Search PubMed⌕ Search

Biomedical subjects

A T Kidmas

Publications and source records attributed to A T Kidmas.

18 recordsLinked to original sources
PubMed2006

Incarcerated umbilical hernia in children.

BACKGROUND: Umbilical hernia is common in children. Complications from umbilical hernias are thought to be rare and the natural history is spontaneous closure within 5 years. PATIENTS AND METHODS: A retrospective analysis was performed of the medical records of a series of 23 children who presented with incarcerated umbilical hernias at our institution over an 8-year period. RESULTS: Fifty-two children with umbilical hernias were seen in the hospital over the period. Twenty-three (44.2%) had incarceration. Seventeen (32.7%) had acute incarceration while 6 (11.5%) had recurrent incarceration. There were 16 girls and 7 boys. The ages of the children with acute incarceration ranged from 3 weeks to 12 years (median 4 years), while the ages of those with recurrent incarceration ranged from 3-15 years (median 8.5 years). Incarceration occurred in hernias of more than 1.5 cm in diameter (in those whose defect size was measured). Twenty-one children (15 with acute and all six with recurrent incarceration) underwent repair of the umbilical hernia using standard methods. The parents of two children with acute incarceration declined surgery after spontaneous reduction of the hernia in one and taxis in the other. One boy had gangrenous bowel containing Meckel's diverticulum inside the sac, for which bowel resection with end-to-end anastomosis was done. Operation led to disappearance of pain in all 6 children with recurrent incarceration. Superficial wound infection occurred in one child. There was no mortality. CONCLUSION: Incarcerated umbilical hernia is not as uncommon as thought. Active observation of children with umbilical hernia is necessary to prevent morbidity from incarceration.

Child↗
PubMed2005

A review of the radiological diagnosis of small bowel obstruction using various imaging modalities.

Radiological investigation is an important tool in the diagnosis of small bowel obstruction (SBO). While plain abdominal radiograph remains the commonest investigation done in SBO, contrast gastrointestinal radiography, ultrasonography (US), computerised tomography (CT) scan -- with or without contrast enhancement are increasingly being advocated particularly in equivocal cases of SBO. We conducted manual, medicine and internet search for relevant literature on diagnosis of SBO using radiological investigations. Plain abdominal radiograph has a diagnostic accuracy for SBO that varies widely from 50 - 92% . Contrast gastrointestinal radiograph in equivocal cases of adhesive SBO can readily differentiate between complete and partial obstruction. Abdominal ultrasound is cheap and readily available. Accuracy of as high as 89% has been reported in experienced hands. CT scan has an added advantage of predicting the site and cause of obstruction. In developing countries like ours, plain abdominal radiography still remains an important diagnostic tool. The role of abdominal ultrasonography needs further evaluation since it is safe, readily available and affordable.

Humans↗
PubMed2004

Acquired rectal fistula in human immunodeficiency virus-positive children: a causal or casual relationship?

Acquired rectal fistula in human immunodeficiency virus (HIV)-positive children is a new and worrisome entity. The aim of this paper is to highlight the relationship between HIV infection and acquired rectal fistula (RF) in children in order to create awareness among clinicians who attend to children. Over a 1-year period, 11 girls aged 4 weeks-11 months (median 5 months) with acquired RF were managed at our institution. Ten were HIV-positive by enzyme-linked immunosorbent assay and confirmed by Western blot test. One child defaulted before the test. All the mothers and three fathers of the 10 children were seropositive for HIV. Bronchopneumonia, otitis media, oral thrush, diarrhoea, and lymphadenopathy were common associations. Treatment was essentially conservative because the result of surgical intervention was disappointing. Two of the infants and one of the fathers are now dead from full-blown acquired immunodeficiency syndrome. Acquired RF seems to be a sign of HIV infection in children. It will be necessary to screen any child presenting with acquired RF for HIV infection.

Causality↗
PubMed2004

Lower limb amputation in Jos, Nigeria.

OBJECTIVE: To determine the pattern of lower limb amputation (LLA) and highlight preventable causes in our hospital. DESIGN: A retrospective study. SETTING: University Teaching Hospital, Jos, Nigeria. SUBJECTS: Eighty seven patients who had LLA over a five and a half year period. There were 62 males and 25 females aged between three and 83 years (mean+/-SD = 44.5+/-21.1). MAIN OUTCOME MEASURES: Indications, morbidity and mortality. RESULTS: A total of 94 LLA were performed in the 87 patients managed. Trauma, diabetic foot sepsis and malignant conditions of the limb were the main indications for LLA in 26(29.9%), 23(26.4%) and 20(23%) patients respectively. Others were peripheral vascular gangrene (PVG) in eight (9.2%) patients; chronic osteomyelitis, three (3.5%); chronic leg ulcers, three (3.5%); Ainhum, three (3.5%) and snake bite in one patient (1.1%). Above knee amputation (AKA) was the most common procedure performed (48.9%) followed by below knee amputation (BKA) in 37.2%. There were 11 deaths (12.6%), out of which eight were due to sepsis with multiple organ failure following diabetic foot sepsis, two cases of clostridial myonecrosis complicating compound fractures and a case of metastatic osteosarcoma in a child. CONCLUSION: Majority of the cases of LLA could have been avoided with early presentation and appropriate management. A case is made for community health education on the need for early presentation to hospital for limb lesions.

