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Biomedical subjects

S A Adebonojo

Publications and source records attributed to S A Adebonojo.

At least 19 recordsLinked to original sources
PubMed1999

Impact of revised stage classification of lung cancer on survival: a military experience.

STUDY OBJECTIVES: This report reviews results of surgical management of lung cancer at a military medical center using the revised 1997 stage classification and determines the impact of the revised system on survival rates. It also compares our results with the recent reports from Japan and from a large, multinational study involving several institutions. DESIGN: Retrospective review. SETTING: Department of Cardiothoracic Surgery, Walter Reed Army Medical Center (WRAMC), Washington, DC. PATIENTS OR PARTICIPANTS: Active military members, their dependents, and eligible retired military members who were admitted to WRAMC for surgical treatment of lung cancer between January 1984 and December 1996. METHODS: Records of all patients who had surgical resection with intent to cure were reviewed. Data extracted included clinical and pathologic stages according to the 1997 revised stage classification. Survival probabilities for the stages were calculated by the Kaplan-Meier actuarial method. The log rank test was used to compare survival rates between stages and stage subsets. A p value < 0.05 was considered statistically significant. MEASUREMENTS AND RESULTS: Five hundred fifty-two of the 1,398 patients with primary lung cancers underwent curative surgical resection (39.5%). The operative mortality was 2%. Using the revised 1997 stage classification, the survival rate for stage IA was 77%; IB, 62%; IIA, 57%; IIB, 47%; IIIA, 28%; IIIB, 20%; and IV, 0%. The overall actuarial 5-year and 10-year survival rates were 58% and 45%, respectively (median survival, 3.3 years; mean survival 3.9+/-0.1 years). CONCLUSIONS: Our results confirm the justification for the recent revisions in the staging system of lung cancer; however, there are still discrepancies that cannot be explained.

Adenocarcinoma↗
PubMed1998

Video-assisted talc pleurodesis for malignant pleural effusions utilizing local anesthesia and I.V. sedation.

METHODS: Twenty-four consecutive patients aged 36 to 84 years (mean, 63.3+/-12.9 years) underwent video-assisted talc pleurodesis (VATP) for malignant pleural effusion (MPE) utilizing local anesthesia with IV sedation at the Walter Reed Army Medical Center. The VATP procedure was performed in the operating room with the patient in the lateral decubitus position breathing spontaneously through a face mask with 4 L/min of oxygen. Anesthesia was achieved by intercostal nerve block using a 50/50 mixture of 1% lidocaine with epinephrine and 0.5% bupivacaine hydrochloride (Marcaine) supplemented with local infiltration of the access (Surgiport) sites as necessary. Sedation was achieved with propofol, and pleurodesis was performed with 3 to 8 g (average, 5 g) of sterile talc insufflated through a talc atomizer. RESULTS: The mean operating time was 44.3+/-14.9 min (range, 23 to 75 min). The average number of days of chest tube drainage was 2.9+/-1.2 days (range, 1 to 5 days). Patients stayed on the cardiothoracic ward for an average of 4.4+/-1.3 days before discharge home or transfer to a medical oncology ward. Seventeen of the 24 patients (71%) had excellent results, 4 patients (17%) had good results, and 3 patients (12%) had poor results. The three patients with poor results all had primary lung cancer as their underlying malignancy. The overall actuarial survival was 66% at 6 months, 48% at 12 months, and 32% at 24 months with a mean survival of 9 months. There was one operative death in an 84-year-old patient with primary lung cancer. Twelve of the 24 patients are alive 4 to 30 months after VATP. CONCLUSIONS: VATP, performed under local anesthesia, is a safe and highly effective method of managing MPE.

Adult↗
PubMed1997

The results of modern surgical therapy for multiple primary lung cancers.

STUDY OBJECTIVES: The purpose of this report is to review our experience with multiple primary lung cancers (MPLC) at the Walter Reed Army Medical Center, Washington, DC, and to determine the outcome of our surgical management of this complex problem. PATIENTS AND METHODS: The data from the Lung Cancer Registry on patients with MPLC from January 1984 to December 1995 were reviewed. We used the criteria of Martini and Melamed modified by Antakli for the diagnosis of synchronous and metachronous MPLC. Survival probabilities were calculated by the Kaplan-Meier actuarial method with the dates of resection as the starting point and included deaths from all causes. The log rank test was used to compare survival rates between groups and Wilcoxon rank sum test was used to compare the intervals between the first and the second metachronous cancers. A p value of 0.05 was considered statistically significant. RESULTS: Fifty-two patients, consisting of 51 patients who had "curative" pulmonary resections and 1 patient who had radiation therapy for previous primary lung cancer, developed second or third primary lung cancers. Thirty-seven patients developed metachronous cancers within 1 to 15 years of the first operation (median, 24 months) while 15 patients had synchronous cancers (10 unilateral, 5 bilateral). The probability of cancer-free interval among patients with metachronous cancers was 41% at 3 years, 16% at 5 years, and 3% at 10 years. Two of the 36 patients who had pulmonary resection for the second metachronous cancer died in the perioperative period (operative mortality, 5.6%), and one patient had radiation therapy for the second metachronous cancer. There were no deaths among patients with synchronous cancers. The actuarial 5-year survival for second metachronous cancers was 37% and for synchronous cancers was 0%. CONCLUSIONS: We conclude that an aggressive surgical approach is safe and justified in most patients with MPLC, especially patients with metachronous cancers, while patients with synchronous lung cancers have poorer prognosis. The operative morbidity and mortality are acceptable and long-term survival is possible in many patients with metachronous lung cancer.

