Surgery

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Awareness of colorectal cancer screening and its associated risk factors among adults attending outpatient clinics in regional referral hospitals in Dar es Salaam.
(ISAR Journal of Medical and Pharmaceutical Sciences, 2024-11-28) Mziray, Amir N.; Mbembati, Naboth A.; Swai, Samuel P.; Wandwi, Wambura B.; Mkiramweni, Jerome P.; Kategile, Albert M.; Muganyizi, Daniel J.; Gangji, Raidah R.
Background: Colorectal cancer screening aims to detect early signs of colorectal cancer before symptoms develop, increasing the chances of successful treatment and survival. Screening methods include colonoscopy, and stool-based tests like fecal occult blood tests (FOBT) or fecal immunochemical tests (FIT), which detect blood in the stool. Screening guidelines vary by country, but it is generally recommended to start regular screenings around age 40 for the average-risk individuals. Objective: To assess colorectal cancer (CRC) awareness, risk factors and screening utilizing FOBT and colonoscopy among participants in regional referral hospitals in Dar es Salaam. Methodology: A total of 150 participants were recruited for the study. FOBT was done to all participants, with positive cases undergoing further diagnostic interventions, including stool analysis, H. pylori antigen testing, and endoscopic interventions. Results: Of the 150 participants, 73.3% tested negative and 26.67% tested positive for FOBT. Further investigations revealed hookworm ova 12.5% (n=5/40) and H. pylori infection 22.5% (n=9/40) among FOBT positive cases. Conclusion: CRC screening using FOBT demonstrated significant number of positive cases, highlighting the need for improved awareness and education about CRC and its risk factors
Cardiac Surgery: One Year Experience of Cardiac Surgery at Muhimbili National Hospital, Dar es Salaam – Tanzania
(East and Central African Journal of Surgery, 2010) Wandwi, Wambura B.
Background: Establishing a cardiac unit in developing countries is usually difficult as it is associated with many obstacles of both expertise and financial constraints and more alarming is the mortality rate that may be high. Even after success in the initial stage sustainability of such program is a dilemma. The aim of this study was to determine pattern of disease profile, type of cardiac surgery done and the overall outcome. Methods: All patients who underwent cardiac operation at the centre were prospectively recruited. Patients’ demography and disease characteristics as demonstrated at echocardiography and its confirmation at operation were recorded. Peri-operative factors were the measurable statistics that determined the overall patients’ outcome. All data were entered and analyzed using a spss11.5 window program. Results: A total of 105 cases of cardiac surgery were done 21% were male and 79% were females. Mean age was 19.4±12.3. The majority of cases were due to Rheumatic heart diseases (47.6%), congenital heart disease (35.2%), myxomatous valvular degeneration (16.2%) and pericardial disease 1%. Mitral valve disease was the commonest cause of cardiac disease (58.1%). Prolonged duration of aortic cross-clamp and total operation time were associated with prolonged intensive care stay and poor patients’ outcome respectively (p<0.05). While, ventricular dysfunction and total cardiopulmonary bypass time were not. The overall mortality rate was 13.3%. Majority of all death (64.3%) followed mitral valve repair. Conclusion: The majority of patients (86.7%) who underwent cardiac surgery had full recovery. The mortality of (13.3%) is probably comparable to other settings. The diversity of spectrum of cardiac disease found elsewhere is also found in our community and therefore need to increase community awareness. Mitral valve repair deserve a special entity that requires skills and expertise. The mere presence of suboptimal ventricular dysfunction is probably not a contraindication to cardiac operation. The duration of aortic cross-clamp and total operation time were determinant of postoperative outcome.
Cholelithiasis in Dar es Salaam, Tanzania.
(The Central African Journal of Medicine, 1996) Wandwi, Wambura B.
