Goenka M.K.,Apollo Gleneagles Hospitals |
White R.E.,Tenwek Hospital
Annals of the New York Academy of Sciences | Year: 2014
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on nutritional support during chemoradiation, esophageal stents before surgery, and stenting the cervical esophagus. © 2014 New York Academy of Sciences.
Parker R.K.,Tenwek Hospital |
Parker R.K.,Indiana University |
Dawsey S.M.,U.S. National Cancer Institute |
Abnet C.C.,U.S. National Cancer Institute |
And 2 more authors.
Diseases of the Esophagus | Year: 2010
Esophageal cancer has a strikingly uneven geographical distribution, resulting in focal endemic areas in several countries. One such endemic area is in western Kenya. We conducted a retrospective review of all pathology-confirmed malignancies diagnosed at Tenwek Hospital, Bomet District, between January 1999 and September 2007. Tumor site, histology, sex, age, ethnicity, and location of residence were recorded. Cases were analyzed within and outside a traditional catchment area defined as ≤50 km from the hospital. Since 1999, the five most common cancer sites were the esophagus, stomach, prostate, colorectum, and cervix. Esophageal cancer accounted for 914 (34.6%) of the 2643 newly diagnosed cancers and showed increasing trends within and outside the catchment area. Fifty-eight (6.3%) patients were ≤30 years old and 9 (1%) were ≤20 years old; the youngest patient was 14 years at diagnosis. Young cases (≤30) were more common among patients of Kalenjin ethnicity (9.2%) than among other ethnicities (1.7%) (odds ratio [95% confidence interval] 5.7 [2.1-15.1]). This area of western Kenya is a high-risk region for esophageal cancer and appears unique in its large proportion of young patients. Our findings support the need for further study of both environmental and genetic risk factors for esophageal cancer in this area. © 2010, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.
Dawsey S.P.,U.S. National Cancer Institute |
Tonui S.,Tenwek Hospital |
Parker R.K.,Brown University |
Fitzwater J.W.,Texas Tech University |
And 4 more authors.
PLoS ONE | Year: 2010
Certain geographically distinct areas of the world have very high rates of esophageal cancer (EC). Previous studies have identified western Kenya as a high risk area for EC with an unusual percentage of cases in subjects 30 years of age or younger. To better understand EC in these young patients, we abstracted available data on all 109 young patients diagnosed with EC at Tenwek Hospital, Bomet District, Kenya from January 1996 through June 2009, including age at diagnosis, sex, ethnicity, tumor histology, residence location, and medical interventions. We also attempted to contact all patients or a family member and obtained information on ethnicity, tobacco and alcohol use, family history of cancer, and survival. Sixty (55%) representatives of the 109 young patients were successfully interviewed. The median survival time of these 60 patients was 6.4 months, the most common tumor histology was esophageal squamous cell carcinoma (ESCC) (98%), the M:F ratio was 1.4:1, and only a few subjects used tobacco (15%) or alcohol (15%). Seventy-nine percent reported a family history of cancer and 43% reported having a family history of EC. In summary, this case series describes the largest number of young EC patients reported to date, and it highlights the uniqueness of the EC experience in western Kenya.
PubMed | Tenwek Hospital, Information Management Services, University of Nairobi, Mayo Medical School and U.S. National Cancer Institute
Type: Journal Article | Journal: The American journal of gastroenterology | Year: 2016
Esophageal squamous cell carcinoma (ESCC) is endemic in east Africa and is a leading cause of cancer death among Kenyans. The asymptomatic precursor lesion of ESCC is esophageal squamous dysplasia (ESD). We aimed to determine the prevalence of ESD in asymptomatic adult residents of southwestern Kenya.In this prospective, community-based, cross-sectional study, 305 asymptomatic adult residents completed questionnaires and underwent video endoscopy with Lugols iodine chromoendoscopy and mucosal biopsy for detection of ESD.Study procedures were well tolerated, and there were no adverse events. The overall prevalence of ESD was 14.4% (95% confidence interval (CI): 10-19%), including 11.5% with low-grade dysplasia and 2.9% with high-grade dysplasia. The prevalence of ESD was >20% among men aged >50 years and women aged >60 years. Residence location was significantly associated with ESD (Zone A adjusted odds ratio (OR) 2.37, 95% CI: 1.06-5.30 and Zone B adjusted OR 2.72, 95% CI: 1.12-6.57, compared with Zone C). Iodine chromoendoscopy with biopsy of unstained lesions was more sensitive than white-light endoscopy or random mucosal biopsy for detection of ESD and had 67% sensitivity and 70% specificity.ESD is common among asymptomatic residents of southwestern Kenya and is especially prevalent in persons aged >50 years and those living in particular local regions. Lugols iodine chromoendoscopy is necessary for detection of most ESD but has only moderate sensitivity and specificity in this setting. Screening for ESD is warranted in this high-risk population, and endoscopic screening of Kenyans is feasible, safe, and acceptable, but more accurate and less invasive screening tests are needed.