Actuarial Analysis↗
PubMed1989

High density lipoprotein cholesterol as a determinant factor in coronary heart disease in Africans.

A study of the lipid profile of 200 normal Nigerian subjects (Group A) shows a steady increase in the total cholesterol and triglyceride values with increasing age in both sexes, while the high density lipoprotein (HDL) cholesterol and percent HDL cholesterol values show a steady decrease with increasing age in both sexes. A similar study of 160 patients with high-risk factors (Group B), ie, patients with hypertension, diabetes mellitus, cigarette smokers, and obese patients, shows significantly higher values of mean triglyceride than in the normal subjects (P less than 0.001). The HDL cholesterol and percent HDL cholesterol values are significantly lower in the high risk patients than in the normal subjects (P less than 0.001). A study of the lipid profile of 15 Nigerian patients with coronary heart disease (CHD) (Group C) shows significantly lower in the high-risk patients than in the percent HDL cholesterol than normal subjects (P less than 0.001). These values were also found to be significantly lower in Group C patients than in Group B patients (P less than 0.01). A comparison of the lipid profile of normal Nigerian subjects with those of black Americans shows that the total cholesterol values of normal black Americans are significantly higher than those of normal Nigerians of comparable age and sex (P less than 0.001). Although there is no significant difference in the HDL cholesterol values of both black American and Nigerian males and females, the values of the percent HDL cholesterol of black Americans are significantly lower (P less than 0.01) than those of Nigerians of comparable age and sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The status of cardiovascular surgery in West Africa.

This report reviews the present status of cardiovascular surgery in West Africa and highlights some of the constraints of development in this field.Rheumatic heart disease is still endemic in the tropics, where it constitutes about 20 percent of all cases of cardiovascular disease (CVD) in Nigeria. Endomyocardial fibrosis is a disease of unknown etiology accounting for 10 to 20 percent of cases. Purulent pericarditis is a common complication of pyomyositis and osteomyelitis found in 5 percent of patients. Chronic constrictive pericarditis is a sequela of infective pericarditis found in 5 percent of all cases of CVD. Calcification is found in 30 percent of cases and pericardiectomy can be performed successfully without cardiopulmonary bypass. Infective endocarditis is equally rare, occurring in 2.5 percent of cases; it is a common source of septic emboli to coronary artery and a very difficult disease to treat in the West African environment.Ischemic heart disease is relatively uncommon, accounting for less than 0.5 percent of patients. The rarity of the disease in black Africans has been attributed to dietary habits and environment rather than to racial and psychosocial factors. Congenital heart disease accounts for 5 percent of all cases of CVD in this review. Ventricular septal defect and patent ductus arteriosus are the most common acyanotic defects, while tetralogy of Fallot and transposition of the great arteries are the most common cyanotic defects.Vascular diseases are uncommon in this series, with traumatic injuries accounting for most of the cases. Abdominal aortic aneurysms, peripheral occlusive vascular disease, and atherosclerotic aortic aneurysms are quite rare. This review further confirms the rarity of deep venous thrombosis and pulmonary embolism in Africans.

Adolescent↗
PubMed1984

Developmental anomalies of the lung in Nigerian children.

Five cases of developmental lung anomalies occurring in Nigerian children are reported; three were congenital lobar emphysema while two were scimitar syndromes. The radiological features demonstrated in each case effectively excluded the common causes of pulmonary disorders. Three patients were treated surgically with successful results in two. We believe that an increased awareness in our tropical setting would result in improved detection of these treatable but rare conditions.

Female↗
PubMed1982

Suppurative diseases of the lung and pleura: a continuing challenge in developing countries.

