Biomedical subjects

Paul T Nmadu

Publications and source records attributed to Paul T Nmadu.

4 recordsLinked to original sources

PubMed2006

Pediatric surgery in Nigeria.

BACKGROUND: Pediatric surgery is a well-established specialty in many developed countries, but little is known about the status of the specialty in most developing countries. METHOD: The status of pediatric surgery in Nigeria was reviewed. RESULT: Nigeria currently has an estimated population of 126 million people with a growth rate of 2.8%, one half of whom are children. Pediatric surgery is a well-recognized specialty in the country. At the moment, there are 35 trained pediatric surgeons but only 26 are fully functional (1 pediatric surgeon:2.2 million children). Most of the available pediatric surgeons are in tertiary hospitals in major cities and towns. There is a well-established formal training program and certification run by the West African College of Surgeons; it takes an average of 4.5 to 6 years to train in pediatric surgery, 2 years of which must be spent in general surgery. Only 1 to 2 trainees graduate every year, and there are less than 10 trainees in the 5 accredited training centers at the moment. Funding for training is poor, and pediatric surgical research receives little or no funding. CONCLUSION: There is a need for more pediatric surgeons in Nigeria. More trainees need to be mentored and encouraged to take up the specialty. Collaboration with centers in developed countries and other parts of Africa and improved funding are necessary to improve the profile of the specialty.

Certification↗

PubMed2005

Symptomatic vitelline duct anomalies in children.

A wide variety of anomalies may occur as a result of the vitelline duct (VD) failing to obliterate completely. Most reports on symptomatic VD focus on Meckel's diverticulum, while other anomalies are given little attention. A retrospective review was conducted at our institution. According to the records 18 symptomatic children with VD anomalies were seen over 22 years, including 10 boys and 8 girls aged 11 days -14 years (median 7.5 months). Twelve patients aged below 10 years (median 28 days) had patent vitelline ducts (PVDs), 3 children aged 13 months, 13 years and 14 years respectively had Meckel's diverticulum (MD), presenting as inflammation, tapeworm incarceration and volvulus respectively. Two patients, both 8 years old, had umbilical sinus, and a 3-year-old had a vitelline cyst. Only 1 patient with PVD had an associated anomaly (intestinal malrotation). The diagnosis of PVD was obvious clinically, but in 1 patient the fistula was demonstrated by fistulogram. The diagnosis of MD was intraoperative in all 3 patients. Treatment was by various types of resection for PVD and MD and excision for umbilical sinuses and cysts. One patient with PVD developed postoperative intestinal obstruction from adhesions, requiring re-laparotomy and adhesiolysis. Two patients with PVD died from sepsis and anaesthetic-related complications, respectively. Although MD is the most commonly VD anomaly, PVD is the most common symptomatic presentation in our environment.

Adolescent↗

PubMed2003

Complicated umbilical hernias in children.

Umbilical hernia is a common problem in children, particularly in Africans, but complications in these hernias are thought to be rare. In a retrospective study of 47 children presenting for umbilical hernia repair in 14 years, 30 had complications. The complications included acute incarceration 15, recurrent incarceration 10 and spontaneous evisceration 5. Of the 15 with acute incarceration, 2 required bowel resection for gangrene, and an abscess formed in the hernia sac in one. The age of patients with acute incarceration was 2 months-8 years (median 5 years). The 10 with recurrent incarceration were aged 1-3 years (median 3 years). Of the 5 with spontaneous evisceration, one had umbilical sepsis and another intestinal obstruction from intussusception. These patients were aged 3-12 weeks (median 7 weeks). All the complications occurred in hernias that were 1.5 cm or more in diameter. The hernias were repaired using standard methods. Postoperatively, 2 patients developed wound infection. There was no mortality. Though complications of umbilical hernias appear to be rare, there is a need for more active observation of these hernias to identify complications early and treat promptly to avoid morbidity.

Child↗

PubMed2002

Major complications of omphalitis in neonates and infants.

Omphalitis is a common problem in developing countries, and a wide range of complications requiring surgery may occur. We conducted a retrospective review of 19 neonates and infants treated for major complications of omphalitis: 13 boys and 6 girls aged 5-75 days (median 33 days). Five (26%) patients presented with spontaneous evisceration of small bowel through the umbilical cicatrix, resulting in intestinal gangrene in 1. Necrotizing fasciitis (NF) occurred in 5 (26%) patients involving mainly the scrotum, and in 2 involving the penis as well. Three (16%) patients had peritonitis, resulting in intra-abdominal abscesses in 2. Three (16%) had superficial abscesses, 2 (11%) had hepatic abscesses resulting in extensive destruction of the left lobe in 1, and 1 (5%) developed an adhesive intestinal obstruction. Although Staphylococcus aureus was the most commonly cultured organism, many cultures were sterile due to the use of antibiotics before presentation. Treatments consisted of repair of the umbilical cicatrix for evisceration (and intestinal resection for gangrene), radical debridement for NF, drainage and lavage for peritonitis, drainage of superficial abscesses, and lysis of adhesions. Broad-spectrum antibiotics were also given. No patient developed tetanus. One patient died from peritonitis. There was no death from NF. As serious complications may result from omphalitis in neonates and infants, with high morbidity and possible mortality, early recognition and prompt treatment are necessary for a good outcome.

Abscess↗