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Biomedical subjects

O O Lawal

Publications and source records attributed to O O Lawal.

17 recordsLinked to original sources
PubMed2005

The severity, outcome and challenges of breast cancer in Nigeria.

Breast cancer is a very common disease in Nigeria. It is often associated with a poor prognosis for a variety of reasons. This study was designed to investigate the challenges, severity, outcome and factors influencing the outcome of the management of breast cancer in a Nigerian Teaching Hospital with a view to finding ways to improve the current dismal outlook for patients with the disease. The clinical records of patients seen with breast cancer over an 8-year period (1996-2003) in the two units of the Teaching hospital were reviewed. The two units serve the urban, semi-urban and rural communities of some parts of southwestern Nigeria. Two hundred and twelve patients with breast cancer were seen over the 8-year period of the study. The mean age was 48 years (23-85 years). There were 211 female and one male. One hundred and three patients (48.7%) had either postprimary or tertiary education. A proportion of 66.7% were premenopausal, 79.2% had pregnancy early in life and were multi-parous. These also gave a history of prolonged breast-feeding of their children. The tumour was self-detected in 195 (92%). The mean duration of symptoms was 11.2 months (9 days-7 years). Pain in 100 patients (47%) was the most common symptom and the cancer was in the left breast in 113 (53.3%). Localized cancer was in the upper outer quadrant in 85 (40%), whereas the whole breast was involved in 55 patients (26%). Loco-regional features of advanced cancer were seen in 157 patients (74%). The tumour was fungating in 83 (39%) and there was clinical evidence of systemic metastasis in 28 patients (13%). One hundred and seventy-four (80.6%) patients had advanced disease (stages 3 and 4). Definitive surgery was possible in 185 patients (87.3%), neoadjuvant chemotherapy was required in 65 (30.6%), postoperative adjuvant chemotherapy in 178 (84%; drug combinations were CMF-cyclophosphamide, methotrexate, 5-fluorouracil, CMFP-CMF plus prednisone, and CAF-cyclophosphamide, adriamycin, 5-fluorouracil), tamoxifen was administered in all the patients. Only 70 (33.2%) patients were known to have received radiotherapy among those referred to the Radiotherapy unit, with associated fair treatment compliance after surgery. Outpatient clinic attendance was also very poor, only 27 (12.7%) were still being seen in the clinic, 83 patients (39%) were known to be dead and 102 patients were lost to follow-up. The mean follow-up period was 8.4 months (1 week-6 years). In conclusion, breast cancer is very common in our area of practice in Nigeria; the majority of our patients were young and premenopausal women presenting in the advanced stages of cancer. Treatment compliance was very poor. The majority of the patients were dead or lost to follow-up within a year of diagnosis.

Adult↗
PubMed2005

Haematological parameters in sickle cell anaemia patients with and without splenomegaly.

BACKGROUND: The aim is to investigate the clinical and haematologic effects of persistent splenomegaly (PS) and splenectomy in a population of Nigerians with sickle cell anaemia (SCA). MATERIALS AND METHODS: SCA patients attending the Haematology clinic of the OAUTHC, Ile-Ife, were examined physically and haematologically. Patients with PS were compared with age and sex-matched controls without splenomegaly. Foetal haemoglobin (HbF), packed cell volume (PCV), reticulocyte count and the frequency of blood transfusion were noted for both groups. The clinical effects of splenectomy were documented in three patients who underwent the procedure because of symptomatic massive splenomegaly (> or = 10 cm). RESULTS: Seventy-one patients, 40 males and 31 females, aged 16-48 (median, 21) years were studied. Nineteen (26.8%) had PS ranging from 3-22 cm (mean +/- SD = 9.4 +/- 4.4 cm; median = 7 cm). Ten of these had massive splenomegaly (spleen > or = 10 cm) varying from 10-22 cm (mean +/- SD = 12.3 +/- 3.8 cm; median = 12 cm). No significant differences were found between the mean values of HbF, PCV, reticulocyte count, frequencies of pain crisis, transfusion requirement, weights and heights in SCA with PS and age-sex matched controls without PS. Annual transfusion requirement showed a mild negative correlation with splenic size (r = -0.06), which was not statistically significant (p = 0.882). Significant haematologic improvement was confirmed in the 3 patients who underwent elective splenectomy for splenomegaly-induced hypersplenism. CONCLUSIONS: We conclude that massive persistent splenomegaly is a recognised cause of significant morbidity in SCA patients as evident in the patients that underwent splenectomy. However, where it is mild to moderate, PS may not have significant adverse effect on the overall clinical picture of the disorder.

