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Biomedical subjects

O A Adebo

Publications and source records attributed to O A Adebo.

At least 19 recordsLinked to original sources
PubMed2003

Presentation of primary mediastinal masses in Ibadan.

OBJECTIVES: To determine clinical features, anatomic location and histological types of primary mediastinal masses diagnosed and treated in a black African population. DESIGN: A retrospective study of clinical data collected from patients case notes, the cardiothoracic unit's and pathology records between June 1975 and May 1999. SETTING: University College Hospital, Ibadan, Nigeria which hosts a major cancer center in the West African sub-region, and serves community clinics. PATIENTS: All patients with primary mediastinal masses referred for evaluation and treatment. MAIN OUTCOME MEASURES: Excluded metastatic, oesophageal and vascular-lesions. All patients had radiological evalulation and tissue biopsies. The anatomic subdivision of the mediastinum into anterosuperior, middle and posterior section was used. RESULTS: One hundred and five consecutive patients were evaluated and treated. The mean age was 34.0 +/- 20.4 years. There were 75 males and 30 females. Eighty one (77.1%) were symptomatic, 24 (22.9%) were asymptomatic. Thirty seven (45.7%) of the symptomatic patients had malignant disease while 44 (54.3%) had benign disease. Forty five patients (43%) and 60 patients (57%) had malignant and benign diseases respectively. Incidence of symptoms, was 82.2% for malignant and 73.3% for benign diseases. This difference in incidences is statistically insignificant (p=0.283). Majority of asymptomatic patients (70.8%) had benign disease while 29.2% of patients with malignancy were asymptomatic. This difference in incidence was statistically significant (p=0.0039). The frequency of mediastinal masses were anterosuperior, in 67 patients (63.8%), posterior mediastinal, 24 patients (22.9%) and middle mediastinal in 14 patients (13.3%). Lymphoma 23 (21.9%), thymus glands tumours 19 (18.1%) and endocrine tumours (goiters) 18 (17.1%) were the commonest types of primary mediastinal masses treated. CONCLUSION: Majority of our patients with mediastinal masses (whether benign or malignant) are symptomatic and the absence of symptoms is more associated with benign disease. Majority of lesions are situated in the anterosuperior mediastinum. Lymphoma is the most frequent primary mediastinal mass.

Adolescent↗
PubMed2003

The place of clinical features and standard chest radiography in evaluation of mediastinal masses.

One hundred and five primary mediastinal masses were seen between 1975 and 1998, at the Cardiothoracic surgical Unit of the University College Hospital Ibadan. These were studied to establish the importance of clinical features and plain chest radiography in preoperative evaluation of these masses. The sources of information were unit's record, cancer registry and the patients case note. The age range of the 75 male patients was 3 to 80 years (mean 35.2 +/- 22.1 year) and for the 30 female patients was 2.5 to 70 years (mean 30.9 +/- 18.6 years). Anterosuperior mediastinal masses were the most common (63.8%) followed by posterior mediastinal masses (22.9%). Middle mediastinal masses made up the remaining (13.3%). The most common primary mediastinal tumour was lymphoma (21.9%) next to which were thymus gland neoplasia and thymus cysts/hyperplasia (18.1%). Endocrine tumours (mainly goiters) constituted 17.1% of the masses. On the whole, 45 (42.9%) of the mediastinal tumours were malignant and 60 (57.1%) were benign. Eighty one patients (77.1%) were symptomatic at presentation, 24 patients (22.9%) were asymptomatic. Malignancy was more associated with symptoms in this series (82.2%) and benign lesion were more frequently (70.8%) asymptomatic. Cervical lymphadenopathy (78.6%), was more frequent in patients with malignant lesion. Tracheal deviation (60.3%) and neurological signs (78.9%) were more frequent in benign disease. Superior vena cava syndrome was more frequently associated with primary malignant mediastinal tumours. All masses (100%) were visualized on plain chest x-ray. On the basis of clinical features and chest x-ray, majority of patients (76.2%) with primary mediastinal masses had exploratory thoracotomy, sternotomy or biopsy of their mediastinal mass.

