Department of Surgery
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Item Impact of Improved Eye Care Services on Time of Diagnosis of Primary Open Angle Glaucoma(Ghana Medical Journal, 1999-06) Ackuaku, E.M.; Hagan, M.The case notes of new glaucoma patients seen at the Eye Unit of Korle-Bu Teaching Hospital, Accra, Ghana between the period of January, 1996 and April 1998 were reviewed. The results were compared with a study done by Hagan et al. A total of two hundred and twenty eight case notes were reviewed. Only 20.2% were found to be blind in both eyes when first seen and 50.4% had useful vision in both eyes. This shows a great change as compared to the situation in 1986-1990 when 63.3% were blind in both eyes and only 20.1% had good vision in both eyes. About 25% of patients seen at the clinic were referred from outreach services run by ophthalmic nurses. 58% reported directly with blurred vision in one or both eyes; 15 .4% reported with other complains and only 13.3% were picked up from family screening during the period under review.Item Informed consent: British otolaryngologists surveyed(1999-06) Dawes, P.J.D.; Kitcher, E.A repeat postal questionnaire of British otolaryngologists has been carried out to assess changes in their practice of obtaining informed consent. The previously reported high level of good practice is maintained. Currently informed consent is more often obtained in outpatients or the preadmission clinic than it was in 1991. Consultants and specialist registrars are more involved in this process. Although there is little evidence given to support a persistent increase in a defensive approach towards gaining informed consent, there is some change in the reporting of surgical complications that may reflect an increased awareness of the concept of 'material risk'.Item Multiple primary carcinomas of the gastrointestinal tract.(1998-10) Naaeder, S. B.; Jumah, K.B.A case of multiple primary Carcinomas of the gastrointestinal tract is reported in a man presenting with Carcinomas of the rectum and oesophagus.Item Effect of acute dietary fibre supplementation on colonic pH in healthy volunteers.(1998-07) Naaeder, S. B.; Evans, D.F.; Archampong, E. Q.Dietary fibre and undigested starch are fermented to short chain fatty acids by colonic bacteria with acidification of the colon. It has been suggested that acidification of the colon by these fatty acids inhibits bacterial metabolism, but this concept has been disputed. The aim of this study was to investigate the short term effect of a dietary fibre load on colonic metabolism. Colonic pH and breath hydrogen was measured in healthy omnivorous British male volunteers following ingestion, in turn and at weekly intervals, of 15g lactulose, wheat bran biscuits, oat bran biscuits and ispaghula husk. All the test meals caused a reduction in caecal pH and an increase in breath hydrogen production. The changes were greatest with lactulose. Lactulose and wheat bran caused acidification of the right and left colon whereas oat bran and ispaghula husk caused acidification of mainly the right colon. An inverse correlation between right colonic pH and breath hydrogen was observed in only the oat bran study. This study has demonstrated the ability of dietary fibre to lower right colonic pH and to increase breath hydrogen excretion. The changes were greater with soluble fibre than with insoluble fibre but the change in luminal pH was persistent all round the colon with insoluble fibre.Item One-stage resection of acute sigmoid volvulus.(1995) Naaeder, S. B.; Archampong, E. Q.Item Clinical spectrum of acute abdominal pain in Accra, Ghana.(1999-01) Naaeder, S. B.; Archampong, E. Q.In a 12-month prospective study 370 patients with acute abdominal pain were admitted to a single surgical unit of a large teaching hospital. The most common diagnoses were appendicitis (23.5 percent), Non-specific abdominal pain (NSAP) (21.4 percent), acute intestinal obstruction (10.8 percent), gynaecological causes (9.5 percent, and peptic ulcer (9.2 percent). Emergency operations were performed in 146 patients (39.5 percent). Appendicectomy was the commonest operation (77 cases or 52.7 percent) and there was a high incidence of complicated appendicitis (41.6 percent). Eleven patients (3.0 percent) died within 30 days of admission (8 postoperative and 3 non-operative deaths). The clinical spectrum of the acute abdomen in this study shows that surgeons in developing countries are not facing surgical challenges similar to those of their counterparts in developed countries and the most important diagnostic distinction surgeons in both localities have to make is that between acute appendicitis and non-specific abdominal pain.Item Changing pattern of acute intestinal obstruction in Accra.(1993-04) Naaeder, S. B.; Archampong, E. Q.Five hundred and fifty-two cases of intestinal obstruction were seen over a two year period, January 1987 to December 1988. Strangulated external hernias and adhesions still remain the most common causes of intestinal obstruction in Accra, but there has been a change in their relative incidence with external hernias falling to 59.8 per cent and adhesive obstruction increasing to 21.0 per cent. There has been no change in the overall mortality and mortality from inguinal hernia which are still 9.4 per cent and 4.9 per cent respectively. However, there has been a significant improvement in mortality rate from volvulus and a slight improvement in mortality from adhesive obstruction even though the overall resection rate has increased from 12.7 per cent to 17.6 per cent.Item Acute appendicitis and dietary fibre intake.(1998-10) Naaeder, S. B.; Archampong, E. Q.It has been postulated that acute appendicitis is the first serious disease to emerge with the adoption of fibre-depleted diets. The incidence of acute appendicitis is rising in Africa and this has been attributed to socio-economic advancement and the adoption of low residue diets. The aim of this study was to determine whether income levels and the level of dietary fibre intake play any role in the rising incidence of acute appendicitis in Ghana. Between June and November 1997 patients aged 13 years and above with acute appendicitis were studied. Their monthly net income levels or those of their parents if they were minors were ascertained and a dietary fibre questionnaire completed on each patient in order to assess his or her dietary fibre intake. The clinical details of each patient were recorded on a proforma. One hundred and seventy-three patients, 128 males and 45 females, mean age 29.2 (range 13-75) years were studied. 14 percent presented within 6 h, 46.8 percent within 24 h and 41.6 percent after 2 or more days. 53.2 percent had acute appendicitis and 42.8 percent presented with complicated appendicitis. The appendix was normal in 4.0 percent. Two patients died (1.2 percent). 61.3 percent of patients were low income earners and 38.7 percent were high income earners. The overall dietary fibre intake was 39.4 g per day with no significant difference in fibre consumption between low income earners (39.0 g/day) and high income earners (43.5 g/day). We conclude that dietary fibre may not be the important factor in acute appendicitis and other luminal and/or morphological factors may be predisposing factors.Item Large sublingual lipoma [2].(1997-05) Parkins, G.E.A.Item Priapism: experience with the caverno glandular shunt.(1991-07) Klufio, G.O.; Quartey, J.M.Twenty cases of Priapism were managed surgically over a 3-year period with the A1-Ghorab modification of the caverno-glandular shunt. The procedure was simple and short. Except for post-operative bleeding in 2 patients, no major complications were encountered. Post-operative potency rate of 39 per cent was achieved. Late presentation and repeated previous episodes may have contributed to this low potency rate.