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.
Penetrating abdominal injuries in children
(Eleventh House Publishing Limited, 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.
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.
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.
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.
Pediatric intussusception in Ibadan, South Western Nigeria
(Wolters Kluwer - Medknow, 2008) Ogundoyin, O. O.; Afolabi, A. O.; Lawal, T. A.
Background: Intussusception is the most common cause of acquired intestinal obstruction in children presenting commonly as a surgical emergency between the fifth and ninth months of life. Method: A retrospective review of cases seen over eight years in our hospital was done to study the pattern of presentation and factors influencing management in our environment. Results: Thirty four patients were managed with age ranging from one week to six years. Thirty patients (88.2%) were infants. Majority were boys (58.8%) and the most common symptoms were vomiting (94.1%), passage of red currant jelly stool (91.2%), excessive crying (58.8%) and fever (52.9%). All the patients had exploratory laparotomy done with half of them undergoing simple reduction of the intussusception. There were three mortalities, two of which presented very late after two weeks of onset of illness with septicemia. There was no recurrence. Conclusion: Late presentation is a major cause of morbidity and mortality in developing countries. Early presentation, aggressive resuscitation and non- operative treatment will help in reducing the high mortality associated with late presentation.
Pattern and outcome of childhood intestinal obstruction at a Tertiary Hospital in Nigeria
(Faculty of Medicine, Makerere University, 2009) Ogundoyin, O. O.; Afolabi, A. O.; Ogunlana, D. I.; Lawal, T. A.; Yifieyeh, A. C.
Background: Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa. Methods: A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome. Results: One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates. Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprungís disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates. Conclusion: While mortality as an outcome of management is low, the morbidity was very high in this study.