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   2014| January-June  | Volume 24 | Issue 1  
    Online since June 16, 2014

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Cervical cerclage in a Nigerian tertiary hospital: A review
Abieyuwa P. Osemwenkha, James A. Osaikhuwuomwan
January-June 2014, 24(1):1-6
Aim: The aim of the following study is to document the outcome of cervical cerclage in pregnancy. Materials and Methods: A retrospective analysis was undertaken of patients who had cervical cerclage for cervical incompetence at the Obstetrics and Gynecology Department of the University of Benin Teaching Hospital, Benin-City, Nigeria from January 2007 to December 2012. The cerclage was termed successful if the pregnancy was carried to term. Multiple demographic and clinical characteristics and their relationship to cerclage outcome were analyzed. Results: The records of 123 patients who underwent cerclage over the 6 years period reviewed were analyzed. The mean age was 33.3 ± 3.9 and majority (68.3%) were multiparous, with most of them (90.2%) having had a previous miscarriage. Majority (90.2%) had elective cerclage and 4 (3.3%) had emergency cerclage. Overall majority of patients delivered at 37 and 38 weeks gestation 23.6% and 19.5% respectively. Outcome of cerclage was adjudged successful in 92 (74.8%) of cases and failed in 31 (25.2%) cases. The most frequent complication was pre-viable or preterm rupture of membranes (14.6%). Cerclage outcome was not influenced by age, parity, gestational age at cerclage or experience of the surgeon. The mean duration for which pregnancy was prolonged after an emergency cerclage was 2.6 ± 2.4 weeks and emergency procedure was significantly associated with a failed cerclage. Of the 111 patients with previous miscarriages who had cerclage procedure, 68 (61.3%) had term deliveries and 23 (20.7%) preterm births. Fetal salvage rate of 98 (79.7%) was observed. Conclusion: Use of cerclage for suspected cases of cervical incompetence can have an important beneficial effect in carefully selected cases of cervical incompetence even amongst pregnant black African women.
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Idiopathic polypoidal scrotal calcinosis leading to delay in diagnosis of testicular tumor
Ankur Bhatnagar, Vinay Verma, Vishal Purohit
January-June 2014, 24(1):23-27
Idiopathic polypoidal scrotal calcinosis (IPSC) is a rare and benign condition with disputed etiology and it is characterized by multiple calcific nodular deposits in scrotal skin. Here we report a case of a 45-year-old male patient with testicular tumor and 7 years history of scrotal calcinosis is reported. Discussed is the delay in diagnosis of testicular tumor due to IPSC and difficulty in performing fine-needle aspiration cytology in such cases. In our case, no evidence of cystic structure was found around calcified materials. It was indicated that IPSC might be idiopathic. In addition, highlighted the importance of meticulous clinical examination to accurately diagnose the clinical entity and avoid delay in treatment. They are slow growing asymptomatic tumors. Complete excision of the lesion along with the involved scrotal skin with scrotoplasty of the residual scrotal skin is the treatment of choice. Reports of such rare calcified scrotal nodular lesions especially when associated with other malignant conditions need publication and the treatment protocol shared among the surgeons.
  5,742 355 -
Maxillary antral lesions: An analysis of 108 cases seen in a Tertiary Hospital in Benin City, Nigeria
Osawe Felix Omoregie, Amina Lami Okhakhu
January-June 2014, 24(1):12-17
Aim: This article aims to determine the clinicodemographic pattern and histopathological types of the maxillary antral lesions in a Nigerian population. Materials and Methods: Eleven years retrospective review of case records of patients with histologically diagnosed maxillary antral lesions seen at the Otorhinolaryngological and Oral Pathology/Medicine Departments, University of Benin Teaching Hospital, Benin City, Nigeria was performed. Result: A total of 108 patients with maxillary lesions were seen during the period under review, comprising of 57 (52.8%) males and 51 (47.2%) females, giving a ratio of 1.1:1. The patients' mean age was 41 years (±1.9 standard deviation) and the peak age group was the third decade of life (n = 22, 20.4%). The most frequent clinical features were painless maxillary swelling (n = 91, 84.3%), nasal discharge (n = 41, 38.0%), nasal obstruction (n = 34, 31.5%) and toothache (n = 30, 28.0%). Most patients (n = 31, 28.7%) presented for treatment within a year of onset of the lesion (n = 69, 63.9%) and the left maxillary antrum was the most commonly affected site (n = 64, 59.3%). The antral lesions were mostly malignant lesions (n = 56, 51.9%), with squamous cell carcinoma accounting for 37 (34.3%) of the cases; followed by benign lesions (n = 23, 21.3%), inflammatory/infective lesions (n = 13, 12.0%), cystic lesions (n = 9, 8.3%), and reactive lesions (n = 8, 7.4%). Conclusion: A high prevalence of neoplastic maxillary antral lesions, consisting mostly of malignant lesion was observed in this study. Routine histopathological examination of recurrent or persistent maxillary antral lesions is recommended for early detection of malignant lesions or malignant transformations among reactive or benign antral lesions.
