scholarly works

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A fifteen year experience of total thyroidectomy for the management of simple multinodular goitres in a low medium income country
(Association of Surgeons of South Africa, 2016) Afolabi, A. O.; Ayandipo, O. O.; Afuwape, O. O.; Ogundoyin, O. A.
Introduction: Total thyroidectomy as a treatment for simple multinodular goitre is not well recognised in most centres in low middle income countries. Methods: This paper is a retrospective review of outcomes of total thyroidectomy for simple multinodular goitres in the last fifteen years in a tertiary hospital in Nigeria. Results: A total of 652 thyroidectomies were done from January 2001 to December 2015. Simple multinodular goitres were indication for a total thyroidectomy in 447 patients (68.6%) with a male to female ratio of 1:6. Postoperative complications were hypocalcaemia in 22 (4.9%), unilateral recurrent laryngeal nerve palsy in 13 (2.8%) and haemorrhage in 2 patients. Others were seroma and cellulitis. Tracheostomy was required in 35 (5.8%) patients but none was permanent. Conclusion: Total thyroidectomy is a relatively safe treatment option for patients who have simple multinodular goitre. It provides a permanent cure with a low postoperative morbidity risk. The burden of replacement l-thyroxine needs to be discussed with the patients.
Ambulatory cleft lip surgery in a developing country
(2015) Olawoye O.A; Olusanya A.A; Ademola S.A; Iyun A.O; Michael A.I; Akinmoladun V.I.
Background: Ambulatory cleft lip surgery has been practiced extensively in many developed countries, however cleft lip repair in most developing countries involve patient hospitalization of varying duration. Driven bythe recent acute shortage of pediatric bed space in our hospital, an increasing number of cleft lip surgeries are being performed on out-patient basis. The aim of this study was to report our experience with ambulatory cleft lip surgery at the University College Hospital, Ibadan. Methods: A retrospective review of Cleft lip Surgeries performed between February 2007 and January 2010 was done. Data of patients who had cleft lip surgery was retrieved from our Smile Train data base, the operating room surgery records and the Nurses' admission/discharge records on ail the wards on which the patients were either received or admitted. Information obtained included the demographic characteristics of the patients, complications reported, length of stay (LOS) for in-patients and the need for re-admission before the first follow-up clinic appointment among the two groups. Results: Eighty three patients were identified but complete data was obtained for forty patients. (Retrieval rate of 48%) The ambulatory group comprised of 15 patients while- the in-patient group had 25 patients. The mean patient age was 5.7years in the ambulatory and 9.7 years in the in-patient group. Both groups were homogenous for other parameters. None of the patients in the ambulatory group was re-admitted for any post-operative complication while only one patient in the in-patient group had a post-operative complication necessitating prolonged hospitalization. Conclusion: Ambulatory cleft lip surgery was found to be safe in our practice with comparable patient outcome to the in-patient group. It is anticipated that this may assume increasing prominence in the scope of cleft lip management in many more centers in the developing world.
An analysis of skin cancer in albinos in ibadan
(2015) Ademola S.A.
Context: Skin cancers are common among albinos living in Africa. Deleterious effect of ultraviolet rays from sunlight and nearness to the equator places the African Albinos at risk for skin cancer. Aims: This study aims to present skin cancers in albinos as seen by a plastic surgeon, sensitize the public to the magnitude of dangers that albinos are exposed to, highlight the challenges faced in their management and suggest strategies for improved outcomes. Settings and Design: A retrospective review of skin cancers among albinos was conducted at the University College Hospital, Ibadan, Nigeria. Methods and Material: The charts, operation and cancer registry records of all albinos referred to a plastic surgery division over a ten year period was reviewed. Demographic data and relevant information relating to skin lesions were extracted. Statistical Analysis: Descriptive analysis was done with the aid of statistical package for social sciences (SPSS) version 20. Results: Nineteen patients with fifty nine skin lesions comprising 13 males and 6 females were reviewed. Mean age of the patients was 33.6 (SD 12.8) years, 50% were unmarried, over 90% were Christians and 44% were not employed. The lesions were on the face in 84.6% while scalp and neck lesions were present in 36.8 and 31.6% of patients respectively. In 73.7% of the patients, the lesions were advanced. Basal cell carcinoma and squamous cell carcinoma were of equal proportion. Conclusions: Albinos in Nigeria should be exposed to public health intervention to reduce the incidence of skin cancers through targeted public health educational programmes; structured multicenter and population based research, surveillance, and improved access to healthcare.
