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REVIEW ARTICLE
Surgical templates for dental implant positioning; current knowledge and clinical perspectives
Mohammed Zaheer Kola, Altaf H Shah, Hesham S Khalil, Ahmed Mahmoud Rabah, Nehad Mohammed H Harby, Seham Ali Sabra, Deepti Raghav
January-June 2015, 21(1):1-5
DOI:10.4103/1117-6806.152720  PMID:25838757
Dental implants have been used in a variety of different forms for many years. Since the mid-20 th century, there has been an increase in interest in the implant process for the replacement of missing teeth. Branemark was one of the initial pioneers who applied scientifically based research techniques to develop an endosseous implant that forms an immobile connection with bone. The need for a dental implant to completely address multiple physical and biological factors imposes tremendous constraints on the surgical and handling protocol. Metallic dental implants have been successfully used for decades, but they have serious shortcomings related to their bony union and the fact that their mechanical properties do not match those of bone. However, anatomic limitation and restorative demands encourage the surgeon to gain precision in planning and surgical positioning of dental implants. Ideal placement of the implant facilitates the establishment of favorable forces on the implants and the prosthetic component as well as ensures an aesthetic outcome. Therefore, it is advisable to establish a logical continuity between the planned restoration and the surgical phases, it is essential to use a transfer device that for sure increases the predictability of success. The surgical guide template is fabricated by a dental technician after the presurgical restorative appointments that primarily include determination of occlusal scheme and implant angulations. Here, authors genuinely attempted to review the evolution and clinical applicability of surgical templates used in the placement of dental implants.
  20 6,140 389
ORIGINAL ARTICLES
Preoperative prediction of difficult laparoscopic cholecystectomy: A scoring method
Nikhil Agrawal, Sumitoj Singh, Sudhir Khichy
July-December 2015, 21(2):130-133
DOI:10.4103/1117-6806.162567  
Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. This study is undertaken to determine the predictive factors for difficult LC. Aim: The aim was to evaluate a scoring method to predict difficult LC preoperatively. Materials and Methods: There were 30 cases operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. Score up to 5 predicted easy, 6-10 difficult and >10 are very difficult. Results: Prediction came true in 76.4% for easy and 100% difficult cases; there were no cases with a score above 10. The factors like previous history of hospitalization (P - 0.004), clinically palpable gallbladder (GB) (P - 0.009), impacted GB stone (P - 0.001), pericholecystic collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P - 0.009) were found statistically significant in predicting difficult LC. Conclusion: The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%.
  13 3,700 223
Evaluation of immunohistochemical profile of breast cancer for prognostics and therapeutic use
Prem Chand, Anubha Garg, Vandana Singla, Nisha Rani
July-December 2018, 24(2):100-106
DOI:10.4103/njs.NJS_2_18  PMID:30283220
Introduction: Breast cancer is leading cancer in women, and the incidence of breast cancer in India is on the rise. The most common histologic type of breast cancer is infiltrating ductal carcinoma. Prognostic and predictive factors are used in the management of breast cancer. Estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor-2 (HER2/neu) are immunohistochemical markers of prognosis as well as predictors of response to therapy. Aims and Objectives: The study was conducted to evaluate ER, PR, and HER2/neu expressions in invasive ductal carcinomas of the breast by immunohistochemistry, to explore the correlation of these markers to each other and to various clinicopathological parameters: age of the patient, histological grade, tumor size, and lymph node metastasis. Materials and Methods: This prospective study was conducted on 100 cases of infiltrating ductal carcinoma. Slides were prepared from blocks containing cancer tissue, and immunohistochemical staining was done for ER, PR, and HER2/neu expressions. Interpretation of expressions was done using Allred scoring system for ER/PR and the American Society of Clinical Oncology/College of American Pathologists guidelines for HER2/neu. Statistical analysis was performed to determine the statistical significance by applying Chi-square test. Results: Majority of tumors were ER and PR positive and HER2/neu negative. ER and PR correlated significantly with age, tumor size, and tumor grade; whereas, HER2/neu correlated significantly with tumor size only. No association was seen with axillary lymph node metastasis. ER and PR expression correlated with each other, but none correlated with HER2/neu. Conclusions: As the majority of the tumors are ER, PR positive and since ER and PR correlate with each other as well as with age, tumor size, and grade. Therefore, routine assessment of hormone receptors is recommended for prognostic and therapeutic information in breast cancer cases.
  13 4,939 338
Management of fistula-in-ano with special reference to ligation of intersphincteric fistula tract
Mohanlal Khadia, Iswar Chandra Muduli, Sushanta Kumar Das, Sworupa Nanda Mallick, Laxman Bag, Manas Ranjan Pati
January-June 2016, 22(1):1-4
DOI:10.4103/1117-6806.169818  PMID:27013849
Context: The surgical management of fistula-in-ano is still debatable and no clear recommendations have been made available until now. The present study analyses the results of ligation of intersphincteric fistula tract (LIFT) technique in treating fistula-in-ano in particular with recurrence, healing time, and continence status. Aims: LIFT in the management of patients of fistula-in-ano of cryptoglandular origin. Settings and Design: Prospective study. Materials and Methods: This is a prospective study of 52 patients admitted from September 2012 to August 2014. Patients were managed with LIFT technique and results of LIFT technique were compared with other studies in terms of recurrence rate, incontinence rate, and other postoperative complications. Results: A total of 52 patients were studied. Median follow-up was 24 weeks. Primary healing was achieved in 32 (71.11%) patients. Thirteen patients (28.88%) had a recurrence. No patient reported any subjective decrease incontinence after the procedure. Conclusions: LIFT technique is simple and easy to learn. With this method fistula-in-ano could be easily treated even at primary health care level. LIFT technique is a simple and novel modified approach for the treatment of fistula-in-ano with rapid healing rate and without any resultant incontinence.
