surgeons to do. Occasionally nonmedical persons embark on some of the procedures such as male circumcision. Published serious complications from urological procedures considered minor or simple were identified from a Medline search (1966 through 1999) and reference lists of relevant publications. The operations regarded as minor were carried out by medical personnel of all grades as well as by nonmedical persons. The complications can be classified as mutilatory, infective, hemorrhagic, or obstructive. Although the mutilatory complications affect mainly procedures on the penis, infective and hemorrhagic complications affect almost all the procedures. Tumor implantation has occurred along needle biopsy tracts. Although many of the complications are not related to technique or competence, a plea is made for the awareness of their occurrence to encourage preventive strategies. Adequate training of surgical personnel remains essential worldwide.
Biopsy↗
Female genital mutilation: A global bug that should not cross the millennium bridge.
Female genital mutilation (FGM) has been practiced worldwide, clothed under the tradocultural term "circumcision." Indications for its practice include ensuring virginity, securing fertility, securing the economic and social future of daughters, preventing the clitoris from growing long like the penis, and purely as a "tradition." Outlawed only in the United Kingdom, Sweden, and Belgium, no law forbids it in most other countries. Classified into four identified types, the current perpetrators are mainly quacks, but trained medical personnel still connive at and encourage FGM. Early complications include hemorrhage, urinary tract infection, septicemia, and tetanus. Late complications include infertility, apareunia, clitoral neuromas, and vesicovaginal fistula. Reasons for the ritual persisting include fear that legislation would force it underground and it will be performed in unsterile conditions, belief that it is racist to speak out against FGM, "tolerance" by health professionals, continued use of the term "female circumcision," lack of awareness of the culture of immigrants by the physicians in areas where FGM is not culturally practiced, and sporadic or uncommitted eradication efforts. We believe there is no reason for the continued practice of FGM. It should incur global abolition, the same way slave trade or Victorian chastity belts have done. We advocate that in medical communications the term "female genital mutilation" be used in place of "female circumcision." World leaders should include unacceptable cultural practices such as FGM in the "world summit" agenda. The year 1999 should be declared the year for global eradication of FGM.
Circumcision, Female↗
Male genital mutilation: 'whodunnit'?
A 26-year-old man was brought to hospital having sustained amputation of his penis, scrotum and testes. Although he claimed that his 'master' did it, the 'master' denied the allegation. The police subsequently retrieved the two testes but the amputated penile shaft was never found. The remaining scrotum and short penile stump were repaired to enable him pass urine. The evidence of the patient was not corroborated. No motive for the amputation was established. The patient refused to appear in court as prosecution witness against the accused, his 'master'. Furthermore, although he has not withdrawn his accusation, he has paid friendly visits to the master subsequently. There is, therefore, the suspicion that the patient was himself responsible for the amputation. This patient will require long-term psychological, endocrinological and urological follow-up.
Journal Article↗