Clinicopathological Features, Management and Outcome of Paediatric Solid Renal Tumours in Southeast Nigeria: The Need for Protocol and Multidisciplinary Collaboration

Introduction: Renal malignancies are common in children and they constitute 6-7% of all childhood tumours and nephroblastoma is the most common solid renal tumour in children. Currently, standardised institutional protocols in management of renal tumours in children are the norm. Large scale collaborative studies have started emerging, yet not much has been documented on the clinical presentation, pathology and outcome of solid renal tumours particularly in Africa. Aim: To review the presentations, pathology and the management-outcome of solid renal tumour in the centre in the absence of a coordinated protocol and multi-disciplinary collaboration. Materials and Methods: This was a nine and a half year longitudinal retrospective audit study of consecutive patients with solid renal tumours managed in a single tertiary centre: Nnamdi Azikiwe University Teaching Hospital Nnewi South-east Nigeria. It took place from January 2009-June 2018. Relevant data on demography, clinical features, management and outcome were extracted from records. Results were analysed using Statistical Package for Social Sciences (SPSS) version 22. Categorical data were tested for independence using Chi-square test and significant p-value set at <0.05. Results: Twenty two paediatric cases (15 males and 7 females) were included in the study. The mean age at presentation was 50.10±4.8 months. There were 15 males and 7 females. The mean duration of symptoms was 5.5 months; 21 (95%) presented with abdominal masses while 6 (27.3%) had gross haematuria and 13 (59%) were emaciated. Tumours involved left kidney in 15 (68%). Histological reports were available in 9 cases with nephroblastoma being the most common 6 (27.3%). The Commonest stage was stage 3, 10 (45%) and commonest procedure was nephroureterectomy, 11 (50%). Neo-adjuvant and adjuvant therapies were inconsistent. Conclusion: Late presentation, discordant treatment protocol, noncompletion of treatment and poor collaboration, were found to contribute largely to poor outcome of solid renal tumours in children in our setting. It is strongly believed that adoption of standard protocol and a multidisciplinary collaboration in management will improve records keeping and outcome.

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Primary Carcinoid Tumour of the Kidney: A Review of the Literature

Advances in Urology ◽

10.1155/2013/579396 ◽

2013 ◽

Vol 2013 ◽

pp. 1-11 ◽

Cited By ~ 19

Author(s):

Ayodeji O. Omiyale ◽

Anthony Kodzo-Grey Venyo

Keyword(s):

Carcinoid Tumour ◽

Incidental Finding ◽

Case Reports ◽

Left Kidney ◽

Carcinoid Tumours ◽

Renal Tumours ◽

Rare Tumours ◽

The Mean ◽

Well Differentiated ◽

Work Up

Context. Primary renal carcinoid tumours are rare. Their pathogenesis is unknown and the clinical presentation is similar to other renal tumours thus posing diagnostic dilemmas for clinicians.Objectives. To review the literature for case reports of primary renal carcinoids.Methods. Literature was extensively searched for case reports for primary renal carcinoids. Reports of metastatic carcinoids to the kidneys were excluded.Results. Approximately less than 90 cases of primary carcinoid tumours of the kidney have been reported in the literature. A total of 29 cases of primary renal carcinoids were reviewed. The mean age of presentation was 48 years (range 29–75) with both right kidney (48.3%) and left kidney (44.8%) being equally affected. 28.6% of the cases reviewed were diagnosed as an incidental finding. The mean followup time was 20 months with 73.1% of patients without evidence of disease after surgical treatment (radical or partial nephrectomy). Primary carcinoid tumours of the kidney are often well differentiated tumours. They are often misdiagnosed because of their rarity and similar presentation with other renal tumours.Conclusions. Primary carcinoid tumours of the kidney are rare tumours with an indolent course with frequent metastasis. Metastatic work up and followup is required in their management.