  10 7,116 256
Age-specific serum prostate specific antigen ranges among apparently healthy Nigerian men without clinical evidence of prostate cancer
Stephen O Ikuerowo, Michael O Ajala, Abimbola A Abolarinwa, Olufunmilade A Omisanjo
January-June 2016, 22(1):5-8
DOI:10.4103/1117-6806.169821  PMID:27013850
Introduction: Serum prostate specific antigen (PSA) levels increase with age and varies among different races and communities. The study was aimed at defining the age-specific reference ranges of serum PSA in our environment. Methods: We evaluated the relationship between age and serum PSA levels and the age-specific reference ranges of serum PSA among civil servants in Lagos, who underwent routine medical checkups. Criteria for inclusion were men who have no lower urinary tract symptoms, normal digital rectal examination and serum PSA ≤ 20 ng/ml. SPSS Statistic 21 was used for data evaluation and the mean, median, 95th percentile PSA levels were estimated. Pearson's correlation was used to examine the relationship, and P < 0.05 was considered significant. Results: 4032 men met the criteria for inclusion in the evaluation. The mean age was 51.6 (range 40–70) years, and there was a strong correlation between serum PSA levels and age (r = 0.097, P < 0.001). PSA ranges of 0–2.5, >2.5–4.0, >4.0–10, and >10 ng/ml were found in 3218 (80%), 481 (12%), 284 (7%), and 52 (1%) men, respectively. The mean, median and the 95th percentile PSA for the overall group were 1.84, 1.33, and 5.2 ng/ml respectively. However the 95th percentile PSA levels for men aged 40–49, 50–59, and 60–70 years were 4.78, 5.47, and 8.93 ng/ml respectively. Conclusion: The age-specific PSA levels among Nigerian men for each age group is higher than what was described for men in the Western world. These reference ranges of serum PSA should be considered for men aged ≥40 years in our environment.
  9 4,039 156
New visual prostate symptom score versus international prostate symptom score in men with lower urinary tract symptoms: A prospective comparision in Indian rural population
Ashutosh Roy, Amandeep Singh, Darshan Singh Sidhu, RP Jindal, Mishi Malhotra, Haramritpal Kaur
July-December 2016, 22(2):111-117
DOI:10.4103/1117-6806.189002  PMID:27843276
Introduction: Benign prostrate hyperplasia (BPH) is a leading source of healthcare problem in aging men around the world including India. Both International Prostate Symptom Score (IPSS) and New Visual Prostate Symptom Score (VPSS) are used to assess the lower urinary tracts symptoms (LUTSs) in men. The present study was planned to compare these two scores, IPSS and VPSS in Indian rural men prospectively and their efficacy was compared with urodynamic evaluation of the patients. Materials and Methods: With Institutional Ethical Committee approval, this study was conducted on 100 patients having LUTS and BPH after obtaining written informed consent. Patients' educational status was noted. All the patients were requested to complete the IPSS and VPSS questionnaire, and they were correlated. The urodynamic study was performed on all the patients with uroflowmeter. Two parameters of uroflowmetry, Q max (maximum urine flow rate expressed in ml/s) and Q avrg (average urine flow rate expressed in ml/s) were measured and correlated. Results: Most of the patients (55%) in this study were uneducated. Out of 100 patients, 83% were able to fill the VPSS questionnaire without assistance as compared to only 40% patients in IPSS questionnaire (Z = 6.557, P < 0.001). There was a positive correlation between IPSS and VPSS total score in this study (r = 0.453 and P ≤ 0.001). It was noticed that IPSS Question 2 for frequency of urination had a positive correlation with VPSS Question 1 (day time frequency of urination) r = 0.645 (P = 0.000). Similarly, IPSS Question 7 for night frequency when compared with VPSS Question 2 (nocturia); the value for r was found to be 0.536 (P = 0.000).The IPSS Question 5 for straining when compared to the VPSS Question 3, i.e., the question for the strength of stream during micturition; the positive correlation was found to be 0.266 (P = 0.007). There was a negative correlation between IPSS total score and Q avrg with value − 0.368 (P = 0.000) and between IPSS total score and Q max of − 0.433 (P = 0.000). A negative correlation is also noted between VPSS total score and Q avrg of value 0.497 (P = 0.000) and VPSS total score and Q max of value − 0.719 (P = 0.000). Conclusion: VPSS correlates significantly with the IPSS to quantify the LUTS due to BPH. The VPSS can be used instead of the IPSS for the assessment of symptom severity in men with LUTS, who are illiterate or have limited education.