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An insight into the inferior vena cava leiomyosarcoma
Bhupinder Singla, Anshuma Bansal
January-June 2014, 24(1):18-22
Primary vascular leiomyosarcoma (LMS) is a rare tumor accounting for 2% of all LMSs, with the most common site being inferior vena cava (IVC). Overall prognosis is poor, with a median survival of 2 years only. Definitive treatment strategy has not been defined yet, due to the availability of small case series or reports only. However, extrapolating from the treatment of other sarcomas, definitive surgery followed by adjuvant treatment in the form of radiation and chemotherapy is usually followed. This review article focuses on presentation, diagnostic workup, the treatment options for IVC LMS, and their effect on the outcome, so that optimal management can be planned for individual cases. For this, a literature PubMed/Medline search was performed from January 1995 to December 2013 and reviewed to define the rare presentation of these vascular tumors, diagnostic workup, surgical options and reconstruction methods available, and the indications for the use of adjuvant chemotherapy and radiation.
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Tunica vaginalis flap cover in hypospadias cripples: Our experience in a tertiary care center in India
Nitin Sharma, Minu Bajpai, Shasanka S. Panda, Ajay Verma, Mini Sharma
January-June 2014, 24(1):7-11
Objective: The objective of the following study is to assess the outcome of treatment with tunica vaginalis flap cover in cases of proximal penile hypospadias cripples. Materials and Methods: This retrospective study included cases of proximal penile hypospadias cripples managed by thiersch-duplay urethroplasty. Cases were divided into three groups. Group I included cases with tunica vaginalis flap, group II with dartos flap and group III included staged hypospadias repair on Bracka's principle. All cases were managed by a uniform protocol. Outcome was assessed at day 10 after stent removal and at first follow-up. Urethroplasty was considered successful in case with no leak. P value was considered to be significant if less than 0.05. Results: Out of 67 cases, 18 cases were in group I, 24 cases were in group II and 24 were in group III. They formed the study group. Leak at the time of stent removal was present in 1/18 (5.57%), 4/24 (16.67%), 2/24 (8.33%) cases in group 1, II and III respectively (P = 0.04 and 0.4). Leak at the time of first follow-up was present in 1/18 (5.55%), 5/24 (20.83%) and 3/24 (25%) cases in group I, II and III respectively (P = 0.03 and 0.3). Complete disruption of urethroplasty was present in 1/18 (5.57%), 2/24 (8.83%) and 1/24 (4.16%) cases in group I, II and III respectively (P = 0.1). The overall success rate in group I, II and III were 15/18 (83.83%), 13/24 (54.16%) and 18/24 (75%) respectively (P = 0.01 and 0.1). Conclusions: Tunica vaginalis flap reinforcement in cases of hypospadias cripples is a viable and reliable option. This should be favored over dartos flap.
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Hydatid disease involving pectoralis minor muscle alone
Bhupinder Singla, Inderjit Chawla, Karnail Singh, Mandeep Singh, Jalaj Rathi, Sorabh Gupta
January-June 2014, 24(1):28-30
Hydatid cysts are rarely found in muscles. Reports have shown the presence of hydatid cysts in the pectoralis major muscle alone or together with the pectoralis minor muscle. Herein, we present a rare case of a hydatid cyst found in the pectoralis minor muscle alone without the involvement of the pectoralis major or any other muscle or organ.
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