A 31-year-old G4P2 at 33 weeks gestation was transferred from a local hospital for persistent cough and a right hemothorax. Her obstetric history was significant for two uncomplicated vaginal deliveries at term, followed by a spontaneous abortion 6 months prior to the current pregnancy.Significant labs included an elevated BHCG of 118,946. A CTscan of the chest showed multiple lung nodules without hilar adenopathy. The pulmonary service performed a diagnostic bronchoscopy, which was unsuccessful in making a diagnosis secondary to the peripheral location of the pulmonary nodules. Approximately 12 days after initial presentation, the patient underwent cervical mediastinoscopy, revealing negative mediastinal lymph nodes. Right VATS then allowed excisional biopsies of two right lower lobe lesions. The procedure was performed without any complications. Pathology returned as choriocarcinoma (Fig. 1). (A. Ahmed). Figure 1 Thoracoscopic view of lung metastases.
Background: Management of complex genital fistulae is challenging due to the cost and technical skill required. This study reports our experience in the management of patients with complex genital fistulae and to highlight the crucial role of the reconstructive urologists.Methods: This was a retrospective review of female patients managed at a tertiary hospital in Nigeria from 2006 to 2017 for complex urinary fistulae. Data were extracted from patient case notes and the data analysed using the SPSS software.Results: Twenty-four female patients mean age 28.9±11.1 years. Fistulae resulted from prolonged obstructed labour 10 (41.6%), caesarean hysterectomy 7 (29.2%), caesarean section and abdominal hysterectomy 2 (8.4%) respectively. The fistulae were vesicovaginal 16 (66.7%), ureterovaginal 3 (12.5%). Others were vesicocutaneous, urethrovaginal and rectovaginal. Prior attempts at repair were done in 7 (29.2%) and the number of attempts ranged from 1 to 4. Surgical procedures included direct closure in 9 (37.5%), closure and uretero-neocystostomy 7 (29.2%), uretero-neocystostomy only 3 (12.5%) closure and abdominal hysterectomy 2 (8.3%), closure and continent catheterizable neo-bladder 2 (8.3%) and 1 (4.2%) closure, abdominal hysterectomy and uretero-neocystostomy. Post-operative complications were noted in 2 (8.3%) and consisted of gynaeatresia and recurrent RVF. Repair was successful in 70.8% of patients while failed repair was recorded in 16.7% and while stress incontinence was present in 12.5%.Conclusions: Complex genital fistulae in our practice are of obstetric origin involving the bladder, ureters and rectum. The reconstructive urologist has a crucial role the management for a favourable outcome.
Field surveys were conducted during the 2015 cropping season to identify and determine the distribution of legume viruses in Niger State, Nigeria. A total of 27 locations were visited during the surveys. Leaves were collected from weed plants showing virus and virus-like symptoms in fields of cowpeas, groundnuts and soyabean. Samples were also collected from asymptomatic plants within the vicinity of infected plants. The antigen coated plate -enzyme linked immunosorbent assay (ACP -ELISA) method was employed for virus detection in the collected leaf samples. Results showed that Blackeye cowpea mosaic virus (BICMV), Cowpea mild mottle virus (CPMMV) and Cowpea mottle virus (CPMoV) were the viruses detected. Thus Aeschynomene indica, Amaranthus caudatum and Centrosema pubescens were positive to BICMV; while Aspilia africana, Cleome viscera, Euphorbia hirta and Heterotis rotundifolia were hosts of CPMoV and CPMMV was detected in Chenopodium amaranticolor, Desmodium scorpiurus, and Vicia faba. The detection of these viruses in weed species in the surveyed areas indicates their importance in the ecology, survival and the significant role they play in the epiphytology of the various virus diseases. The occurrence of BICMV, CPMoV and CPMMV in these weed species is believed to be the first report in the study area.
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