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Githaiga, JW.  Submitted.  Evaluation of diagnostic peritoneal lavage and needle paracentesis in the management of penetrating and blunt abdominal trauma, at Kenyatta National Hospital. Abstract

OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients

Githaiga, JW, Adwok JA.  Submitted.  Wandering spleen presenting as a right hypochondrial mass and intestinal obstruction. Abstract

This is a case report of a 23 year old multiparous woman who presented with intestinal obstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4 Kg spleen in the right lumbar region compressing the ascending colon. There was also ileal volvulus around the splenic pedicle. This is probably the first documented case of wandering spleen in the right hypochondrium, presenting as right large bowel obstruction, to be reported in our region. Wandering spleen is a rare condition, often asymptomatic, but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarely made. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971 only 350 cases had been reported in the western literature. Review of English literature from 1900 to 1991 reported only 51 cases in children. In our region 11 cases were reported in Uganda between 1968 and 1971. No other literature is available from our region. Clinical presentation, aetiology, investigation, and management of wandering spleen is discussed

2012

Muma, N, Saidi H, Githaiga JW.  2012.  Surveillance of injuries among Kenya Rugby Union (KRU) players — Season 2010. Annals of African Surgery. 9(2):88-92. Abstract

Objective: To determine the incidence and characteristics of injury amongst Kenya rugby union players and associated factors.
Design: A whole population prospective cohort study.
Methods: 364 registered Kenya rugby union (KRU) players were studied
throughout the 2010 season. Data on their demographics, injury incidence, pattern and severity were gathered. The study tool used was the Rugby International Consensus Group (RICG) Statement.
Results: There were 173 backs and 191 forwards. One hundred and two
1 injuries for 60 league games (2400match player hours) were recorded. The incidence of injuries was 42.5/1000 match player hours (mph), (44.2 for forwards and 40.8 for backs). Lower limb injuries were the most common (41.2%). Players were most prone to injuries in the in tackle scenario (63.7%), at the beginning of the season (47.1%), and in
the last quarter (50%) of a game.
Conclusion: The injury incidence recorded contrast the earlier Kenyan
data but is comparable to international amateur level incidence, uniqueness of the Kenyan environment notwithstanding. The higher
rates associated with the tackle/tackled scenario, earlier part of the season and later part of the game, suggest interventions can target player conditioning, and use of protective gear.

2011

Saidi, H, Abdihakin M, Njihia B, Jumba G, Kiarie G, Githaiga J, ABINYA NO.  2011.  Clinical Outcomes of Colorectal Cancer in Kenya. Annals of African Surgery. 7 Abstract

Background
The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges.
Method
Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was mortality while secondary outcomes included recurrence rates, time to recurrence and the patient, disease and treatment factors associated with mortality and recurrence. Kaplan Meir charts were charted for survival trends.
Results
Half of the lesions were located in the rectum. There was no relationship between the sub-site location and recurrence and mortality. The mean follow-up period was 15.9 months. Overall recurrency and mortality rates were 37.5% and 29.4% respectively. Most recurrences occurred within one year of surgery. Recurrence was not influenced by age, gender, sub-site, chemotherapy receipt or presence of comorbidity.
Factors significantly associated with mortality included the
male gender ( p 0.04), presence of co-morbidity (p 0.029), recurrence (p 0.001), curative intent (p 0.01), disease stage (p 0.036) and receipt of chemotherapy ( p< 0.01).
Conclusion
Follow up of colorectal cancer patients is still challenging. The mortality and recurrence rates are high for the short follow up periods. Further studies are needed to explore the determinants of both survival and recurrences, especially with longer follow ups.

2008

W, DRGITHAIGAJOSEPH.  2008.  Saidi H, Nyaim EO, Githaiga JW, Karuri D.CRC surgery trends in Kenya, 1993-2005.World J Surg. 2008 Feb;32(2):217-23. World J Surg. 2008 Feb;32(2):217-23. : University of Nairobi Press Abstract

BACKGROUND: CRC (CRC) rates are low but increasing in Africa. Data on detection, treatment, and outcome are scarce. OBJECTIVE: The aim of this study was to evaluate the presentation, treatment, and outcome pattern of CRC and to compare the care processes for two time periods. SETTING: The setting was Kenyatta National Hospital (KNH), a teaching and referral center. PATIENTS AND METHODS: A total of 259 patients seen over two time periods (1993-1998 and 1999-2005) were analyzed for admission date, sex, subsite involvement, diagnostic process, treatment, follow-up, and outcome. The distribution of variables between the time periods were analyzed using Student's t-test and chi2 as appropriate. Survival trends were generated using Kaplan Meier method; p<0.05 was statistically significant. RESULTS: The average number of CRC diagnoses showed a 2.7-fold increase during the study periods. The mean age at presentation was 49.7 years. The mean duration of symptoms was 29.6 weeks; and the commonest subsite was the rectum (55.3%). The overall resection rate was 67.7%. For rectal tumors the abdominoperineal rate was 51.4%. Mortality was higher for poorly differentiated cancer, advanced disease, age>50 years, and emergency surgery. There was no change in the age, duration of symptoms, proportion of patients<40 years, or the colon/rectal ratios of the cancer site. The second time period saw more adjuncts for diagnosis, less in-hospital mortality, and better staging data. CONCLUSION: CRC peaks during the fifth decade of life in Kenyans. The disease is characterized by late presentation, rectal preponderance, and inadequate pathology data. Improved patient follow-up will unravel the true pattern of disease outcome.

