Surgical Outcome of Treatment of Tracheobronchial Foreign Bodies in Children: A Retrospective Analysis.

BACKGROUND: Foreign body aspiration is an important cause of morbidity and potential mortality in children. The diagnosis of foreign body aspiration may be difficult in children as they are unable to give a history and the condition mimics a host of other childhood illnesses. In this study, we present our experience with foreign body aspiration in children. OBJECTIVES: To study the presentation of children with airway foreign bodies in our environment and discuss the outcomes of management. METHODS: This is a single centre retrospective study of all children who were confirmed to have tracheobronchial foreign body aspiration from January 2015 to December 2019. Biodata, clinical features, radiological features and outcome of management are presented in the article. Statistical analysis used: Measures of central tendency, dispersion and other relevant statistical analysis done with IBM SPSS® version 22. RESULTS: Twenty-one records were complete and analysed. The mean age was 5.95years with a M: F ratio of about 3:1. About 70% of the children presented more than 24 hours after the incident and the vast majority of aspirated objects were inorganic. About half of the children had received a prior wrong diagnosis. Majority of the foreign bodies were left sided (47.6%). Twenty of the 21 foreign bodies were successfully extracted. There were two mortalities recorded in this study. CONCLUSION: Foreign body aspiration is a life threatening condition. Physicians ought to consider this diagnosis in children presenting with unexplained acute respiratory symptoms.

CONTEXTE: L'aspiration de corps étranger est une cause importante de morbidité et de mortalité potentielle chez les enfants. Le diagnostic de l'aspiration de corps étranger peut être difficile chez les enfants car ils sont incapables de donner une histoire et la condition imite une foule d'autres maladies infantiles. Dans cette étude, nous présentons notre expérience avec l'aspiration de corps étrangers chez les enfants. OBJECTIFS: Étudier la présentation des enfants porteurs de corps étrangers des voies aériennes dans notre environnement et discuter des résultats de la prise en charge. MÉTHODES: Il s'agit d'une étude rétrospective monocentrique portant sur tous les enfants dont la ponction trachéobronchique de corps étrangers a été confirmée de janvier 2015 à décembre 2019. Les données biologiques, les caractéristiques cliniques, les caractéristiques radiologiques et les résultats de la prise en charge sont présentés dans l'article. ANALYSE STATISTIQUE UTILISÉE: mesures de tendance centrale, de dispersion et d'autres analyses statistiques pertinentes effectuées avec IBM SPSS® version 22. RÉSULTATS: Vingt et un dossiers ont été complets et analysés. L'âge moyen était de 5,95 ans avec un rapport M:F d'environ 3:1. Environ 70 % des enfants se sont présentés plus de 24 heures après l'incident et la grande majorité des objets aspirés étaient inorganiques. Environ la moitié des enfants avaient déjà reçu un mauvais diagnostic. La majorité des corps étrangers étaient du côté gauche (47,6%). Vingt des 21 corps étrangers ont été extraits avec succès. Deux décès ont été enregistrés dans cette étude. CONCLUSION: L'aspiration de corps étranger est une condition potentiellement mortelle. Les médecins devraient envisager ce diagnostic chez les enfants présentant des symptômes respiratoires aigus inexpliqués. MOTS-CLÉS: corps étranger, trachéobronchique, voie aérienne, aspiration, enfant, fluoroscopie.

Aortic Valve Regurgitation following Transthoracic Open Surgical Ligation of Patent Ductus Arteriosus.

BACKGROUND: Transthoracic open surgical ligation (TTOSL) of patent ductus arteriosus (PDA) remains the most readily available and affordable treatment option in resource-poor countries such as Nigeria. OBJECTIVES: To determine the incidence and outcome of aortic valve regurgitation (AR) following TTOSL of PDA. METHODS: Retrospective audit of consecutive patients who underwent TTOSL of PDA over a 4½-year period (January 2015 to June 2019) at the OAUTHC, Ile-Ife, Nigeria. Hospital records including echocardiograms (pre-operative, immediate post-operative and follow-up performed a day after TTOSL, at 1, 3 and 12 months) were reviewed for presence and severity of AR. RESULTS: Twenty-six patients (11 males and 15 females) aged 3 months 24 years (Mean = 3.16 years) had TTOS PDA ligation. Only 3 (11.5%) patients had AR pre-operatively; 2 graded moderate AR and 1 graded mild. Twenty (76.9 %) patients had immediate post-operative AR; 4 (20.0%) of which were moderate and the others (80.0%) were mild. Eighteen (69.2%) patients still had AR post-operative day 1; 16 were mild and the rest 2 which were moderate were the same patients that had AR pre-operatively. At 3 months follow-up, 6 of 20 patients (30.0%) had AR; all were mild. Only 2 of 18 (11.1%) followed up for 12 months had AR. They both had had moderate AR pre-operatively which were now graded as mild. There was no mortality. CONCLUSION: Aortic regurgitation is common after TTOSL of PDA. However, in most instances, it is mild and transient.

