Biomedical subjects

V O Adegboye

Publications and source records attributed to V O Adegboye.

14 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↗

PubMed2002

Trans-hiatal oesophagectomy as palliative treatment for carcinoma of the oesophagus.

OBJECTIVE: To determine the role of palliation with trans-hiatal oesophagectomy in Nigerian patients with carcinoma of the oesophagus. DESIGN: Prospective case series. The first series was from February 1986 to September 1987 (Series A) while the second series was from March 1989 to November 1996 (Series B). SETTING: Cardiothoracic Surgery Unit (CTSU) of the University College Hospital, Ibadan, Nigeria. SUBJECTS: First series consisted of 10 consecutive operable patients with carcinoma of oesophagus seen over the period of study. The second series consisted of 21 consecutive patients with same disease. INTERVENTION: All patients had transhiatal oeosphagectomy by a two team approach and immediate placement of the freed stomach in the posterior mediastinum and cervical oesophagogastrostomy. RESULTS: Patients in both series had a comparable age range of 43 - 80 years for series A and 40 - 82 years for Series B. The duration of symptoms were 2 - 6 months and 2 - 12 months respectively, for series A and B. In series A, nine patients had carcinoma of the middle-third (M1/3) of the thoracic oesophagus and one patient had carcinoma of lower-third (L1/3) of the thoracic oesophagus. In series B, 18 patients had M1/3 and three patients had L1/3 lesions. Average blood loss in series A was 1,067 mls, corresponding value for series B was 852 mls. Postoperatively, all cases were classified as stage III or stage IV disease. There were 18 complications in eight patients in series A and 22 complications in 10 patients in series B. The commonest complications in series A were pleural enteries in six patients, haemorrhage four patients (three intraoperative, one post-operative) and respiratory failure (two patients). The commonest in series B were pleural enteries in nine patients, anastomotic leaks and stenosis in four patients and respiratory failure in three patients. Hospital mortality was 50% in Series A and 14.3% in series B. The causes of death were haemorrhage and respiratory failure in series A, respiratory failure in series B. Survival period in series A of the five patients discharged was for a median of 84 months, for series B, four patients were alive at 18 months post-operative, one patient attended follow-up clinic 24 months after surgery. No other adjunctive therapy was offered to the patients. CONCLUSION: Trans-hiatal oesophagectomy is a procedure suitable for patients with carcinoma of the oesophagus and affords palliation at an "acceptable price" among carefully selected patients with advanced carcinoma of the oesophagus.

Adult↗

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↗

PubMed2002

Reexpansion pulmonary oedema as a complication of pleural drainage.

One hundred and one (6%) of 1,678 patient studied had bilateral reexpansion pulmonary oedema(RPO). On the whole, one thousand, seven hundred and seventy nine (1,779) pleural spaces were studied, fifteen pleural spaces (0.8%), with mean age of 23 +/- 4.5 years had RPO. Among these 15 patients with RPO, the mean period of lung collapse before pneumothorax (PThx) was evacuated was 31.8 +/- 21.8 days and for hydrothorax (HThx) was 31.3 +/- 30.1 days; for 15 patients without RPO (controls), matched for age and sex, the mean period of lung collapse before CTTD was 7.5 +/- 4.1 days and 5.4 +/- 1.3 days respectively for PThx and HThx. The differences in the period of lung collapse among patients with RPO and those without, for each pleural disease was statistically significant (P < 0.03). Volume of pleural fluid drained before RPO was noticed was 2196 +/- 1103 mls, for the 15 matched patients without RPO (controls), it was 1060 +/- 115 mls (p < 0.05). Volume of pleural fluid drained among the patients with SR (Severe response), MR (mild to moderate response) and RD (radiological diagnosis) did not correlate with severity of response. We conclude that prevention of RPO is the desired goal in the management of pleural effusion or Pneumothorax. RPO is commonest among young patients who have had lung collapse for 7 or more days. In these circumstances RPO is prevented, its incidence and severity reduced by methods of gradual evacuation of PThx or pleural fluid drainage.

Adolescent↗

PubMed2002

Pattern of intrathoracic goiter in Ibadan, Nigeria.

