Surgery

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Socio-economic implications of the surgical treatment of hydrocephalus
(1993) Afolabi, A. O.; Shokunb1, M. T.
Between July 1987 and June 1991, 38 patients presented to our service for the surgical treatment of hydrocephalus. The average age at presentation was nine months and the sex ratio was M:F = 1:2: 1. Majority of the patients presented at advanced stage of the disease with gross head enlargement, psychomotor retardation and optic atrophy. Despite the willingness of the parents to have surgical treatment, there was an average delay of six weeks between confirmation of diagnosis and treatment, because of socioeconomic reasons.
Does topical application of bupivacaine (Marcaine)to skin graft donor site have any effect on moriarty sign?
(2000) Oluwatosin O. M; Abikoye F. O; Ademola S. A; Sanusi A. A; Soyannwo O. A.
Moriarty sign designates that when split skin donor site is more painful than recipient site,good graft take is likely. This prospective study was designed for the dual purpose of confirming the validity of Moriarty sign and to determine if bupivacaine topical anaesthetic application to split skin donor site will influence the sign. The difference in response to pain indicated by Moriarty sign between patients that had topical analgesic treatment and those that did not was statistically significant from day one to day five post operatively. Routine application of long acting topical analgesic to donor site is advocated ( Nig J Surg Res 2000;2:131-134)
Penetrating abdominal injuries in children
(2002) Idowu, O. E.; Ogunsanya, W. F. O; Afolabi, A. O; Olapade-Olaopa, E.O
Traumatic injuries are leading causes of morbidity and mortality in children. The ubiquity of various types of weaponry (which is culturally and geographically dependent) has created an epidemic of violence that is spreading into all walks of life, and affecting all ages. The abdomen is the third most commonly injured region in children; 20% of the abdominal injuries are of the penetrating variety, the small intestine being the most commonly injured organ. In this article two illustrative cases of penetrating abdominal injury (PAI), causes, mechanism and pathophysiology of PAI, resuscitation and evaluation are presented. Treatment options with particular reference to the four commonly injured viscera and experience are also discussed.
Recurrent leg ulcers in a 16-year old Nigerian girl
(2003) Afolabi, A.O
This is a report of a 16-year old Nigerian girl who presented with recurrent leg ulcers associated with gastrointestinal symptoms. The management of this patient, who has ulcerative colitis manifesting with pyoderma gangrenous, underlines the need for thorough evaluation of cutaneous ulcers in the tropics. The medical treatment of ulcerative colitis in childhood, with reservation of bowel resection for complications is preferred.
Hypertensive patient in the surgical ward - what the Surgeon should do
(2004) Akute, O. 0; Olubowale, 0. 0|; Aghahowa, M. E; Afolabi., A. 0
Two cases of hypertension are presented to emphasize the need for the surgeons to pay adequate attention to these purely medical conditions that may have a devastating adverse effect on the outcome of surgery. The article also highlights the serious constraints that still characterize the management of these patients in this part of the world. The ideal situation is a multi-disciplinary approach involving the Surgeon, the Physician and the Anaesthetist. The surgeon must not confine himself to the technical aspect of the surgery alone. The hypertension must be controlled whether the patient presents with an elective or emergent surgical condition and anti-hypertensive medication must be continued up till the time ofsurgery and at times intra-operatively. It is not only unnecessary hut also potentially dangerous to withdraw anti-hypertensives before anaesthesia. The main goal of the surgically amenable secondary hypertension is to remove the cause ofter adequate control of the hypertension in preparation for surgery. Patient however must be made to understand that the hypertension may not be "cured" and the anti-hypertensive medication may have to be continued post-operatively particularly if the hypertension is long established before patient presents. Local and/or regional blocks are to be preferred to general anaesthesiafor peripheral lesions and even then it is still preferable to have the hypertension controlled.
Management of haemorrhoid in a tropical .country
(2004) Agbakwuru E.Aug.; Adesunkanmi A.R.K; Ujba A.F; Fadiora S.O.; Ademola S.A; Ogunrombi A.B.
To appraise the pattern of presentation and management of Haemorrhoids in Ile-Ife. Setting: State Hospital and Wesley Hospital, Ilesa 2 major units of Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria. Design: Retrospective Study. January 1990 to December, 2001 Patients and Method. 70 patients who presented with prolapsed (second and third degrees), over 11 years period were studied. Results Age Range was 10-80 years (average 27.8 + 1.9) with a male preponderance. Sixty-seven percent had prolapsing pile; 61.4% had open .excisional haemorrhoidectomy. Conclusion: It is felt that the late presentation was mainly due to fears, false belief and quackery often associated with the disease and its treatment. It was therefore suggested that more effort be made towards education of population in other to reduce above problems and encourage early presentation so that less invasive costly techniques could be used.