  9 8,903 252
Management of brain abscess: Changing trend and experience in Enugu, Nigeria
Chika Anele Ndubuisi, Samuel C Ohaegbulam, Wilfred C Mezue, Mark C Chikani, Sunday P Nkwerem, Ignatius I Ozor
July-December 2017, 23(2):106-110
DOI:10.4103/njs.NJS_46_16  PMID:29089734
Background: Intracranial abscess remains a significant health-care problem. Its causes, diagnosis, treatment, and outcome are changing. Aim: This paper reviewed the demography, examined new trends, and compared outcomes with different treatment options. Methodology: Retrospective analysis of intracranial abscesses managed at Memfys Hospital, Enugu (2004–2014) and University of Nigeria Teaching Hospital (2009–2014). Patients were followed up for at least 6 months. All patients had neuroimaging before intervention. Microscopy and culture were performed for the specimens. Intravenous antibiotics were given for 2 weeks before conversion to oral. Results: Seventy-nine parenchymal abscesses (eight cases per year) were managed. Peak age was the second decade of life. Previous head injury (21.5%) and meningitis (16.5%) were the most common predisposing factors. The frontal lobe was most common anatomical location (32%). Only 24% had positive culture result. Three cases were fungal infections. Seventy percent of patients managed with burr hole drainage and 37.5% of craniotomy made complete recovery. Overall, 58% of patients made complete recovery, whereas 19.0% died. Nine percent of cases died before definitive intervention. Among the 24% of patients that presented in coma, 47% died within 6 months. Most important factor influencing mortality was admission level of consciousness. Abscess recurred in 6% of cases. Conclusion: Intraparenchymal abscesses in Enugu were mostly solitary lesions resulting from poorly managed head injury and meningitis. Predisposition from otitis media and systemic diseases has reduced. The proportion of fungal organisms is increasing. A significant proportion of the patients present in coma. Burr hole and aspiration of abscess is less invasive and has very good outcome.
  9 3,649 98
Micronuclei in exfoliated cells: A biomarker of genotoxicity in tobacco users
Meenakshi Upadhyay, Parul Verma, Robin Sabharwal, Santosh Kumar Subudhi, Suruchi Jatol-Tekade, Vihang Naphade, Basanta Kumar Choudhury, Pravudeva Devidutta Sahoo
January-June 2019, 25(1):52-59
DOI:10.4103/njs.NJS_10_18  PMID:31007513
Aims: The aim of this study was to analyze the tobacco-related genotoxic effects in individual with habit of smoking and chewing tobacco. Materials and Methods: The present study sample consisted of 120 individuals attending the outpatient department of D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh (UP). The sample was divided into four groups as follows: Group I (individuals with habit of smoking tobacco), Group II (individuals with habit of chewing tobacco), Group III (individuals with habit of smoking and chewing tobacco), and Group IV control group (nontobacco-exposed individuals). Patients were asked to rinse their mouth gently with water. The exfoliated cells were obtained by scraping the buccal mucosa of individuals with a wooden spatula. The scraped cells were placed on the precleaned slides. The smears were then stained with RAPID-PAP™ and analyzed under the microscope. Data were analyzed using SPSS statistical software. Results: In the present study, an arbitrary unit was obtained using frequency/day multiplied by the duration of years (risk multiplication factor [RMF], a positive and significant correlation were observed between the RMF and the mean percentage of micronucleated cell count in smokers, chewers, and in individuals with both smoking and chewing habit, respectively. A weak positive and nonsignificant correlation were observed between age and mean percentage of micronucleated cells in smokers and smokers + chewers, respectively, while it was weak negative and nonsignificant in chewers. In control group, correlation between age and percentage of micronucleated cells was weak positive and nonsignificant at 5% level of significance. Conclusion: The micronuclei in exfoliated mucosal cells from buccal mucosa can be used as a biomarker of genotoxicity in predicting the effects of carcinogens.
  9 2,717 166
Radiographic evaluation of anterior loop of inferior alveolar nerve: A cone-beam computer tomography study
Om Prakash, Pankaj Kumar Srivastava, Bhuvan Jyoti, Rafiya Mushtaq, Tarun Vyas, Purumandla Usha
July-December 2018, 24(2):90-94
DOI:10.4103/njs.NJS_1_18  PMID:30283218
Background: A well awareness of the variation of inferior alveolar canal is mandatory to avoid iatrogenic complication. This study was conducted among 90 patients to determine variation in inferior alveolar nerve (IAN) loop through cone-beam computed tomography (CBCT) images. Materials and Methods: CBCT images of 90 patients were involved in this study. All images were studied by the expert radiologist to see Type I, Type II, and Type III pattern of IAN canal (IANC). Results were subjected to statistical analysis for correct inferences. Results: Forty males and 50 females were included in the study. The difference was statistically nonsignificant (P = 0.5). Type I pattern was seen in 26 patients, Type II in 19, and Type III in 45 patients. The difference was statistically significant (P < 0.05). The most prevalent pattern was Type III (males - 15 and females - 30), followed by Type I (males - 14 and females - 12) and Type II (males - 11 and females - 8). There was statistical significance difference between males and females in Type II (P < 0.05). Conclusion: The anterior loop of IAC is quite common and IANC may show variation in structure. The most common pattern recorded was Type III. CBCT is very useful in the detection of IANC.