Adolescent↗
PubMed2003

Traumatic vertebral artery pseudoaneurysm: a case report.

A case of traumatic vertebral artery pseudoaneurysm in a 16-year-old Nigerian male following a stab wound is described. Successful surgical treatment by proximal Subclavian artery control and excision of the lesion was achieved. The value of Doppler ultrasonography in the diagnosis is highlighted. This case illustrates and re-emphasises that this rare lesion should be considered in patients with neck mass following penetrating posteriorly located neck injuries.

Adolescent↗
PubMed2002

Diaphragmatic injuries.

This study seeks to define the clinical presentation, the usefulness of diagnostic tests, surgical management approach and outcome of treatment among patients with diaphragmatic injuries. One hundred and sixteen patients with diaphragmatic injuries were treated. This was 6.5% of 1,778 chest trauma patients. Eighty-four of these patients (6.8%) were among 1230 patients who had blunt chest injury and the remaining 32 patients (5.8%) were among 548 patients who had penetrating chest injury. The commonest mechanisms of injury were motor vehicle accidents (48.8%) for blunt and gunshot wounds (56.3%) for penetrating diaphragmatic injuries. The left diaphragm was most commonly involved (86.9% for blunt, 59.4% for penetration), 12.5% of the patients with penetrating chest injury had bilateral diaphragmatic injuries. There were no bilateral diaphragmatic injuries amongst the patients with blunt chest injury. Chest radiographs gave a highly positive yield in the diagnosis of blunt diaphragmatic hernias (67.9%) while nonspecific chest radiological findings (59.4%) were more common among those with penetrating injuries. In 57 patients (49.1%) out of 116, preoperative diagnosis of diaphragmatic hernia was certain. In the remaining 59 patients (50.9%), diagnosis was intraoperative (40 patients), or at postmortem (19 patients). Surgery was emergent in 69 patients (71.1%), semi emergent in 21 patients (21.6%) and elective in 7 patients (7.2%). Surgical approaches were mainly thoracotomy (57 patients), laparotomy (17 patients), laparotomy and thoracotomy (20 patients). In seventy seven patients (79.4%) the diaphragmatic injuries were left sided and in 20 patients (20.6%), the diaphragmatic injuries were right sided. There were 19 preoperative and 21 postoperative deaths. The overall mortality was 34.5%. Associated abdominal and thoracic injuries were the commonest causes of mortality among the patients with diaphragmatic injuries in this study. We conclude that diaphragmatic injury should be suspected in all thoracoabdominal trauma. Lack of specific signs and symptoms is common and a high index of suspicion is required. Routine chest radiograph remains the best screening test for diaphragmatic rupture. Diaphragmatic injury may be a predictor of severity of injury in blunt trauma patient. Surgical approach should be individualized.

Accidental Falls↗
PubMed2002

Trans-oral irrigation for the management of cervical esophagogastric anastomotic leak.

Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.

Adolescent↗
PubMed2001

Anterior mediastinotomy--a diagnostic tool.

This is a review of our experience with anterior mediastinotomy (AM) in the diagnosis and evaluation of diseases of the mediastinum and lung. Thirty consecutive patients who had AM between 1984 and 1999 were retrospectively studied. The mean age of patients was 28 +/- 6.5 years. There were 22 males to 8 females. Sixteen patients had superior vena cava (SVC) obstruction (12 patients with lung cancer, 4 with primary mediastinal tumours), 4 patients had radiological evidence of mediastinal contiguity of upper lobe tumours and 10 patients had primary mediastinal tumours. AM was 1st procedure in 10 patients and 2nd procedure in 20 patients after failed or inconclusive result from FNAB, scalene node/cervical lymph node biopsy or bronchoscopy. Eighteen right-sided and 12 left-sided AMs were performed. Satisfactory histological diagnoses were achieved in all patients. Complications were easily controlled bleeding (4 patients) and life-threatening haemorrhage in 2 patients. Three patients had delayed wound healing and 4 had inadvertent pleural entries. There was no mortality temporarily related to the procedure. We conclude that AM is valuable as a surgical technique for obtaining tissue for histological purposes in diseases of the mediastinum and the lung when tissue specimens from less invasive procedures are unsatisfactory.