This study is to review the pattern of intrathoracic goiter in a large black population. In a retrospective review, the cardiothoracic unit managed ninety-eight primary mediastinal masses of which sixteen patients with intrathoracic goiters were treated during the same period. This constitutes 1.3% of treated goiters and 16.3% of primary mediastinal masses. Seventy-five per cent of the intrathoracic goiters were in association with cervical goiters. Twelve of the intrathoratic goiters were located in the anterosuperior mediastinum, and two in the middle mediastinum. There were three goiters in the posterior mediastinum. Six patients had cervical exploration and median sternotomy, three had cervical exploration and thoractomy, 3 had only thoractomy, two had only median sternotomy for excision. Thirteen patients (81.3%) had either simple colloid or multinodular intrathoracic goiter, one had follicular adenoma, and 2 patients had malignant goiters. One patient had recurrent cervical goiter. The endemicity of thyroid disease does not seem to increase the frequency of intrathoracic goiter.

Age Distribution↗

PubMed2002

Blunt chest trauma.

A retrospective study was conducted at the cardiothoracic surgical unit of the University College Hospital, Ibadan on all consecutive, blunt chest injury patients treated between May 1975 and April 1999. The period of study was divided into 2 periods: May 1975-April 1987, May 1987-April 1999. The aim was to determine the pattern of injury, the management and complications of the injury among the treated. Blunt chest trauma patients were 69% (1331 patients) of all chest injury patients (1928 patients) treated. Mean age for the 2 periods was 38.3 +/- 15 years and 56.4 +/- 6.2 years, the male:female ratio was 4:1 and 2:1 respectively. The incidence of blunt chest trauma tripled in the second period. Blunt chest trauma was classified as involving bony chest wall or without the involvement of bony chest wall. Majority of the blunt chest injuries were minor chest wall injuries (68%, 905 patients), 7.6% (101 patients) had major but stable chest wall injuries, 10.8% (144 patients) had flail chest injuries. Thoracic injuries without fractures of bony chest wall occurred in 181 patients (13.6%). Seven hundred and eighty-seven patients (59.1%) had associated extra-thoracic injuries, in 426 patients (54.1%) two or more extra-thoracic systems were involved. While orthopaedic injury was the most frequent extra-thoracic injury (69.5%) associated with blunt chest trauma, craniospinal injury (31.9%) was more common injury among the patients with severe or life threatening chest trauma. The most common extra-thoracic operation was laparotomy (221 patients). Nine hundred and seventy patients (72.9%) had either closed thoracostomy drainage or clinical observation, 361 patients (27.1%) had major thoracic surgical intervention (emergent in 134 patients, late in 227 patients). Most of the severe lung contusion that needed ventilatory care (85 patients) featured among patients with bony chest wall injury, 15 were without chest wall injury. Majority of patients 63.2% (835 patients) had no significant complications, 486 patients (30.8%) of 1321 survivors had 741 complications. The commonest complications were atelectasis (201 patients) and pleural space complications (263 patients). Overall mortality was 36.2% (154 patients) among 426 patients. We conclude that majority of blunt chest trauma can be managed by simple procedures with minimal complications. Severe soft tissue chest injuries can occur without bony chest wall fractures.

Adolescent↗

PubMed2001

Penetrating chest injuries in civilian practice.

The purpose of this retrospective study is to show the pattern of penetrating chest injury, methods of management and the outcome. Were viewed all consecutive penetrating chest injured patients admitted to the Cardiothoracic Surgical Unit of the University College Hospital, Ibadan between May 1975 and April 1999. We found that 597 patients had penetrating chest injuries. This was 31% of all chest injuries treated. To analyse pattern of injuries, period of study was divided into 2 periods of 12 years each, May 1975 to April 1987 (Group A) and May 1987 to April 1999 (Group B). Mean ages of the patients in group A and B were, respectively, 27 +/- 12.5years and 48 +/- 10.2 years; male:female ratio for the 2 groups were 20:1 and 17:1, respectively. The main mechanisms of injury were gunshot wounds (GSW) in 364 patients (61%) and stab wounds (SW) in 214 patients (35.8%). The ratio of GSW to SW was reversed for the 2 periods, 1:3 for group A and 7:1 for group B. Nine patients died during resuscitation. Four hundred and eleven patients of 588 patients (69.9%) were managed conservatively. Sixty-five (11.1%) by clinical observation and 346 (58.8%) by closed thoracostomy drainage. Mortality among the conservatively managed was 2.2%, morbidity was 18.2% (75 out of 411 patients). Ninety patients had early major surgery, 75 had late major surgical management of complication of conservative management. The operative mortality was 22% (in 39 patients). The determinant of mortality were haemorrhage, respiratory insufficiency and sepsis. We conclude that penetrating injury is a third of chest injuries we see. It is commoner in men and currently involves the older age group and it is most frequently inflicted by gunshot. Majority may be managed conservatively with low incidence of complications. Prompt major surgery limits mortality among the salvageable.

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↗

PubMedDate not supplied

Postoperative closed chest drainage without an underwater seal: a preliminary report.