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Diabetic Ketoacidosis in Children with Type-1 Diabetes in a Tertiary Hospital in Sokoto, North-Western Nigeria: Clinical Profile and Outcome

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1130933 ◽

2021 ◽

pp. 142-152

Author(s):

M. O. Ugege ◽

T. Yusuf

Keyword(s):

Type 1 Diabetes ◽

Abdominal Pain ◽

Diabetic Ketoacidosis ◽

Clinical Profile ◽

University Teaching ◽

Duration Of Symptoms ◽

Male Adolescents ◽

The Mean ◽

North Western

Introduction: Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes (T1D). Few reports are available on DKA among children in North-west Nigeria. Objective: To describe the clinical profile and outcome of children managed for DKA in the Paediatric Endocrinology Unit of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, North-western Nigeria over a ten-year period (January 2011- December 2020). Methods: This was a retrospective review of the case records of all children managed for T1D between 2011 and 2020. Socio-demographic and clinical data of those with DKA were extracted and analysed using SPSS version 23. Results: Ten (62.5%) out of 16 children with T1D had DKA, comprising 8 males and 2 females; M: F ratio 4:1. Majority (90%) were adolescents aged 10-15years. The mean age ± standard deviation (SD) at diagnoses of T1D was 11.1 ± 3.14 years; DKA was the presenting manifestation of diabetes in 4 (40%) children, while 6(60%) were known diabetics with an average of 2-episodes per patient. The median duration of symptoms was 5 days (range 1-42 days). Abdominal pain (90%), polyuria (80%), fast breathing (70%), vomiting (70%), altered consciousness (70%), dehydration (100%) and Kussmaul respiration (70%) were the common presenting features. The mean blood glucose, bicarbonate and venous PH at admission were 23.28± 7.14 (range; 12.3-33.3) mmol/L, 14.1± 3.41 (10-21) mmol/L and 6.96± 0.06 (6.92-7.00) respectively. Co-morbid conditions included infections (80%), predominantly malaria (70%). There was no mortality. Conclusion: DKA is common in male adolescents, with good management outcome in our facility. Abdominal pain, dehydration, polyuria and Kussmaul respiration were the commonest presenting features. A high index of suspicion of DKA is recommended in any child, particularly, male adolescents with the aforementioned features. Effort should be made to confirm diagnosis and prompt treatment instituted.

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Surgical management of gynaecomastia: Experience from a tertiary health facility in Southwest Nigeria

Annals of Health Research ◽

10.30442/ahr.0601-08-68 ◽

2020 ◽

Vol 6 (1) ◽

pp. 67-73

Author(s):

BA Salami ◽

BA Ayoade ◽

AO Adekoya ◽

O Odusan ◽

OM Fatungase

Keyword(s):

Postoperative Complications ◽

Local Anaesthesia ◽

University Teaching ◽

Subcutaneous Mastectomy ◽

Duration Of Symptoms ◽

Local Experience ◽

Southwest Nigeria ◽

Good Cosmetic ◽

The Mean ◽

Age Range

Background: Gynaecomastia is the benign enlargement of the male breast as a result of glandular proliferation, usually resulting in feminine appearance. The treatment is usually surgical for cosmetic reasons. Objective: To describe the local experience with the surgical treatment of gynaecomastia by conventional subcutaneous mastectomy. Methods: This is a retrospective study of all cases of gynaecomastia seen at the surgical out-patient department of the Olabisi Onabanjo University Teaching Hospital, Sagamu, covering the period from January 2009 to October 2019.The data obtained included age, duration of symptoms, treatment, postoperative complications and type of anaesthesia. Results: A total of twenty-three cases were seen. The mean age was 26.4±17.5 years with an age range of 15 to 84years. The mean duration of symptoms was 2.9±3.6 years. About 70% of the cases were aged less than 21years. Twenty-one patients (91.3%) had a subcutaneous mastectomy, and local anaesthesia was deployed for the procedure in 16 (76.2%) cases. Two patients (9.5%) developed postoperative haematoma while one patient developed severe keloid at the surgical site. Conclusion: Subcutaneous mastectomy for gynaecomastia can be safely done under local anaesthesia and it gives a good cosmetic effect with minimal postoperative complications.

