Objective: Uterine rupture is one of the major obstetric complications of labour which contributes significantly to maternal and perinatal mortality in the low resource and developing countries This study determined the incidence, predisposing factors and feto-maternal outcome of ruptured uterus. Methods: A 10-year retrospective study of all cases of uterine ruptures that were managed in University of Benin Teaching Hospital, Benin City, Nigeria between 1st January, 2005 and 31st December, 2014 was undertaken. Data collected from maternity records were transferred to a data sheet. The data were entered and analyzed using SPSS statistical software, version 15.0. Results: Out of 15,818 deliveries over the study period, 92 had uterine rupture, giving a prevalence of 0.58% or 1 in 172 deliveries. The majority of the patients 56, (60.8%) were Para 1 and 2. Majority (77.2%) were unbooked. Of the 92 patients with uterine rupture, 73 (85.9%) had emergency caesarean section. Fourteen patients had prolonged labour: 2 were primigravidas and 12 were multigravidas. Case fatality rate was 2.2% while the perinatal mortality rate was 61.9%. Conclusion: Uterine rupture constituted a major obstetric emergency in the study hospital and its environs. An "unbooked" status was a key associated factor. The incidence and perinatal mortalities were high. There is therefore a need for education of women on health-related issues, utilization of available health facilities, adequate supervision of labour and provision of facilities for emergency obstetric care.

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Background: Upper gastrointestinal (GI) bleeding is a medical emergency that remains a common cause of morbidity and mortality worldwide. The aim of this study was to determine the common causes of upper GI bleeding in the University of Benin Teaching Hospital, South-Southern Nigeria. Methods: Records of all patients referred with upper GI bleeding to the endoscopy unit of the University of Benin Teaching Hospital from February 2006 to January 2013 were reviewed. Relevant data and findings at diagnostic upper GI endoscopy were retrieved from the endoscopy register. Data obtained were analyzed using Statistical Package for Social Sciences version 15.0. Results: A total of 1084 patients had upper GI endoscopy during the study, of those 311 (28.7%) had upper GI bleeding. The mean age of patients with upper GI bleeding was 51.48 ± 17.5. Range was 14–90 years and the male: female ratio was 2.04:1. The most common cause of upper GI bleeding was peptic ulcer disease (PUD), found in 102 (32.8%) cases, followed by gastritis in 88 (28.3%) cases. Esophageal varices accounted for 47 (15.1%) cases whereas duodenitis was found in 16 (5.1%) cases. Carcinoma of the stomach occurred in 13 (4.2%) cases while 12 (3.9%) patients had esophagitis. Gastroesophageal reflux disease accounted for 11 (3.5%) cases whereas esophageal ulcers occurred in 3 (1.0%) cases. Carcinoma of the esophagus and esophageal candidiasis each constituted 2 (0.6%) cases. The cause of bleeding was not found in 15 (4.8%) patients. Conclusion: PUD is the most common cause of upper GI bleeding in patients undergoing endoscopy in the University of Benin Teaching Hospital, South-Southern Nigeria.

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Objectives: We sought to determine the current trends in groin hernia characteristics and surgical care in our hospital. Materials and Methods: A prospective descriptive study from Wesley Guild Hospital Ilesa Nigeria: A tertiary hospital unit in a semi-urban community. All adults who had groin hernia repair between September 2008 and August 2013 were reviewed for age, gender, occupation, hernia type, repair technique and anaesthesia, complications of surgery and duration of hospital stay were analyzed for descriptive and inferential statistics. The main outcome measures were post-operative complications and recurrence. Results: Totally, 270 patients with 296 hernias were treated. Majority were males (256; 94.8%). The modal age group was 51-60 years (20.4%). Hernias were unilateral in most patients (251; 93%) with the majority of them right-sided (162/270; 60%). There were 295 inguinal hernias and one femoral hernia. Indirect inguinal hernia was most common (205 patients; 73.3%); while 79 (27.7%) were direct and 11 (4%) pantaloon hernias. Repairs were for recurrent hernias in 17 cases (3.8%) while 64 patients (23.7%) presented with complications requiring emergency operation. Local anesthesia (LA) was most commonly used (80.7%), and day-case surgery was common (206, 76.3%). Nylon darn (155; 52.4%), mesh hernioplasty (94, 31.8%) and Bassini (43; 14.5%) techniques were commonly used. Morbidity (17, 6.3%) was mainly from the surgical site infection (6, 2.2%). Mortality rate was 0.7%. Follow-up ranged from 3 to 30 months (mean = 9.8 months); no recurrence was recorded. Conclusion: Most repairs are now done using LA as day-case procedures. Mesh hernioplasty is becoming popular.

