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Biomedical subjects

J T Momoh

Publications and source records attributed to J T Momoh.

At least 19 recordsLinked to original sources
PubMed2002

Cleft lip and palate: the Jos experience.

OBJECTIVE: To determine the pattern of occurrence of cleft lip/palate and the factors that may have influenced treatment outcome. DESIGN: Descriptive Study. SETTING: Jos University Teaching Hospital, Jos, Nigeria. SUBJECT: This study included 107 consecutive patients with cleft lip/palate managed between January 1991 and June 1997. MAIN OUTCOME MEASURES: The pattern of occurrence of cleft lip/palate, the peculiarities of the malformation in this environment as well as factors that influenced treatment outcome. RESULTS: The 107 patients were aged between one day and twenty-six years at presentation. There were three adults aged between 18 and 26 years with a mean of 22.3 years and 104 children with a mean age of 9.5 months. The male/female ratio was 1. 1:1, the anomaly was 2.4 times commoner on the left and the cleft lip alone was the most frequent mode of presentation (52%). The incidence was higher in the 3rd and 4th siblings. In 13% of these patients, there were other associated congenital anomalies such as Van der Woude's Syndrome, Down's Syndrome and congenital heart disease. Complications were noted in 16(14.9%) patients and these included dehiscence after repair in 8(7.5%) patients, oronasal fistulae in 2(1.9%), nasal speech in 4(3.7%) and hypertrophic scar in 2(1.9%). Eighty nine percent of these repairs were satisfactory to the parents of the affected children. All the adult patients were satisfied with their repair. CONCLUSION: The low incidence of this anomaly in our environment may be due to underreporting in the rural areas. Public enlightenment programs should help improve early presentation.

Abnormalities, Multiple↗
PubMed2001

Van der Woude syndrome with mental retardation: case report.

A report of a four and half-year old African patient with Van der Woude syndrome and mental retardation is reported. In addition to cleft lip/palate, hypodontia and lower lip pits; features consistent with Van der Woude syndrome, he manifested features consistent with growth and mental retardation. A genetic basis for these associated features can only be determined by detailed karyotype studies.

Abnormalities, Multiple↗
PubMed2000

Tru-cut biopsy of palpable breast lesions: a practical option for pre-operative diagnosis in developing countries.

OBJECTIVES: To establish the role of Tru-cut needle biopsy in the pre-operative diagnosis of breast lesions in a developing country. DESIGN: Prospective cross sectional study. SUBJECTS: 112 consecutive patients with palpable breast lesions who had both Tru-cut and excision biopsy as a pre-operative diagnostic procedure. RESULTS: Four (3.6%) patients had specimens that were inadequate for histological diagnosis. Tru-cut biopsy diagnosed 42 of the remaining 108 as malignant and 66 as benign, but only 40 and 61 respectively were confirmed to be correctly so by excision biopsy. Tru-cut biopsy, therefore, achieved a sensitivity of 88.9% (95% CI 79.7 to 98.1) specificity of 96.8% (95% CI 92.5 to 100) and an over all diagnostic accuracy of 93.5% (95% CI 88.9 to 98.2). There was a false positive rate of 4.8%, a false negative rate of 7.6% and a positive predictive value of 95.2%. The pathologist was able to make a correct specific histological diagnosis in 76.2% of all the adequate Tru-cut samples. CONCLUSION: If Tru-cut biopsy is done instead of excision biopsy, it will sufficiently reduce waiting time and reduce cost (four fold). It is well tolerated by patients. We regard the procedure as a useful adjunct and indeed a practical option for accurate pre-operative diagnosis of palpable breast lesions.

Biopsy↗
PubMed1999

One-stage procedure in the management of acute sigmoid volvulus.

In a descriptive prospective study, twenty-seven patients with sigmoid volvulus and three with ileosigmoid knotting had primary resection of the redundant sigmoid colon with immediate anastomosis after intraoperative antegrade colonic irrigation. There was no clinical anastomotic leak nor mortality in any of our patients. Superficial wound infection occurred in four patients (13.3%). Intraoperative colonic irrigation time ranged between 25 to 50 minutes with a volume of saline/Hartmann's required to achieve a clean colon ranging between 1.5 to 5.0 litres. The duration of hospital stay ranged between 7 and 14 days. The result of this study suggests that resection of acute sigmoid volvulus and primary anastomosis after antegrade intraoperative colonic lavage is safe provided the patient is reasonably fit.

Adult↗
PubMed1997

Management of childhood splenic trauma--the Jos experience.