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Clinical profile and outcome of pelvi-ureteric junction obstruction (PUJO) in children presenting above 1 year

International Surgery Journal ◽

10.18203/2349-2902.isj20183724 ◽

2018 ◽

Vol 5 (9) ◽

pp. 3066

Author(s):

Pramod S. ◽

Ashwath Narayan Ramji

Keyword(s):

Renal Damage ◽

Left Kidney ◽

Treatment Protocol ◽

Clinical Profile ◽

Paediatric Surgery ◽

Delay In Diagnosis ◽

Pain Abdomen ◽

Diuretic Renogram ◽

The Mean ◽

Functioning Kidney

Background: Pelvi-ureteric junction obstruction (PUJO) is defined as anatomical or functional obstruction to the flow of urine from the pelvis to the upper ureter. With the advent of ultrasonography most of the cases of PUJO are identified in antenatal period. The treatment protocol for antenatal diagnosed PUJO is standardized. Few children present later in life. Present study was done to evaluate clinical profile and outcome of children presenting with PUJO above 1 year.Methods: A retrospective observational study conducted by the department of Paediatric Surgery, KIMS hospital Bangalore. All children with PUJO above 1 year of age from January 2015 to January 2018 were included. Clinical, biochemical and imaging findings of these children were tabulated. A diuretic renogram was done to confirm the diagnosis. The children underwent either pyeloplasty or nephrectomy, depending on the function of the kidney. In children with calculi, pyelolithotomy with pyeloplasty was done. The children were followed up post-surgery.Results: Twenty-six children were included in the study. Mean age of presentation was 6.86±4.13years. Most common presentation was pain abdomen. Left kidney was commonly involved. The mean anteroposterior pelvic dimension (APPD) of involved kidney was 38.96±17.7 mm. 5 children presented with poorly functioning kidney with split renal function less than 10%. In three children PUJO was associated with pelvic calculi. Out of the 26 children simple nephrectomy was required in 4 (15%) children. The remaining 22 children underwent pyeloplasty. Mean duration of stay was 6.19±1.8 days. Post-pyeloplasty diuretic renogram showed improved drainage with improved function.Conclusions: PUJO is common cause of urinary obstruction in children. Delay in diagnosis or presentation leads to increased chances of renal damage and loss. Hence it is important to diagnose PUJ obstruction at the earliest and receive prompt treatment.

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Prevalence of HIVInfection inPatients with TBSpine Admitted to the University Teaching Hospital, Lusaka, Zambia

Journal of Preventive and Rehabilitative Medicine ◽

10.21617/jprm2021.3211 ◽

2021 ◽

Vol 3 (2) ◽

pp. 64-68

Author(s):

Chabwela D. Shumba ◽

Keyword(s):

Hiv Infection ◽

Teaching Hospital ◽

Prevalence Rate ◽

Laboratory Data ◽

University Teaching ◽

Duration Of Symptoms ◽

Radiological Features ◽

The Mean ◽

Extra Pulmonary ◽

The University

Background: Extra pulmonary TB is an AIDS defining opportunistic infection in patients with HIV infection. TB spine is the commonest form of bone TB and whose clinical picture depends on the site and the presence of HIV infectionMethod: This was a retrospective review of patient records (n=101) over a two-year period (2008-2010) at the University Teaching Hospital, Lusaka, Zambia. Clinical and radiological features, laboratory data were analyzed Results: One hundred and one patients (57 male: 44 female) had TB spine in this period. The mean age was 37.22 ± 14.29 years. The main presenting complaint was backache in 71(70.3%) patients and the mean duration of symptoms was 2.68 ± 1.23 months. The Gibbus was present in 77 (76.24%) of the patients while neurological deficit was identified in 32 (31.6%) patients. The lumbar spine the most affected in 64(63.4%) patients. The mean ESR was determined to be 59.43 ± 32.23 mm/hour. The prevalence rate of HIV infection in the patients with TB spine was 24.8 %. The average CD4 count was found to be 262± 121.3 cells/μl.Conclusion: The prevalence rate of HIV infection (24.8%) is higher than that obtaining in the Zambian general population (13.7%) but lower than the general prevalence of HIV infection in patients with TB (68%).

