Biomedical subjects

O Adejuyigbe

Publications and source records attributed to O Adejuyigbe.

At least 19 recordsLinked to original sources

PubMed2006

Pattern and factors affecting management outcome of spina bifida cystica in Ile-Ife, Nigeria.

BACKGROUND AND OBJECTIVE: There is paucity of data on the pattern and factors affecting the management outcome of patients with spina bifida cystica in the Ife-Ijesa zone, Nigeria. This study was designed to address this research question. METHOD: One hundred and six consecutive cases of spina bifida cystica who presented in our hospital from January 1990 to December 2004 were reviewed. We obtained information on sociodemographic factors, medical history and management as well as clinical outcome. SPSS was used to analyze the data. RESULT: Males constituted 54.7% and females 45.2% of cases. Mortality was high in those presented after the 4th week of life (p = 0.04). The malformation occurred in the lumbar and lumbosacral regions in 77.4%. Myelomeningocele was the most common type (86.8%). Hydrocephalus was recorded in 53.8% of patients. Surgical closure was done for 91.5% of the patients. About 77% of all the patients were discharged while 22.7% died. This was significantly related to age at presentation (p = 0.04) and infection before surgery (p = 0.045). Postoperative complications were more frequent in patients with ruptured lesions (p = 0.025), a larger size of defect (p = 0.028) and a lower birth weight (p = 0.006). CONCLUSION: Myelomeningocele is the most common type of spina bifida cystica in our environment. Late presentation and preoperative infection are associated with high mortality in our patients.

Abnormalities, Multiple↗

PubMed2005

Successful separation of two pairs of conjoined twins in Ile Ife, Nigeria: case reports.

Conjoined twins are rare phenomena occurring in one in 1 in 50,000 live births. Successful surgical separation of conjoined twins is a major undertaking requiring careful planning by a multidisciplinary team. Reports of seperation of joined twins in developing countries like Nigeria are rare. Ten cases of conjoined twins were separated between 1936 and January 2003 (including the authors two new cases). There were five omphalopagus, two pygopagus, two heterpagus and one ishiopagus twins. Three underwent emergency separation with 83.3% mortality while seven underwent elective seperation with 64.3% survival. The overall mortality rate was 50%. Despite the absence of advanced technological resource selected group of conjoined twins can be successfully separated in a developing country like Nigeria. An improvement in facilities and availability of trained personnel in likely to be associated with improved outcome.

Adult↗

PubMed2004

Experience with anorectal malformations in Ile-Ife, Nigeria.

The study was carried out to determine the characteristics and outcome of management of anorectal malformations (ARM) in Nigerian children at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC) in Ile-Ife, Nigeria, between January 1986 and December 2002. Eighty-six children with ARM were studied, 48 males and 38 females. Only 12 (13.9%) presented to the hospital within 24 h of birth. Twenty-four (27.9%) patients had one or more associated congenital anomalies, with oesophageal atresia with tracheo-oesophageal fistula being the most common associated malformation. A low variety was identified in 26 (30.2%) cases, while 60 (69.8%) had intermediate or high lesions. Twenty-two patients with the low type of anomaly were offered primary anoplasty in the neonatal period, whereas 59 patients with intermediate or high malformations were offered a preliminary colostomy. A definitive pull-through procedure was ultimately performed in 27 of these 59 cases. Twenty-six patients (30.2%) died. Infection and severe associated malformations were responsible for most (65%) of the deaths. Early results of definitive surgery among survivors were generally good after a mean follow-up period of 13 months. Late presentation, inadequate facilities for neonatal intensive care, and paucity of specialist supportive personnel appear to have negatively influenced the outcome of treatment in our environment. Increasing awareness and availability of medical facilities and specialists are needed.

Abnormalities, Multiple↗

PubMed2004

Anaesthesia for neonatal surgical emergencies in a semi-urban hospital, Nigeria.

OBJECTIVE: To establish the techniques of anaesthesia for neonatal surgical emergencies in a semi-urban hospital in Nigeria, assess their adequacy and make recommendations to improve our practice. DESIGN: Retrospective study. SETTING: Obafemi Awolowo University Teaching Hospital, Ile-lfe, Nigeria, from January 1990 to December 2000. SUBJECTS: One hundred neonates aged one to twenty eighty days. RESULTS: One hundred neonatal surgical emergencies were operated but only 76 case notes were available for review. Three hundred and fifty eight elective neonatal surgeries were done during the same period. The ASA classification were: ASA IE=10, 2E=25, 3E=28, 4E =12 and 5E=1. The mean weight was 2.66+/ 0.52 kg. Over 95% of the cases were done under general anaesthesia. Anorectal malformations and intestinal obstruction were the most common indications for surgery (64.5%). Nurse anaesthetists gave over 50% of the anaesthetics. Peri-operative adverse events such as tachycardia, respiratory distress, aspiration and hypothermia were recorded in 11.8% of the cases. Mortality was 39.2%. CONCLUSION: General anaesthesia is still the main technique of anaesthesia and mortality following surgery is still high. Efforts should be made to train appropriate personnel to provide improved care and thereby reduce morbidity and mortality.