Adolescent↗
PubMed1998

Clinical pattern of perforated prepyloric and duodenal ulcer at Ile-Ife, Nigeria.

High morbidity and mortality often attend perforation of duodenal ulcer. Over a 6-year period at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria, 22 patients presented with prepyloric or duodenal ulcer perforations--a relatively low yearly rate of about four. Of the 15 patients evaluated, approximately three-quarters were working class young men and eight (53%) had no ulcer history. The high morbidity, and 20% mortality rate, observed were attributable to late presentation and the presence of advanced bacterial peritonitis in 67% of the patients at admission. Imprecise clinical features in those with small perforations led to misdiagnosis in a third of cases. Treatment of perforations in the majority (93%) of patients was by simple closure or truncal vagotomy and pyloroplasty. An increase in patients' awareness of the potentials of optimal operative management should encourage earlier presentation.

Adolescent↗
PubMed1998

Ectopic pregnancy involving the rectum.

A case of advanced extrauterine pregnancy involving the rectum and with passage of fetal limb through the anus is presented. The patient probably had a heterotopic gestation.

Adult↗
PubMed1993

Cholecysto-choledochal fistula--Mirizzi syndrome (type II) in a Nigerian.

Mirizzi syndrome is an uncommon cause of obstructive jaundice in which the common hepatic duct is obstructed by stones trapped within the neck of the cystic duct of the gall-bladder. In long standing cases the calculi may erode through into the common duct and may in fact, impact in the resulting fistula. This syndrome with its later progression is a rare complication of calculous disease of the gall-bladder worldwide. While it is perhaps encountered in the developing countries where cholelithiasis is not as prevalent as in the affluent countries, there has not been much documentation. This article reports on a Nigerian patient with a fistulous complication of Mirizzi syndrome (Type II) managed by cholecystectomy and choledochoduodenostomy and also presents a discussion of the condition.

Biliary Fistula↗
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

Giant inguino scrotal hernia: a case report.

Giant inguino--scrotal hernia is largely a problem of developing countries. A case of an unusually giant inguino-scrotal hernia is reported highlighting the problems encountered in management. Orchidectomy, bowel resection and relaxing epigastric incision were successfully employed in repairing the hernia. Hernias may not be difficult to manage if they ar not neglected. Efforts of health education need intensifying in this direction. We propose thorough peri-operative pulmonary exercises to cut down the post-operative pulmonary morbidity.

Adult↗
PubMed1991

Experience with 29 cases of female ventral incisional hernias in Ile-Ife, Nigeria.

Ventral incisional hernia, a major cause of postoperative morbidity after abdominal operations is reviewed in 29 adult female patients following 2042 major procedures during a 10-year period in Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria. All the patients were in the reproductive age group. The overall incidence of 1.4% is low but being a hospital incidence, the authors feel that it should not be deluding. Premature deliveries were associated with pregnancy coexisting with incisional hernia. Operations for complicated obstetric conditions and wound infections, were the major predisposing factors. It is noted that a reduction of the frequency of occurrence of incisional hernia and its complications in female patients can be achieved through a combination of health education and sound surgical technique with good wound care. An elective repair of hernia is most auspicious.

Abdominal Muscles↗
PubMed1990

Gravid uterus in an anterior abdominal wall hernia of a Nigerian woman.

A case of a gravid uterus in an incisional hernia in the anterior abdominal wall of a 27-year-old Nigerian woman is presented. The patient developed an ulceration of the anterior abdominal wall necessitating prolonged hospitalization. She was delivered by emergency lower segment cesarean section at 35 weeks gestational age because of premature labor. The patient unfortunately died from primary postpartum hemorrhage.