Flexible fiberoptic bronchoscopy in respiratory care: Diagnostic yield, complications, and challenges in a Nigerian Tertiary Center.

INTRODUCTION: Flexible fiberoptic bronchoscopy (FOB) is a key diagnostic and therapeutic procedure in pulmonology. Experience with fiberoptic bronchoscopy is scanty in most developing countries. OBJECTIVES: The goal of this study was to report our experience and clinical utility of fiberoptic bronchoscopy. METHODS: A review of bronchoscopy requests, services, and reports performed over a 5-year period was performed. Demographic characteristics were extracted. Indications for the procedures, type of bronchoscopic sampling done, final diagnosis, and complications were reported. Sensitivities, specificities, and overall diagnostic yield of the procedures were determined. RESULTS: About 163 diagnostic bronchoscopies were performed during the study. Ninety-nine patients with complete data were analyzed. Mean age was 54.8 ± 19.2 years, with males constituting the majority, 56.6%. Suspected bronchial cancer and pleural effusion were the main indications for bronchoscopy (33% and 19.1%, respectively). A total of 80, 39, and 99 bronchial washings, brushings, and bronchial biopsies were performed, respectively. Bronchial cancer was confirmed in 51.5% and was diagnostic in 57% of suspected pleural effusion. Pulmonary tuberculosis was confirmed in 50% of suspected cases and additional 8 cases were diagnosed. The overall diagnostic yield of bronchoscopy was 62%. Specificities of bronchial brushing and washing cytology for excluding bronchial cancer were 90.9 and 83%, respectively, and sensitivities of detecting bronchial cancer were 64.3% and 59%, respectively, P< 0.05 each. Serious complication occurred in about 1%. There was no mortality. CONCLUSIONS: These results show that FOB is a useful and safe procedure with a low complication rate in our setting.

Haemodynamic Changes during Awake Fibreoptic Bronchoscopy in Nigeria.

INTRODUCTION: There are no reports on haemodynamic changes on West African patients undergoing fibreoptic bronchoscopy (FOB). The aim of this study was to document these changes in West African patients undergoing awake FOB. MATERIALS AND METHODS: All consenting patients considered for awake FOB had their pulse rates, blood pressures and oxygen saturations documented at various phases of FOB, during procedures and up to 30 minutes after FOB to monitor any changes from pre-procedure levels. The values were analysed using SPSS version 16. RESULTS: One hundred and sixty FOB were performed on 145 patients. In non- sedated patients, the maximum oxygen saturation fall was 6% at the level of the vocal cord while the pulse rate rose as high as 13% at the carina. Bronchial washings exerted the most changes in sedated patients (SPO2 fell by 4.9%, and pulse rate rose by 11.9%). The mean arterial pressure increased occurred during bronchial washing for both groups (18.7% for non-sedated and 15.7% for sedated patients) CONCLUSION: Tachycardia, elevations in blood pressure and hypoxaemia are more pronounced and occur earlier during FOB in non-sedated patients. Traversing the vocal cords and bronchial washing evoke the most cardivascular changes during FOB.

Unrecognised guide wire migration during internal jugular cannulation and its retrieval--a case report.