  8 4,500 202
Comparative efficacy of amoxicillin/clavulanic acid and levofloxacin in the reduction of postsurgical sequelae after third molar surgery: a randomized, double-blind, clinical trial in a Nigerian university teaching hospital
Kizito Chioma Ndukwe, Ramat Oyebunmi Braimah, John Foluso Owotade, Stephen Babatunde Aregbesola
July-December 2016, 22(2):70-76
DOI:10.4103/1117-6806.179830  PMID:27843268
Background: The most common sequelae after surgical removal of mandibular third molar are pain, trismus, swelling, and dysphagia. However, these symptoms can also signal the onset of surgical site infection and alveoli osteitis. The aim of this study was to evaluate the efficacy of prophylactic amoxicillin/clavulanic acid and levofloxacin and preemptive therapy of amoxicillin/clavulanic acid in the reduction of postinflammatory complications, surgical site infection, and alveolar osteitis following the third molar surgery. Patients and Methods: A total of 135 patients were randomized into three equal groups: Group A (preemptive therapy of amoxicillin/clavulanic acid) with preoperative dose of 875/125 mg amoxicillin/clavulanic acid followed by 500/125 mg amoxicillin/clavulanic acid 12 hourly for 5 days, Group B (amoxicillin/clavulanic acid prophylaxis) with a single preoperative dose of amoxicillin/clavulanic acid 875/125 mg tablets, and Group C (levofloxacin prophylaxis) with a single preoperative dose of levofloxacin 1000 mg tablets. All patients had ostectomy using surgical handpiece and burs and received same analgesics (tabs ibuprofen 400 mg 8 hourly for 3 days). Results: No case of surgical site infection or alveoli osteitis was recorded in the study groups. There were no statistically significant differences between the treatment groups with regard to pain, mouth opening, postoperative facial dimension, and body temperature. Conclusion: Amoxicillin/clavulanic acid as a single preoperative bolus should be adequate for the prevention of postoperative wound infection and alveoli osteitis following the third molar extraction as there is no need for an extension of the antibiotic. Moreover, levofloxacin can be utilized as prophylaxis in patients undergoing mandibular third molar extraction if such patients are allergic to penicillins.
  8 4,862 314
Prognostic factors and outcome of management of ischemic priapism in Zaria, Nigeria
Muhammed Ahmed, Benjamin Augustine, Messi Matthew, Mudi Awaisu, Abdullahi Sudi, Kolapo B Hamza, Ahmad Bello, Hussaini Yusuf Maitama
January-June 2017, 23(1):15-19
DOI:10.4103/1117-6806.199965  PMID:28584506
Objectives: The objective of this study was to determine the nuances of management, prognostic factors, and outcome of ischemic priapism in patients seen at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Patients and Methods: We retrospectively studied the case notes of all patients managed for ischemic priapism in the Ahmadu Bello University Teaching Hospital, Zaria, over a period of 10 years (2006–2015). The data extracted included patients' age, occupation, duration of painful penile erection, and previous episodes. Addition information including precipitating factors, hemoglobin genotype, treatment, and complications was also retrieved. Data obtained were analyzed using SPSS version 20. Results: The records of a total of forty patients managed for priapism over the period under review were retrieved. Thirty-three (82.5%) of these patients had an operative intervention. The mean age was 23.7 years with a range of 8–53 years. Sixty percent of patients were young adults in their third decade of life. The minimum duration of erection at presentation was 18 h and a maximum period of 10 days with a mean of 105.5 h (4 days). Thirty-three patients (82.5%) had sickle cell anemia (HbSS). Erectile dysfunction (ED) accounted for 60% of all forms of postpriapism complications. Five patients (12.5%) had residual tumescence from fibrosis, and three patients had recurrence outside the immediate postoperative period. Duration of symptoms before surgical intervention, SSA and previous episodes were the most important prognostic factors. Conclusion: Priapism is a disease of the young, mostly sickle cell anemic patients. Late presentation remains the norm in our environment, hence a higher incidence of ED. The distal penile shunt is an effective means of achieving detumescence even with failed conservative management. Favorable outcome is highly dependent on the duration of erection and early intervention.
  8 4,325 145
Reasons for patronage of traditional bone setters
Innocent Egbeji Abang, Joseph Asuquo, NE Ngim, Ikpeme Asanye Ikpeme, P Agweye, SE Urom, C Anisi, E Mpama
July-December 2016, 22(2):102-106
DOI:10.4103/1117-6806.188993  PMID:27843274
Aims and Objectives: The objectives of this study were to analyze the different reasons why patients with fractures patronize traditional bone setters (TBS) and their impression of the outcome of the treatment by the TBS. Materials and Methods: A 24 month prospective observational study was conducted from February 2012 to January 2014. All the patients were recruited from the orthopedics outpatient clinic. The demographic data of each patient, the type of injury, presentation to hospital or not, reasons for leaving the hospital, reasons for patronage of the TBS and their impression of the outcome of TBS' treatment, effect of educational background on patronage of TBS and reason for presenting to hospital for orthodox treatment. Data Analysis: Analysis was done with SPSS software Version 20. Results: A total 79 patients were recruited for the study and they had different reasons for patronizing TBS. These reasons include an external locus of decision making in 19 (24.1%) patients, and greater faith in TBS compared to orthodox medicine in 16 (20.3%). Twelve (15.2%) believed that TBS are more competent than orthodox medical practitioners while another group 11 (13.9%) considered the fees of TBS cheaper than those in the hospital. The delay in treatment in the hospital, forceful removal of patients from hospital against their will and nonsatisfaction with hospital treatment accounted for 5 (6.3%). Poor attitude of hospital staff, fear of amputation, and patients being unconscious during the injury accounted for 2 (2.5%). Their ages ranged from 17 to 83 years, with mean age of 36.8 ± 11.8 years. The male: female ratio was 1.5:1. Conclusions and Recommendations: With recent advancements in the practice of orthopedics and trauma, there is still a very high patronage of the TBS by most of our patients. This is largely due to the dependence of the patients on their sponsors for treatment, while the influence of cultural and religious beliefs continues to play a major role in these decisions.