Adult↗
PubMed1996

Closed chest drainage without an underwater seal.

Six hundred and eighty-five patients requiring pleural drainage were referred to and managed by the Cardiothoracic Unit of the University College Hospital, Ibadan between June 1985 and September 1992. Two hundred patients, in which Aldon's urobag (e.g. Simpla S4 type) was used for pleural drainage were studied. The indications for pleural drainage were pyothorax or pyopneumothorax (106 patients), malignant pleural effusion (53 patients), tuberculous effusions (23 patients) and chest trauma (18 patients). In seven of these patients, the Aldon's urobag was used for out-patient care pleural drainage. Some of the reasons for discontinuing its use were major tracheobronchial injuries (2 patients), clotted haemothorax (5 patients), chronic empyema thoracis (10 patients) and loculated malignant pleural effusions. The few easily surmountable complications encountered were obstruction of the tube by blood clot and fibrinous coagulate, stoma necrosis and periosteal reaction. The advantages observed from the use of Aldon's urobag for pleural drainage were reduction in cost of pleural drainage, availability of this drainage system and its use for out-patient care when indicated.

Drainage↗
PubMed1994

Age-related changes in normal Chinese hearts.

The heart weights, ventricular wall thickness and valve circumferences were measured in 507 autopsy specimens of normal hearts from persons aged from 10 to 90 years. The heart weights increased with age and were greater in the males than in the females, except from the 6th to 8th decades where they were reversed. The body weight was the best predictor of heart weight. The ventricular wall thickness in males did not differ significantly from that in females. The values of the indexed left ventricular wall thickness (i.e. values divided by BSA) in the females exceeded those in the males from the 6th to 9th decades. The mean valve circumference was greater in the males but it was significant (P < 0.05) only for the tricuspid valves at the 9th decade of life. The pulmonary valve circumferences were greater than the aortic for all decades and the ratio of the aortic to pulmonary valve circumference remained constant. In the clinical evaluation of the specimens of Chinese hearts, the absence of the aged-related dilatation of the aorta described in Caucasian hearts should be duly taken into account.

Adolescent↗
PubMed1993

Prevalence of peripheral artery disease in patients with coronary artery disease.

The incidence of coronary artery disease in Singapore has shown a rapid rise in recent years, however, there is a subjective impression that the prevalence of atherosclerotic peripheral artery diseases, although sharing common aetiological factors with coronary artery disease, has not shown a similar rise. We set out to determine the incidence of occlusive peripheral artery diseases of the lower limb in a selected population of Asian patients using a non-invasive test and we analysed the risk factors. The overall prevalence of peripheral artery disease of the subjects as determined by an abnormal ankle brachial index less than 0.9 in at least one limb was 19.1%. Increasing age, hypercholesterolemia and smoking were risk factors. In patients with proven coronary artery disease, abnormal ankle brachial indices were present in 21.3% of patients with angiographic evidence of coronary artery disease but in only 13.0% of those without. In this study, the incidence of peripheral artery disease in this selected Asian population was high. With the increasing availability of vascular laboratories and awareness of the diseases, we can expect to see increasing numbers of patients presenting with these problems.

Adult↗
PubMed1993

Oesophagoplasty in the treatment of oesophageal stricture.

Two children with oesophageal stricture due to corrosive oesophagitis and retained foreign-body respectively, were treated with resection and primary oesophageal reconstruction. Both were complicated by anastomotic leaks which healed after adequate drainage with temporary enterostomy feeding. The long-term results have remained excellent without dysphagia or reflux. The technique of primary repair is recommended for short-length stricture of the oesophagus as an alternative to reconstruction by gastric or colonic tube interposition.