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Background: Surgical acute abdomen is one of the most common causes of admission into the surgical emergency room. It is a sudden onset of abdominal disease condition which requires immediate surgical evaluation and intervention. Aim: This study aims to determine the pattern and outcome in surgical acute abdomen. Patients and Methods: This was a prospective descriptive study carried out at University of Benin Teaching Hospital, Benin City over 1 year between September 2009 and August 2010. Consecutive patients aged 18 years and above with a diagnosis of surgical acute abdomen formed the study sample. Surgical acute abdomen caused by gynecological and urological problems were excluded from the study. A data form was opened for all patients on admission. Patients who met the inclusion criteria were recruited. Data collated from the patients were analyzed using SPSS version 16. Results: One hundred and eighty-six patients who met the inclusion criteria were recruited. There were 99 males and 87 females with male to female ratio of 1.1:1. The mean age of the patients was 36.60 ± 16.74 years with the age range of 18–92 years. Acute appendicitis confirmed on histopathology in 71 patients was the most common cause of surgical acute abdomen in the study. One hundred and seventy-four patients were treated and discharged while 12 patients died. The overall mortality rate was 6.5%. Conclusion: This study has shown that acute appendicitis is the most common cause of surgical acute abdomen at the University of Benin Teaching hospital, Benin City, and the 21–30 years of age group was most commonly affected.

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It is generally believed that bones retained freely in the endometrial cavity could behave as an intrauterine contraceptive device. We report a case of retained fetal bone causing chronic pelvic pain in a 29-year-old single Para 0 + 1 female. This followed the termination of a 16-week pregnancy through dilatation and curettage 8 years earlier. Pelvic ultrasound suggested the presence of two highly echogenic objects in the uterine cavity and uterine synechia. Hysteroscopic adhesiolysis and removal of the embedded fetal bone fragments (confirmed by histology) with insertion of size 10 Foleys catheter was performed. She was subsequently placed on estrogen (progynova 2 mg twice daily) for 6 weeks. Her menstruation returned 2 months after the hysteroscopy with complete resolution of the pelvic pain.

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Background: Delay in presentation and treatment of abdominal wall hernias is phenomenal in Africa. The three-pronged problem of delayed presentation, multiple comorbidities, and advancing age makes management of complicated abdominal wall hernias more tasking and hazardous. The purpose of this study was to determine the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in our environment. Patients and Methods: This was a 3-year multicenter prospective study of the causes of delayed presentation and treatment outcomes of complicated abdominal wall hernias in rural Southeast Nigeria. Results: A total of 138 patients with complicated abdominal wall hernias were enrolled and comprised of 117 males and 21 females. Of the entire patients, those with inguinal hernia represented 76.1% followed by umbilical hernia (8.0%). Only 18.1% presented within 24 h after the onset of complications, 24.6% between 24 and 48 h, 29.0% between 49 and 72 h, and 28.3% after 72 h. In the preoperative period, theater waiting time was 0–12 h in 10.9%, 13–24 h in 23.2%, 25–48 h in 39.1%, and >48 h in 18.1%. The major barriers against early presentation were financial constraint (23.9%) and treatment at alternative homes (15.9%). The overall morbidity rate was 58.0%, whereas the mortality rate was 13.8%. The bowel resection rate was 26.1%, and majority of the resection (77.8%) and deaths (73.7%) occurred in those who had overall delay beyond 72 h before surgical repair. Conclusion: The rates of morbidity and mortality were proportionally related to the length of delay in the presentation and duration of waiting time before operative repair.

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Long loop vas, encountered during orchidopexy for undescended testis, is a rare entity and deserves a note. We report the case of an 8-year-old child who presented with pain in the left groin and was clinically diagnosed to have undescended testis and palpable in the left groin. Ultrasonography confirmed the presence of testis in the left inguinal region. The incidental finding of long loop vas intraoperatively mandates careful dissection during surgery to preserve the viability of the testis. Examination for a looping vas by inspecting structures caudal to the testis should be done during orchidopexy to avoid inadvertent transection. In view of paucity of literature of long loop vas, our aim is to enhance the already existing scanty literature and suggest the effective single-stage management of this rare condition.

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Dermatomyositis (DM) is a rare inflammatory autoimmune disease of the muscle and skin characterized primarily by proximal myopathy and various cutaneous signs, with multi-systemic manifestations. The hallmark cutaneous changes are confluent macular violaceous erythema and edema in characteristic anatomic locations including eyelids (heliotrope rash), posterior neck, shoulder girdle and upper arm (shawl sign), extensor elbow, knee, and knuckles (Gottron's sign).Proximal muscle weakness is also a common manifestation of the disorder.Dermatomyositis can occur as manifestation of internal malignancy.This case report is that of a 53 year old man with Dermatomyositis and Nasopharyngeal carcinoma.