Hedges J.P.,Tenwek Hospital |
Hedges J.P.,University of Colorado at Denver |
Mock C.N.,World Health Organization |
Cherian M.N.,World Health Organization
World Journal of Surgery | Year: 2010
Emergency and essential surgery (EES) remains a low priority on global health agendas even though a growing body of evidence demonstrates that EES is a cost-effective public health intervention and that it holds the potential to prevent a sizable number of deaths and disabilities. The inferior status of EES should be considered, in part, a political problem and subject to political analysis. This type of political economy examination has been used for other important global health issues but has not been applied to EES. By addressing political concerns and prospects, EES can be better positioned on international agendas, thus improving surgical care delivered to the poor. © Société Internationale de Chirurgie 2010.
Parker R.K.,Tenwek Hospital |
Parker R.K.,Brown University |
White R.E.,Tenwek Hospital |
White R.E.,Brown University |
And 4 more authors.
Gastrointestinal Endoscopy | Year: 2011
Background: Self-expandable metal stents (SEMSs) are an established palliative therapy for esophageal cancer. SEMS placement for cancers near the upper esophageal sphincter (UES) is controversial because of a perceived increased risk of complications. Objective: To compare outcomes after patients stented for proximal esophageal cancer (PC) and distal esophageal cancer (DC). Design: Matched case-control study from a prospective database. Setting: Tertiary referral center, Tenwek Hospital, Bomet, Kenya. Patients: All patients with PC located within 6 cm of the UES were matched with randomly selected controls with DC. Interventions: Outcomes of PC cases were compared with those of DC controls. Main Outcome Measurements: Dysphagia score, complications, median survival. Results: A total of 151 patients with PC were identified and were randomly matched with DC controls. Ninety-three case-control pairs had adequate follow-up information available. Mean dysphagia scores (scale 0-4) improved from 3.4 and 3.3 before stenting for PC and DC, respectively, to 1.5 after stenting for both groups (P = .93). Early complications occurred in 6.5% of PC cases and 9.7% of DC controls (P = .44). Late complications occurred in 20.4% of PC cases and 15.1% of DC controls (P = .25). Median survival was 210 days for PC cases and 272 days for DC controls (P = .25). Outcomes were similar for the subgroup of PC cases whose cancer extended to within 2 cm of the UES. Limitation: An important limitation is the absence of adequate follow-up data for 58 of the 151 case-control pairs. Conclusions: SEMSs effectively palliate dysphagia in PC cases, whereas complication and survival rates are not statistically different from those of DC controls. Copyright © 2011 by the American Society for Gastrointestinal Endoscopy.
Okorie C.O.,Banso Baptist Hospital |
Okorie C.O.,Tenwek Hospital
Nephro-Urology Monthly | Year: 2013
Background: Most contemporary series on urethral prolapse report either on the use of excisional or conservative treatment approaches. Objectives: To introduce a modified ligation over a Foley catheter treatment method for urethral prolapse that addresses most of the previously reported complications. Patients and Methods: Five consecutive patients with urethral prolapse treated between 2003 and 2011, all using the ligation method on an outpatient basis were studied prospectively. Maintaining the inflated balloon of the Foley catheter with timed removal of the catheters among other modifications to the original technique is further described in the article. The main outcome measures were to evaluate for recurrence, post-operative appearance of the urethral orifice and satisfaction of parents. Secondarily the actions of the parents of the patients and those of the receiving physicians were also recorded. Results: The mean age of the patients was 6 years old (ranging from 3 to 8 years). All parents suspected sexual molestation and in two cases, the suspected perpetrators were verbally threatened of dire consequences of their actions if proven. None of the receiving medical personnel were aware of this condition. Maximum length of catheterization was for 4 days. The post treatment urethral openings appeared normal and there were no complications. Conclusions: The ligation method with attention to the modifications described further in the article is a simple, safe and cost effective option for the management of urethral prolapse. Maintaining the inflated balloon of the Foley catheter with timed catheter removal especially adds predictability to this technique. © 2013, Nephrology and Urology Research Center; Licensee KowsarKowsar Ltd.