Anesthesia↗

PubMed2003

Acute generalized peritonitis in African children: assessment of severity of illness using modified APACHE II score.

BACKGROUND: Generalized surgical acute abdomen is a significant cause of morbidity and mortality among children. Severity assessment is useful in order to prioritize treatment and reduce complications. Patients with a high severity score are often faced with high morbidity and mortality, thus, requiring more intensive treatment than those with low severity scores. The purpose of the present study was to assess the severity of the acute abdomen in paediatric patients using a modification of the acute physiological and chronic ill-health evaluation II score (APACHE II). METHODS: Children admitted and operated on for generalized acute abdomen over a period of 7 years from January 1993 to December 1999 were prospectively studied. A study proforma was drafted and demographic, clinical, preoperative, operative and postoperative data on each patient were entered. Each patient had severity of illness assessed using APACHE II parameters with minor modification to make it applicable to children. Postoperative outcome and severity of illness were compared to determine any correlation. RESULTS: There were 69 patients operated on within the period of the study. Age ranged from 3 months to 15 years, with a mean of 9.1 SD 4.3 years. Forty-two patients (61.2%) were male and 27 (39.8%) were female. Typhoid intestinal perforation accounted for 35 (50.7%) and intestinal obstruction with or without intestinal gangrene accounted for nine (13%). Modified APACHE II score ranged from 0 to 18, mean 8.5 SD 5. For survivors, the mean score was 8; for non-survivors, 13. Eight patients died (11.6%): four of 63 (6.4%) patients who scored 0-15 died; four of six (66.7%) patients who scored 16-18 (P < 00.05) died. A modified APACHE II score greater than 15 was associated with a significantly greater mortality. The data for postoperative morbidity and hospital stay were not conclusive. CONCLUSION: Although the APACHE II score was designed for adults, a modification can be suitably applied to predict mortality in children with generalized peritonitis. There will be a need to apply this to large number of patients in order to validate our finding.

APACHE↗

PubMed2002

Rectovestibular fistula with absent distal vagina in an adolescent Nigerian girl.

Rectovestibular fistula is the most common variant of anorectal malformations reported in girls. Rarely does the whole of the anorectum occupy an ectopic position in the vestibule of the vulva. The authors report a case of a 15-year-old girl with rectovestibular fistula associated with occult distal vaginal atresia that was managed successfully by posterior sagittal anorecto-vaginoplasty (PSARVP).

Adolescent↗

PubMed2002

Gastrointestinal duplications in Ile-Ife, Nigeria.

BACKGROUND: Gastrointestinal duplications are rare congenital malformations that commonly present within the first year of life. When they present in older age groups, diagnosis is often difficult. This difficulty derives from the lack of specific clinical features attributable to these lesions OBJECTIVES: To document the challenges posed to surgeons by gastrointestinal duplications in different parts of the world and to report our experience in its management in Ile-Ife, Nigeria. DESIGN: A retrospective study. It involved a study of the clinical records of all patients diagnosed to have gastrointestinal duplication in our hospital. SETTING: A Paediatric and General Surgical unit, University of Ile-Ife Teaching Hospital, Ile-Ife, Nigeria.. RESULTS: Five patients were diagnosed to have gastrointestinal duplications over the of the study. The ate, ranged from 28 days to 52 years. There were four males and one female. One patient presented within the first month of life. The others presented after the age of one year. There were two gastric, two ileal and one rectal duplication. All had the cystic variety of duplication. Three of the patients had excision, one had mucosal stripping and one had internal drainage of the duplication. The outcome was satisfactory in all of them. CONCLUSION: Duplications tend to present at a much older-age group in our environment. Early diagnosis therefore depends on a high index of suspicion and every surgeon operating in the abdomen must be familiar with the management of this condition.

Adolescent↗

PubMed2002

Management of oesophageal foreign bodies in children.