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Wandering spleen is a rare condition that accounts for < 0.25% of all indications for splenectomy. It is characterized by ectopic localization of the spleen owing to the lack or weakening of its ligaments. Clinical presentation is varied and ranges from asymptomatic abdominal mass to an abdominal mass with recurrent pain and acute abdomen following torsion of its pedicle. We report a case of wandering spleen in a 47-year-old female presenting with recurrent abdominal pain for a year duration, which was treated by splenectomy.

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Parasitic conjoined twinning is a rare clinical entity with a reported incidence of only 1/1 million births. The most common site of attachment of the parasite is epigastrium. The parasitic attachment at ischium is among the least common subtypes. Here, we report a case of ischiopagus parasitic twin with a favorable outcome. The host twin had no major anomaly, and the twins did not share any organ. Surgical separation of parasitic twin and primary closure of the defect of autosite was done without challenges. The aim of this communication is to add to the literature another rare case of parasitic twinning and to highlight the fact that ischiopagus parasitic twinning although, rare, has a good prognosis in the absence of associated anomalies.

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Chest wall reconstruction (CWR) is desirable, especially after the excision of huge chest wall tumor, and using mechanical prostheses for the closure of defects is fraught with some complications. We present a case of a 45-year-old man with a 6-week history of recurrent left-sided lower chest wall mass. Chest examination showed a linear surgical scar 8 cm lower and lateral to the left nipple with an underlying huge mass, whose histology from the previous excisional biopsy revealed dermatofibrosarcoma protuberance. He had the excision of the chest wall tumor and subsequently the superior advancement of the diaphragm and using rectus muscle for the CWR. This method was effective in closing the defect without the known complications.

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This study reports a rare case of parosteal osteosarcoma, a low-grade malignant lesion diagnosed in a 67-year-old female who presented with a slow growing oval-shaped, well circumscribed, bony hard, left maxillary swelling of 4 months' duration; extending from the region of the left upper lateral incisor tooth (22) to the left upper first molar tooth (26) and fixed to the overlying gingival. Oblique lateral radiograph showed the left maxillary alveolar ridge with lobulated ossified mass. The clinical differential diagnoses of the lesion were osteoma, and fibrous dysplasia histopathological diagnosis of parosteal osteosarcoma was made after incisional biopsy of the lesion. Surgical resection (with a wide margin) of the affected maxillary segment and the associated teeth was performed, and postsurgical biopsy confirmed the diagnosis of parosteal osteosarcoma. Parosteal osteosarcoma shares similar clinicopathological characteristics with some periosteal lesions. However, special imaging techniques and histopathological evaluation remain the most reliable tools for definitive diagnosis of these lesions.

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Aims: This study aims to determine the profile of patients as well as identify predisposing factors of patients presenting with low back pain (LBP) in Irrua Specialist Teaching Hospital Irrua, Edo state of Nigeria. Subjects and Methods: A retrospective study in which case records of all newly diagnosed patients with LBP from January 2011 to December 2013 were analyzed and the following data were extracted: demographic indices, duration of symptoms before presentation, predisposing factors, etc. Results: Within the study periods, 3120 patients presented at the orthopedic clinic, out of these, 101 patients had LBP. The prevalence rate was 3.24%. Median age was 58 years. Peak age incidence was 61–70 years. Age range 13–84 years. Male:female 1:1. Most affected occupational age groups were farmers 24 (23.76), traders 23 (22.77%), and civil servants 17 (16.83%). The most common predisposing factors to LBP were trauma to the lower back 23 (22.8%), lifting of heavy objects 11 (10.9%), and obesity 8 (7.9%). Spondylosis was the leading Diagnosis. L4/L5, L5/S1 were the most affected segments The percentage of patients presenting as acute, subacute, and chronic LBP were 28.7%, 9.9%, and 61.4%, respectively. Conclusions: Chronic LBP rank the highest among patients with LBP in our environment. Middle and elderly age brackets were other highlights. Trauma, lifting of heavy weights and obesity were notable predisposing factors.

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Context: Immediate recognition of postpartum complications, prompt, and due management are key to reduction in maternal mortality ratio (MMR). Aims and Objectives: To evaluate the pattern and outcomes of postpartum referrals from traditional birth attendants (TBAs) in rural Nigeria. Materials and Methods: A prospective observational study of patients referred after delivery from TBAs to a Mission Hospital in rural Nigeria. Analysis was by Epi Info statistical software. Results: Two hundred and sixty-two patients were so referred. Perineal injury (29.4%) was the most common diagnosis followed by pyrexia (22.5%), postpartum hemorrhage (18.3%), and genital sepsis (10.3%). The MMR was 4961.8/100,000 live births with PPH accounting for the majority (53.8%). Conclusion: Delay in referral and transportation difficulties were major impediments to prompt access of care from the Mission Hospital. TBAs should be encouraged to refer all cases to well-equipped orthodox medical facilities and get paid for each case as if managed by them.

