Browsing by Author "Clegg-Lamptey, J.N.A."
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Item Aorto-oesophageal fistula: An unusual cause of upper gastrointestinal bleeding(Ghana Medical Journal, 2002-12) Clegg-Lamptey, J.N.A.; Tettey, Y.; Hodasi, W.M.; Amenuveve, C.We report a case of a 35-year-old man who pre- sented with haematemesis, chest pain and a very high fever following the swallowing of a fishbone five days previously. He was correctly diagnosed as having a mediastinitis but had an exsanguinating haematemesis and died within 24 hours of arrival in hospital. Post mortem revealed mediasinitis and an aorto-oesophageal fistula. The difficulty in making the diagnosis of this condition and the often- resulting catastrophic haemorrhage that occurs are discussed. It is a condition that should be considered in a patient presenting with fresh haematemesis and a history of ingestion of a foreign body five to seven days previouslyItem Appendicitis in Accra: A contemporary appraisal(Ghana Medical Journal, 2003-06) Clegg-Lamptey, J.N.A.; Naaeder, S.B.Appendicitis used to be a rare disease in Accra and other parts of West Africa over five decades ago. By 1971 the incidence in Accra had increased to 2.63/10,000. From 1st June 1998 to 31st May 2000 patients presenting with appendicitis in all the major hospitals and clinics in Accra were analysed to determine the incidence of appendicitis. A prospective study of all patients admitted with acute appendicitis at the Korle Bu Teaching Hospital (KBTH) during the same period was done to determine the use of preoperative prophylactic antibiotics, complication rate and duration of hospital stay (bed occupancy) following appendicectomy. The frequency of appendicectomy for acute appendicitis relative to other general surgical emergency operations and to total operations in KBTH was also determined. There were 1409 cases of appendicitis, 72% male and 28% female, an overall male to female ratio of 2.6:1. The yearly incidence of appendicitis in Accra was 3.18/10,000, only slightly more than three decades ago. The peak incidence was in the 20 to 24 age group. In almost all age groups it was twice as common in males as in females. In KBTH, appendicitis constituted 31% of emergencies and 14% of general surgical operations. Ninety one percent received prophylactic antibiotics. The appendix was retrocaecal at operation in 55% of cases. The wound infection rate following appendicectomy in KBTH was 8.75% with a total complication rate of 17%. The mean duration of stay in hospital was 6 days. The 30-day mortality was 1.3%. Acute appendicitis is the commonest general surgical emergency in Accra, being twice as common in males as in females below 60 years. Its incidence has remained relatively stable over the past 30 years.Item Clinical features of acute appendicitis: A two-year study in a Surgical Unit at Korle Bu Teaching Hospital(Ghana Medical Journal, 2002-12) Clegg-Lamptey, J.N.A.Acute appendicitis is one of the commonest surgical emergencies all over the world although it is less common in developing countries the incidence has been on the increase and is now known to constitute as much as 30% of all emergency general surgical emergencies in Accra. The diagnosis can sometimes be difficult to make and it may require the use of scoring systems (like the Alvarado), laboratory investigations like white cell count and creative protein, or more detailed investigations like high resolution ultrasonography, CT scan, radioisotope scan and laparoscopy. Since these are unaffordable in many developing countries, the clinical features remain the most important for making the diagnosis. The symptoms, sign and white cell count were studied in a 24-month prospective study of 156 patients with acute appendicitis at the Korle Bu Teaching Hospital. Abdominal pain (100%), vomiting 71.2%) and loss of appetite (62.2%) were the most important symptoms. The classical pain of appendicitis, which moves from the peri-umbilical region to the right iliac fossa (RIF), was present in 48.3%. Tender- ness in the RIF was the most important sign (98.7%), followed by a pulse of >80/minutes (87.2%). The white cell count was raised above 10 x 10 9 /1 in only 43.7% of the patients. Dunphy’s sign was more important than Rovsing’s sign. The appendiceal foetor was hardly recognized by any of the attending doctors.Item Comparison of four-day and