  7 6,819 290
Odontogenic tumors: A review of 675 cases in Eastern Libya
Saravana HL Goteti
January-June 2016, 22(1):37-40
DOI:10.4103/1117-6806.176397  PMID:27013857
Aims: The aim of this study was to determine the relative frequency of odontogenic tumors (OTs) in an Eastern Libyan population based on the 2005 World Health Organization (WHO) classification, and also to compare the actual data with previous studies. Materials and Methods: We retrieved and analyzed 85 OTs from a total of 675 tumors and tumor-like lesions of the oral and perioral structures, for gender, age, tumor site, and frequency. The diagnosis was based on the most recent WHO (2005) classification of OTs. Results: OTs constituted 12.6% of all oral/jaw tumors and tumor-like lesions. Ameloblastoma (28.2%) was the most common type, followed by keratocystic odontogenic tumor (25.2%) and odontoma (19.9%). The male: female ratio was 1.2:1, and maxilla: mandible ratio 1:2. The mean age of occurrence of tumors was 29 years with a peak incidence between 10 and 40 years. Conclusions: OTs are relatively common lesion in this Libyan Population, but the incidence of tumors is neither similar to Caucasians nor Sub-Saharan population.
  7 3,848 204
Long-term outcome of endoprosthetic replacement for proximal femur giant cell tumor
Gurinder Singh Gosal, Avneet Boparai, Gurpreet Singh Makkar
July-December 2015, 21(2):143-145
DOI:10.4103/1117-6806.162583  
Introduction: Giant cell tumor (GCT) of bone is locally aggressive benign tumor involving the epiphysis of long bones in young adults. Various treatment options include intralesional curettage, extended curettage, wide resection, resection and reconstruction and amputation. The main variables to be considered for planning treatment include the site of involvement and Campanacci stage of the tumor. Functional and oncological outcomes of these treatment options vary widely, the predominant detrimental factor being tumor recurrence rate. Aim: A study was conducted to evaluate the long-term oncological and functional outcome of patients with GCT of the proximal femur that underwent tumor resection and endoprosthetic replacement. Materials and Methods: Eleven patients with Campanacci stage-III GCT of proximal femur who underwent wide excision of tumor and endoprosthesis replacement with a mean follow-up the duration of 10.6 years were assessed using standard proforma. The treatment outcome was evaluated using the Revised Musculoskeletal Tumor Society Rating Scale for the lower extremity. Results: At mean follow-up the duration of 10.6 years, none of the cases had tumor recurrence, infection, prosthesis loosening or dislocation. All the patients were community ambulators among whom eight patients were walking without support while three patients were using a cane for support. The mean total Musculoskeletal Tumor Society Score was 26.8 out of 30 indicating the good outcome. Conclusions: The authors recommend that wide resection and endoprosthetic replacement should be considered as a preferred treatment option for proximal femur GCT as the functional, and oncological outcome is satisfactory with this modality of treatment.
  7 3,518 83
Posterior urethral valves in children: Pattern of presentation and outcome of initial treatment in Ile-Ife, Nigeria
Ademola Olusegun Talabi, Oludayo Adedapo Sowande, Amarachukwu Chiduziem Etonyeaku, Abdulkadir A Salako, Olusanya Adejuyigbe
July-December 2015, 21(2):151-156
DOI:10.4103/1117-6806.162591  
Background: The management of posterior urethral valves (PUV) and its sequelae is still a challenge to most pediatric surgeons in our environment due to late presentation and inadequate facilities for long-term evaluation and treatment. Despite initial successful treatment about 40% would develop chronic renal failure. The aim is to describe the presentation, management and outcome of the initial treatment in boys with PUV. Materials and Methods: It is a retrospective analysis of PUV in boys 8 years and below over a 17 years period. Demographic characteristics, clinical features, investigations, and treatment outcome were reviewed. Results: Thirty-seven cases were analyzed. The median age was 5 months (range from birth to 8 years). Three (8.1%) patients had prenatal ultrasound diagnosis. The most common presentation was voiding dysfunction 37 (100%). Part of the preoperative investigation included micturating cystourethrogram (n = 31: 83.8%) and abdomino-pelvic ultrasonography (n = 37:(100%). The mean serum creatinine value of those who presented within thefirst 30 days of life and those who presented afterwards were 325 (±251) µmol/L and 141 (±100) µmol/L respectively, P = 0.003. Surgical interventions included trans-vesical excision of valves (n = 9: 28.1%), valvotomy (n = 10: 31.3%), balloon avulsion (n = 8: 25.0%), vesicostomy (n = 4: 12.5%) and endoscopic valve avulsion (n = 1: 3.1%). Seventeen (56.7%) patients had serum creatinine >70.4 µmol/L after 1-month of valve excision. Five (13.5%) patients had postrelief complications and 5 (13.5%) died on admission. Ninety percentage (27/30) of patients had poor prognostic indices. Conclusions: The initial treatment outcome was good but most had poor prognostic factors.
