Ahmad Bello

Penile gangrene: an unusual complication of priapism in a patient with bladder carcinoma.

A 40-year-old, apparently healthy farmer presented with a 4-day history of progressively painful penile erection with no known predisposing or precipitating factor. He had an emergency El-Ghorab shunt which resulted in almost complete detumescence. He was noticed to have developed ischemic changes of the distal part of the penile skin which progressed to gangrene of the distal part of the penis on the 4th day post intervention. Abdomino-pelvic ultrasound revealed an intravesical mass and urine and corpus cavernosa aspiration cytology were positive for malignant cell. The patient, however, declined further treatment and was discharged against medical advice.

Hypospadias: 10 year review of outcome of treatment in pediatric urological practice

Introduction: Hypospadias and its surgical correction is a challenging urologic discipline. Various surgical procedures for correction of this anomaly have evolved, in order to reduce complication rate and improve cosmetic outcome. The aim of this study is to review the complication rate and cosmetic outcome in patients who had hypospadias surgery at Ahmadu Bello University Teaching Hospital, Zaria. Patients and Methods: The case records and clinical appearance of 54 patients with hypospadias who had surgery between June1998 and June 2008 were reviewed. The effect of different variables on the overall complication rates were evaluated, including: the degree of chordee; the urethral meatal site after correction of any penile curvature; the age of the patient at surgery; the source of the neourethra; and tubularization of the flap. Result: The mean age of the patients was 1.97 (0.5-12) years. Most patients had their repair at 2 years of age. Twenty-six had distal hypospadias while twenty-eight were mid penile or proximal hypospadias. Distal hypospadias have a better outcome than proximal hypospadias. Onlay flaps have lower stricture and fistula compared with tubularized flaps. Repairs are done recently at earlier age with equal or better outcome. Conclusion: Skin flap procedures have had sufficiently extensive use to support the feasibility of a one-stage repair of different types of hypospadias. Snodgrass is gaining popularity in recent times, and more procedures are likely to evolve in order to improve cosmetic outcome.

Rapid and complete decompression of chronic urinary retention: a safe and effective practice.

Summary We carried out a prospective study of consecutive patients who presented with chronic urinary retention over a period of 2 years in order to determine the safety and effectiveness of rapid and complete decompression of chronic urinary retention. A total of 22 patients met the inclusion criteria. Although slow decompression is thought to reduce complications, it harbours the disadvantages of impracticability, time and labour demands and an increased risk of infection. Post-obstructive diuresis, haematuria and hypotension are relatively frequent in rapid and complete decompression of chronic urinary retention. However, they are mild, transient and clinically insignificant. Rapid and complete decompression of the chronically obstructed urinary bladder not only saves time, it is safe and effective and should be adopted as the standard practice.

Fixing Climate Change: Accounting Disclosure Remedies

Many scholars attributed industrialization and rapid urbanization to economic development; however, they failed to consider the price of the said development that could be attributed to the negative impact on the environment via carbon emission. Emissions are documented to have devastating effect on climate condition. The carbon emission could also be a result of corporate entities’ role on industrialization and urbanization where their actions are seen as the contributing factor to global warming, hence, climate change. Thus, the issue of Kyoto Protocol arose to curtail carbon emission. While not all the countries agreed to the Kyoto agreement on reducing carbon emissions among others, enforcing sustainability reporting among firms across the globe could have a positive impact toward saving the earth. This piece explores areas in which sustainability reporting could be expanded beyond corporate environmental reporting to other necessary disclosures that will curve recklessness in the course of pursuing economic goal.

Variable presentation of retrocaval ureter: Report of four cases and review of literature

Retrocaval ureter is a rare anomaly in which the ureter passes behind the inferior vena cava due to abnormal embryogenesis. Very few cases have been reported from Africa. Although the anomaly is congenital, patients become symptomatic in the third or fourth decade of life. We reviewed the records of four patients with the diagnosis of retrocaval ureter and managed in our centre between January 2010 and December 2016. Three patients presented with recurrent colicky right flank pain while one was asymptomatic. Two patients each had Type I and Type II retrocaval ureters, respectively. Surgical repairs were achieved in the three symptomatic cases and recovery was uneventful. Retrocaval ureter, though congenital, manifests in young adults and it may be symptomatic. Pre-operative diagnosis may be difficult when the lesion is high and mimics pelviureteric junction obstruction. Thus, a high index of suspicion is required for pre-operative diagnosis. Under-reporting and asymptomatic cases may account for the low incidence.