2007

H Saidi, EO Nyaim, KJWGD.  2007.  Young patients with colorectal cancer at a tertiary hospital in Kenya, 1993–2005. Annals of African Surgery. 1 AbstractWebsite

BACKGROUND: The onset of colorectal cancer appears to be two to three decades earlier in developing countries. Data on whether colorectal cancer in the young has worse prognosis than in older patients is conflicting.
METHOD: Clinical charts of 70 patients ≤40 years old were reviewed to determine clinical and pathological patterns and treatment outcomes. Their data were compared with a
larger group of older patients treated between 1993-2005 at Kenyatta National Hospital in Nairobi, Kenya.
RESULTS: The data retrieval was highest for sub-site distribution and lowest for pathology information. Patients ≤ 40 years of age comprised 27.3% of all colorectal cancer
cases treated over the study period. There were 41 males (58.6%) and 29 (41.4%) females patients. The most common symptoms were abdominal pain (76.9%), change in bowel habit
(71.4%) and rectal bleeding (54.3%). The mean duration of symptoms was 24.6 ± 30 months. The rate of advanced colorectal disease (Duke C and D) was 73.5%. Mean follow-up time was 5.8 months with median survival of only 6.9
months. The Duke staging, histology, symptom duration, locations of tumours, follow-up and the complication rates were similar for young and older patients.
CONCLUSION: Younger patients form a significant proportion of colorectal cancer burden. Both the clinico-pathological
characteristics and treatment outcome correspond to older individuals. It is suggested that the concluded colorectal symptoms in younger patients should also be aggressively
evaluated including early endoscopy. A prospective follow-up study of patients with the disease will unravel the true survival picture

2002

W, DRGITHAIGAJOSEPH.  2002.  Githaiga JW, Adwok JA.Diagnostic peritoneal lavage in the evaluation of abdominal trauma using the dipstick.East Afr Med J. 2002 Sep;79(9):457-60. East Afr Med J. 2002 Sep;79(9):457-60. : University of Nairobi Press Abstract
OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.
W, DRGITHAIGAJOSEPH.  2002.  Githaiga JW, Adwok JA.Wandering spleen presenting as a right hypochondrial mass and intestinal obstruction. East Afr Med J. 2002 Aug;79(8):450-2.. East Afr Med J. 2002 Aug;79(8):450-2.. : University of Nairobi Press Abstract
This is a case report of a 23 year old multiparous woman who presented with intestinal obstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4 Kg spleen in the right lumbar region compressing the ascending colon. There was also ileal volvulus around the splenic pedicle. This is probably the first documented case of wandering spleen in the right hypochondrium, presenting as right large bowel obstruction, to be reported in our region. Wandering spleen is a rare condition, often asymptomatic, but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarely made. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971 only 350 cases had been reported in the western literature. Review of English literature from 1900 to 1991 reported only 51 cases in children. In our region 11 cases were reported in Uganda between 1968 and 1971. No other literature is available from our region. Clinical presentation, aetiology, investigation, and management of wandering spleen is discussed.

1996

W, DRGITHAIGAJOSEPH.  1996.  Wandering spleen: a case report . East Afr Med J. 2002 Sep;79(9):457-60. : University of Nairobi Press Abstract
OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.
W, DRGITHAIGAJOSEPH.  1996.  Use of diagnostic peritoneal lavage in the management of abdominal trauma (extracted from M.MEd thesis). Submitted for publication to the east African Medical Journal. Authors: Dr. J. W. Githaiga, Prof. J. Adwok.. East Afr Med J. 2002 Sep;79(9):457-60. : University of Nairobi Press Abstract
OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.
W, DRGITHAIGAJOSEPH.  1996.  HIV education for schools . East Afr Med J. 2002 Sep;79(9):457-60. : University of Nairobi Press Abstract
OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.
W, DRGITHAIGAJOSEPH.  1996.  Evaluation of diagnostic peritoneal lavage and needle paracentesis in the management of penetrating and blunt abdominal trauma, at Kenyatta National Hospital. M.med thesis 1996. East Afr Med J. 2002 Sep;79(9):457-60. : University of Nairobi Press Abstract
OBJECTIVE: To determine the accuracy and sensitivity of diagnostic peritoneal lavage in the assessment of intra-abdominal injury using the dipstick method. DESIGN: Prospective study, involving the performance of diagnostic peritoneal lavage in the out patient department and surgical wards prior to surgical intervention. SETTING: Kenyatta National Hospital-General Surgical and Orthopaedic wards and outpatient department. The study was conducted over a duration of six months, starting from January 1995 to July 1995. RESULTS: Ninety six patients with penetrating (68) and blunt (28) abdominal trauma underwent diagnostic peritoneal lavage as evaluation of the severity of abdominal trauma. Dipstick (combur 9 strips) was used to evaluate lavage effluent for red blood cells, white blood cells, protein and bilirubin. Forty three patients had positive diagnostic peritoneal lavage (DPL) results, of which 40 (93%) had positive findings at laparatomy and three (7%) had negative findings at laparatomy. The remaining 53 patients had negative DPL results and were managed conservatively. One patient with a negative DPL result became symptomatic and had a positive laparatomy. Conservatively managed patients were discharged after 24 hours observations without any complications. DPL had an accuracy and sensitivity of 93% and specificity of 98%. CONCLUSION: Diagnostic peritoneal lavage is a cheap, safe and reliable method for assessment of abdominal trauma. The method is easy to perform by trained junior doctors in the OPD, or as a bedside procedure. Use of this method reduced negative laparotomy rate from 50% to 6.9% and average duration of stay from 6.5 days to 1.9 days. This method is recommended as a basic tool in the assessment of abdominal trauma patients.

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