ten-day post-mastectomy passive drainage in Accra, Ghana(East African Medical Journal 84(12): 33-37, 2007) Clegg-Lamptey, J.N.A.; Dakubo, J.C.B.; Hodasi, W.M.Item Laparoscopic Cholecystectomy at the Korle Bu Teaching Hospital, Accra, Ghana(West African Journal of Medicine, 2010-03) Clegg-Lamptey, J.N.A.; Amponsah, G.BACKGROUND: Laparoscopic cholecystectomy (LC) the preferred treatment for gallstones was not available in Ghana until 2005. OBJECTIVE: To report experience from Ghana of laparoscopic cholecystectomy in the treatment of galestones. METHODS: In a prospective study of patients with gallstones, information was obtained on demography, duration of various stages of the operation, analgesia and complication of patients with gallstones. All patients had general anaesthesia using endotracheal intubation, muscle relaxant and intermittent positive pressure ventilation. A standard four-trocar technique and maximum pneumoperitoneum pressure of 14mmHg were maintained during surgery. RESULTS: There were 50 women and two men aged 17-72 years (mean 44.2 years). All had symptomatic gallstones treated by interval LC. The main indications were biliary colic 23(44%) and previous cholecystitis 15(29%). There were scars from previous abdominal surgery in 22 (42%), mainly pfannenstiel. The Verres needle was used to obtain pneumoperitoneum in 40 (77%). Only one patient (1.9%) had the operation converted to open cholecystectomy. Most patients, 47/51 (92%), were discharged in 24 hours. The mean durations of various stages were: anaesthesia (110 minutes), pneumo-peritoneum (67.5 minutes) and reverse trendelenburg (47.8 minutes). The mean operating time reduced from 81 to 68 minutes in the last 20 patients. Complications were sore throat 11(21.6%), infection of the umbilical wound 3(5.9%), right shoulder tip pain (3; 5.9%) and bile leak 1(2%). There was no peri-operative mortality. CONCLUSION: Elective laparoscopic cholecystectomy can be performed with good results in patients with symptomatic gallstones in Accra.Item Late Presentation of Breast Cancer in Lower- and Middle-Income Countries(Springer Nature, 2019-09) Clegg-Lamptey, J.N.A.; Vanderpuye, V.; Dedey, F.Purpose of Review Breast cancer incidence and mortality in low- and medium-income countries has increased and is predicted to rise. Late presentation, associated with poor prognosis, is unfortunately common to most of these countries. This review discusses recent studies and offers recommendations to address pertinent issues raised. Recent Findings Late presentation continues to prevail in many LMICs, worse in sub-Saharan Africa. Socioeconomic and demographic factors play a significant role. The fear of mastectomy is a prominent cause of reluctance to seek treatment. Increasing awareness, clinical breast examination and opportunistic mammographic screening have a role to play in addressing the issue. The provision of health infrastructure and creating access may overcome some of the other factors that sometimes seem unsurmountable.Item Pattern Of Breast Diseases In Accra: Review Of Mammography Reports(Ghana medical journal, 2013-09) Brakohiapa, E.K.; Armah, G.E.; Clegg-Lamptey, J.N.A.; Brakohiapa, W.O.Objectives: To document the mammographic patterns in females seeking medical attention in Accra. Design: An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. Setting: The radiology departments of Korle-Bu Teaching Hospital, the Trust Hospital and Medical Imaging Ghana, all located in Accra. Results: One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41–50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41–50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain. Conclusion: The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.Item Profile of Breast Disease at self-referal clinic in Ghana(West African Journal of Medicine, 2009) Clegg-Lamptey, J.N.A.; Aduful, H.K.; Yarney, J.; Adu Aryee, N.A.Item Profile of breast diseases at a self-referral clinic in Ghana(West African Journal of Medicine, 2009-03) Clegg-Lamptey, J.N.A.; Aduful, H.K.; Yarney, J.; Adu-Aryee, N.A.; Vanderpuye, V.; Kyereh, M.; Nkansah, A.; Edwin, A.BACKGROUND: Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. OBJECTIVE: To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. METHODS: Abreast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. RESULTS: Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450(50.2%), lump 