AIMS AND OBJECTIVES: The objective of this article is to report a case of unrecognised missed guide wire diagnosed two months after right internal jugular cannulation and which was successfully retrieved from the right femoral vein. PATIENT AND METHODS: The case record of a patient that had retained intravenous guide wire was reviewed with relevant literature. RESULT: A 40-yr-old female had an emergency left thoracotomy on account of haemorrhagic pleural effusion. A right internal jugular central venous catheter (CVC) insertion was performed for resuscitation and haemodynamic monitoring before induction of anaesthesia. A follow-up thoraco-abdominal Computed tomography (CT) scan taken after 8 weeks showed a pigtail intravascular metallic foreign body traversing the distal superior vena cava, right atrium, inferior vena cava, and ending at the right femoral vein. The guide wire was successfully removed via a right femoral venotomy under local anaesthesia. CONCLUSION: Intravascular loss of a guide wire is a rare complication of CVC insertion. If basic precautionary measures were taken, the loss of guide wire would have been avoided.

The impact of psychological illness on outcome of corrosive esophageal injury.

PURPOSE OF STUDY: Esophageal stricture is a debilitating condition with significant morbidity and mortality, occurring often as a complication of the ingestion of corrosives. In the adult, majority of cases are intentional whilst being accidental in the pediatric population. We therefore sought to describe the circumstances of intentional corrosive ingestion and determine the presence and impact of psychiatric illness on the outcome of management. MATERIALS AND METHODS: A retrospective analysis of case folders of patients managed with this condition over a ten-year period (2000-2009) was done by comparing sociodemographics and outcome of management in patients with and without psychiatric disorders. RESULTS: Twenty seven cases were reviewed. Mean age was 30.7 (SD =16.01), with a M:F ratio of 1.25:1.86.2% had a diagnosable psychiatric condition, the most common being depression in 55.6% of the patients. Caustic soda (55.6%) was the most common corrosive ingested. There was a significant difference in mean duration before presentation in patients with (1.7 days) and without (6.6 days) previous psychiatric illness (P = 0.01). A significant positive association was also found between surgical outcome and previous history of psychiatric disorder (P = 0.02). CONCLUSION: Early recognition of psychosocial distress is important to prevent deliberate self-harm. Counter-intuitively, a previous history of psychopathology limits esophageal injury by early presentation and therefore improve chances of a good surgical outcome.

Oxygen supplementation during awake fibreoptic bronchoscopy in a Nigerian tertiary hospital.

BACKGROUND: Examination of the airway is necessary in a wide variety of conditions. This study was carried out to determine the need for oxygen supplementation during the conduct of flexible fibreoptic bronchoscopy on the awake patient. STUDY DESIGN: A prospective study of consecutive consenting patients requiring awake flexible bronchoscopy between January 2010 and December 2011 using a fibreoptic bronchoscope in the study centre was conducted. With the aid of transcutaneous pulse oximetry, baseline oxygen saturation values were recorded as well as at the various stages of the procedure as well as during brush cytology, washings, biopsy, transbronchial biopsies and transbronchial needle aspirations and 5, 15 and 30 minutes post-procedure. Data was analysed using SPSS 16 and significant values were taken at pd"0.05. RESULTS: Sixty-seven awake fibreoptic bronchoscopies were performed on 61 patients comprising 38 males and 29 females and a mean age of 51.9 ± 18.9 years. The lowest mean SPO2 of 91.2% was attained during brush cytology. Thirty- four patients (50.7%) had the procedure without oxygen supplementation. Supplemental oxygen was required in all seven patients with a baseline SPO2 of d"92% while it was required in 63.2% of patients with baseline SPO2 of 93- 96%. Baseline oxygen saturation was the most important predictor of the need for oxygen supplementation (p= 0.005). CONCLUSION: Routine oxygen supplementation is not mandatory for the safe conduct of flexible bronchoscopy. The baseline oxygen saturation value accurately predicts the need for oxygen administration.

Testicular and para-testicular tumors in south western Nigeria.

BACKGROUND: Tumors of the testis and paratesticular tissues are rare, especially in men of African descent. In recent reviews however, the incidence is rising among the Caucasians and black Americans. We set out to determine the incidence in South-Western Nigeria and to examine the histopathologic variants. METHODS: A retrospective study of patients who had histopathologically confirmed testicular and para-testicular tumours between 1989 and 2005 (17 years). Their records were documented at the Ife-Ijesha cancer registry which serves 4.7 million men residing in three states of South-Western Nigeria. RESULTS: There were 26 cases of testicular and para-testicular tumors with an average incidence of 1.5 cases per year. The incidence of testicular cancer in our study was 0.55 per 100,000 population (95% CI, 0.52-0.57) and accounted for 1.1% of all male cancers. Rhabdomyosarcomas were the most common variety (70% of the paratesticular tumors and 26.8% of all tumors of the testis). Seminomas comprised 50% of the germ cell tumors and 15.4% of all testicular tumors in this series. CONCLUSION: There still remains a low incidence of testis cancer in the South Western Nigeria. The reduction in the incidence of seminomas makes rhabdomyosarcomas the most predominant tumor in South Western Nigeria.