A retrospective study of 1,150 consecutive patients with thoracic and cardiovascular diseases seen at the University College Hospital, Ibadan, Nigeria, over a five-year period (January, 1975, to December, 1979) showed that 42% (481 patients) were treated for suppurative diseases of the lung and pleura, notably empyema thoracis, lung abscess, and bronchiectasis. Of these, 336 or 70% were treated for empyema thoracis, most of whom were less than 2 years old. Seventy-five patients (16%) had lung abscess, 53 of whom were treated medically with 8 deaths, while 22 had emergency resection for massive hemoptysis with 9 deaths. Of the 70 patients with bronchiectasis, 37 were treated medically with 2 deaths, while 33 were treated surgically with 5 deaths. These data demonstrate that infectious diseases of the lung and pleura remain the greatest challenge to the thoracic surgeons in tropical, developing countries who are often handicapped by inadequate facilities, lack of drugs, illiteracy, poverty, superstitious beliefs, and poor environmental hygiene.

Adolescent↗
PubMed1981

Purulent pericarditis: a continuing surgical challenge.

This report presents a prospective series of 12 patients with a diagnosis of purulent pericarditis who were treated between April 1978 and September 1979 by the cardiothoracic surgical unit at the University College Hospital, Ibadan, Nigeria. These patients were studied to determine the adequacy of a therapeutic protocol consisting of systemic antibiotics and pericardiostomy tube drainage. All patients were in the pediatric age group with an average age of 6¾ years. Bronchopneumonia was the antecedent focus of sepsis in eight patients, with pyomyositis in four (33 percent). Two patients expired prior to surgery.No mortality or significant morbidity occurred in the ten patients who underwent pericardiostomy.The results of this series combined with the initial experience reported in 1978 by the same authors confirm the described protocol as the treatment of choice in their environment.

Anti-Bacterial Agents↗
PubMed1981

Management of tuberculous destroyed lung in Nigeria.

Between 1969 and 1979, 20 patients under-went pneumonectomy for tuberculous destroyed lungs (TDL) at the University College Hospital (UCH), Ibadan, Nigeria. Their ages ranged from 9 to 57 years, with an average age of 24 years. The left lung was involved in 16 patients (80 percent) and the right lung in four patients (20 percent). All patients had received treatment for pulmonary tuberculosis (PTB) for over three years, and all patients had negative cultures of acid-fast bacilli (AFB) at the time of operation. Pulmonary function studies were performed in 15 patients, bronchography in 18, and pulmonary angiography in four. Ninteen patients had elective resection because of mild to moderate hemoptysis without mortality. The only death occurred in a 37-year-old man who had emergency resection because of massive hemoptysis. He died intraoperatively of cardiac arrest. One patient developed bronchopleural fistula (BPF), empyema, and wound infection. The fistula closed spontaneously following prolonged chest drainage and pleural irrigation with antibiotics and antituberculous drugs. As a result of our experience with pulmonary tuberculosis in our environment, the authors now recommend elective resection for patients with TDL in order to prevent massive hemoptysis which may prove fatal.

Adolescent↗
PubMed1980

Open pulmonary valvotomy: report of the first successful open heart surgery at the University College Hospital, Ibadan, Nigeria.

Although cardiac surgery has become the standard procedure for management of intracardiac and extracardiac defects in developed countries, it is still relatively new in Africa. This report describes our first successful open heart surgery on a 16-year-old Nigerian boy who underwent open pulmonary valvotomy under cardiopulmonary bypass for congenital pulmonary stenosis at the University College Hospital, Ibadan, Nigeria, on September 18, 1979.

Adolescent↗
PubMed1980

Management of post-pneumonectomy empyema and bronchopleural fistula in Nigeria.

This report reviews our experience with six patients with post-pneumonectomy empyema and bronchopleural fistula over a ten-year period (1969-1978) at the University College Hospital, Ibadan. The most common indications for pneumonectomy in this environment are TB-destroyed lung and suppurative diseases of the lung complicated by massive hemoptysis. Five of the six patients who developed these complications presented with life threatening hemoptysis due to lung abscess and pulmonary aspergillosis. The sixth patient presented with TB destroyed lung.This study shows that these complications are more common following emergency pulmonary resection for suppurative lung diseases and following the removal of the right lung. We have achieved the best results with initial closed chest tube drainage followed by continuous pleural irrigation and later by Clagett procedure or open tube drainage.

Adolescent↗
PubMed1980

Esophagopleural fistula: a complication of chest intubation for empyema.

This report documents the first recorded patient in the recent literature with an esophageal perforation and an esophagopleural fistula following chest intubation for empyema. It was treated successfully by conservative method with feeding gastrostomy. It is important to realize that tube thoracostomy drainage is not an innocuous procedure and to be alert to this complication, especially in the presence of empyema.

Child, Preschool↗