On Ekeke

Management of Priapism in Adult Men

This study aims to present the management of priapism in adult men in Port Harcourt, Nigeria. All patients who presented with priapism in 2 hospitals in Port Harcourt from July 2007 to April 2014 were prospectively studied. Treatment was assigned based on clinical presentation. Data analyzed included: age on clinical presentation, risk factor, mode, and outcome of management. There were 18 patients aged 17 to 60 years (median age: 30 years). Three patients (16.7%) presented with stuttering priapism. Most of the patients presented after 24 hours of onset. Sixteen patients (89.9%) had hematological disorders. Five patients (27.8%) took suspected aphrodisiac medications. Seven patients (38.9%) were managed conservatively. The rest achieved detumescence following glandulo-cavernous shunting. Erectile function after treatment was satisfactory in 5 patients (27.8%). The commonest cause of priapism in Port Harcourt was hematological disorder. Most of the patients presented late. Prevalence of erectile dysfunction after treatment was high.

Surgical inpatient mortality in a Nigerian Tertiary Hospital

BACKGROUND There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore, there is a great disparity and dearth in apportioning health care services appropriately. AIM The determination of the pattern of mortality in a surgical unit helps in planning, provision of quality surgical care and prioritizing of limited resources in developing countries. METHODS This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards, the emergency unit, surgical outpatients, and theater records. RESULTS A total of 527 deaths occurred among the 8230 patients admitted during the 6-year period giving a mortality rate of 6.4%. Three hundred and forty-five (65.5%) were male, while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%), general surgery (5.5%), neurosurgery (7.9%), urology (6.0%), orthopedics (3.8%), pediatric surgery (3.4%), and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows, respectively: 2007 (7.1%), 2008 (6.0%), 2009 (4.5%), 2010 (6.5%), 2011 (7.2%), and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20- and 70-year-old. CONCLUSION Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required.

P-Selectin As A Marker of Platelet Activation in Africans with Prostate Cancer: A Cross-Sectional Study.

Background: Platelets are components of blood involved in processes such as inflammation, metastasis and atherosclerosis by the use of adhesion molecules.sP-Selectin is a cellular adhesion molecule that promotes platelet-tumor cell interactions, venous thromboembolism and tumor metastasis. High plasma levels independently predict venous thrombosis in cancer patients and are known to play a major role in tumor metastasis. No study has determined the levels and associations of sP-selectin in prostate cancer patients in Africa. Objectives: To evaluate sP-selectin levels in prostate cancer patients and assess the associations with increased values. Methods: We prospectively enrolled 88 histologically diagnosed prostate cancer patients, reviewed their case notes for duration of presentingsymptoms, PSA at diagnosis, evidence of metastatic disease and history of comorbid states. Also, 40 healthy male controls were enrolled. Full blood count was done using EDTA samples and citrated samples for sP-selectin determination using ELISA for both groups of subjects. Results: We found significantly reduced haemoglobin in cases than controls (10.79 ± 2.20 vs 13.59 ± 2.20g/dl; p= 0.001), sP-selectin was significantly higher in cases (57.86 ± 69.92vs 25.83 ± 9.72 ng/l; p =0.01). Twenty four patients (27.3%) had sP-selectin levels >53.1ng/ml (mean 114.3 ± 171.1ng/mL). sP-selectin was significantly higher in patients whose BMI was > 25g/m 2 (p=0.03), those with 2 or more co-morbidities (p=0.02) and more so in patients with diabetes mellitus (p=0.009). sP-selectin was increased in metastatic cancer patients, although not significantly. Conclusion: The findings from this study indicate that there is increased platelet activation in prostate cancer patients as measured by sP-selectin, indicating a significant cardiovascular risk in these patients. Platelet activation was significantly associated with higher BMI and presence of co-morbidities. The ability of sPselectin to predict metastasis and risk of VTE in this environment needs to be elucidated in studies with larger cohorts.

Clinicians' awareness on thromboprophylaxis in cancer-associated thrombosis

Context: Venous thromboembolism is a significant cause of morbidity and mortality in cancer patients. Awareness of patients at risk will enable clinicians proffer thromboprophylaxis promptly and thus reduce morbidity and mortality. Aims: The aim of the study is to evaluate the clinicians′ awareness and practice of thromboprophylaxis in cancer patients. Materials and Methods: A descriptive questionnaire-based survey of clinicians in the University of Port Harcourt Teaching Hospital. Statistical analysis used: The Statistical analysis was done using SPSS 17.0. Results: Ninety-four clinicians responded (78.33%). Forty (42.55%) could define Venous thromboembolism (VTE) appropriately. Fifty-seven (60.63%) clinicians saw 1-6 cancer patients monthly and majority; 84 (89.36%) said cancer patients were at higher risk of VTE than noncancer patients. The most commonly cited risk factors for cancer-associated thrombosis (CAT) were the site of the tumor (98.9%), surgery (76%), body mass index (76%). Thirty-seven (39.36%) reported offering some form of thromboprophylaxis to their cancer patients. Low molecular weight heparin was most prescribed; by 24 (64.87%) respondents. Fifty-four (57.45%) of the respondents had no idea of the effect of heparins on tumor progression. Conclusions: The awareness of CAT and the importance of thromboprophylaxis amongst our clinicians is low.

Urological malignancies in Port Harcourt, Nigeria: a 14-year review

Normal 0 false false false Background: Urological malignancies are complex, covering the urinary system in both sexes and the genital system of males. They are common in this setting and posing a lot of problems to the patients. In most cases, the disease terminates in the death of the patient. Aim: To study the pattern and frequency of urological malignancies. Methods: All the urological tissues histologically diagnosed as malignant at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria between 1990 and 2003 were retrospectively studied. Variables such as the age and sex of the patients, anatomical site of the cancer, laterality of the tumours, clinical presentation and the histological types were obtained from the theatre operation register, patients case notes, histology request forms, reports and autopsy reports. Results: There were 270 histologically confirmed urological malignancies during the period under review. This accounted for 11.3% of the total malignancies and affected all ages of both sexes with a male to female ratio of 9.8:1 . The 70 years and above age group were most affected [103(38.1%)] and carcinoma of the prostate was the most frequent [189(70.0%)]. Adenocarcinoma of the prostate gland was the leading histological variant [187(64.0%)] and urinary outflow obstruction was the most common clinical presentation [62(23.0%)]. Conclusion: Urological malignancies are fairly common in this environment and carcinoma of the prostate gland is dominating. Keywords: Urogenital system, Malignancies, Port Harcourt