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Incomplete Kawasaki disease - a diagnostic and therapeutic challenge

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v9i4.10234 ◽

2014 ◽

Vol 9 (4) ◽

pp. 30-35

Author(s):

S Datta ◽

S Maiti ◽

G Das ◽

A Chatterjee ◽

P Ghosh

Keyword(s):

Kawasaki Disease ◽

Intravenous Immunoglobulin ◽

Incomplete Kawasaki Disease ◽

Duration Of Symptoms ◽

Clinical Criteria ◽

Echocardiographic Finding ◽

2D Echocardiography ◽

Acquired Heart Disease ◽

The Mean ◽

One Year

Background The diagnosis of classical Kawasaki Disease was based on clinical criteria. The conventional criteria is particularly useful in preventing over diagnosis, but at the same time it may result in failure to recognize the incomplete form of Kawasaki Disease. Objective To suspect incomplete Kawasaki Disease, because early diagnosis and proper treatment may reduce substantial risk of developing coronary artery abnormality which is one of the leading causes of acquired heart disease in children. Method Nine cases of incomplete Kawasaki Disease were diagnosed over a period of one year. The diagnosis of incomplete Kawasaki Disease was based on fever for five days with less than four classical clinical features and cardiac abnormality detected by 2D- echocardiography. A repeat echocardiography was done after 6 weeks of onset of illness. The patients were treated with Intravenous Immunoglobulin and/or aspirin. Result The mean age of the patients was 3.83 years and the mean duration of symptoms before diagnosis was 12.1 days. Apart from other criteria all of our patients had edema and extreme irritability. All the patients had abnormal echocardiographic finding. Five patients received only aspirin due to nonaffordability of Intravenous Immunoglobulin and four patients received both aspirin and Intravenous Immunoglobulin, but the outcome was excellent in all the cases. Conclusion Incomplete Kawasaki Disease can be diagnosed with more awareness and aspirin alone may be used as a second line therapy in case of non affordability of Intravenous Immunoglobulin. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 30-35 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10234

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63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.222 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Lau ◽

Z Arshad ◽

A Aslam ◽

A Thahir ◽

M Krkovic

Keyword(s):

Economic Impact ◽

Treatment Protocol ◽

Case Series ◽

Consecutive Series ◽

Financial Loss ◽

Patient Demographics ◽

Tertiary Centre ◽

The Mean ◽

Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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POS1281 HOW DOES OBESITY INFLUENCE THE FEATURES OF KNEE OSTEOARTHRITIS?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3602 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 923.4-924

Author(s):

H. Hachfi ◽

D. Khalifa ◽

M. Brahem ◽

N. Ben Chekaya ◽

M. Younes

Keyword(s):

Knee Osteoarthritis ◽

Functional Impairment ◽

Statistical Significance ◽

Obese Group ◽

University Hospital ◽

Obese Patients ◽

Cross Sectional ◽

Duration Of Symptoms ◽

Lequesne Index ◽

The Mean

Background:Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery.Objectives:The aim of this study was to study the influence of obesity on knee osteoarthritis features.Methods:A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index.Results:The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035).Conclusion:Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity.References:[1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627.Disclosure of Interests:None declared

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Chronic vulval problems: A gynaecologist’s perspective

10.1055/s-0039-1685355 ◽

2016 ◽

Author(s):

Akanksha Sharma ◽

Saritha Shamsunder ◽

Geetika Khanna ◽

Neeti Khunger ◽

Vijay Zutshi

Keyword(s):