Single versus two layer suturing for wound closure after inguinal hernia repair.

OBJECTIVE: Method of skin-subcutaneous closure after inguinal herniorrhaphy affects the operation time and immediate outcome of the wound. The study was aimed to assess the effects of a single layer closure of the skin and subcutaneous wound of inguinal herniorrhaphy, in contrast to the conventional two layer closure. DESIGN: Prospective randomized controlled trials. SETTING: Obafemi Awolowo University Teaching Hospital Ile-Ife, Osun State, Nigeria. PATIENTS AND METHOD: All adult patients attending surgical out patient clinic with uncomplicated inguinal hernia and had surgery, after randomization into two groups from June 2000 Dec 2005 were included in the study. One group had one layer - closure i.e. closure of skin and subcutaneous tissues together at once while the second group had two layer closure i.e. closure of skin and subcutaneous tissues separately. Duration of operation and complications were documented for comparison. RESULTS: One hundred and eighty wounds were studied in 160 patients; the extra wounds being from bilateral inguinal hernias. There were 93 wounds in group one (two layer closure) and 87 wounds in group two (one layer closure. There was no significant difference between healing of wounds and appearance of scars in both groups. The single layer closure group was, however, apparently quicker. (P= 0.006). CONCLUSION: The immediate outcome of the wound in both groups was similar. The medical personnel time was saved by closing the wound in single layer.

Informed consent in surgery: an audit of practice in Ile-Ife, Nigeria.

OBJECTIVES: This study was conducted to assess patients' knowledge of their diagnoses and proposed surgical procedures before giving consent for such procedures in the various surgical units of Obafemi Awolowo University Teaching Hospitals Complex, (OAUTHC), Ile-Ife. MATERIALS AND METHODS: A structured questionnaire was administered to 80 consecutive patients who had just undergone an elective major surgery in general surgery, gyneacology, orthopaedics and surgical subspecialty units of the hospital. RESULTS: Sixty patients (75%) gave consent themselves, while other consents were obtained from close relations. Thirty-seven (46.25%) respondents were informed of the diagnoses and procedure by the unit consultants but no consultant was involved in the completion of the consent form. Seventy-five (93.75%) respondents had a knowledge of the diagnoses, 68(85%) understood the procedure but only 21(26.25%) knew any alternative to the procedure, 29(36.25%) knew at least one complication of the procedure and 12(15%) knew an option or complication of anaesthesia. Forty-five (56.25%) of the consent forms were properly filled while other forms had one error or another. CONCLUSION: Well structured and standardized method of obtaining informed consent from surgical patients should be adopted. While educating patients, the various alternatives to the procedure and possible complications should be carefully explained to the patients who should be carried along in decision making.

Fournier's gangrene complicating ruptured Richter's inguinal hernia.

BACKGROUND: The deceptive entity of Richter's hernia typically presents with complications that are usually associated with high morbidity and mortality. OBJECTIVE: The purpose of this case report is to highlight the association between Richter's groin hernia and Fournier's gangrene as demonstrated in a patient we managed recently. METHODS: A case report of the management of an elderly patient who presented with Fournier's gangrene to a Nigerian tertiary institution following a neglected Richter's hernia on the right groin. The scrotal gangrene was managed by aggressive debridement and secondary closure while the ruptured caecal Richter's hernia was treated by a limited right hemicolectomy with end-to-end ileocolonic anastomosis and repair of the internal ring. REPORT: We describe a rare case of Fournier's gangrene complicating a neglected caecal Richter's inguinal hernia in a 75-year-old Nigerian; highlighting the pathogenesis and management options. CONCLUSION: Caecal Richter's hernia can be associated with Fournier's gangrene.