Surgery : Current Challenges with Their Evolving Solutions in Surgical Practice in West Africa
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Editors : E.Q. Archampong, V.A. Essuman, J.C.B. Dakubo, J.N Clegg-Lamptey
Publisher : Sub-Saharan Publishers
Date of Publication : 2013
Place of Publication : Accra
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Browsing Surgery : Current Challenges with Their Evolving Solutions in Surgical Practice in West Africa by Author "Clegg-Lamptey, J.N."
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Item ACUTE APPENDICITIS(2013-12-09) Naeder, S.B.; Clegg-Lamptey, J.N.; Dakubo, J.C.B.There is considerable variation in the incidence of acute appendicitis worldwide. The disease is common in western nations but much less so in developing countries. However recent reports suggest that the incidence of acute appendicitis is declining in the developed world and the reverse is occurring in developing countries. Acute appendicitis is now the leading cause of the acute abdomen in Africa including Ghana and West Africa. The aetiology of acute appendicitis has been attributed to the substitution of high residue diets with refined foods but this hypothesis has been disputed. Appendicular luminal obstruction by a faecolith is thought to initiate the inflammatory changes associated with acute appendicitis as the majority of cases are due to an obstructing faecolith. Diagnosis of acute appendicitis is largely clinical with the symptomatology essentially similar globally. In children, the elderly and pregnancy acute appendicitis may present a formidable diagnostic challenge and therefore a high index of suspicion is required. Sophisticated investigations are not necessary in the majority of cases. However ancillary investigations may be done to improve diagnostic accuracy and minimize the negative appendicectomy rate. The treatment of acute appendicitis is appendicectomy. Prophylactic antibiotics are required in all cases to reduce the incidence of surgical site infection. However in resource-limited settings conservative management with antibiotics may be the only option as the natural history of acute appendicitis includes spontaneous resolution. Recurrence rates following conservative treatment are, however, unacceptably high. Generally mortality and morbidity rates are low in acute appendicitis but are higher in those with complicated appendicitis.Item Current Global Developments in Breast Cancer and Management in Ghana(2013-12-09) Clegg-Lamptey, J.N.; Vanderpuye, V.Breast cancer is the leading malignancy globally, and one of the leading cancers in Ghana. Global developments in the management of breast cancer have led to better patient management. These include the use of multidisciplinary teams (MDTs) in the formulation of management plans. These teams form the basis for best practice in the management of breast disease, and there are attempts to incorporate them in the management of Breast cancer in the two main treatment centres in Ghana. Others include the concept of patient-centred care, use of protocols and clinical trials. Developments in mammographic screening have not been reproduced in developing countries like Ghana for many reasons. These include the absence of mammographic facilities and the relatively young age of patients. A suggested programme that involves Clinical Breast examination, Breast self examination and opportunistic screening has been recommended. Triple assessment remains the basis for diagnosis. Of the various means of biopsy now possible, methods for taking biopsy of non-palpable lesions need to be developed in Ghana, since more patients now have mammograms with some of them reporting with non-palpable abnormalities There have been advances in treatment: surgery, radiotherapy and chemotherapy. Biological therapy in the treatment of patients with HER2 receptor overexpression is often hindered by the high cost of treatment. Generally, Breast cancer management in Ghana has kept pace with global developments. The young age breast cancer patients in Ghana, sociocultural differences and financial limitations require some modifications in the approach of the management of this condition in our country.