Adolescent↗
PubMed2004

Acute appendicitis in inguinal hernia: report of two cases.

We report two cases of acute appendicitis in right incarcerated inguinal hernia (Amyand's hernia). One patient had gangrenous appendicitis that affected the adjoining caecum. A limited right hemicolectomy was done by extending the groin incision laterally and proximally. The second patient had simple appendicectomy. Posterior wall was repaired using nylon darn in both cases. Acute appendicitis should be considered in the differential diagnosis of obstructed right inguinal hernia.

Acute Disease↗
PubMed2004

Prevalence of umbilical hernia in a private school admission-seeking Nigerian children.

BACKGROUND: Despite the claims that umbilical hernia (UH) is common among Nigerian children, the socio-economic class-related prevalence or incidence rate of UH in the Nigerian children is not known. We therefore undertook this study to determine the prevalence of UHs among Nigerian children of high socio-economic class. PATIENTS AND METHODS: This 7- years prospective study assessment of the prevalence of primary umbilical hernias among a private school admission seeking Nigerian children. Clinical evaluations of the umbilicus were conducted on 7,968 Nigerian children, attending interview into Nigerian Airforce Military schools from across the country. RESULTS: Umbilical hernia was present in 102 (1.3% ) out of 7968 children, giving a prevalence of 12.8 per 1,000. Fifty-three (52.% ) were boys and 49 (48% ) were girls; their ages ranged from 6 to 9 years (mean 6.5 years). Umbilical hernia was 1.4 times as common in the girls as in the boys, with a prevalence of 15.3 per 1,000 and 11.1 per 1,000, respectively. The overall prevalence in this study is comparatively lower than those previously reported. CONCLUSION: Our study suggests that there is a low prevalence rate of UH among the children of high socio-economic class in Nigeria.

Child↗
PubMed2004

Thyroglossal duct lesions in childhood--a review of experience in Nigerian children.

This is a retrospective study of 36 children with thyroglossal duct lesions managed at a tertiary hospital in Nigeria, between 1993 and 2003. The aim was to determine the pattern of presentation and outcome of management. The majority of patients presented with a chronic thyroglossal sinus with associated recurrent inflammation. The location and relationship of the lesions to the hyoid bone were similar to those encountered in the rest of the world. Despite their well-documented clinical features, thyroglossal duct lesions were misdiagnosed in some patients. The main complications were surgical site infections and recurrence. A plea is made for clinicians to pay attention to clinical and operative details so as to diagnose these lesions accurately and manage them properly.

Child↗
PubMed2003

Mass casualty management: Jos University Teaching Hospital experience.

Three experiences of management of mass casualties in Jos University Teaching Hospital were analysed. Classification into minor, moderate and major mass casualties was done using multiple criteria of number of casualties, number of doctors required to contain the situation, number of nurses and paramedical staff, degree of distruption of hospital services and time required to handle the immediate stabilisation of the casualties. The classification recognises a category called "regional disaster" and attempts to enunciate a principle of initiation, mobilisation and co-ordination of management of such disasters among hospitals and human and material resources within the region. It is envisaged that coalescence of "regional disaster preparedness" would from the bedrock of national ambulance services system.

Accidents, Traffic↗
PubMed1997

Management of childhood splenic trauma--the Jos experience.

We studied retrospectively 22 children who were managed for splenic injuries at Jos University Teaching Hospital between September 1988 and October 1995. Sixteen were males and six were females (M:F = 2.7:1) with their ages between five and 15 years and a mean of 10.3 years. Eleven were knocked down by vehicles while crossing the freeway, playing or hawking goods; seven fell from slippery mango trees after a downpour of rain while two were passengers in a vehicle that was involved in a head-on collision and another two were kicked in the abdomen as a result of assault. All had surgery. Four sustained Uphadhyaya and Simpson's Type 1 injuries while six sustained Type IV injuries. Twelve had total splenectomy, seven had total splenectomy with heterotopic autotransplantation of splenic wafers while three had splenorrhaphy augmented with omentoplasty. An average of 1.5 units of blood per patient were transfused. There was only one death. Considering that the majority (18) of these children sustained their splenic injuries while crossing the freeway (playing or hawking goods) and from falls from mango trees after the rains, we believe that there are preventable causes. Mandatory primary and junior secondary school education as well as legislature against child labour will help keep these children safe out of harm's way and thus drastically reduce the incidence of childhood splenic injuries in our environment.

Adolescent↗
PubMedDate not supplied

Typhoid intestinal perforation in north central Nigeria.

