KNH-UoN Ethics and Research Committee

Obective:To carry out an overview of the medical treatment of the benign prostatic hyperplasia using the combination drugs of alpha adrenergic uro-selective blockers(tamsulocin,alfuzocin) and the 5 alpha reductase iso-enzymes 1&2 inhibitor dutasteride . Data source :Review of researches don and those ongoing especially those sponsored and financed by GlaxoSmithcline in the multicenter international control trials. Data selction: Selected data from international researches on BPH from the following research groups MTOPS,PREDICT,PLESS,VCOOP,ALFIN,DUTASTERIDE 4-DATA 2004/PHASE 111a studies,COmbAT2007,SMART-1, also from GlaxoSmithkline data files.Data Extraction:Selection of research conclusions from various researches tested for clinical use by the international researchers.Data synthesis:From these the advantages of drug compliance  on clinical use on BPH was analysed.                                                                           

Scientific paper presented during the FIFTH ANNUAL REGIONAL WORKSHOP  ON THE THEME;`` WATER IS LIFE``. Abstract: The paper illustrates the health status of water in the human body in health and in disease situations and how body water content depends on many variables including age, sex, fat content,leaness of muscles ,the internal environment of body cells and the external envronmental air and  temperature.

A 72 year old African male presented with a 2 weeks history of haematurla with clots, dysuria, nocturia, frequency and subsequently 2 day history of acute urinary retention (AUR). There were no colonic symptoms of mucus discharge, blood per rectum or malaena stools. Imaging studies demonstrated a tumour mass invading the roof of the urinary bladder whilst cyctoscopic finding were inconclusive. Following surgical intervention, the mass was subjected to histopathological evaluation which confirmed colonic adenocarcinoma matastasis in the urinary bladder. It is now 4 ½ years since surgery was carried out and follow up shows good prognosis.

Objective: Benign prostatic hyperplasia (BPH) incidence and progression has been shown to vary by race, geography and ethnicity with African-Americans having a more aggressive disease than other races. Combination drug therapy has been shown to be a favorable option for medical therapy of symptomatic BPH but data is lacking on the effects of this therapy in black race patients locally. This study aims to assess the early (six months) response, by both International-Prostate Symptom Score (IPSS) and peak urinary flow rate (QMax), to combination drug therapy of Tamsulosin and Dutasteride for management of symptomatic BPH in a predominantly African black race population cohort as a pilot study.
Patients and Methods: Dutasteride 0.5mg and Tamsulosin 0.4mg once daily were administered orally to 52 patients aged 45years and above of black race with confirmed BPH for six months. The main outcome measures of change in mean QMax and IPSS were assessed at three months and six months. Secondary outcome measures were mean Total Prostate Specific Antigen (tPSA) and Prostate Volume (PV) changes. Drug compliance by Modified Morisky Scores (1) and adverse/side effects reported were documented. Paired sample t test and Pearson correlation as well as ANOVA were used to analyze the data.
Results: There was a statistically and clinically significant increase in mean QMax by 13.3ml/sec and decrease in mean IPSS by 14.5 points at six months. There was a fairly rapid reduction in mean Total PSA of 0.9ng/ml as early as two months and a slower fall in mean PV of 10.224mls most evident at the last follow-up. Safety and tolerability of the drugs was consistent with previous experience and majority of the patients portrayed an excellent drug compliance profile.
Conclusion: These results suggest the efficacy of combination drug therapy of Dutasteride and Tamsulosin for moderate-to-severe BPH in the black race. These patients seem to have a more drastic and rapid mean IPSS, QMax and PV response to therapy than reported for other races but their mean total PSA decrease was less. Combination drug therapy is therefore recommended as a useful alternative to surgery in management of BPH in the black race.
Key Words: Benign Prostatic Enlargement, Urinary flow rate, Prostate Specific Antigen, IPSS
Corresponding Author: Professor J.S. Oliech Professor of General Surgery/Urology
Department Of Surgery, University Of Nairobi, Nairobi, Kenya.Email:

Combination use of alpha-adrenergic blockers (tamsulocin or alfuzocin) and 5 alpha iso-enzyme 1&2 inhibitor (dutasteride) in symptomatic benign prostatic hyperplasia (BPH) is the best first optional mode of treatment giving good results with minimal treatment  adverse effects especially for those at risk for surgical intervention and those who are still sexually active. 