Awareness and attitude of doctors and nurses at a crossmark teaching hospital to skin donation and banking
(2014) Michael A.I; Ademola S.A; Olawoye O.A; Iyun A.O; Oluwatosin O.M.
Introduction: This study sought to determine the awareness and attitude of doctors and nurses in a teaching hospital to skin donation and banking, and to identify needs for personnel educational programmes. Methods: A cross sectional survey on doctors and nurses was carried out using a 44-item questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes were determined. Results: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores (p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. Conclusion: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management.
Bile duct structure: A sign of things to come?
(National Postgraduate Medical College of Nigeria, 2005) Akute, O. O.; Afolabi, A. O.
Objective: The aim of the report is to highlight this difficult to-treat condition hitherto uncommon in our environment and warn of the likelihood of more to come with the rising incidence of gallstone in our sub region. Patient and Method: A case report of an 18-year-old male undergraduate patient. Result: A successful management with clinical, biochemical and radiological evidence (OTC and tubograms) despite inadequate investigative tool. Principal Conclusion: With the rising incidence of gall stones in our environment, it is imperative that the Trainee Surgeon must be schooled in common biliary surgery and help prevent this dreaded complication (bile duct stricture) and other sequelae of gall bladder surgery. A plea is also made for the provision of essential investigative tool to facilitate management of such cases in recognised centers.
Bl-RADS lexicon: An urgent call for the standardization of breast ultrasound in Nigeria
(Association of Resident Doctors, University College Hospital, 2005) Obajimi, M. O.; Akute, O. O.; Afolabi, A. O.; Adenipekun, A. A.; Oluwasola, A. O.; Akang, E. E. U.; Joel, R. U.; Adeniji-Sofoluwe, A. T. S.; Olopade, F.; Newstead, G.; Schmutz, R.; Sennett, C.
Ultrasound technology and its ability to demonstrate breast anatomy and pathology has changed dramatically and rapidly in the last decade, sonography is now utilized to characterize and manage palpable and mammographic abnormalities. It is also useful in evaluating nipple discharge and mammary implants. Breast ultrasound (BUS) is on invaluable tool for assessing the extent of malignant disease and regional lymph nodes is also available for evaluation of the breast after breast cancer treatment. All of the above have encouraged the development of Bl-RADS ultrasound to further improve and standardize Breast Sonography. This Lexicon is being presented to radiologists, breast surgeons, breast oncologists, breast pathologists, and breast sonographers.
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.
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.
Clinicopathologic pattern and outcome of management of Pancreatic Carcinoma in Ibadan, Nigeria
(Cient Periodique, 2019) Alegbeleye, B. J.; Afolabi, A. O.
Background: Pancreatic cancer is one of the most challenging tumor entities worldwide, characterized as a highly aggressive disease with dismal overall prognosis and an incidence rate equaling mortality rate. Objective: In order to have an up to date data on pancreatic cancer incidence and trend in Nigeria, West- Africa; we conducted an epidemiological analytical review of the pattern, management and management outcome of pancreatic cancer in Ibadan, Nigeria. Methods: We performed a retrospective hospital-based study in which we analyzed the records of 126 pancreatic cancer patients registered, evaluated and treated in the University College Hospital, Ibadan, a major referral tertiary Hospital in the South Western region of Nigeria, West African from January 1999 to January 2013.The data obtained include bio-data, clinical presentation, treatment and outcome which were analyzed with descriptive statistics using SPSS 22. Results: During the period of study, 126 patients were diagnosed with pancreatic cancer; with a mean age of 60.2 years, and a male to female ratio of 1.52:1; other parameters such as a medical history smoking and alcoholism history, tumor site; histological type as well as the stage of diagnosis were also enrolled in the study. Our statistical analyses reported a very significant correlation between patients who belonged to the age group of 30-45 years and the advanced stage of diagnosis (based on TNM classification) with P=0.02. Conclusion: Pancreatic cancer is increasingly diagnosed in young adults at an advanced stage in the West African sub-region. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis, screening, treatment and research. The role of public health campaign to educate the populace on the disease and early presentation cannot be overemphasized.
