Endoscopic evaluation of the colorectum in patients presenting with haematochezia at korle-bu teaching hospital accra

SUMMARY BACKGROUND

Colorectal endoscopy is the gold standard investigation of the large bowel in patients with rectal bleeding and is employed as a means of secondary prevention of colorectal cancer.

AIM

To determine the frequency of benign lesions and carcinomas in patients who underwent colorectal endoscopy because of rectal bleeding and to evaluate the role of endoscopy in secondary prevention of colorectal carcinoma in our centre.

METHOD

A retrospective study was undertaken on patients who underwent colorectal endoscopy between January 1995 and December 2000 for rectal bleeding.

RESULTS

Five hundred and ninety six (596) patients were studied. Males were 403 and females 93, mean age 50.9 (SD 7.07). Three hundred and ten patients (52%) had rigid proctosigmoidoscopy, flexible sigmoidoscopy 105 (17.6%) and colonoscopy 181 (30.4%). Of those who had colonoscopy complete examination of the colon was achieved in 55 patients (30.4%). Those in whom colonoscopy was incomplete had double contrast barium enema. Haemorrhoids were the commonest disease diagnosed, 316 patients (53%). Colorectal carcinoma 39 patients (6.7%), non-specific colitis 34 patients (5.7%), diverticular disease 27 patients (4.5%) and adenomatous polyps 17 patients (2.9%) were the next common disease. Less common conditions were ulcerative colitis, rectal schistosomiasis and angiodysplasia. In 125 patients (21.0) the cause of bleeding could not be found.

CONCLUSION

An appreciable number of the patients with rectal bleeding had serious pathology that was diagnosed early by endoscopy confirming the important role of endoscopy in secondary prevention of colorectal carcinoma. The low success rate of full colonoscopy underscores the need for training in this procedure.

Congenital nephrotic syndrome of the finnish type

SummaryCongenital Nephrotic Syndrome of the Finish type (CNF) is a rare and severe disease. A neonate with CNF is described. The diagnosis carries a dramatically poorer prognosis than nephrotic syndrome diagnosed after one year. The clinical course is one of persistent oedema and recurrent infections leading to death. The gene for the Finish type has been mapped to the long arm of chromosome 19. Case reports show it to be responsive to captopril and indomethacin. It is uniformly resistant to steroids and immunosuppressive drugs.

Human pentastomiasis: a case report

We report a case of human pentastomiasis in a 55-year-old farmer whose diagnosis was made incidentally during laparotomy on account of a mechanical small intestinal obstruction caused by adhesions. Encysted parasites and degenerative granulomas were found in the omentum and in the subserosal layer of the small intestine. These parasites were diagnosed as Armillifer armillatus larvae. The patient made an uneventful recovery after the operation and was discharged. He is being followed up.

Osteometric analysis of sexual dimorphism in the sternal end of the rib in a west African population

This study, and others, are being carried out in order to establish a Forensic Anthropology databank on age estimation and sex determination of skeletonized remains in Ghana. An osteometric study of sexual dimorphism in the sternal end of the right fourth rib on 346 consecutive coroner's autopsy cases (221 males, 125 females) of known age, sex, and race was conducted. The height and width of the sternal end of the rib were measured in each case. The sample was analyzed in three groups: young (< 30 years), old (> or = 30 years), and total sample (total group). Stepwise discriminant function analysis showed that the accuracy of sex determination varied from 80% in the young and 74% in the old groups to 78% for the total group. Statistical analysis of the results obtained when the functions derived from the study were tested using another batch of ribs showed the functions to be effective and reliable in determining sex. When functions derived from a previous study of American Whites were used to determine sex in our study sample, the vast majority of males were misclassified as females. This is the first time, to our knowledge, that a Black African population has been studied osteometrically to evaluate sexual dimorphism in the sternal end of the fourth rib.