  7 4,563 172
Association between use of tobacco and age on graying of hair
Robin Sabharwal, Atul Gupta, Ninad Moon, Ashish Mahendra, Vinod Sargaiyan, Asheesh Gupta, Santosh Kumar Subudhi, Shivangi Gupta
July-December 2014, 20(2):83-86
DOI:10.4103/1117-6806.137308  PMID:25191099
Aims and Objectives: To determine the association between smoking, chewing tobacco (gutka), and age of individual on graying of hair. Materials and Methods: The present study was conducted on 120 patients attending the Outpatient Department of the DJ College of Dental Sciences and Research, Modinagar, UP. The individuals were classified into four groups (group I, II, III, IV) on the basis of the form of tobacco use (smoking or chewing). The Pearson correlation coefficient was utilized to find the correlation between the mean percentage of individuals with gray hair, risk multiplication factor (RMF), and age of the individual. Results: Mean percentage of individual with gray hair and RMF (r = 0.6487) are found to be positively associated. A significant and positive correlation was observed between the age of the individual and the frequency of individuals with gray hair. Conclusion: This study suggests that there is a significant association between tobacco use and aging on graying of hair.
  7 4,432 151
Reconstruction of mandibular defects using nonvascularized autogenous bone graft in Nigerians
Kizito Chioma Ndukwe, Stephen Babatunde Aregbesola, Innocent Chinedu Ikem, Vincent I Ugboko, Kehinde Emmanuel Adebiyi, Olawunmi Adedoyin Fatusi, Foluso John Owotade, Ramat Oyebunmi Braimah
July-December 2014, 20(2):87-91
DOI:10.4103/1117-6806.137309  PMID:25191100
Objectives: The aim of this study is to evaluate the success rate and complications of mandibular reconstruction with nonvascularized bone graft in Ile-Ife, Nigeria. Patients and Methods: A total of 25 patients who underwent reconstruction of mandibular discontinuity defects between January 2003 and February 2012, at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife constituted the study sample. Relevant information was retrieved from the patients' records. This information include patients' demographics (age and sex) as well as the type of mandibular defect, cause of the defect, type of mandibular resection done, source of the bone graft used, and the method of graft immobilization. Morbidity associated with the graft procedures were assessed by retrieving information on graft failures, length of hospital stay following surgery, rehabilitation device used and associated graft donor and recipient site complications. Result: There were 12 males and 13 females with a male:female ratio was 1:1.1. The age of the patients ranged from 13 to 73 years with a mean age for males 32.7 ± standard deviation (SD) 12.9 and for females 35.0 ± SD 17.1. Jaw defect was caused by resection for tumours and other jaw pathologies in 92% of cases. Complete symphyseal involvement defect was the most common defect recorded 11 (44%). Reconstruction with nonvascularized rib graft accounted for 68% of cases while iliac crest graft was used in 32% of the patients. Successful take of the grafts was recorded in 22 patients while three cases failed. Wound dehiscence (two patients) and postoperative wound infection (eight patients) were the most common complications recorded. Conclusion: The use of nonvascularized graft is still relevant in the reconstruction of large mandibular defects caused by surgical ablation of benign conditions in Nigerians. Precise surgical planning and execution, extended antibiotic therapy, and meticulous postoperative care contributed to the good outcome.
  7 5,432 244
Basal cell adenoma-clinicopathological, immunohistochemical analysis and surgical considerations of a rare salivary gland tumor with review of literature
AD Bhagat Singh, Swapan Majumdar, Amal Kanti Ghosh, Lakshmi Gandi, Nidhi Choudaha, Ipsita Sharma, SP Pal
January-June 2015, 21(1):31-34
DOI:10.4103/1117-6806.152723  PMID:25838763
Introduction: Basal cell adenoma (BCA) of the salivary glands is a rare benign salivary gland tumour. Differentiation of BCA from varied entities involving maxillofacial area is mandatory. Aim: To analyze the clinicopathological, histopathologic features, immunohistochemcal analysis and surgical considerations of this rare entity. Materials and Methods: This study included 12 cases of BCA from archives of department reported over the period of 13 years. All the pertaining clinicopathologic features such as incidence, age, sex and site of lesions were assessed. Tissue sections were stained by using panel of immunohistochemical markers, i.e. Pan CK, CK 5/6 and S100, Calponin, p63, CD 117 and smooth muscle actin. Results: BCA was observed in 26-52 years age group (mean age, 38.75 years) with female propensity of 7:5 male to female ratio. It is seen more commonly in parotid gland, followed by upper lip, buccal mucosa and palate. Solid type is the most common histopathologic type followed by tubular, membranous and trabecular. Only one case of membranous type of BCA showed recurrence. Pan CK, CK 5/6 showed strong immunoreactivity, calponin showed moderate staining, p63 and Ki-67 mild staining, whereas CD 117 and SMA showed negative immunostaining. Conclusion: Vigilant comprehensive analysis of all the pertaining clinicopathologic and histopathologic features and immunohistochemical analysis are required for differentiating from other lesions with basaloid differentiation having varying prognosis.