Colon and rectal cancer in Ibadan, Nigeria: an update
(The Association of Coloproctology of Great Britain and Ireland, 2010) Irabor, D. O.; Arowolo, A.; Afolabi, A. A.
Introduction Colorectal cancer was hitherto a rarity in the rural African in general and in Nigerians inclusive. Ibadan is a sprawling city in Western Nigeria with a population of about 2.5 million inhabitants. Lately, several publications from surgeons in this city have alluded to an increase in the number of colorectal cancer cases managed in the teaching hospital. Objectives To examine the incidence of this disease over 10 years in order to confirm or exclude the apparent significant increase in colorectal cancer cases in Ibadan, Nigeria. Method This is a retrospective study highlighting the age, sex, clinical features, operations performed and histopathological subtypes of patients who had surgery for colorectal cancer in the University College Hospital Ibadan between July 1995 and August 2004. Results Two and sixty-eight patients were seen over 10 years. The male: female ratio was 1.16:1. The mean age was 41 years and the peak age was the 51- to 60-years group. Fourteen per cent of the patients were 30 years and below. Sixty-two per cent of the patients had rectal carcinoma while 33.2% had colonic carcinoma. Around 60.7% of colonic lesions were right-sided. The most common histopathological subtype was adenocarcinoma (78.8%), mucinous adenocarcinoma was 10.8% and signet ring type was 2.6%. Conclusion Colorectal cancer is a disease on the increase in Ibadan. The mean age of 41 years is much lower than in the Western world. The male: female ratio still favours male patients slightly. About one in seven patients are 30 years and below. Adenomatous polyps were absent in the resected specimens.
Comparative review of burns with inhalation injury in a tertiary hospital in a developing country
(2016) Iyun A.O.; Ademola S.A.; Olawoye, O.; Michael A.I.; Oluwatosin O.M.
Objective. Inhalation injury is an acute respiratory tract insult caused by direct thermal injury, carbon monoxide poisoning, or toxic chemical inhalants, such as fumes, gases, and mist. The aim of this study is to review the authors’ experiences in a regional burn unit in a developing country. Methods. The university college Hospital, Ibadan, Nigeria prospective burn unit database was retrospectively reviewed from January 2001to December 2013and analyzed using SPSS software, version 16 (SPSS Inc, Chicago, IL). Results. There were 840 patients in all, 63% (527) had cutaneous burns only, while 37%(313) had associated inhalation injury. There was a male preponderance in both groups. Those with cutaneous burns only and those with associated inhalation injury had a male to female ratio of 1.6;1 and 1.5:1, respectively. The mean ages were ears (inhalation injury) and 21 years ± 17 years cutaneous burn only) (P < 0.05). The mean total body surface area (TBSA) of the burn injuries was 55% (inhalation injury) and 25% cutaneous burn only) (P < 0.05). Burn injury occurred most frequently between 19.00 hours and 24.00 hours, and 56% of burn es that occurred during this time were associated with inhalation injury (P < 0.05). Major causes of burns were flames and scalding (86.2%). Mortality was 71% in patients with inhalation and 26% in patients with cutaneous burns only (P < 0.05). Conclusion. The association of inhalation injury with cutaneous burns portends a grave condition. An upgrade of expertise and infrastructure in the management of these patients is necessary in order to improve outcomes.
Demographic characteristics and prognostic indicators of childhood burn in a developing country
(2014) Olawoye O.A; Iyun A.O; Ademola S.A; Michael A.I; Oluwatosin O.M.