In a five year review, there were 30 cases of cholelithiasis treated at the Muhimbili Medical Centre, Dar es Salaam, Tanzania. The male to female ratio was 1:3, and the peak age for cholelithiasis was in the 30 to 49 years age group. Right upper quadrant abdominal pain was the commonest presenting symptom (100 pc), and cholecystectomy was performed in all patients. Local complications of gall stones were recorded in seven patients (23.3 pc) and these included; gall bladder empyema, pericholecysteal abscess, CBD stone, gall bladder adenoma, gall bladder mucocele, and two patients had acute cholecystis. Stones were multiple in 90 pc of patients, and on macroscopic classification the ratio of cholesterol to pigment stones was 2:1. There was no death in this series of 30 patients.
Clinical assessment and examinations of colorectal cancer in outpatient clinics: a synopsis from a study conducted in regional referral hospitals in Dar es Salaam – Tanzania
(ISAR Journal of Medical and Pharmaceutical Sciences, 2024-11-28) Mziray, Amir N.; Mbembati, Naboth A.; Swai, Samuel P.; Wandwi, Wambura B.; Mkiramweni, Jerome P.; Kategile, Albert M.; Muganyizi, Daniel J.; Gangji, Raidah R.
Background: Colorectal cancer (CRC) is one of the most preventable cancers, with early detection significantly improving treatment outcomes. Screening methods such as FOBT and colonoscopy are crucial but underutilized, especially in resource-limited settings. Objective: To assess awareness of colorectal cancer screening and risk factors among adults attending outpatient clinics in regional referral hospitals in Dar es Salaam. Methodology: This cross-sectional study involved 150 participants, and screening was done through FOBT, followed by further diagnostic tests for those with positive results. Results: Of the participants, 26.67% tested positive for FOBT, and 5 of them were diagnosed with colorectal cancer. There was a significant gap in knowledge and awareness regarding colorectal cancer screening. Conclusion: There is a need for enhanced public health efforts to raise awareness about colorectal cancer and its risk factors in Tanzania.
Closed mitral valvotomy-a life saving procedure in facility deprived countries: experience at Muhimbili National Hospital, Tanzania
(East and Central African Journal of Surgery, 2011) Wandwi, Wambura B.
Background: Rheumatic heart disease remains a major health cardiac problem in developing countries as the culprit of rheumatic fever. Mitral valve stenosis is the most common complication of valvular heart disease and its consequences of increase in pulmonary hypertension, heart failure, pulmonary vascular disease and if untreated death ensues. The management of this condition varies depending on availability of expertise and resource; however in a facility deprived country with low economic status closed mitral valvotomy remain the standard palliative treatment! The aim of this study was to evaluate the clinical status of patients with mitral stenosis following closed mitral valvotomy treated at Muhimbili National Hospital, Cardiothoracic Unit. Methods: All patients presenting with severe mitral stenosis in absence of calcification in its leaflets and regurgitation were enrolled for the study from May 2008 to November 2009. Excluded were those who failure consents. Results:A total of fourteen patients were included in the study of which 10 (71.4%) were females and 4 (28.6%) were males. They had a mean age of 21.5±8.8 and range from 11 to 41 years. The diagnosis was based on clinical evaluation using NYHA class and 2D-Echocardiography findings. All patients’ demographic data, preoperative and post operative findings were taken and data analysis was done using an SPSS 11.5 program. Categorical data were compared and analyzed using two Tailed- χ2 and values were taken 5% significance level. Conclusion: There was an overall highly significant improvement in clinical stage of the disease, reduction in mean pressure gradient across the mitral valve, reduction in pulmonary hypertension and mean left atrial size. Similarly there was improvement in ventricular function in terms of ejection fraction and increase in mean mitral valve area.
Coronary artery fistula to bronchial artery on contralateral side of coronary atherosclerosis and myocardial insufficiency. A case report.
(Angiology, 1996) Wandwi, Wambura B.
Among coronary vessels anomalies is the rare coronary artery fistula. Myocardial insufficiency resulting from fistula steal phenomenon can not be clinically distinguished from that of coronary atherosclerosis, if these conditions coexists in the same patient. The authors present a case of extracardiac left coronary artery fistula connecting the circumflex branch and left bronchial artery, with inferior wall myocardial insufficiency attributable to the right coronary artery atherosclerosis.