257(28.7%) and nipple discharge 62(8.3%). Fifty (5.6%) came for check-up; 139(18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1(10.5) months, lump 11.9(7.7) months, and pain 113(8.9) months. The main diagnoses were: Normal breasts 192(27.7%), mastalgia 135(18.1%), fibroadenosis 114(15.2%), fibroadenomas 84(11.2%), breast cancer 58(7.8%), suspected breast cancer 25(3.3%), galactorrhea 9(1.2%), mastitis 8(1.1 %), musculoskeletal pain 8(1.1%), duct ectasia 8(1.1%), mondor's disease 7(0.94%) and recurrent breast cancer 6(0.8%). In patients with breast cancer, 42(66%) had advanced disease, 6(9.4%) had recurrent disease and 4(6.3%) had metastatic disease. CONCLUSION: The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.Item Psychosocial aspects of breast cancer treatment in accra, Ghana.(East African Medical Journal, 2009) Clegg-Lamptey, J.N.A.; Dakubo, J.C.B.; Attobra, Y.N.OBJECTIVES: To evaluate psychosocial influences and effects of breast cancer treatment. DESIGN: Cohort questionnaire survey. SETTING: Surgical Outpatient Department, Korle Bu Teaching Hospital (KBTH), Accra, Ghana. SUBJECTS: Women previously treated for breast cancer, including those still on hormonal therapy. MAIN OUTCOME MEASURES: Perception of quality of treatment and psychosocial support; and patients' felt needs for alternative treatment. RESULTS: Eighty nine women treated one to 22 years previously were interviewed. The majority (86%) had mastectomy. Chemotherapy was the most unpleasant aspect of treatment in 58 (65.2%), and 27 (30.3%) were not warned about complications of treatment. Thirty eight (42.7%) reported being afraid (frightened or terrified) at the diagnosis; other reactions were shock, devastation, weeping and depression. Twenty two (24.7%) received no counselling and 15 (18.5%) did not have opportunity to express their fears of death 55 (61.8%), mastectomy/deformity 27 (30.3%) and financial incapability 23 (25.8%). Forty four (49.4%) used alternate 'treatment', mainly prayer camps (25 cases) and herbs (22 cases), before and during hospital treatment. Use of alternate treatment led to delays in treatment in 23 women. They had complaints about the care they received: lack of sympathy and emotional support (16 cases), lack of information and communication (13 cases), lack of counselling (9 cases) and slow processes (8 cases). CONCLUSIONS: Many patients utilise prayer camps and herbs leading to delays in treatment. Breast cancer patients in Ghana (West Africa) are not receiving satisfactory emotional support, communication and counseling. Adequate psychosocial interventions need to be implemented.Item Upper Gastrointestinal Endoscopy at the Korle Bu Teaching Hospital, Accra, Ghana(2007-03) Aduful, H.K.; Naaeder, S.B.; Darko, R.; Baako, B.N.; Clegg-Lamptey, J.N.A.; Nkrumah, K.N.; Adu-Aryee, N.A.; Kyere, M.Objectives To study the indications for endoscopy, the endoscopic diagnosis and other lessons learnt. Methods A retrospective and prospective audit of all upper gastrointestinal endoscopies performed in the Endoscopy Unit of the Korle-Bu Teaching Hospital from January 1995 to December 2002 was performed. Results A total of 6977 patients, 3777 males and 3200 females with age range 1 year 8 months to 93 years were endoscoped. The mean age of males was 43.5 ± 0.5 and females 43.7 ± 0.6 years. Epigastric pain (42.5%), dyspepsia (32.8%) and haematemesis and melaena (14.2%) were the commonest reasons for endoscopy. Chronic duodenal ulcer (19.6%), acute gastritis (12.7%), duodenitis (10.2%), oesophagitis (7.5%) were the commonest diagnoses. Normal endoscopy was reported in 41.1% patients, and was higher in the younger age group compared to the older (R = 0.973, P<0.001). Nine hundred and ninety (14.2%) patients were endoscoped for haematemesis and melaena of which chronic duodenal ulcer (32.1%), gastritis/gastric erosions (12.8%), oesophageal varices (9.8%), carcinoma of the stomach (6.4%), and duodenitis (4.2%), were the commonest causes. No lesion was found in 20.6% of these patients. Urease test was positive in 75% of all biopsy specimen and 85% in chronic duodenal ulcer, gastritis and duodenitis. Conclusion The normal endoscopy rate is high and needs to be reduced in order to help prolong the lives of the endoscopes. Chronic duodenal ulcer is usually associated with H. pylori infection and is the commonest cause of upper gastrointestinal bleeding.