Anastomosis, Surgical↗
PubMed1992

Intravascular hemolysis after mitral valve repair: a word of caution.

The case of a young patient who presented with severe hemolysis after mitral valve repair is presented. Valve repair included chordal shortening, transposition of chordae tendinae, and annular remodelling using a Duran flexible ring. Reoperation and valve replacement were required to control hemolytic anemia. The possible mechanisms leading to such an uncommon complication after plastic repair of the mitral valve are commented on. The scanty literature concerned is reviewed.

Adult↗
PubMed1992

Coronary artery bypass surgery in young patients.

Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long-term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty-nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with perioperative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow-up ranged from 3 to 54 months. There were no late deaths. It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair.

Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.

Adult↗
PubMed1992

Ectopic thymoma: a case for median sternotomy for complete thymectomy.

Thymomas are normally found in the superior mediastinum or the upper part of the anterior mediastinum. We report a case of thymoma arising in the inferior aspect of the anterior mediastinum. This case illustrates that thymic tissue may be found low in the anterior mediastinum and supports the practice of a median sternotomy approach for thorough mediastinal exploration in all cases of thymectomy.

Aged↗
PubMed1991

Combined resection of hepatoblastoma and intracaval right atrial extension with profound hypothermia and circulatory arrest.

Hepatoblastoma is an uncommon liver neoplasm in children but its intraatrial extension through the inferior vena cava is extremely rare. The case described is a 3-year-old boy in whom profound hypothermia and circulatory arrest were used to resect a hepatoblastoma and its extension to the right atrium. This technique allows maximal resection and relief of venous obstruction from atrial extension of hepatoblastoma.

Carcinoma, Hepatocellular↗
PubMed1991

Implication of altered pulmonary function in pneumonectomy for tuberculous destroyed lung.

Twelve patients undergoing pneumonectomy for tuberculous destroyed lung were studied to determine the value of preoperative spirometry in the assessment of their pulmonary reserve, and prediction of their postoperative morbidity. Preoperatively, the mean functional losses (as percentage of predicted values) were 44.5% of FVC, 54% of FEV, and 44% of PFR. No significant alteration occurred in FVC, FEV1 or PFR post-pneumonectomy. All patients were in Class 1 (NYHA) pre- and postoperatively. It is concluded that operability in these patients cannot be based on broncho-spirometry. The assessment of preoperative clinical (symptomatic) stage and the cardiovascular status appears to be the major determinants of pulmonary functional results.

Adolescent↗
PubMed1991

Myocardial revascularisation in patients with carotid artery disease.

From January 1987 to December 1989, 80 patients with carotid bruit and/or history of transient ischaemic attack/stroke underwent digital subtraction angiography (DSA) prior to consideration for coronary artery bypass graft. Thirty-eight patients (Group I) out of the 80 had coronary artery bypass graft done with postoperative stroke in five (13.2%); this contrasted with a group of 320 patients (Group II) without cerebrovascular disease who underwent coronary artery bypass graft during the same period with postoperative stroke in two cases (0.63%) (p less than 0.0005). Carotid artery stenosis was noted on the DSA in 66% of Group I patients, with significant disease (greater than 70% occlusion) in 15%, while the study was normal in 34% of cases. Combined carotid endarterectomy and coronary artery bypass graft was done in five of Group I patients, with postoperative stroke in one; this was the only one among the stroke patients with significant carotid disease. All strokes, except in one patient, resolved within one to 6 1/2 months. These results suggest that the risk of stroke after coronary artery bypass graft is increased in patients with carotid bruit or history of transient ischaemic attack/stroke and in the presence of established carotid artery disease. The place of combined carotid endarterectomy and coronary artery bypass graft in these cases remains to be determined.

Angiography, Digital Subtraction↗