Assessment of biochemical liver function tests in relation to age among steady state sickle cell anemia patients

Background and Objective: Multiorgan failure including liver dysfunction is a common finding in sickle cell anemia (SCA) patients, the cause of which is multifactorial with advancing age said to be a major determinant. There is a paucity of data on liver function among SCA patients in relation to age in northern Nigerian hospitals, including Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. This study was to assess the biochemical liver function tests (LFTs) as they relate to age among SCA patients in steady state, with a view to improving the overall monitoring of these patients. Subjects and Methods: This study was carried out in ABUTH, Zaria, Northern Nigeria. LFTs were carried out in 100 SCA and 100 apparently healthy participants (controls). The SCA group was made up of fifty adults and fifty children diagnosed of SCA, whereas the control group was made up of fifty adults and fifty children who were apparently healthy and had hemoglobin AA. Paired two-tailed Students t-test for matched samples and Pearsons linear correlation statistical methods were employed for the data analysis using Microsoft Office Excel 2007. A P ≤ 0.05 was considered as statistically significant. Results: The serum concentrations of total bilirubin (TB), alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and AST/ALT ratio were significantly higher in SCA patients compared to the controls (P = 0.001, P = 0.001, P = 0.05, P = 0.05 and P = 0.001, respectively). Serum total protein (TP) and ALB were significantly lower (P = 0.01 and P < 0.05, respectively) in SCA patients compared with the controls. The levels of TB, ALT, AST, ALP, and AST/ALT were significantly lower in SCA adults compared to SCA children, whereas TP and ALB were higher in SCA adults compared to the SCA children. There were significant negative correlations between age and each of TB, ALT, AST, ALP, and AST/ALT, and significant positive correlations between age and each of TP and ALB in SCA patients. Conclusion: There are mild LFTs derangements in SCA patients even in steady state with the extent of the abnormalities decreasing with advancing age of the patients.

Abstract B71: First ten malignancies by ranking from a population of rural Africans in Zaria, Nigeria: A fourteen years review and report

Every environment is noted for its variability in incidences of various malignancies and subtypes. The objective of this study is to analyze the trend of malignant tumors in a population of rural Africans attending Ahmadu Bello University Teaching Hospital Zaria, Nigeria with particular emphasis on the first ten most frequently diagnosed cancers over a period of 14 consecutive years (2001-2014). Histologically diagnosed cancers in the various cancer registries of the ABUTH Zaria were included in this study. The ten most commonly presenting cancers were extracted and their demographic characteristics and other relevant clinical data documented using a standardized questionnaire. The data obtained were analyzed using SPSS software version 20.0. There were 6,553 histologically diagnosed cancers over 14 years in Ahmadu Bello Unibersity Teaching Hospital Zaria with the following in descending order: Cervical cancer 1042 (15.90%), Breast cancer 788 (12.02%), Prostate cancer 496 (7.56%), Colorectal cancer 360 (5.49%), Lymphoma 306 (4.66%), Eye/orbit cancer 170 (2.59%), Bladder cancer 169 (2.45%), Nasopharyngeal cancer 139 (2.12%), Ovarian cancers 94 (1.43%), and Liver cancer 52 (0.79%). Cervical cancer tops the list as the most frequently diagnosed cancer however, this should be noted that it is a cancer exclusive to females so also breast cancers though rarely males may present with breast cancer. Prostate cancer is a male exclusive disease therefore the percentage would have been higher if the diagnosis would have excluded the females. Of the ten most frequently diagnosed cancers, liver cancer is the tenth despite the fact that complications of viral hepatitidis are known to facilitate liver carcinogenesis and the prevalence of hepatitis C and B in the Nigerian population is 5 and 20 respectively. Citation Format: Abdulmumini Hassan Rafindadi, Surajo Mohammed Aminu, Mohammed Faruk, Yawale Iliyasu, Abdullahi Mohammed, Sani Ibrahim, Ahmed Adamu, Mohammed Sani Shehu, Abdullahi Jubril Randawa, Adamu Abdullahi, Saad Aliyu Ahmed, Maitama Yusuf Hussaini, Danladi Amodu Ameh, Ukwenya Yahaya, John Idoko, Oguntayo Olanrewaju Adekunle, Almustapha Aliyu Liman, Abdulkadir Lawal Rafindadi, Aisha Maude Suleiman, Jigo Dangude Yaro, Ahmad Bello, Bello Kumo. First ten malignancies by ranking from a population of rural Africans in Zaria, Nigeria: A fourteen years review and report. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B71.