Adult↗
PubMed1990

The predictive value of bacterial contamination at operation in post-operative wound sepsis.

Wounds of 53 surgical patients were studied prospectively both clinically and bacteriologically. There were 26 males and 27 females with a mean age of 38.3 yr. Culture of fascia-deep wound swabs at closure of wound at the end of operation was related to culture if postoperative wound infection occurred. Overall wound infection rate was 15.1% with an infection rate for clean wounds of 3.7% being lowest and the dirty wound infection rate of 60% being highest. Pathogenic organisms in seven of eight infected wounds had been isolated at wound closure while in one instance they were different from organisms in the wound at closure. Risk of development of subsequent infection was significant if enteric organisms rather than Staphylococcus were isolated from the wound at closure. Wounds that had negative culture at the end of operation had no post-operative infection. The study underlines the importance of bacteriological analysis of wounds at the end of operation in identifying those at risk of post-operative infection and the probable causative pathogenic organisms. This will be useful in the choice of prophylactic antibodies for treatment of high-risk patients.

Adolescent↗
PubMed1990

Burkitt's lymphoma in a 45-year-old Nigerian woman.

A clinically advanced stage of Burkitt's lymphoma (BL) occurring unusually in a middle-aged perimenopausal woman in an endemic area is reported. Successful treatment was achieved by tumour debulking and intensive pulsed combination chemotherapy. BL needs to be considered in the differential diagnosis of abdominal swellings in adults in endemic areas.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1990

Omental and mesenteric cysts in Nigerian children.

Omental and mesenteric cysts are rare intra-abdominal lesions which may be congenital, traumatic, neoplastic or infectious in origin. They give rise to non-specific clinical features and may be a cause of the surgical acute abdomen, especially in children. Correct preoperative diagnosis is infrequent but a high index of suspicion and use of ultrasonography when available would improve clinical diagnosis. Six omental and mesenteric cysts encountered in five children over a 10-year period (1978-87) are reported. All the cysts were congenital. Three patients presented with non-specific symptoms and two presented with acute abdomen. Correct preoperative diagnosis was made in two patients. All five patients had surgery. Two had enucleation of the cysts, two had excision of the cysts with adjacent bowel segment and one patient with two cysts had partial excision of the wall of the cysts with free internal drainage into the peritoneal cavity. All patients survived.

Adolescent↗
PubMedDate not supplied

Helicobacter pylori in the dental plaque and gastric mucosa of dyspeptic Nigerian patients.

BACKGROUND: Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa. OBJECTIVES: To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians. METHODS: Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology. RESULTS: The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%. CONCLUSIONS: This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.

Adolescent↗
PubMedDate not supplied

Surgical audit in the developing countries.

Audit assures provision of good quality health service at affordable cost. To be complete therefore, surgical practice in the young developing countries, as elsewhere, must incorporate auditing. Peculiarities of the developing countries and insufficient understanding of auditing may be, however, responsible for its been little practised. This article, therefore, reviews the objectives, the commonly evaluated aspects, and the method of audit, and includes a simple model of audit cycle. It is hoped that it will kindle the idea of regular practice of quality assurance by surgeons working in the young developing nations and engender a sustainable interest.

Developing Countries↗
PubMedDate not supplied

Antimicrobial susceptibility of Helicobacter pylori isolates of dyspeptic Nigerian patients.

The resistance of Helicobacter pylori to antibiotic treatment is a growing global concern, but this has not been well studied in our environment. This study sought to determine: the susceptibility of the organism to common antimicrobial agents used in its eradication therapy. Twenty H. pylori isolates from dyspeptic patients were subjected to standard procedures for sensitivity testing and the determination of minimum inhibitory concentration against amoxycillin, ciprofloxacin, clarithromycin, erythromycin, metronidazole, rifampicin and tetracycline. The study showed marked in vitro multiple antimicrobial resistance to the commonly used eradication agents. All twenty isolates were however sensitive to ciprofloxacin. The findings of marked antimicrobial resistance may affect the effectiveness of currently recommended eradication regimes. In our environment, incorporating ciprofloxacin into the existing H. pylori antimicrobial therapy may improve the outcome of eradication.

Adult↗