OBJECTIVE: To evaluate the use of medical therapy in the management of patients with mild, moderate and severe symptoms of benign prostatic hyperplasia. DESIGN: Prospective study. SETTING: Private urology clinic in Mater Hospital, Nairobi between 1995 and 2005. PATIENTS: Six hundred and eighty patients with benign prostatic hypertrophy aged 50-80 years. RESULTS: Two hundred and eighty (43.8%) patients benefited from the drug treatment alone and were released from the clinic follow up after five years. Two hundred and seventy (42.2%) cases could not complete the five years follow up on drugs alone due to symptoms recurrence or severity or unavailability of drugs. They were removed from the drugs alone treatment and put on other interventions. Ninety (15.9%) cases were operated on based on their decision and insistence or severity of their symptoms or no drugs response. CONCLUSIONS: This observational study confirms that medical treatment is beneficial in the management of benign prostatic hyperplasia (BPH) and is cheap and gives better first line option of treatment choice to many patients. It also gives hopes to the surgical risk patients. The quality of life (QOL) of patients and their family disturbance is also improved.

Background: Thermal injuries are a major cause of morbidity and mortality in Kenya. Though a lot is known about burns, the morbidity patterns and mortality rates of burns in this country have not been established. This study was designed with the general objective of investigating the outcome of moderate and severe burns managed at the Kenyatta National Hospital (KNH). It was also the aim of the authors to try to validate an existing simple clinical burn injury score, based on the Abbreviated Burn Severity Index (ABSI) score.
Methods: This was a retrospective study of burn patients treated at KNH between January 1999 and December 2000. The main parameters studied included the age, sex, and depth of burn injury, inhalation injury and percentage total burn surface area (%TBSA). Other parameters recorded were the type of burn, pre-morbid or co-morbid illnesses, specimen culture and sensitivity and the length of hospital stay. Single variable analyses (χ2-test) were used to determine the value and influence of single variables on burn mortality. Multiple stepwise logistic regression analysis was performed on all the variables used in the ABSI score, as well as on hospital stay and type of burn (scald or flame), to determine their influence on burn mortality.
Results: Out of the 1205 patient records retrieved, 1157 satisfied the inclusion criteria for the study. The findings confirmed the role of percentage total burn surface area, associated inhalation injury and depth of burn as the strongest prognostic variables (multivariate analysis); while age and sex have prognostic significance on single variable analysis. This data was then used to validate the ABSI score, which performed very accurately as a prognostic score.
Conclusion: It is recommended that the ABSI score be adopted into clinical practice in this country, as an objective and accurate predictive clinical score.

OBJECTIVE: To evaluate the use of medical therapy in the management of patients with mild, moderate and severe symptoms of benign prostatic hyperplasia. DESIGN: Prospective study. SETTING: Private urology clinic in Mater Hospital, Nairobi between 1995 and 2005. PATIENTS: Six hundred and eighty patients with benign prostatic hypertrophy aged 50-80 years. RESULTS: Two hundred and eighty (43.8%) patients benefited from the drug treatment alone and were released from the clinic follow up after five years. Two hundred and seventy (42.2%) cases could not complete the five years follow up on drugs alone due to symptoms recurrence or severity or unavailability of drugs. They were removed from the drugs alone treatment and put on other interventions. Ninety (15.9%) cases were operated on based on their decision and insistence or severity of their symptoms or no drugs response. CONCLUSIONS: This observational study confirms that medical treatment is beneficial in the management of benign prostatic hyperplasia (BPH) and is cheap and gives better first line option of treatment choice to many patients. It also gives hopes to the surgical risk patients. The quality of life (QOL) of patients and their family disturbance is also improved.

