Orient Journal of Surgical Sciences

The department of surgery of the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Awka, Nigeria is pleased to publish this maiden edition of the Orient Journal of Surgical Sciences (OJSS).
The Journal covers all aspects of General Surgery, Surgical sub-specialties and related disciplines including Anaesthesia and Radiology.

Venous thromboprophylaxis aims at reducing avoidable morbidity, death and chronic ill health from hospital associated venous thromboembolism (VTE). Reports indicate little awareness of VTE and inadequate provision of primary thromboprophylaxis on surgical patients managed in most hospitals in Africa. Clinical practice guidelines (CPG) regarding VTE risk assessment, risk categorization and preventive methods using mechanical means and pharmacological agents for the patients at risk are virtually non-existent in most of our health institutions. Compliance with such guidelines where available is poor due to lack of enforcement.

This article is an overview of VTE and the provision of thromboprophylaxis for hospitalized general surgery patients.

It is strongly recommended that a hospital-based thromboprophylaxis guideline be formulated and enforced at each surgical service in our health community in order to optimise patients outcome .

Key words: Thromboprophylaxis; VTE; Clinical Practice Guidelines; General Surgery

Objective: To determine the visual outcome of cataract surgery in HIV-positive patients at the Guinness Eye Center Onitsha.

Materials and Methods: The case files of HIV-positive patients who had cataract surgery at the Guinness Eye Center Onitsha between 2006 and 2014 were retrieved. Information obtained included socio-demographics, co-morbidities, pre- and post-operative visual acuity and surgical complications.

Results: Twenty six eyes of 18 patients (7 males, 11 females); age range: 32-73 years; median – 51 years had cataract surgery. Preoperatively, 22 eyes (84.6%) had visual acuity <3/60; 6 months after surgery 17 (65.4%) had attained acuity

≥ 6/18, with 9 (34.6%) having acuity ≥ 6/6. Post-operative blindness and low vision were due to pre-existing co-morbidity, uveitis, endophthalmitis and posterior capsule opacity.

Conclusions: The visual outcome of cataract surgery in HIV-positive patients is encouraging. However, the patients need to be regularly followed up post-surgery.

KEY WORDS: HIV, Cataract, Surgery, Visual outcome, Nigeria

Background: Breast lump is a common clinical presentation of breast lesions. The physical characteristics associated with breast lumps are very vital in making a clinical diagnosis of breast disease.

Objective: To evaluate the accuracy of the initial clinical diagnosis (as obtained from the physical characteristics of the breast lump) with the definitive histopathological report of the various breast lesions.

Methodology: A one-year prospective study of all consecutive patients with palpable breast lumps presenting at the general surgery out-patient clinic of a tertiary health institution. Patients were evaluated clinically and then followed up until the histology reports were obtained following open surgical biopsy. The data were entered into a database and statistical analyses carried out using the Statistical Package for Social Sciences (SPSS) version 17.0.

Results: Of the 110 patients evaluated, 47.3% had malignant breast lesions while 52.7% others had benign lumps. Fifty-four individuals had masses greater than 5cm in their widest diameter, 13 of which were benign and 41 malignant. Thirty-five subjects had axillary lymphadenopathy, 30 were malignant while five were histopathologically benign. Forty-seven tumours were hard: 3(6.4%) benign and 44(93.6%) malignant. Of the 37 patients with attached growths, 3(8.1%) had benign disease while 34(91.9%) were malignant. Out of 52 cases with malignancy, 23(44.2%) had no cutaneous involvement while 29(55.8%) manifested at least one skin change. Only 4(6.9%) people out of 58 with benign diagnosis had skin changes.

Conclusion: The physical characteristics of breast masses still accurately reflect the histopathological diagnosis.

Key words: Breast masses, Physical features, Histological diagnosis.

Purpose: To determine the proportion of patients who would benefit from low vision aids and their preferences for these devices in the eye clinic of University of Nigeria Teaching Hospital Ituku-Ozalla, Nigeria

Methods:

This was a prospective cross-sectional study of all new consecutive low vision patients seen at the hospital within the study duration of 12 months. All patients with low vision were evaluated by the researcher and the findings entered on a research protocol. Data were analyzed using descriptive statistics to generate frequency and percentage distributions. Analytical statistics was employed to test for significance of observed inter-group differences. Statistical significance was indicated by p < 0.05.

Results:

A total of 197 patients were seen comprising of 120 males and 77 females (M: F = 1.6:1), mean age was 39.3 ± 22.9 SD years. From the study, 114 (57.9%) of the patients would benefit from optical low vision aids while 83 (42.1%) would benefit from non-optical low vision devices. In the group that had improvement with optical aids, 38.2 % required only telescopes, 14.5% benefited from magnifiers alone, and 32.8% required both telescopes and magnifiers. The remainder, 14.5%, required both optical and non optical devices like face caps, antiglare glasses, and table lamps. Majority of patients who preferred magnifiers wanted either spectacle borne (41.4%) or handheld (39.0%). Most of the patients who chose telescopes wanted spectacle borne (71.4%).

Conclusion: Majority of patients in this survey preferred either spectacle borne magnifiers or telescopes.

Keywords: Low vision, Preference, Nigeria

Background - Late presentation is the norm for breast cancer cases in many parts of the developing world.

Consequently, some of these lesions are fungating at the time of presentation for medical treatment. The intraoperative

handling of these ulcerated tumours could be messy and daunting to the surgeon if no barrier measures are provided.

Objective - To describe the use of “glove-shield” as the improvisation we found consistently useful in isolating and concealing fungating breast wounds intraoperatively. This barrier mitigates the peculiar challenges faced by the surgeon during the palliative resection of ulcerated breast malignancies.

Methodology - A retrospective study of 7 consecutive histologically confirmed cases of fungating breast cancer who underwent palliative mastectomy at a mission hospital over a three-year period (2015 – 2018). Intraoperatively, routine skin preparation and draping were performed before the ulcerated tumour was enclosed within a stretched sterile latex glove to create what we termed “glove-shield” which completely concealed the ulcerated surface.

Results - All 7 patients were females. Their ages ranged between 29 years and 56 years. The “glove-shield” was used to achieve concealment of the ulcerated tumour surface in these patients. Mean duration of post operative hospital stay was 22 days. No perioperative mortality was recorded.

Conclusion - Late cases of breast cancer may present as fungating lesions. The “glove-shield” is an intra-operative barrier which mitigates the peculiar challenges posed by fungating breast cancers to the attending surgeon during palliative (toilet) mastectomy.

Key Words - Glove-shield; Fungating breast cancer; Barrier; Late presentation; Palliative mastectomy.

Airbag is one of the new innovations in automotive safety. It is being increasingly installed in motor vehicles by the car manufacturers to cushion the vehicle occupants in the event of a car crash. However, increased general morbidity and mortality have been recorded following auto crash involving vehicles fitted this facility. Eye injuries, in particular, have escalated leading to higher ocular morbidity. The mechanisms of ocular damage by the airbag include mechanical, thermal and chemical.

Two cases of airbag related ocular injuries involving two males aged 69 years and 55 years are presented. One was a driver while the other was a passenger. The former sustained globe rupture while the latter suffered thermal and chemical burns of the cornea.

In conclusion, airbag does not provide 100% safety but only helps to mitigate injuries following a car crash. On some occasions, it could be a source of injury especially when the victim is not wearing a seat belt. In some cases, airbag related eye trauma could be very severe with resultant significant ocular morbidity.

KEYWORDS: Airbag, Ocular trauma, Auto crash.