Children constitute a significant proportion of burn victims in most studies from the developing countries. While there has been a progressive improvement in the outcome from childhood burn in many developed nations, the morbidity and mortality remains high in many low and middle income countries. The aim of our study is to evaluate the demographic characteristics and prognostic indicators of childhood burn in a major referral teaching hospital in a developing country. A review of the records of 638 patients with acute burns managed over a 10-year period from January 2001 to December 2010 at the University College Hospital, Ibadan Nigeria was done. The clinical and epidemiological data were retrieved from computerized data base using the ISBI proforma. Information obtained includes Biodata, Etiology, location, TBSA, presence of Inhalation injury and the treatment outcome. Data of patients aged 16 years and below were analyzed using the SPSS version 16. The main outcome measure was the patient’s survival. 289 children representing 45.3% of the total number of burn patients were managed over the period. The M:F ratio was 1.1:1. The median age of the cohort was 4.0 years while the median TBSA was 21.0%. Nonintentional causes were responsible for 89.6% cases. Most of the injuries (88.6%) occurred at home. Eighty-three patients had inhalation injury out of which 57 (68.7%) deaths were recorded. The overall mortality rate in the cohort was 39.5% with an LA50 of burn size of 45%. The TBSA was also found to be a determinant of outcome. Majority of childhood burns are from preventable causes with attendant dismal mortality figures. Effective burn prevention strategies and improved quality of care remain pivotal in reducing childhood burn morbidity and mortality in the developing countries.
Diabetes and surgery
(2007) Ademola S.A
Distribution and morphological pattern of clefts in the craniofacial region seen in a sub-saharan tertiary hospital
(2015) Olusanya A.A; Michael A.I; Olawoye O.A; Akinmoladun V.I; Ademola S.A; Iyun A.O; Oluwatosin O.M.
Aim: Clefts in the craniofacial region are one of the commonest congenital anomalies recorded in literature. The incidence varies globally with racial differences observed. In Nigeria, the evaluation of the absolute incidence of oral clefts is a challenge as births and deaths are not adequately registered. Especially lacking is the relative prevalence of rare craniofacial clefts to the more common cleft lip and palate anomaly. This study aims to document the pattern of distribution of craniofacial clefts, including cleft lip and palate anomaly, rare craniofacial clefts, unusual presentation of some of these anomalies, as well as other abnormalities noted in affected cleft patients seen at our centre. Material and methods: Information on age, gender, weight at presentation, type of cleft anomaly, other abnormalities, as well as affected relatives were extracted from the clinic records of the Cleft Clinic of the University College Hospital, Ibadan, Oyo, Nigeria, from April 2010 to September 2012. Results: One hundred and forty-two cases were seen within the 30-month period, consisting of 58 men and 84 women with a mean age of 43.54 months and a median of 2.0 months. Eighty-eight per cent of the cases were cleft lip and palate anomalies, while 12.0% were craniofacial clefts. Thirteen per cent had other abnormalities, while 3.5% were considered to be unusual cleft anomalies. Conclusion: The pattern of distribution of clefts in the craniofacial region in our centre has been documented. Cleft of the primary palate was the commonest while rare craniofacial clefts constituted about one-eighth of all the craniofacial clefts.
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)
Experience with managing retrosternal goitres in ibadan, Nigeria
(Wolters Kluwer - Medknow, 2016) Ayandipo, O. O.; Afolabi, A. O.; Afuwape, O. O.; Bolaji, B. E.; Salami, M. A.
Background: There is no general consensus on the definition of retrosternal goitre however thyroidectomy remains the gold standard of treatment with or without a sternotomy Aim: To review the outcome of surgical management of retrosternal goitres. Methodology: Retrospective review of records of patients who had thyroidectomy for retrosternal goitre over a 15-year period. Results: Out of a total of 45 patients, 34(76%) were females and 11(24%) were males with a male/female ratio of 3:1; while their age ranged between 28 and 72years with a mean of 57+15SD. All the patients were euthyroid and a quarter did not have symptoms apart from a neck mass. In all, 15% of the patients had recurrent goitre. CT scan of neck and chest was done in 31 (72%) patients; while 44 (98%) patients had cervical retrosternal goitres, 1(2%) patient had ectopic retrosternal goitre. A cervical incision was sufficient in 28 (62%) patients while 17 (38%) patients required additional sternotomy. Total thyroidectomy was done in all the patients. There were post-operative complications in 19 (42%) patients. Histopathology showed that 3(6.6%) patients had papillary thyroid carcinoma while 42(93.4%) had benign pathology findings. Conclusion: Surgical removal is the treatment of choice. Most retrosternal goitres can be resected through a collar stud incision; however the possibility of a need for a sternotomy should always be planned. The simultaneous occurrence of cervical and ectopic retrosternal goitre should always be ruled out with a CT scan.
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.
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.
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.
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.