OBJECTIVE: To evaluate the pattern and outcome of management of retained oesophageal foreign bodies in children. DESIGN: Retrospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, January 1991 to December 2000. SUBJECTS: One hundred and eight paediatric patients, aged 0-14 years managed for retained oesophageal foreign bodies. INTERVENTION: The foreign bodies were removed endoscopically, using either a larynoscope or a rigid oesophagoscope, under general anaesthesia. RESULTS: There were 108 patients, with a mean age of 3.0 +/- 0.8 years and age range of 23 days to 14 years. The male to female ratio was 1.5: 1. Sixty four (59.3%) patients were within 1-5 year age group. Coins constituted 79.6% of the retained foreign bodies. Over 90% of patients presented within the first four days of the incidence. The dominant complaints were drooling of saliva in 37 (40.2%) and difficulty in swallowing in 35 (38.1%) patients. The commonest sites of the foreign body retention were the upper third of oesophagus 52(48.2%) and the hypopharynx 36(33.3%). The main complications following the foreign body removal were oesophageal perforations 4(3.7%) and lacerations 16(15%). CONCLUSION: Retained oesophageal foreign body is a common childhood health hazard. Early diagnosis and prompt skillful removal are necessary for a satisfactory outcome.

Adolescent↗

PubMed1999

Prognostic factors in childhood inguinal hernia at Wesley Guild Hospital, Ilesa, Nigeria.

OBJECTIVE: To determine the pattern, outcome and the prognostic factors in childhood inguinal hernia. DESIGN: A five-year prospective study. SETTING: Wesley Guild Hospital, Ilesa, Nigeria. RESULTS: Two hundred and eight patients presented with 237 inguinal or inguinoscrotal hernias. Seventy one per cent were aged five years and below and 24% were infants. Male patients accounted for 94.7% of the cases. Mean duration of symptoms was 1.2 years in the patients without hernia complication but less than five months in complicated hernia. Symptoms of complication such as vomiting and abdominal pain occurred in 7.8% to 15% of children mainly under five years. Inguinoscrotal hernia was diagnosed in 76.5% of cases, of whom 53.8% presented on the right side, 32.3% on the left and 14% bilaterally. Undescended testes, low birthweight, anaemia and malnutrition presented in 22.6% of the cases. Incarcerated hernia was diagnosed in 16 patients (7.7%), all males, with ages ranging from two weeks to two years. Eighty nine per cent of the patients were operated upon as outpatients. Undescended testes constituted the commonest associated operative finding in about five per cent of the patients and one patient had non-rotation of the gut involved in strangulation. Statistical analysis showed that clinical pattern, outcome and the incidence of postoperative complication were significantly dependent on the sex, age and presence hernia complications. CONCLUSION: Inguinoscrotal hernia is commoner and predominantly in the male, majority of whom were below the age of five years. Most associated clinical and operative findings occurred in infants. Incarceration occurred more significantly in infants. Wound infection was the commonest complication. This and other complications were significantly affected by the age of the patients and incarceration.

Adolescent↗

PubMed1997

Total and percentage body water in healthy Nigerian children aged 5-15 years.

Bioelectrical impedance was used to measure total body water in Nigerian children in a clinical setting. Total body water and percentage body water were determined in 454 boys and 450 girls, all healthy Nigerian children aged between 5 and 15 years. The age range and total body water were similar in both sexes but percentage body water was significantly higher in boys than in girls (p = 0.000001). Total body water increased with age in both boys and girls. Percentage body water increased with age but not significantly so in boys (p > 0.076) and decreased significantly with age in the girls (p = 0.008), an indication of differences between the sexes in how the proportion of body fat mass changed with age. These data are very similar to those reported in the literature. The bioelectrical impedance method for body water determination is non-invasive, cheap, portable and well accepted by children. Its more general clinical application in paediatric practice is recommended.

Adolescent↗

PubMed1997

Fat mass, fat mass percentage, body mass index, and mid-upper arm circumference in a healthy population of Nigerian children.

We determined body fat mass, body mass index, and mid-upper arm circumference, in 5-15-year-old Nigerian children consisting of 454 (50 per cent) males and 450 (50 per cent) females. We derived regression equations between body fat mass and age, body mass index, and mid-upper arm circumference for each sex. The mean of age and height were similar in both sexes, while that of fat mass, percentage fat mass, body mass index, and mid-upper arm circumference were significantly higher in the female than male. Percentage fat mass varied between 3.02 and 32.16, and 1.88 and 53.84 in males and females, respectively (P = 0.0000). The percentage fat mass increased slightly with age (but significantly) in the female and decreased slightly with age in the male. Based on the US standards 164 (18 per cent) of the children were obese. We conclude that with improvement in living standards, childhood obesity may become a medical problem in Nigeria.

Adipose Tissue↗

PubMed1996

Presacral myelolipoma: sonographic appearance.

We describe an uncommon case of presacral myelolipoma in a 11/2-year-old boy, causing urinary retention and constipation. The sonographic appearance of the mass mimics a "pseudoprostatic enlargement".