We studied retrospectively 22 children who were managed for splenic injuries at Jos University Teaching Hospital between September 1988 and October 1995. Sixteen were males and six were females (M:F = 2.7:1) with their ages between five and 15 years and a mean of 10.3 years. Eleven were knocked down by vehicles while crossing the freeway, playing or hawking goods; seven fell from slippery mango trees after a downpour of rain while two were passengers in a vehicle that was involved in a head-on collision and another two were kicked in the abdomen as a result of assault. All had surgery. Four sustained Uphadhyaya and Simpson's Type 1 injuries while six sustained Type IV injuries. Twelve had total splenectomy, seven had total splenectomy with heterotopic autotransplantation of splenic wafers while three had splenorrhaphy augmented with omentoplasty. An average of 1.5 units of blood per patient were transfused. There was only one death. Considering that the majority (18) of these children sustained their splenic injuries while crossing the freeway (playing or hawking goods) and from falls from mango trees after the rains, we believe that there are preventable causes. Mandatory primary and junior secondary school education as well as legislature against child labour will help keep these children safe out of harm's way and thus drastically reduce the incidence of childhood splenic injuries in our environment.

Adolescent↗
PubMed1993

Another look at acute appendicitis in tropical Africa: and the value of laparoscopy in diagnosis.

Acute appendicitis is believed to be one of the commonest causes of the acute abdomen in tropical Africa. Negative appendicectomy rates are usually above 20%, which is now considered unacceptably high because of increased risk to patients and the availability of diagnostic facilities to aid clinical decision-making. Our negative appendicectomy rate over a 4-year retrospective period was 29.7% in males, and 47% in females. These reduced to 11% and 10%, respectively, after the introduction of laparoscopy for doubtful cases of acute abdominal pain.

Abdomen, Acute↗
PubMed1992

Laparoscopy in developing countries in the management of patients with an acute abdomen.

Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultrasonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.

Abdomen, Acute↗
PubMed1988

Bloodless operation for a giant hydrocele.

A new hydrocele eversion technique designed for treating giant hydroceles (fluid content over 3 L) is described. The technique takes advantage of the existence of an avascular, loose areolar plane between the external and internal spermatic fascia within which a subdartos-cremasteric pouch is developed. The hydrocele fluid is drained through a trochar and cannula, and the tunica vaginalis is everted and then quilted with 2/0 chromic catgut. The testis and the quilted tunica are placed in the subdartos-cremasteric pouch and the incision is closed. The quilting of the tunica vaginalis not only prevents reinversion of the sac, but, together with the tight fit of the pouch around the sac, it also reduces the potential space into which postoperative seroma can accumulate.This technique is particularly useful when fibrous adhesions develop between the tunica vaginalis and the subjacent spermatic fascia in giant hydroceles. No drains or external pressure dressing are required, and the technique has been used in 14 giant hydroceles with no complications or recurrence.

Adult↗
PubMed1987

Intussusception in infants and older children: a comparison.

The clinical features and operative findings in 37 infants and 29 older children with intussusception seen over a 10-year period were compared and contrasted. While most of the children presented acutely, 28% of older children had chronic intussusception compared with 5% in infants. Only about a third of all children had the four classical features of abdominal pain, vomiting, abdominal mass and bloody stool; the rest had two or three of the above features. Pain and palpable abdominal mass were more common features in older children while abdominal distension, constipation and diarrhoea were more prominent in infants. Fifty-four per cent of intussusceptions in infants were entero-colic while in older children 69% were colonic. All the intussusceptions in infants were idiopathic while in 14% of older children there were predisposing causes. Resection for gangrene/perforation was required in 30% of infants compared with 7% of older children.

Adolescent↗
PubMed1986

Quadrant mucosal stripping and muscle pleating in the management of childhood rectal prolapse.

A new operation that has been found effective in the treatment of frequently recurring rectal prolapse in children is described. It involves excision of narrow strips of mucosa at three or four quadrants and inserting nonabsorbable sutures in the denuded area to pleat the prolapsed segment. The technique is simple, safe, and effective for both mucosal prolapse and full-thickness rectal prolapse. It is free from major complications. The controversy surrounding the predisposing factor, the nature of the prolapse, and the various suggested treatments are highlighted.

Child↗
PubMed1985

External hernia in Nigerian children.