A study of clinical presentation and management of renal cell carcinoma (RCC) in 35 patients during the period 1983 to 1997 is presented. The peak age was 40-50 years. Haematuria, abdominal pain, fever of unknown origin and abdominal mass were the commonest presenting features. Computerised tomographic (CT) scanning, intravenous urography (IVU) and magnetic resonance imaging (MRI) were the important diagnostic tools. Early diagnosis and surgery are the most important approaches in management.

At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery.

At the Kenyatta National Hospital (KNH) and other private hospitals in Nairobi urinary stone disease is not being correctly diagnosed. Over a 15 year period (1980-1995) only 56 patients have been confirmed to have urinary tract stones out of the expected number of 220 patients. The age range was 10-60 years. The peak age was 30-40 years. Pain and haematuria were the commonest presenting symptoms. Ultrasonography and plane abdominal radiology were the commonest methods of diagnosis. Open surgery and endoscopic stone removal were the commonest modes of management. Extracorporeal shortwave lithotripsy (ESWL) has recently been introduced into the Nairobi Hospital, but was not functional at the time of this study. Percutaneous nephrolithotomy (PCNL) is possible but has not been adequately used due to lack of correct equipment. Septicaemia and haemorrhage were the commonest complications of the open surgery

A 30 year old female with an unexpected right adrenal phaechromacytoma invading the renal vein, the inferior vena cava and extending into the right atrium is presented. She also had BuddChiari syndrome due to invasion of the hepatic veins by the tumour. Additionally, the tumour had metastasised to the liver and the lungs. Despite elevated 24 hour urinary vanillylmandelic acid (VMA) the patient was normotensive pre-operatively. The patient underwent right adrenalectomy and extended nephrectomy with milking of the tumaur from the inferior vena cava. Unfortunately, the patient developed multiple hypotensive episodes and adult respiratory distress syndrome post-operatively and died three weeks after surgery.

Renal transplantation is not readily available in the majority of countries in Africa. It is expensive and difficult to sustain on the meagre funds allocated to health. We report our short experience with fifteen living donor recipients followed in our unit for at least 24 months, range 26 - 48 (mean 35 months) post-transplantation. The donors and recipients were mostly young adults with mean ages of 36.7 years and 32.6 years respectively. The majority of the donors and recipients were males. The donors in most cases were siblings. Within this time, one graft has been lost at one year and the patient restarted on haemodialysis. Three patients died, two within the first year, the third at 23 months after transplantation, all with functioning grafts. The one year graft and patient survival rates were 93% and 86.6% respectively. The second year graft survival rates remained at 93% and the patients survival rate 80%. The nature and frequency of complications seen in these patients is comparable to those in other centres. Of all medical complications, bacterial infections contributed 69.4% of all infections. Cardiovascular complications comprised 31.25% of the complications. Hypertension seen in 85.5% of the patients accounted for 65% of the cardiovascular complications. Acute rejections were common and occurred in seven patients. Transplantation is a viable mode of renal replacement therapy (RRT) in our environment. The practice should be supported to make it more readily available to the many young end stage renal failure (ESRF) patients.

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.

A study of 14 proven cases of phaeochromocytoma operated on at the Kenyatta National Hosspital was done.The management problems and the difficulty in diagnosis is disscussed

Review of twenty cases of live-donor kidney transplants in Kenya for a period of 5 years (1985-1989) and the follow up study results revealed that there were both high graft losses, high morbidity and mortality due to various complications pertaining to surgery and immunosuppression. The most serious complications were intercurrent infections, acute or chronic rejection, pulmonary embolism, steroid induced diabetes, pneumonia, and myocardial infarction. At the end of the first year follow up, there were only twelve graft patients alive. Magnetic Resonance Imaging (MRI) was not available for assessing the anatomical and functional behaviour of the transplanted kidneys. This would have assisted in early diagnosis of the degree and onset of rejection for appropriate treatment before the death of the allografts. It would also assist in differentiating perfusional problems from rejection.