Pattern of Bacterial Pathogens In Burn Wound Infections In Ibadan, Nigeria
(2004) Kehinde A.O; Ademola S.A; Okesola A.O; Oluwatosin O.M; Bakare R.A.
A retrospective study of 85 patients with burn wound infections was carried out in University College Hospital, Ibadan, Nigeria, between April 1998 and March 2001. A total number of 85 specimens consisting of 35 wound swabs (41.2%) and 50 wound biopsies (58.8%) were processed during the period. Burn wound infections were significantly more frequent in children and adolescents (5-20 yr) than in adults (p < 0.05). Klebsiella species was the pathogen most commonly isolated, constituting 34.4%. This was closely followed by Pseudomonas aeruginosa (29.0%) and Staphylococcus aureus (26.8%). The rate of isolation of Gram-negative organisms was more than twice that of Gram-positive organisms. More than 75% of the Gram negative isolates were resistant to gentamicin, a commonly used antibiotic for Gram-negative infections, but sensitive to ceftazidime and pefloxacin. Gram-positive isolates were predominantly Staphylococcus aureus sensitive to azithromycin and pef- loxacin. This study highlights the predominant bacterial pathogens and their antimicrobial profile among infected burn wounds in our centre.
Goldenhar syndrome: a case report and literature review
(2005) Bekibele C.O || Ademola S.A || Amanor-Boadu S.D || Akang E.E.|| Ojemakinde K.O; Ademola S.A; Amanor-Boadu S.D; Akang E.E.; Ojemakinde K.O
Summary The case of a 24-year-old female Nigerian with features of Goldenhar syndrome is presented and the challenges of management especially with reference to reconstructive facial surgery and general anaesthesia are discussed.
Clefts of primary and secondary palate: a review of history and of cases seen from 2001 to 2005
(2006) Adekolujo; Dr lyun; Ademola S.A; Oluwatosin O.M.
The management of the cleft of the primary and secondary palate is interdisciplinary. It is complex endeavor requiring coordinated expertise of several specialists in various disciplines. We reviewed 62 patients with cleft of the primary and or the secondary palate managed between January 2001 and September 2005. The mean age at presentation was 25 months. There were 34 females (54.8%) and 28 males (45.2%). Isolated cleft of the primary palate was the most frequent accounting for 44.3%, of the patients while cleft of the primary and secondary palate was seen in 41.0%, and isolated cleft of the secondary pedate in 13.1 %. The male to female ratio in patients with isolated cleft of the primary palate (unilateral and bilateral) was 1.1 to 1, for unilateral cleft of the of the primary palate was 1.56 to 1 but all the patients with isolated bilateral cleft of the primary palate were females. The male to female ratio for patients with cleft of the primary and secondary pedate was 1 to 1 but all the patients with isolated cleft of the secondary palate were females. In cleft of the primary palate, the cleft was most frequently on the left and was complete in 63.8%. Associated malformations were seen in 11.3% of the patients, the most common being cardiac malformations We conclude that there is a need for a formation of a formal cleft team in our center to facilitate the optimum management of these patients.
Focal palmoplantar keratoderma in 2 children leading to gait abnormalities.
(2006) Adebola. O.; Ademola S.A.
Hereditary focal palmoplantar keratoderma are a heterogeneous group of disorders of keratinization characterized by focal areas of thickening of the palms and soles Different genetic abnormalities have been identified for the disorders under this group. However most of them have palmoplantar keratoderma as a common manifestation. This report is about Nigerian children who presented with focal palmoplantar keratoderma without associated disorders. They presented with gait abnormalities resulting from the plantar hyperkeratosis. One of the children had surgical excision of the lesions with skin grafting, which greatly improved the gait abnormality. Perhaps surgical intervention should be carried out earlier in this group of children in case of absence of other treatment modalities available so as to prevent permanent gait abnormalities. have a similar problem. Examination revealed a young boy with normal scalp hair. His dentition and buccal mucosa were normal. His palms and nails were also found to be normal. The soles of the feet showed bilateral striate hyperkeratosis warty in appearance with well defined edges. Both ankle joints were hyper extended. All other systems were within normal limits. Histology of the excised tissue showed marked hyperkeratosis, acanthosis, hypergranulosis and acanthosis. Histologic features of epidermolytic hyperkeratosis and human papilloma virus were absent. A diagnosis of focal palmoplantar keratoderma without associated features was made, most likely of the striate type. In view of the extent of the lesions and the gait problems. Surgical excision of the hyperkeratosis was suggested. The areas with warty hyperkeratoses were excised bilaterally and skin was taken from the thighs and grafted to the feet. Both grafts healed well. He was then encouraged to bear weight gradually on the graft with the help of physiotherapy. The graft keratinized gradually in the pressure bearing areas and he was adviced to use well padded shoes and take extra care of his feet. He also started physiotherapy to encourage ambulation.