  7 3,967 157
Prophylactic use of pentoxifylline and tocopherol in patients undergoing dental extractions following radiotherapy for head and neck cancer
Karun Aggarwal, Manish Goutam, Madhavi Singh, Neetu Kharat, Vandana Singh, Suyash Vyas, Harkanwal Preet Singh
July-December 2017, 23(2):130-133
DOI:10.4103/njs.NJS_40_16  PMID:29089739
Background: In head and neck cancer patients undergoing radiotherapy, osteoradionecrosis (ORN) of the jaw is one of the major but uncommon complications. Satisfactorily results have been observed while treating ORN patients with upcoming treatment modalities such as combination therapy of pentoxifylline and Vitamin E (PVe). It is believed that in patients undergoing dental extractions, these treatment modalities can be used prophylactically for lowering the risk of development of ORN. Hence, keeping all these things in mind, we planned the present study to assess the prophylactic role of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of head and neck. Materials and Methods: A total of 110 patients were included in this retrospective study, which had radiotherapy for cancer of the head and neck. After radiotherapy, a total of 450 dental extractions were done in these 110 patients. Results: External beam therapy was given in 92.72% of the patients. 7.27% and 40% of the patients received intensity modulated radiotherapy combination of chemotherapy and intensity modulated radiotherapy, respectively. ORN developed only in 2 patients. Patients had taken PVe for a mean of 12 (24) weeks preoperatively and 14 (18) weeks postoperatively. The incidence was lower than that normally associated with dental extractions in irradiated patients. Conclusion: In patients undergoing dental extractions, after receiving radiotherapy of head and neck region, combination therapy of pentoxifylline and tocopherol are sufficiently effective.
  7 4,540 232
Is final histopathological examination the only diagnostic criteria for xanthogranulomatous cholecystitis?
Anshuman Pandey, Dinesh Kumar, Shakeel Masood, Smita Chauhan, Suneed Kumar
July-December 2019, 25(2):177-182
DOI:10.4103/njs.NJS_1_19  PMID:31579373
Background: Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory disease of gallbladder (GB) and can mimic GB cancer in extensive form. This study aims to assess the predictability of XGC on the basis of clinical presentation, laboratory tests, and radiological or intraoperative findings on frozen section analysis. Materials and Methods: This is a retrospective study, conducted over a period of 4 years from October 2013 to November 2017. In this study, all patients with histopathological reports of XGC, who underwent cholecystectomy or a radical cholecystectomy, were included. Clinical records of these patients were reviewed for clinical features, laboratory tests, and findings on radiological imaging. Results: Out of 700 consecutive cholecystectomies reviewed, 34 had histologically proven XGC (4.85%). Two patients had simultaneous presence of GB carcinoma with XGC. The most common presenting symptoms were right upper quadrant pain in 32 (94%) patients, jaundice in 9 (36%) patients, and fever in 5 (14%) patients. The most common radiological finding was cholelithiasis in 85.2% of cases. Thick-walled GB was present in 79.4% of patients; irregular wall thickening was present in 20.5% of patients. Intramural nodule was present in two patients, whereas hepatic invasion was observed in 11% and pericholecystic infiltration was present in 8.8% of patients. Regional lymphadenopathy was present in 9 (26.4%) patients. Conclusion: Clinical presentation and laboratory parameters were unequivocal due to considerable overlap. Despite recent advances in radiology, none have significant sensitivity and specificity to accurately diagnose XGC preoperatively. Intraoperative frozen section can add to the diagnosis with limited accuracy. The diagnosis of XGC can be confirmed only on histopathological examination.
  7 2,438 97
CASE REPORTS
Basal cell ameloblastoma: A rare histological variant of an uncommon tumor
Meela Sridhar, L Raja Bhaskar Reddy, Sagar Kharat, BS Mahesh, Lakshmi Gandi, Ashish Mahendra, Pankhuri Nigam, Parveen Grewal
January-June 2015, 21(1):66-69
DOI:10.4103/1117-6806.152730  PMID:25838772
Ameloblastomas are an inscrutable group of oral tumors. Basal cell ameloblastoma is a rare variant of ameloblastoma with very few cases reported until date. The tumor is composed of more primitive cells and has less conspicuous peripheral palisading. It shows remarkable similarity to basal cell carcinoma, basal cell adenoma and intra-osseous adenoid cystic carcinoma. This report describes the case of a 27-year-old male with an ameloblastoma in the right posterior mandible. Orthopantomography computed tomography and finally histopathological examination directed us toward the confirmatory diagnosis of basal cell variant of ameloblastoma. Considering the rarity of the lesion and histological paradox regarding its diagnosis, we report here an interesting and rare case of basal cell ameloblastoma of the mandible with emphasis on differential diagnosis from other entities with basaloid differentiation having varying prognosis. After surgery, long-term follow-up at regular intervals is recommended as no sufficient statistical information regarding the behavior of this tumor is available.