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A study of patients at St Peter’s Group of Hospitals,(Central London), University of London,and at Kenyatta National Hospital,University of Nairobi who had indwelling catheters for various reasons was done to compare the rates of catheter-induced infections in relation to the type/make,size fenestration or not and duration of stay in situ.
The closed system in the indwelling of catheters was the most important factor in reducing the infection rate to lessthan 10%. Breaking it increases the infection to 90%.
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This a report of thirty patients who presented at Kenyatta National Hospital( KNH),Uinversity Of Nairobi (UON) during the three year period January 1974-December 1976 with a diagnosis of thyroid carcinoma.Fourteen had follicular, eight papiilary,four anaplastic,and four medullary types.
Eight patients had metastatic deposits in lymph nodes,lung,or bone and majority of these were anaplastic.Twenty patients received surgical treatment.Five total thyroidectomy, 12 had subtotal thyroidectomy,3 had hemithyroidectomy and 2 had radioactive iodine treatment without surgery.
Most patients received subtotal thyroidectomy with or without radiotherapy. The anaplastic cancers had the poorest prognosis, all dying within six months of diagnosis.Early diagnosis with frozen section the papillary/follicular possess good prognosis if appropriate surgical treatment of subtotal or hemithyroidectomy is done.
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Ten males,6 of whom were azoospermic and 4 oligospermic were studied for their subfertilityor infertility after the gynaecologist had proven wives normal and referred them to urology clinic for further tests .Study showed that the causes of subfertility or infertility are uncorrectable and in the few that can be corrected, the results of the improved fertility in so far as getting child is concerned has no workable formula.
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Although it has been said that local symptoms are uncommon and that large goiters are oftenwell tolerated ( Sloan,1971), this is not true of our patients.Pressure effects may depend upon size and position of the the gland but asymmetry of nodular thyroid and strong anterior neck muscles and fasciamay cause severe compression or deviation of the trachea. In KNH,Nairobi, we have been truck by the frequency of the pressure symptoms caused by these goiter weighing less than 100gms
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Although pyogenic thyroiditis is rare,the four cases have been seen and treated at Kenyatta National Hospital (KNH) over the last 10 years.This is a report of one of these cases detailing the clinical presentation and operative findings.
A middle aged female with a large painful shining anterior neck swelling of 4days duration.She had difficulty of swallowing,but no dyspnoea.She was febrile,with moderate anaemia, polymorph-leucocytosis (52%)and lymphocytosis(36%).Thyroid immunoglobulins were unavailable.131 iodine uptake studies was reduced,plain x-ray of the trachea/neck was unremarkable.
A thick suppurative pus from the left lobe grew on organisms.The discusses various forms of thyroid abcesses ,their causes and treatment.

No abstract available yet.ABSTRACT.

This a report of thirty patients who presented at Kenyatta National Hospital( KNH),Uinversity Of Nairobi (UON) during the three year period January 1974-December 1976 with a diagnosis of thyroid carcinoma.Fourteen had follicular, eight papiilary,four anaplastic,and four medullary types.
Eight patients had metastatic deposits in lymph nodes,lung,or bone and majority of these were anaplastic.Twenty patients received surgical treatment.Five total thyroidectomy, 12 had subtotal thyroidectomy,3 had hemithyroidectomy and 2 had radioactive iodine treatment without surgery.
Most patients received subtotal thyroidectomy with or without radiotherapy. The anaplastic cancers had the poorest prognosis, all dying within six months of diagnosis.Early diagnosis with frozen section the papillary/follicular possess good prognosis if appropriate surgical treatment of subtotal or hemithyroidectomy is done.

ABSTRAC
A three-year (1974-1977) retrospective study of 163 patients with goiter and signs of thyrotoxicosis was carried out.Of thesepatients, 65 (40%) had confirmed thyrotoxicosis,the rest were euthyroid.Kungu(1) reported 36 cases histologically diagnosed over a period of 5 years(1967-1971).Gitau in a six year study1968-1973) REPORTED 148 cases.This suggests that thyrotoxicosis is on the increase at KNH.One the reasons for the increase may be that the patients are becoming more aware of the disease and therefore reporting to the hospital for treatment.The second reason is that the doctors are increasingly interested in the disease.Thirdly, the introduction of iodised domestic salt may cause some patients to become toxic (iodine stimulation).The majority of patients were treated with antithyroid drugs;if they relapsed or did not respond to medical therpy, surgery or radio iodine were the next methods of treatment.