Okorie C.O.,Pan African Academy of Christian Surgeons at Banso |
Okorie C.O.,Tenwek Hospital
Urology | Year: 2011
Objective: To investigate the possible presence of infection in necrotic nonsalvageable testes of patients presenting with testicular torsion and to question the rationale for deferring orchiopexy in such situations to a later date. Material and Methods: Between 2003 and 2011, 16 consecutive patients underwent same-time contralateral orchiopexy and ipsilateral orchiectomy for testicular torsion with necrosis. In all cases, peritesticular fluid or aspirate directly from the necrotic testes was investigated with Gram staining and culturing. The patients were followed at 1 and 3 months after operation for infection of the scrotal incision, or of the remaining testis. Results: The median age of the patients was 17 years (range 13-32) and the duration of illness ranged from 3-17 days. Both Gram staining and culturing of the peritesticular fluid or testicular aspirate failed to reveal the presence of pathogenic organisms. On follow-up at 1 and 3 months, there was no clinically evident infection of the scrotal incision, or of the remaining testis. Conclusion: In cases where testicular torsion with necrosis dictates that unilateral orchiectomy must be done, there is no evidence to suspect the presence of bacterial infection in the necrotic testis or surrounding fluid. There is no evidence that one-stage surgeryipsilateral orchiectomy and contralateral orchiopexycarries a risk of clinically evident infection related to the necrotic testis and as such patients should be offered one-stage surgery. Continuous and sustained effort should be made toward assuring that testicular torsion receives timely assessment and referral to qualified medical personnel. © 2011 Elsevier Inc.
PubMed | Tenwek Hospital
Type: Comparative Study | Journal: Journal of clinical gastroenterology | Year: 2015
To assess the effect of esophageal stent diameter on outcomes of patients with malignant esophageal obstruction.Esophageal self-expandable metal stents (SEMS) effectively palliate dysphagia due to malignancy, but the best stent diameter is unknown.A prospective randomized trial was conducted at a regional referral hospital. One hundred persons with unresectable esophageal cancer were enrolled, randomized to receive a SEMS of either 18 or 23 mm shaft diameter but identical design, and followed until death. Outcome measurements were dysphagia score, adverse events, endoscopic reintervention, and survival.The study arms were evenly matched. Dysphagia resolved after stent placement in 95% in both groups. After 6 months the cumulative incidence of recurrent dysphagia was 38% (95% CI 18%-53%) versus 47% (26%-63%) in the small-diameter versus large-diameter groups, respectively (P=0.23). The cumulative incidence of adverse events was 57% in both groups at 6 months, with trends toward more frequent gastrointestinal bleeding and esophago-respiratory fistula in the large-diameter group, and more frequent stent migration, stent occlusion, and endoscopic reintervention in the small-diameter group. There was a trend toward longer survival in the small-diameter group (median survival, 5.9 vs. 3 mo; P=0.10). Higher initial performance status score and female gender were associated with improved survival. Limitations include enrollment of only 100 (of a planned 200) persons and incomplete follow-up of some participants.Small-diameter and large-diameter esophageal SEMS provided similar palliation of dysphagia due to esophageal cancer. The overall incidence of adverse events was not affected by stent diameter, but there was a trend toward longer survival with small-diameter stents (Clinical trial registration number: NCT01894763).
PubMed | Tenwek Hospital
Type: | Journal: The Pan African medical journal | Year: 2016
Intestinal obstruction (IO) occurs when there is impedance to the flow of intestinal contents due to a congenital or acquired pathology, and is a common paediatric surgical emergency. This study aimed to assess the pattern and outcome of paediatric IO in western Kenya.A retrospective review of all recorded cases of mechanical IO in patients aged 15 years or below admitted at Tenwek Hospital between January 2009 and December 2013.The cohort included a total of 217 children (130 boys and 87 girls). The mean age was 6.7 years (range: newborn-15 years), with most (65, 30%) cases aged 1-3 years. Vomiting (161, 74.2%), abdominal pain (152, 70%), abdominal tenderness (113, 52.1%), constipation (111, 51.2%), and abdominal distension (104, 47.9%) were the predominant signs and symptoms. The most common causes of IO were ascariasis (96, 44.2%), adhesions (34, 15.7%), and intussusception (30, 13.8%). Intussusception was the leading cause of IO in children aged 1 year, ascariasis in children aged 1-5 and 6-10 years, and adhesions in children aged 11-15 years. Operative management was undertaken in 120 (55.3%) cases with 39 (32.5%) of these having gangrenous bowel. The overall mortality rate was 5%.The most common causes of mechanical bowel obstruction in this series were ascariasis, adhesions, and intussusception. Ascariasis remains a significant cause of paediatric IO in this region, thus public education, improved sanitation and deworming campaigns may be helpful in reducing the worm burden.