Changing epidemiology of skin cancers in southwestern Nigeria.
(2006) Ademola S.A; Gana J.; Oluwatosin O; Ogundoyin O.
Introduction: The incidence of some skin cancers is on the rise in Caucasians1. There is also an observed increase in the diagnosis of Basal Cell Carcinoma in blacks. This study evaluated the Pattern of Skin Cancers in Southwestern Nigeria and compared the trends with what obtained three decades earlier. Methods: A review of 494 cases of skin malignancies recorded at the National cancer registry, Ibadan, Nigeria between January 1981 and December 2000 was carried out. The proportion observed was compared with a similar study carried out thirty years earlier. Results: The commonest lesion recorded was squamous cell carcinoma 40.5%. Malignant Melanoma was 25.1%, Dermatofibrosarcoma Protuberance 9.5%, Kaposi’s Sarcoma 8.3% and Basal Cell Carcinoma 6.7%. There was an observed decline in the proportion of Squamous Cell Carcinoma and an increase in the proportion of Basal Cell Carcinoma. Conclusion: There is a change in the incidence of skin cancers in Southwestern Nigeria.
Primary osteogenic sarcoma of the breast
(2006-12) Ogundiran T.O; Ademola S.A.; Oluwatosin O.M.; Akan E.E; Adebamowo C.A
Background: Primary extra-osseous osteogenic sarcomas have been reported in many tissues of the body but their occurrence in the breast is extremely rare. It can arise as a result of osseous metaplasia in a pre-existing benign or malignant neoplasm of the breast or as non-phylloides sarcoma from the soft tissue of a previously normal breast. Case presentation: A 40 year-old Nigerian woman was clinically diagnosed to have carcinoma of the left breast. The histology report of core-needle biopsy of the mass showed a malignant neoplasm comprising islands of chondroblastic and osteoblastic stromal cells. This report changed the diagnosis from carcinoma to osteogenic sarcoma of the breast. She had a left modified radical mastectomy, however there was significant post surgery skin deficit. A latissimus dorsi musculocutaneous flap was used to cover the anterior chest wall defect. Sections from the mastectomy specimen confirmed the diagnosis of osteogenic sarcoma. She died six months after mastectomy. Conclusion: A diagnosis of osteogenic sarcoma of the breast was made based on histology report and after excluding an osteogenic sarcoma arising from underlying ribs and sternum. This is the second documented case of primary osteogenic sarcoma of the breast coming from Nigeria
Predictors of mortality in paediatric burns at ibadan, Nigeria.
(2007) Odeyinde S.O || Ademola S.A || Oluwatosin O.M.
Patients and Methods: This was a prospective study of children aged 0-13 years, managed in the bums unit of University College Hospital, Ibadan, Nigeria, between January 2001 and September 2003. Results: There were 62 patients, 42 (67.7%) were females and 20 (32.3%) were males (Male: Female= 1:2. Their ages ranged between 1 month and 13 years (mean = 4.8 ± 3.8 years). Majority of the patients (56.5%) were below 4 years of age. Bum was caused predominantly by flame (57%), followed by inhalation injury in 43.5% of the patients. The percentage total burn surface area (%TBSA) ranged between 1 % and 95% (mean 29.7% ± 22.8%), and 41.4% of the patients sustained a major burn (TBSA=30%). Infective complications were present in 37% of patients. The overall mortality was 33.9%, and occurred in those patients with %TBSA of 14 95% (mean = 48.8%). Mortality rate was 62.9% among those that had inhalation injury compared with 11.4% in those without inhalation injury. There was no mortality in those patients whose %TBSAranged between 1 and 32% (mean = 17.5%). Conclusion: Percentage of the total body surface area burnt and the presence of inhalation injury were important predictors of mortality in childhood bums injury.