  6 3,797 188
ORIGINAL ARTICLES
Endoscopic evaluation of upper and lower gastro-intestinal bleeding
Emeka Ray-Offor, Solomon N Elenwo
July-December 2015, 21(2):106-110
DOI:10.4103/1117-6806.162575  
Introduction: A myriad of pathologies lead to gastro-intestinal bleeding (GIB). The common clinical presentations are hematemesis, melena, and hematochezia. Endoscopy aids localization and treatment of these lesions. Aims: The aim was to study the differential diagnosis of GIB emphasizing the role of endoscopy in diagnosis and treatment of GIB. Patients and Methods: A prospective study of patients with GIB referred to the Endoscopy unit of two health facilities in Port Harcourt Nigeria from February 2012 to August 2014. The variables studied included: Demographics, clinical presentation, risk score, endoscopic findings, therapeutic procedure, and outcome. Data were collated and analyzed using SPSS version 20 software. Results: A total of 159 upper and lower gastro-intestinal (GI) endoscopies were performed during the study period with 59 cases of GI bleeding. There were 50 males and 9 females with an age range of 13-86 years (mean age 52.4 ΁ 20.6 years). The primary presentations were hematochezia, hematemesis, and melena in 44 (75%), 9 (15%), and 6 (10%) cases, respectively. Hemorrhoids were the leading cause of lower GIB seen in 15 cases (41%). The majority of pathologies in upper GIB were seen in the stomach (39%): Gastritis and benign gastric ulcer. Injection sclerotherapy was successfully performed in the hemorrhoids and a case of gastric varices. The mortality recorded was 0%. Conclusion: Endoscopy is vital in the diagnosis and treatment of GIB. Gastritis and Haemorrhoid are the most common causes of upper and lower GI bleeding respectively, in our environment
  6 4,463 159
A survey of the awareness of prostate cancer and its screening among men attending the outpatient clinics of a tertiary health center in Lagos, Nigeria
Sunday Oladunjoye Ogundele, Stephen Odunayo Ikuerowo
July-December 2015, 21(2):115-118
DOI:10.4103/1117-6806.162589  
Background: Prostate cancer is the most common cancer among Nigerian men and the second most common cause of death from cancer in men worldwide. The aim of this study was to assess the level of awareness of prostate cancer among men attending the various outpatients' clinics of the Lagos State University Teaching Hospital, Ikeja. Materials and Methods: This study is a descriptive cross-sectional study. Self-administered structured questionnaires were used to collect information from consecutives patients attending the various outpatient clinics of the hospital. Results: One hundred and forty-six respondents with an age range of 40–80 years participated in this study. Sixty-nine (47.3%) respondents were aware of prostate cancer while 77 (52.7%) have never heard of the disease. Twenty (13.7%) participants were aware of the availability of a screening test for the disease and only 12 (8.2%) have had any form of screening for prostate cancer. Conclusion: There is a low level of awareness of prostate cancer among patients seen at our center and also level of voluntary screening for the disease is low.
  6 7,613 396
A prospective randomized clinical study of the influence of primary closure or dressing on post-operative morbidity after mandibular third molar surgery
Peter E Egbor, Birch D Saheeb
July-December 2014, 20(2):59-63
DOI:10.4103/1117-6806.137288  PMID:25191094
Objective: The aim of the following study is to determine the effect of primary closure or dressing on post-operative morbidity after impacted lower third molar surgery. Materials and Methods: This was a randomized clinical study of 72 patients who had surgical extraction of impacted mandibular third molars. The subjects were divided into two groups of A and B. Group A had total closure (primary closure) and Group B had whitehead varnish dressing of the socket. Pain, swelling and trismus were evaluated pre-operatively using visual analogue scale, flexible tape measuring method and inter-incisal distance measurement with Vernier Callipers respectively as well as post-operatively on 1 st , 2 nd , 3 rd , 5 th and 7 th day. Results: The study participants consisted of 27 males and 45 females in a ratio 1:1.7. With a mean age of 24.7 ± 4.9 years (range 19-33 years) for Group A and 25.5 ± 4.3 years (range 20-39 years) for Group B. Post-operative pain was not significantly affected by the closure techniques (P > 0.05). Dressing was found to significantly reduce the degree of swelling and trismus peaking on the 2 nd day (P = 0.0207 and P = 0.010 respectively). Conclusion: The use of dressing was more effective than primary closure to reduce the degree of swelling and trismus though its effect on post-operative pain reduction was not significant.
  6 4,289 183
Impact of preoperative patient characteristics on posturethroplasty recurrence: The significance of stricture length and prior treatments
Jibril Oyekunle Bello
July-December 2016, 22(2):86-89
DOI:10.4103/1117-6806.188979  PMID:27843271
Introduction: Urethral strictures are common in urologic practice of Sub-Saharan Africa including Nigeria. We determine the rate of stricture recurrence following urethroplasty for anterior urethral strictures and evaluate preoperative variables that predict of stricture recurrence in our practice. Subjects and Methods: Thirty-six men who had urethroplasty for proven anterior urethral stricture disease between February 2012 and January 2015 were retrospectively analyzed. Preoperative factors including age, socioeconomic factors, comorbidities, etiology of strictures, stricture location, stricture length, periurethral spongiofibrosis, and prior stricture treatments were assessed for independent predictors of stricture recurrence. Results: The median age was 49.5 years (range 21-90), median stricture length was 4 cm (range 1-18 cm) and the overall recurrence rate was 27.8%. Postinfectious strictures, pan urethral strictures or multiple strictures involving the penile and bulbar urethra were more common. Most patients had penile circular fasciocutaneous flap urethroplasty. Following univariate analysis of potential preoperative predictors of stricture recurrence, stricture length, and prior treatments with dilations or urethrotomies were found to be significantly associated with stricture recurrence. On multivariate analysis, they both remained statistically significant. Patients who had prior treatments had greater odds of having a recurrent stricture (odds ratio 18, 95% confidence interval [CI] 1.4-224.3). Stricture length was dichotomized based on receiver operating characteristic (ROC) analysis, and strictures of length ≥5 cm had significantly greater recurrence (area under ROC curve of 0.825, 95% CI 0.690-0.960, P = 0.032). Conclusion: Patients who had prior dilatations or urethrotomies and those with long strictures particularly strictures ≥5 cm have significantly greater odds of developing a recurrence following urethroplasty in Nigerian urology practice.
  6 3,954 102
* Source: CrossRef
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