We present a case report of a 22-year-old Nigerian student who presented to the accident and emergency unit of a Nigerian Teaching Hospital with a history of self-inflicted genital injury following a suicide attempt. He had background history of predisposition to depressive illness, a current diagnosis of a major depressive disorder, and had had two attempted suicidal episodes in the last 3 months prior to this event. The clinical finding shows a patient with sad affect, feeling of hopelessness, and worthlessness; however, the vital signs remained fairly stable. At examination under anesthesia, the testes were exposed and the right already self-castrated. The penis was degloved to the level of the Buck's fascia with intact corpora cavernosa and urethra. He had surgical excision of the hanging self-castrated right testis with debridement and primary closure of the genital laceration. He was promptly reviewed by the psychiatrists who co-managed appropriately.

IntroductionRoad traffic injury (RTI) has assumed major public health importance world-wide and the burden is heavier on the health-care infrastructure of countries in Sub-Saharan Africa. In Nigeria, RTI is the leading cause of trauma related morbidity and mortality. While there are some published epidemiological reports on RTI in the region, studies on the mechanism of causation of road traffic crashes (RTC) are not available.MethodsOver a 9-month period, we prospectively captured the 571 victims of RTC presenting to a single tertiary health care center in Nigeria. Data collected include demographic data, Mechanism of causation of RTC, Injuries sustained and outcomes.ResultsOver three-quarters of the victims are young people and half were either traders (27.5%) or students (20%). Pedestrians, motorcycle riders and open truck occupants (people sitting at the rear loading compartment of trucks) often had fatal injuries. Analysis of collision patterns showed that lone crashes were the most frequent though car-to-motorcycle crashes caused a quarter of the deaths. Host factors (over-speeding driver, driver misjudgment, sleeping driver etc.) were responsible for four-fifths of the crashes while vehicular and environmental factors accounted for the remaining. On binary regression analysis, head injured victims had higher odds of dying than the non-head injured (Odds ratio = 6.5).ConclusionThis paper elucidates the mechanisms of causation of and types of injuries sustained following RTC in Nigeria and thus provide opportunities for prevention and control of this unacceptable situation.

We have presented two cases with rewarding outcomes in the face of 'adaptive' instrumentation due to limited resources.

BackgroundEffusive–constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.MethodsWe conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.ResultsThe diagnosis of effusive–constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.ConclusionEffusive–constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

A 20-year-old male was impaled through the chest, abdomen, and right upper thigh by three 1.5 cm (0.59 in) diameter rods, each 2 m (6.56 ft) in length. The first rod entered below his right nipple, the second through the right hypochondrium, and the third through the right upper thigh. He was transported to the hospital with the rods in situ. This paper provides insight as to how these unusual injuries were managed in a limited-resource environment. Even in a developing country, the challenges posed by multiple impalement injuries can be managed successfully by rapid prehospital transfer, along with an adequate and coordinated hospital team effort.

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Rationale. Pericarditis has been reported as the most common cardiac complication of HIV disease, followed by pericardial effusion. Methods. A retrospective review was conducted of all 68 patients treated for pericardial diseases between August 2003 and July 2008 at University College Hospital, Ibadan, Nigeria. HIV-positive patients (N=42) were compared with those who were HIV negative (N=26). Results. More male than female patients presented with pericardial disease, and the HIV-positive patients were younger than those who were HIV negative. Pericardial effusion was the commonest mode of presentation, accounting for 20 HIV-positive patients (47.7%) and 13 HIV-negative patients (50%). Pericardiostomy was the commonest surgical intervention performed in HIV-positive patients (N=15), while the majority of HIV-negative patients had pericardiocentesis. Conclusion. Pericardial effusion was the commonest cardiac presentation in HIV-positive patients in our setting. We recommend that patients with pericardial effusion be investigated for HIV infection.