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Background: Intestinal obstruction is a common surgical emergency. Its pattern and causes vary between communities. Previous reports, including a study from Nnewi, showed obstructed external hernias to be the most common cause. Objective: The objective of the study is to determine the current pattern of intestinal obstruction at Nnewi. Materials and Methods: All case notes of intestinal obstruction managed at Nnewi between January 1, 2000, and December 31, 2009, were retrieved and analyzed. Results: It was found that adhesions caused 62.1% of cases of intestinal obstruction, while obstructed external hernias caused 21.4%. The rest were from other causes. Furthermore, 62.5% of intestinal obstruction from adhesions were managed nonoperatively. Conclusion: Adhesion has emerged as the most common cause of intestinal obstruction at Nnewi.

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Introduction: Inflammation has been shown to play a major role in the pathogenesis of most malignancies including breast cancer. The inflammatory basis of breast cancer has not been evaluated in our environment. Objective: The purpose of this study is to determine the level of some biomarkers of systemic inflammation in patients with breast cancer compared to those of apparently healthy subjects without the disease in Benin City, Nigeria. Methodology: This is a case control study conducted in Benin City, Edo State, Nigeria. Breast cancer patients from Central hospital, Benin City and controls from the general population had their venous blood sampled and analyzed for Erythrocyte Sedimentation Rate (ESR) and C-Reactive Proteins (CRP) levels using standardized laboratory methods. Data were analyzed using SPSS (version 17). Results: Results showed a statistical significant increase (P < 0.05) in both ESR and CRP levels of patients with breast cancer compared to the control. There is also a significant positive correlation (P < 0.001) between ESR and CRP in the study population. Conclusion: These findings support the fact that inflammation is a risk factor for the development of breast cancer and this association might be of clinical significance as these inflammation markers might be of prognostic value.

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Context: cancer remains the most common reason for death from gynaecological malignancy in Nigeria while screening remains opportunistic. Pregnancy provides a veritable ample opportunity for screening for this malignancy. Aim: to evaluate the risk factors for cervical cancer among antenatal clinic attendees at a tertiary centre and assess their uptake of cervical screening. Methods: This was a cross sectional descriptive study using questionnaires. Result: Three hundred and eighty five out of the 400 questionnaires distributed were analysed. The mean age of respondents was 31.3+6.8 years. Majority 73.2% had tertiary level of education. Only 54% have ever heard of cervical cancer screening. Knowledge was gained mainly via health workers and the media. Of these, only 32 (8.3%) have ever been screened. Many of them (48.3% to 62.5%) knew of some of the risk factors but most of them had no established risk factors. Conclusion: While knowledge of cervical cancer screening is average amongst antenatal clinic attendees at the Federal Teaching Hospital Abakailki is average, the uptake is quite abysmal. Antenatal clinic visits provide an opportunity to increase awareness and uptake of cervical cancer screening among women of reproductive age.

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Introduction: The frequency of clinical prostatic adenocarcinoma and high-grade prostatic intraepithelial neoplasia (HGPIN) in a certain population could be similar to the prevalent model of latent adenocarcinoma as well as to the frequency and extent of HGPIN. The aim of this prospective postmortem study is to determine the prevalence of occult adenocarcinoma and HGPIN and contrasting same with the existing clinical model in the same environment. Subjects and Methods: Adult individuals who died from ailments unrelated to diseases of the prostate glands were the target population using a calculated minimum sample size of 72 cases. The partial sampling method was employed. Sections were assessed for prostatic adenocarcinoma and HGPIN. The biodata and clinical diagnosis were obtained from stored records. Results: Seven patients had occult adenocarcinoma representing 8.1% of the study population of 86 cases. Their median age was 60 years. It had a peak incidence in the sixth decade, with a prevalence of 42.85% in the subset of the study population who had the disease. Gleason's grade 3 and score 6 were the most frequent grades and scores encountered in this study. Those with occult adenocarcinoma were graded International Society of Urological Pathologist (ISUP) 1 using the ISUP grade group system. There were five cases of HGPIN in this study. Their median age was 54 years. It had a peaked incidence in the eighth decade. Conclusion: There exists a subset of the population with occult prostatic adenocarcinoma and HGPIN. These subclinical prostatic lesions may become clinically apparent if these patients had lived long enough, and hence, the prostate should be considered as a possible primary site of metastatic carcinoma because of this concept “occult adenocarcinoma.”

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