Constipation↗

PubMed1995

Malignant solid tumours in Nigerian children.

The subject of neoplasia in African children has received little or no attention within the past two decades. The current study retrospectively reviews malignant solid tumours in children from birth up to the age of 15 years over an 11 year period in Ile-Ife, Nigeria. During this period, 71 pc of solid tumours seen in children were malignant and boys were more often affected than girls. The peak incidence was between the ages of six and 13 years. Lymphoma was the commonest type of tumour, accounting for 72.6 pc of all malignant solid tumours and males predominated. All the rhabdomyosarcomas were seen in boys and the alveolar variant predominated. Osteogenic sarcoma and nephroblastoma were more often seen in girls. No primary brain tumour was seen.

Adolescent↗

PubMed1993

Radiologic and sonographic evaluation of intra-abdominal abscesses in a Nigerian population.

A prospective study to evaluate the radiologic and sonographic features of intraabdominal abscesses in a mixed Nigerian population was undertaken. 30 patients with suspected abscesses were studied and a total of 70 abdominal abscess sites were confirmed at surgery or during autopsy in 22 patients. The more common abscess sites were the paracolic and pelvic areas. Typhoid enteritis, perforated duodenal ulcer and septicaemia were the aetiological factors in 54%, 13.6% and 13.6% respectively. The more common radiological feature was that of extraluminal gas vesicles and relatively echo free collections were identified during ultrasound. Poor prognosis was associated with typhoid enteritis, multiple abscess sites and acute renal failure.

Abdomen↗

PubMed1992

Sources of intra-operative bacterial colonization of clean surgical wounds and subsequent post-operative wound infection in a Nigerian hospital.

The incidence of postsurgical clean wound infection in 101 consecutive operations was 1.98%. Staphylococci were the predominant bacteria cultured from the anterior nares of the patients and attending surgical personnel--and were found to colonize the wounds. The nasal carriage rates of Staphylococcus aureus amongst the patients and surgical staff were 12.1% and 17.% respectively. Group III and non-typeable (NT) S. aureus strains accounted for about 65% of S. aureus isolates cultured from the anterior nares. A low incidence of nasal carriage of S. aureus isolates correlated with low incidence of wound sepsis. The operating room air seemed considerably contaminated but this did not reflect in high incidence of postsurgical wound sepsis. Our results suggest patients microflora and operating room air were the major sources of intra-operative bacterial colonization of wound at this centre.

Adolescent↗

PubMed1992

Abdominal injuries in Nigerian children.

A retrospective review of cases of abdominal injuries in children at the Obafemi Awolowo University Teaching Hospital in Nigeria show that 195 cases were seen over a 10-year period (1980-1989). A majority of the cases (83.6%) resulted from road traffic accidents, and 152 (77.9%) were either brought in dead or died shortly after arrival in the emergency room. The sex incidence was about equal. The spleen and liver were the two most commonly injured abdominal organs. However, there was a high incidence of multiple organ injury in those patients who died before treatment could be given. None of the 43 children who had clinical intervention died though one of the 12 children who had splenectomy subsequently developed postsplenectomy sepsis from which she recovered. Three children had splenorrhaphy and one had partial splenectomy with good results.

Abdominal Injuries↗

PubMed1992

Peri-umbilical cellulitis in Nigerian neonates.

A retrospective analysis was made of 32 neonates with peri-umbilical cellulitis seen at Wesley Guild Hospital, Ilesa, Nigeria from 1979 through 1989. All were full term and delivered after a normal pregnancy. The male:female ratio was 1.3:1. On admission, the mean (Standard Deviation) post-natal age, weight and duration of symptoms were 7.3 (2.7) days, 3.21 (0.5) kg, and 1.9 (1.3) days respectively. Major features were abdominal distension, extensive peri-umbilical induration and inflammation, and foul-smelling discharge. Most mother had antenatal care, but 60 pc were delivered at home or in the mission house. There were no recognisable maternal risk factors. Hot fomentation and unsterile materials applied to the cord were the apparent causative factors. The case fatality rate was very high (71.9 pc). Recommended treatment was antibiotics and surgical debridement. If hospital delivery were accessible to the less privileged poor, this highly lethal condition could be prevented by facilitating instruction in simple sterile cord care.

Cellulitis↗

PubMed1991

Variegate (mixed) porphyria in a Nigerian girl.

A fatal case of variegate (mixed) porphyria in an 11-year-old Nigerian girl is reported. She presented with severe abdominal pain, vomiting, constipation, quadriplegia and cutaneous bullous dermatosis. Remission was temporarily achieved with chlorpromazine, high carbohydrate diet and physiotherapy. She finally died of respiratory paralysis 17 months after diagnosis.

Child↗