Dental fluorosis in Tanzania Great Rift Valley in relation to fluoride levels in water and in ‘Magadi’ (Trona)
(Desalination, 2009) Wandwi, Wambura B.
Information on the extent of health problems caused by fluoride in Tanzania is scanty. To determine the prevalence and the severity of dental fluorosis in relation to fluoride level in water and in ‘magadi’ (Sodium Carbonate and Sodium Bicarbonate), 2912 school children aged 12–18 years from 96 villages within internal drainage basin (IBD) of the Great Rift Valley (in East Africa) were examined using Thylstrup Fejerskov Index (TFI). Fluoride level in water ranged from 1.5 to 24.9 F− mg/L (mean=4.6F− mg/L), whereas that of ‘magadi’ ranged from 2.7 to 31,000 F− mg/kg (mean=3455 F− mg/kg). The prevalence of dental fluorosis was 96.3% while the severity ranged from 3 to 7 TFI. A total of 83.3% of children had at least one tooth with TFI score≥4. Although the findings of this survey did not reveal linear association between dental fluorosis and fluoride levels, probably due to complexity of factors such as ingestion of ‘magadi’, the high prevalence and severity of dental fluorosis calls for an immediate intervention.
Pneumatosis cystoides intestinalis--in Tanzania.
(The Central African journal of medicine, 1995) Wandwi, Wambura B.
Pneumatosis cystoides intestinalis (PCI) is a rare benign condition affecting portions of the intestinal tract, characterised by: multiple subserosa and submucosal gas cysts, unknown aetiology, and non specific clinical presentation. Its diagnosis is often coincidental. Management of PCI entails that of the associated condition.
Right atrial myxoma at Muhimbili National Hospital: a case report
(Tanzania Medical Journal, 2009) Wandwi, Wambura B.
Background: Primary cardiac neoplasms are rare most of them are benign. Cardiac myxomas are the commonest benign lesion and the initial presentation may be accompanied with pulmonary, cerebral or systemic complications. Complete resection of the tumour is associated with good prognosis but recurrence is a frequent post operative complication. We report a first rare case from our centre of right atrial myxoma occurring in a young lady of 20 years old, a diagnosis and technique of resection is also explained. Case presentation: We report a rare case of a young girl who had presented to us with history of shortness of breath and easy fatigability, she was also found to have features of both upper and lower cava hypertension and was in NYHA class IV. The 2-D echocardiography revealed a right atrial tumor encroaching the tricuspid valve, chest radiography showed gross cardiomegally and right lower lung collapse. A clinical diagnosis of right atrial tumour was reached. The patient was scheduled to undergo open heart surgery and tumour resection on 23rd September 2009 and was prepared accordingly. A classical median sternotomy followed by major vessel cannulation in which the cava were cannulated distally. Patient was cooled to 22 centigrade the tumour was found filling the whole of right atrium cavity, friable with a broad stalk on the right atrial appendage extending and infiltrating the crista terminalis. It was excised and tissue was taken for histopathology. The right atrium was reconstructed and closed with adequate size of atrium. The histopathology revealed a typical right atrial myxoma. Postoperatively the patient developed massive right sided pleural effusion that was managed by tube thoracostomy. Eventually the patient recovered and was discharged to be followed at outpatient clinic. Conclusion: Right atrial myxomas are rare lesion occurring in 5- 10% of all cases of cardiac myxoma. The peak incidence is between 3rd to 6th decades of life. Our case was unusual as it occurred in the 2nd decade and in the right atrium with multicentric origin though still confined in the right atrium. She also presented with pulmonary complication of right sided lung collapse. Early diagnosis and resection is followed by good prognosis and recurrence rate is low. Resection was done and the postoperative period was uneventful.