Diabetes and surgery
(2007) Ademola S.A
Skin malignancies in ibadan: a comparative study
(2008) Gana J.Y; Ademola S.A.
Background: The incidence of skin cancers is on the rise in Caucasians. There is also an observed increase in the diagnosis of basal cell carcinoma in blacks. This study evaluated the pattern of skin cancers in Southwestern Nigeria and compared the trends with what obtained three decades earlier. Patients and Methods: A retrospective study of skin malignancies in Ibadan, Nigeria, based on Cancer Registry data was performed. Between January 1981 and December 2000, four hundred and ninety four (494) histologically confirmed cases of skin malignancies were recorded in the Ibadan Cancer Registry. Result: The commonest lesion recorded was squamous cell carcinoma accounting for 40.5% (200) of the cases. This was followed by malignant melanoma (25.1%), dermatofibrosarcoma protuberance (9.5%), Kaposi's sarcoma 8.3% and basal cell carcinoma (6.7%). Less common histological types included adenocarcinoma, undifferentiated carcinoma, mucoepidermoid carcinoma, adenoid cystic carcinoma, fibrosarcoma and mycosis fungoides. Conclusion: Though squamous cell carcinoma is still the leading cause of skin malignancy in Ibadan. There is a statistically significant decline in its proportion and a statistically significant increase in the proportion of basal cell carcinoma, compared to proportions documented three decades earlier. This change is due to subtle differences in aetiology. The proportion of Kaposi's sarcoma has also increased probably due to increasing HIV infection rate. Hospital prevalence for basal cell carcinoma and malignant melanoma did not show the progressive increase in incidence noted among Caucasians.
Predictors of difficult laryngoscopy in children presenting for cleft lip and palate surgery
(2011) Eyelade O.R; Osinaike B.B; Adernola S.A.
Background: Endotracheal intubation is required to maintain a patent and clear airway as well as ensure good surgical access during cleft lip and palate repair in children. This study is aimed at identifying factors that would predict the risk of difficult intubation in patients presenting for cleft lip and palate surgery in order to focus on preventive measures and save lives. Patients and Methods: Data on anaesthetic techniques and ease of intubation was prospectively documented in 88 consecutive patients scheduled for elective cleft lip (61.4%) or palate repair (38.6%) over a period of 24 months. Three variables: age, type of cleft and laryngoscopic assessment using Cormack and Lehane grading were analyzed using univariate analysis in order to determine risk factors for difficult laryngoscopy. Result: There were 88 paediatric patients aged two months to 12 years comprising 51 boys and 37 girls. Tracheal intubation was easy in 73 (83%) patients and difficult in 15 (17%) patients. Of the 15 patients with difficult laryngoscopy, 13 (86.7%) were children aged less than 24 months, 8 (53.3%) presented with complete cleft palate and difficulty occurred across all the four grades of laryngoscopic view. Age and Cormack and Lehane laryngoscopic view grading were found to be significantly associated with difficult laryngoscopy (p<0.05).
Pattern of presentation of pressure ulcers in traumatic spinal cord injured patients in university college hospital, ibadan.
(2011) Lyun A.O; Malomo A.O; Oluwatosin O.M; Ademola A.S; Shokunbi M.T.
The neurosurgery division in University College Hospital (U.C.H.) admits approximately one traumatic spinal cord injured (SCI) patient per week, most of whom stay a minimum of 42 days on admission. A common complication in these patients is the development of pressure ulcers, which contributes to a longer hospital stay and increased hospital expenses. The purpose of this study was to investigate the pattern of presentation of pressure ulcers in patients on admission and to propose policies or protocols to reduce the incidence. It is a prospective study of traumatic SCI patients managed on the neurosurgery ward from January 2003 to June 2004. The data was analysed using descriptive' statistics. Sixty-seven patients were studied. The average hospital stay was 73 days. Thirteen (20%) of the patients were admitted with pressure ulcers, 32 (47-7%) developed it after admission. As much as 87-5% of pressure ulcers seen in the course of this study which occurred on admission in U.C.H. was in the first week of admission, 6-25% in the second week and the remaining 6-25% in the third week. Pressure ulcers were distributed as follows; 69% (42) in the sacral region, 18% (11) trochanteric, 5% (3) scalp, 1-5% (1) ankle, 1-5% (1) ischial tuberosity, the remaining 5% in other sites. Preventive measures for pressure ulcers consisted of basic skin care, pressure dispersion using fenestrated foams and alternating weight-bearing sites by regular turning. Pressure ulcers are commonest in the sacral and gluteal regions and tend to occur within the first week of admission in the neurosurgical wards.