Sensitivity And Specificity ◽

Clinical Examination ◽

Squamous Cell ◽

Well Being ◽

Careful Examination ◽

Blue Dye ◽

Lichen Sclerosus Et Atrophicus ◽

Cell Hyperplasia ◽

Duration Of Symptoms ◽

The Mean

Introduction: Chronic vulval symptoms are common complaints in women seeking health care and can significantly interfere with a woman’s sexual function and sense of well being. Many practitioners feel diagnostically challenged, particularly by chronic or recurrent forms of vulval disease. The aim of this study was to assess the role of various diagnostic modalities in evaluation of chronic vulval symptoms. Methods: Between August 2012 and February 2014, 100 women presenting with chronic vulval symptoms (i.e. ≥ 3 months duration) were evaluated. All of them had a thorough clinical history taken including use of vulval washes and creams, a general and gynaecological examination. Patients having chronic vaginal discharge in addition had urethral, vaginal and cervical smear and culture. All women had a careful examination of the vulva with and without magnification. Vulval scrape cytology was taken after moistening the vulva with normal saline and stained by Pap stain. Colposcopy of the vulva was then carried out after applying 5% acetic acid and 1% toluidine blue dye. Vulval biopsy was taken from suspicious areas on colposcopy and further management was based on histopathology report. Results: The mean age of women in our study was 43.57 years (range 22-80 years.), 70% women were pre-menopausal and 30% were post-menopausal. The mean duration of symptoms was 1.625 years (range 6 months - 15 years) and atypical vulval hygiene practices (excessive washing with soaps) was used in 77% of women. The commonest presenting complaint was pruritus in 92% of women; visible lesions on vulva were seen in 20%, pain in 6% and burning sensation in vulva in 5% of women. The histopathology was abnormal in 77 patients; the most common histopathological finding was non-neoplastic epithelial disorders in 64 women {Squamous cell hyperplasia (n=52), Lichen Sclerosus et atrophicus (n=6), other dermatoses including lichen Planus (n=6)}. Vulvar Intra-epithelial Neoplasia (VIN) was seen in 6 patients, 5 were squamous type VIN and 1 was non-squamous type (Paget’s disease). Squamous cell carcinoma was seen in 3 patients; malignant melanoma, benign appendiceal tumor, angiofibroma and neurofibroma in 1 patient. Examination without magnification had sensitivity of 25.97% and with magnification was 29.87% and specificity was 100% for both of them. Cytology had sensitivity and specificity of 75.32% and 86.95% respectively and sensitivity and specificity of colposcopy was 77.92% and 17.39% respectively. Conclusion: Clinical examination with and without magnification had low sensitivity but were highly specific in diagnosing vulvar lesions. A normal vulval smear and colposcopy have a high negative predictive value and are very reassuring. Colposcopy and biopsy is the gold standard for diagnosis, however clinical examination with naked eyes and magnifying glass are invaluable and can diagnose most of the neoplastic lesions.

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Abdominal Laser Lipolysis Using a Microprocessor-Controlled Robotic Arm with Non-Contact Heating and Cooling

Aesthetic Surgery Journal ◽

10.1093/asj/sjab206 ◽

2021 ◽

Author(s):

Thomas Fiala

Keyword(s):

Cooling System ◽

Subcutaneous Fat ◽

Treatment Protocol ◽

Abdominal Fat ◽

Abdominal Circumference ◽

Ordinal Scale ◽

Robotic Arm ◽

Ultrasound Measurement ◽

Fat Thickness ◽

The Mean

Abstract Background A novel FDA-cleared device uses a 1064 nm laser to non-invasively induce apoptosis for lipolysis of subcutaneous abdominal fat while maintaining comfortable skin temperatures with a proprietary jet cooling system (eon ®, Dominion Aesthetic Technologies, Inc.; San Antonio, TX). A programmable articulated robotic arm moves the treatment head without any subject contact, maintaining an appropriate three-dimensional treatment path, compensating for patient movement. Objectives The goal of this prospective, single center, open-label study was to demonstrate the safety and effectiveness of this device for reducing subcutaneous abdominal fat using an updated power delivery curve. Methods Male and female subjects with Fitzpatrick skin types I-VI (N=26) were treated. Four abdominal zones up to 150 cm 2 each, customized in size and location for body habitus were treated. Each zone underwent a single 20-minute treatment session. Follow-up visits occurred after 6 and 12 weeks. Using a standardized protocol, ultrasound measurement of subcutaneous abdominal fat thickness, abdominal circumference, reported patient satisfaction and digital images were obtained. Results The mean treatment area was 378.5 cm 2. At Week 12, there was a 21.6% mean reduction in abdominal subcutaneous fat thickness and a 4.1-cm (1.6-inch) mean reduction in abdominal circumference. Most subjects (84.6%) were satisfied or very satisfied with their results. The mean pain score was 2.5 on an 11-point ordinal scale. There were no non-responders. Only two adverse events were noted: mild transient erythema (n=1, 3.8%) and localized subcutaneous firmness (n=1, 3.8%) which resolved without intervention within 12 weeks. Conclusions This contact-free device is safe and effective for reducing subcutaneous abdominal fat and represents an improvement on the prior treatment protocol.

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