Surgical experience with closure of an Isolated PDA at Muhimbili Cardiothoracic Unit in Dar es Salaam, Tanzania
(Tanzania. East and Central African Journal of Surgery, 2013) Wandwi, Wambura B.
Background: This study describes our experience in the management of isolated patent ductus arteriosus; complications and mortality rate. Further it describes the innovative technique for the closure of the duct. Methods: We retrospectively recruited all patients’ files that underwent PDA closure from May 2008 to July 2011 in all these patients clinical evaluation and confirmation of diagnosis was made by echocardiography. There were two-treatment group. The first group underwent a standard surgical closure and these were 26 patients this group was obtained from the usual and routinely done PDA ligation. The second group also comprised 26 patients who had undergone a modified closure technique as illustrated by Kirklin1. Patients’ age, sex duration of illness, stage of the disease as classified by New York Heart Association, ventricular function as depicted by left ventricular ejection fraction, any associated lesion were noted. During operation, confirmation of the PDA was done and the total operation time (TOT), total duration of ventilation (VT), and any complication were noted. The total duration of intensive care stay and the postoperative period stay in the ward were noted. Patients had been followed at six months interval for two years; in which during follow up evaluation for their cardiac status to exclude congestive heart failure, presence of residual PDA had been done. All data were entered in a structured data sheet and analyses using Spss window 17 statistical program. Results: A total of 52 patients with clinical diagnosis of PDA, 26 patients in each treatment group of either standard closure or new closure technique. Female patients had outnumbered male patients by 5.5 folds. A total of 46.1% of patients were under five years old. A relatively younger population of patients was seen with the new closure technique as compared to patients in the standard closure technique (p=0.02). Similarly a correspondingly less heavier weight was noted in patients who underwent new closure technique as compared to those who had standard closure technique(p=0.03). Long- term follow up of patients with their treatment modalities it was found that 3 patients and 2 patients had residue lesion and congestive cardiac failure respectively who were exclusively in the standard closure technique, none of such complications were seen with the new closure technique (p=0.04). With such evidence, the practice to date has been the new closure technique for definitive surgical treatment for PDA. Conclusion Open surgery for PDA closure remains the procedure of choice for facility and technically deprived countries. The approach and the technique of closure that minimize the postoperative complications is a challenge from centre to centre. However this study with a new closure in which a purse string on the ampulla of the PDA followed by a silk ligature has proved to be efficient and reliable technique that leaves no residual lesion with no long term complications.
The use of 'BioGlue' for the repair of aortic Insufficiency in acute aortic dissection
(Journal of heart valve disease, 2004) Wandwi, Wambura B.
Background and aim of the study: Concern has been raised regarding the late effects of tissue glues. Herein is described the authors' experience with a new bioadhesive (BioGlue; Cryolife) for repair of the aortic root in acute dissection. Methods: BioGlue is composed of bovine serum albumin (BSA) and glutaraldehyde. Glutaraldehyde exposure causes the lysine molecules of BSA, extracellular proteins and cell surfaces to bind to each other, creating a strong scaffold. Between January 2001 and January 2003, BioGlue was used to repair the aortic root in 22 patients with acute aortic dissection. Moderate or severe insufficiency was present in 16 cases, and mild insufficiency in six. The mechanism of insufficiency was commissure detachment in 15 cases, penetration of the intimal flap into the valve in three, and dilatation of the sinotubular junction in four. The aortic valve was resuspended to the aortic wall using pledgeted sutures. BioGlue was used to glue the dissected layers of the aortic root and create stronger tissue for sewing. Two patients required complete resection of the sinuses and aortic root remodeling with a Dacron graft. Results: There were two operative deaths. Postoperative transesophageal echocardiography showed mild or no aortic insufficiency in 18 patients, and moderate insufficiency in two. During follow up (mean 16 months), none of the patients required reoperation for proximal redissection, delayed rupture, or aortic insufficiency. Conclusion: BioGlue is useful for aortic valve repair in aortic dissection. It is less toxic and has a stronger adhesive effect than the older surgical glues, and is expected to have better long-term results.

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