The Aldon's urobag (e.g. simpla S4) which consists of a 2 litre plastic bag with a flutter valve and a drainage tube has been used in 29 consecutive cases as a postoperative pleural drainage system. The age range of patients was between 2 months and 74 years (mean 26.7 years). Indications for pleural drainage included lobectomy (3 cases), decortication (2 cases), lung biopsy (2 cases). Blalock-Taussig shunt (5 cases), patent ductus arteriosus patent ductus arteriosus (PDA) ligation (1 case), closed mitral valvotomy (1 case), oesophageal surgery (13 cases) and chest wall resection (2 cases). The period of pleural drainage ranged from 1 to 8 days (mean 3.75 days). The only operative death was not related to drainage system. No complications were attributable to the drainage system. This alternative chest drainage was found to enhance early ambulation, increase the efficiency of patient nursing and reduced the cost of consumables.

Adolescent↗

PubMedDate not supplied

Transhiatal esophagectomy in children with corrosive esophageal stricture.

Ten children with corrosive esophageal strictures were referred for esophageal replacement. The children whose ages ranged between 2 and 6 years (mean 4.1 +/- 1.4 years) had transhiatal esophagectomy (THE) and immediate posterior mediastinal transposition of their isoperistaltic stomach and cervical esophagogastrostomy. No patient had a gastric drainage procedure. All patients had nasogastric tube and a cervical perianastomotic drain until full oral intake resumed. Anastomotic leakages were managed by trans-oral irrigation (TOI) and postoperative feeding was through jejunostomy. Postoperative elective mechanical ventilation was for between 24 and 60 hours. Pleural entries were the commonest complication and they occurred in 6 patients (60%), unilateral in 2 patients, bilateral in 4 patients. Cervical anastomotic leaks and strictures occurred in 2 patients (20%) and 3 patients (30%), respectively, and the 2 patients (20%) who had anastomotic leaks and stricture had associated hoarseness. Though the incidence of complications was high, these responded well to appropriate treatment. There was no mortality in the series. THE and esophageal replacement with isoperistaltic stomach in the posterior mediastinum is a safe and useful procedure in the management of corrosive esophageal stricture in children.

Anastomosis, Surgical↗

PubMedDate not supplied

Bronchiectasis consequent upon prolonged foreign body retention.

OBJECTIVE: To review our experience with bronchiectasis complicating prolonged endobronchial retention of foreign bodies (FB) among patients with a history of aspiration of FB seen between 1975 and 1998. DESIGN: A retrospective review of clinical data of consecutive patients with a history of aspiration of FB treated during the time of study. SETTING: The Cardiothoracic Unit of the University College Hospital, Ibadan, directly serves a population of about 40 to 60 million in the South Western Nigeria and the community clinics. SUBJECTS: All patients with a history of FB aspiration (or suggestive of FB aspiration) from whom patients with prolonged FB retention were selected. MAIN OUTCOME MEASURES: Patients with a relevant history or chronic respiratory symptoms had their clinical examination findings, plain chest radiographic (or/and bronchographic) findings, treatment modalities and outcome studied. RESULTS: Sixteen patients among 203 patients who had tracheobronchial foreign bodies removed had this complication. The mean age at presentation was 13.0 +/- 17.3 years. Twelve patients (75%) retained inorganic materials and in four patients (25%) it was organic. The period of retention ranged between 4.8 to 108 months (mean 17.0 +/- 22.6 months). Main presenting symptoms were: productive cough, 16 patients; pyrexia, seven patients; combination of chest pain, fever and copious sputum, five patients. In none of the patients was the history of aspiration of FB definitely elicited before commencement of treatment. Symptoms were worst among patients who retained inorganic materials. All of the patients had bronchoscopy but retrieval of FB by this means was successful in one patient (6.3%). Six patients (37.5%) had thoracotomy and bronchotomy; nine patients had bronchotomy and lung resection [seven (77.8%) lobectomies, one (11.1%) pneumonectomy and one (11.1%) segmentectomy] as the definitive treatment. The one patient who had brochoscopic retrieval subsequently had lobectomy to control symptoms of bronchiectasis. Five out of six (83.3%) who had bronchotomy had persistent symptoms of bronchiectasis. All the nine (56.3%) who had lung resection remained asymptomatic at follow up. There was one mortality (6.3%) in the series--a 75 year old who died from poorly controlled Diabetes mellitus. CONCLUSION: Prevention of aspiration of FB is better than cure. In every medically treated child with persistent cough with or without a history of aspirated FB, the possibility of retained FB should be borne in mind.

Adolescent↗