Reconstruction of a complex anterior abdominal wall defect with autologous tissues - a case report
(2011) Odeyinde S.O; Ademola S.A; Oluwatosin O.M.
Background: The anterior abdominal wall is an important complex composite structure that poses a challenge to the reconstructive surgeon. Defects produced from infection, herniation, tumour extirpation or trauma, are often encountered. Different techniques of reconstruction have been described using autologous tissues and prosthetic materials with varying results, availability and cost implications. The use of totally autologous tissues presents a readily available reconstructive option that has been shown to be associated with a satisfactory outcome and low morbidity. In this report, we describe the use of autologous tissues for the reconstruction of a major abdominal wall defect. Method: This communication describes our experience of the use of purely autologous tissues for a full thickness anterior, abdominal wall defect, presented as a case report. Result: The initial result that was obtained confirms that this is a useful technique with a satisfactory outcome with minimal morbidity. Conclusion: Utilizing purely autologous tissues, avoids most of the complications of the other techniques, is readily available, relatively cost-effective (especially advantageous in the developing country) and is less technically demanding.
Scar assessment as a measure of outcome in cleft lip repair
(2011) Ademola S. A; Olawoye O.A; Akinmoladun V.I; lyun A.O; Olusanya A.A.
As opposed to healing of wounds that occur in early intrauterine life which heals rapidly and without scarring, postnatal cutaneous wound healing is a complex and dynamic process and the end result is formation of a scar. Although the degree of scarring following any surgery depends on many factors, the likelihood of forming more profound howbeit hypertrophic scar may be more in the dark African skin. This has been noted to be a reason for reduced enthusiasm on the part of some adult Africans from embracing cosmetic surgical procedures. Varying degrees of scarring occur following the repair of clefts in children and the degree of scarring may affect the cosmetic and functional outcome of these repairs. With the advent of SmileTrain intervention in the management of clefts in Nigeria, there has been a great increase in the number of surgeries carried out for cleft lip repair such that the resultant scar from these surgeries needs to be assessed and controlled in order to improve the outcome of the surgical interventions. The aim of this paper therefore is to highlight the different methods by which these scars can be assessed and the assessment incorporated into the outcome measures of cleft lip repair. Method: A literature search on scar assessment using the PubMed was conducted. The articles that were written in English Language were retrieved and reviewed with particular attention to those that focus more on the assessment of linear scars. Parameters employed in each of the assessment tools were noted and the suitability of such tool for our patient population was evaluated. Some of the assessment tools were applied to patients that had cleft lip repair in our centre to determine if they are appropriate for use in our patients and possible modifications for their use were suggested. Result: Several scar assessment tools were indentified. The following were found to be applicable to cleft lip assessment specifically - Visual Analogue Scale, Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), Wound Evaluation Scale (WES), Manchester Scar Scale (MSS), Stony Brook Scar Evaluation Scale (SBSES). Application of the methods to our patient population reveals that there is need for some form of modification as discussed below in order to achieve best results. Discussion: Patients who come for cleft lip repair present mainly because of the quest of them patients or their parents for improvement in their appearance. On the part of the surgeon however, the repair is necessary in order to restore form (cosmesis) and function. The degree of scarring after surgery has a role to play in outcome because it can affect both form and function. Assessment of post operative scars prompt the surgeon to take measures that will lead to an improvement of outcome in the subsequent patient he operates and the tools used for this assessment should be adequate to provide insight into what needs to be done to ensure improvement.
Great saphenous vein stripping using nasogastric tub
(2012) Ademola S.A; Adekolujo O.S; lyun A.O; Yunusa-Kaltungo Z |; Nnadozie U.U; Michael A; Oluwatosin O.M.
Background; Crossectomy and Great Saphenous Vein (GSV) stripping remains the gold standard of treatment for great saphenous varicose vein. Many techniques of GSV stripping have been described. However, very few hospitals in developing countries are equipped with a vein stripper. Method and result: We describe the use of nasogastric tube in the stripping of GSV. This simple technique has been successfully applied in three patients. Conclusion: There is a need to carry out a prospective study regarding the application of this technique of GSV stripping.