External hernias as seen in Nigeria constitute a major aspect of paediatric surgical practice. A review of 510 cases seen over a period of 10 years showed that, of those with inguinal hernia, 54% had right inguinal hernia (RIH), 35% left inguinal hernia (LIH), 9% bilateral inguinal hernia (BIH) and 2% hydroceles. There was a 4% incarceration rate which was, however, associated with a high (75%) strangulation rate. Thirty-one per cent of those who had contralateral groin dissection had patent processus vaginalis. This was age-dependent, ranging from 60% at 3 months to 28% at 1 year; only a half of these are likely to present with clinical hernia later in life. The incidence of umbilical hernia in the population is not known, but 35% of those who present for treatment do so because of obstruction/strangulation. Two patients had paraumbilical epigastric hernia and one a transverse incisional hernia in the left lower abdominal quadrant. On comparing our findings with Caucasian-based data, it was observed that Nigerian children had a lower female incidence of inguinal hernia, but a higher incidence of LIH, and that in them the processus vaginalis obliterated more often and at a faster rate than in Caucasians.

Child↗
PubMed1983

Congenital posterior urethral valves: problems of management in countries with limited facilities.

There is scanty reference in the literature from the tropics, especially from Africa, to posterior urethral valves (PUV). The condition is not uncommon in Africans. Forty-five patients seen during a period of 10 years at the Ahmadu Bello University Hospital, Zaria, Nigeria have been analysed in order to discover any problems this abnormality may pose that are peculiar to the developing countries of the tropics. Two-thirds of the patients were under one year of age when first seen, one-third of them being under one month. About a quarter had no urological symptoms at presentation. Most of these were neonates and infants often critically ill due to sepsis and uraemia. These non-urological presentations caused delay in diagnosis and referral with detrimental effects on prognosis. However, the diagnosis could be made on clinical examination by demonstrating a palpable bladder and/or renal masses. Voiding cystourethrogram confirmed the diagnosis when carried out carefully, and required no specialized equipment. Most children were treated satisfactorily by perineal valve ablation, using simple inexpensive instruments. The death rate was high mainly due to delay in diagnosis and in starting appropriate treatment. It is suggested that amongst all who have care of children in the tropics, increased awareness of the varied clinical manifestations of PUV would improve prognosis.

Adolescent↗
PubMed1982

Hirschsprung's disease: problems of diagnosis and treatment.

Due to its varied mode of presentation, Hirschsprung's disease continues to be a diagnostic problem. To identify features that might facilitate diagnosis a retrospective review of 37 patients seen was carried out over a nine-year period. The usual presentation in neonates was failure to pass first meconium, or its delayed passage associated with abdominal distention: in a few of these the distension was accompanied by persistent non-specific diarrhoea. In many of the older children, the distension was accompanied by progressive constipation with or without episodic diarrhoea, usually following delayed passage of first meconium. The classical textbook findings on rectal examination and following barium enema were absent in most of the patients and especially in the neonates. Infection and malnutrition were identified as two of the main causes of a high post-operative mortality of 35%.

Abdomen↗
PubMed1982

Exomphalos: management problems in the tropics.

Twenty-six neonates presenting to Ahmadu Bello University Hospital, Zaria, with omphalocele were reviewed. Most sacs were heavily contaminated and some babies were hypothermic on admission. Treatment in most cases followed the standard textbook practice of attempting primary closure. In the absence of mechanical respiratory support, deaths (42.3%) were usually caused by respiratory failure and septicaemia. It is suggested that in the tropics, because of our limitations, conservative management should probably be the rule rather than the exception. Primary fascia or skin closure should only be cautiously carried out for the small defects. For babies with ruptured omphalocele a surgical glove may be substituted for silastic sheet coverage.

Female↗
PubMed1982

Obliteration of processus vaginalis and inguinal hernial sacs in children.

The configuration of the sac in 100 children presenting consecutively with inguinal hernia was studied in an attempt to understand the mechanism of obliteration of the processus vaginalis. Seven clinicoanatomic varieties were found. From a review of these, three possible mechanisms of obliteration of the processus are postulated: (a) progressive fibrous obliteration of the funicular portion of the process in a cephalad direction beginning above the epididymis, (b) initial compression of the funicular portion of the process into a narrow tubular structure by surrounding tissue pressure followed by fibrous pressure followed by fibrous obliteration and (c) initial segmentation of the funicular portion followed by variable fibrous obliteration. The testicular portion of the process, in any of the above mechanisms, shrinks to form two membranes with potential space between them as the contained fluid is absorbed. The types of potential hernial sacs resulting from arrest of any of these forms of obliteration are also described.

Child↗