Surgical treatment of priapism in sickle cell patients: A noble therapy in preserving erection

Background: Priapism is a pathological condition of erectile tissue tumescence characterized by prolonged erection without any sexual stimulation and excitement. A classification commonly used to differentiate clinical presentation of priapism divides priapism into ischemic (low-flow) and nonischemic (high-flow) priapism. They have different pathological consequences and also differ in the overall management. The present study reviewed the modes of presentation and management and results of treatment of priapism in sickle cell patients. Patients and Methods: All consecutive sickle cell patients with priapism who were managed by surgical intervention at our unit between January 2000 and December 2011 were included in this study. The demographic characteristics, predisposing factors, and mode of treatment were reviewed. The outcomes of the treatment were analyzed using statistical software Statistical Package for the Social Sciences (SPSS) version 16. Results: Thirty-three patients with priapism due sickle cell disease were seen over 12 years; two patients were lost to follow-up and were excluded. Their age range was 2-35 years with a mean of 22.5 years. The patients who had an El-Ghorab cavernospongiosus shunt (ECS) had better results than those who had a conventional perineal cavernospongiosus shunt (PCS). Eleven patients with recurrent previous episodes of priapism had reduced or absent erection. Erection was better in patients with shorter duration of priapism and not more than one previous episode. The mean duration of symptoms from the time of presentation to treatment was 3 days. Of the twenty-one patients who presented in ≤2 days, 18 had normal erections and 3 had reduced erections at 12 weeks. Of the 12 patients who presented in ≥3 days, 5 had normal erections, 2 had reduced erections, and 5 had no erection. Ten patients had treatment with sildenafil during the follow-up period with some improvement. One patient who had PCS developed perineal urethrocutaneous fistula. Conclusion: Early surgical intervention is recommended in patients with ischemic priapism; regardless of the delay in presentation, and immediate unilateral distal venous shunt should be considered the best way to preserve erection. More prospective randomized studies are required to confirm these assertions.

Unusual giant prostatic urethral calculus.

Giant vesico-prostatic urethral calculus is uncommon. Urethral stones rarely form primarily in the urethra, and they are usually associated with urethral strictures, posterior urethral valve or diverticula. We report a case of a 32-year-old man with giant vesico-prostatic (collar-stud) urethral stone presenting with sepsis and bladder outlet obstruction. The clinical presentation, management, and outcome of the giant prostatic urethral calculus are reviewed.

Transrectal ultrasound findings in patients with advanced prostate cancer

Objectives : The objective is to determine transrectal ultrasound (TRUS) findings and their relevance in the diagnosis of prostatic cancer among patients with abnormal digital rectal examination (DRE) and elevated PSA. Materials and Methods : This was a prospective study of 131 patients suspected to have advanced prostate cancer based on clinical presentation, abnormal DRE and elevated PSA (>10 ng/ml), who were evaluated with TRUS prior to prostatic biopsy and the findings correlated with the histologic outcome. Results : The mean prostate size by TRUS was 66.8 g with a range of 15-219 g. The majority of patients with hypoechoic nodules 56.3% (45 of 80) had a malignant histology and the yield was higher among those with both hypoechoic nodules and prostatic capsule invasion 25 (31.3%). Cancer detection in those with mixed echogenicity was next in frequency 33.8% (27 of 80). All the prostates with hyperechoic pattern and most of those with isoechoic appearance had benign histology. Conclusion : Though TRUS findings generally have a low specificity for prostate cancer, the specificity of TRUS findings is probably higher in advanced prostate cancer.