East African medical journal
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Sixty six cases of intussusception were admitted to ESCH, Addis Ababa over a 10 year period. Males dominated in the series. Age distribution showed that 69.7% of the cases were < or = 1 year old, and 85% were < or = 2 years old. ⋯ An underlying intestinal pathology was found in two cases only. The mortality was high probably because the majority of cases presented late for medical attention. The need for early medical advice, diagnosis and intervention should reduce the mortality.
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Over a six-month-period, from 1st March 1988 to 30th September 1988, 127 patients suspected of having ectopic gestation at the Kenyatta National Hospital (KNH) were referred for sonographic examination, of whom 100 (78.7%) had enough data for a final diagnosis. During sonography, ectopic pregnancy was diagnosed in 31 (31%) patients, out of whom 15 (48.4%) were confirmed to have ectopic gestation at laparotomy. Of the 69 who were thought to have other gynaecological disorders at sonographic examination, 2 (2.9%) were later found to have other ectopic gestation at surgery. ⋯ An empty, bulky uterus, demonstrable adnexal mass, pseudo-gestational sac and fluid in the culde-sac, together improved the sonographic positive predictive value to 67.0%. This study has shown that sonography can be used in the diagnosis of ectopic pregnancy at the KNH. However, in order to improve its reliability, further studies are recommended involving a combination of pregnancy test and sonography.
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Ninety eight general surgical patients were studied prospectively to determine the degree and severity of postoperative pain during the first 18 hrs following surgery. In 93% of the patients there was some degree of postoperative pain and in 64.4% the pain was moderate, severe or intolerable. Only 64.2% of the patients complained of pain to the medical staff, the remainder kept silent despite their sufferings. ⋯ More diligent approach to the problem of postoperative pain is needed. Adequate dosage and more frequent administrations of analgesic should be given to post-operative patients. Moreover, patients need to be taught that intolerable pain is not an acceptable postoperative sequelae in exchange for cure.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cholecystectomy with and without drainage: a prospective randomised study.
The use of subhepatic intraperitoneal drains was prospectively studied in 100 patients who underwent elective cholecystectomy for symptomatic gallstones. These patients were randomised to have subhepatic drains (group A, n = 50 patients) or to have no drains (group B, n = 50 patients). There was no difference in the age or sex composition of the two groups. ⋯ Patients in group A tended to have longer post operative hospital stay (mean of 10.2 days) than patients in group B (mean 8.7 days); but the difference between the two groups in this respect was not significant. We conclude that subhepatic intra-peritoneal drains offered no additional advantage in elective cholecystectomy. The evidence we had pointed to their harmful effects.
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Multicenter Study Comparative Study
Asphyxia of the newborn in east, central and southern Africa.
Very scanty information is available in East, Central and Southern Africa on the incidence and risk factors associated with asphyxia of the newborn. A multicentre prospective study involving 4267 deliveries in eight countries was undertaken over a three month period, in maternity units of the central hospitals to determine the incidence; maternal, service and logistic risk factors for asphyxia of the newborn as determined by an abnormally low apgar score. 30% of births were by primigravida mothers, of whom 67% were teenagers. A birth by a teenager had a higher risk for low birth weight. ⋯ These should include identification of the at risk mother, proper referral and management while adhering to correct established procedures. There is also need to develop appropriate and relevant technologies for perinatal and neonatal care through research undertaken in the region. It is also concluded that the co-operation and joint effort between the obstetricians, paediatricians and the nursing staff who all contributed to the collection of this data is a cost effective approach to research in perinatal health and consequently in instituting interventions.