BACKGROUND: Typhoid intestinal perforation is a surgical problem with severe morbidity and high mortality in North Central Nigeria. PATIENTS AND METHODS: In order to determine the pattern and the prognostic indices, we studied 101 patients with typhoid intestinal perforation managed over a ten-year period RESULTS: Children constituted 49% of the cases and majority (78%) of the patients were in the low socio-economic strata. The incidence peaked to 67% between November and March - the dry season in Nigeria. The male/female ratio was 1.9:1 with a mean age of 19 years and a mean hospitalization period of 18 days. There were 167 perforations; four involved the large bowel and appendix, and in 72.2% cases, the perforation was single. The mortality rate was 13.9%, affected mostly children and significantly worsened by prolonged perforation-surgery interval > 72 hours, jaundice, convulsion, ASA V, faecal peritonitis and re-exploration for early intra-peritoneal complications. Morbidity rate was 65.3% and significantly affected more children than adults and associated with perforation-surgery interval of between 24 and 72 hours, haematochezia and multiple perforations. Moribund patients fared better when operated upon under local anaesthesia with adequate analgesia. The least traumatic but effective surgical procedure that could seal the perforations and keep the peritoneum clean gave the best results. Children who survived up to 5 days and adults who survived up to 10 days after surgery had better chances of survival. CONCLUSION: The most significant prognostic factor is late presentation which prolongs perforation-surgery interval and the other complication and mortality indices are directly influenced by it.

Adolescent↗
PubMedDate not supplied

Male breast malignancy in Jos University Teaching Hospital.

BACKGROUND: Male breast malignancies are rare. Cancer of the male breast accounts for about 1% of all breast cancers. Poor level of awareness often results in late presentation and delayed diagnosis in our environment. PATIENTS AND METHODS: A retrospective study of all cases of male breast cancer (MBC) managed in Jos University Teaching Hospital over a 17-year period (January 1987-December 2003.) RESULTS: A total of 302 cases of breast malignancies were managed over the study period. Twenty-six (8.6%) of these were males giving a male:female ratio of 1:10.6. The ages of the 26 MBC cases ranged from 12 years to 85 years, with a mean of 57.9 years and median age of 67 years. The right breast was affected in 15 and the left in 11. Mean duration of symptoms before presentation was 6 months with a range of 3 months to 4 years. All the patients had history of breast lumps, 21 (80.8%) of which were painless. Skin ulceration and axillary node enlargement were present in 19(73.1%) and 24(92.3%) respectively. Five (19.2%) were stage II; 15(57.7%) stage III and 6(23.1%) stage IV. There were 23 (88.5%) carcinomas, 2 (7.7%) fibrosarcomas and a case of Hodgkin's lymphoma. Invasive ductal carcinoma was the most common histological type in 20 (76.9%) of all breast malignancy and 20 (87.0%) of all breast carcinomas. Modified radical mastectomy (mastectomy with axillary clearance with or without division of the pectoralis minor muscle) was done in 10(38.5%) patients. Two of these were fibrosarcomas. Simple mastectomy was done in 13 (50%) as toilet procedures for advanced disease. The only case of Hodgkin's lymphoma had chemotherapy. Bilateral orchidectomy (BO), Tamoxifen, chemotherapy and radiotherapy were offered in 7(26.9%), 13(50%), 17(65.4%) and 7(26.9%) patients respectively. Wound infection was the most common complication in 14(53.8%) patients. There was no case of hospital mortality. CONCLUSION: MBC accounts for 8.6% of all breast cancers in our centre. It affects elderly males. Late presentation with advanced disease and ulceration is a common feature in our environment.

Adolescent↗
PubMedDate not supplied

Immediate mass casualty management in Jos University Teaching Hospital: a successful trial of Jos protocol.

Traumatic, injuries arising from high velocity means of mobility, increased industrialization, frequent ethnic and religious classes and terrorist activities by way of bomb blasts, etc., often result in sudden unexpected mass casualty presenting to a given secondary or tertiary health institution. The successful management of such situation involves multidimensional and multidisciplinary approach anchored on awareness, preplanning and alertness. In response to the challenge, the orthopaedic and trauma unit of Jos University Teaching Hospital worked out the "Jos Protocol" which embodies the principle and strategy for mass casualty management and response to field distress call to the hospital within the practical limitations of our infrastructure. On the sixth of April, 1997 a vehicular collision in a neighbouring village resulted in twenty nine severely injured patients being rushed to the hospital's accident and emergency unit. By activating the protocol and utilizing the cascade call our system, mutual aid, hospital mobilization, reach out system, modified hospital triage, team work, effective manoeuvers and treatment modification, the immediate rescucitation and stabilization of patients was achieved in five hours. The working team comprised fifteen doctors and some hospital workers who could be reached on a weekend. Out of the mortality of 6 patients, 3 died in the triage zone while 3 were brought in dead. The difficulties encountered during the management and recommendation for improved immediate mass casualty management are discussed. Further, we believe that it has become necessary for every secondary and tertiary health institution to work out a mass casualty management protocol adapted to its peculiar working circumstances. A case is made for the establishment of regional disaster committees.

Accidents, Traffic↗
PubMedDate not supplied

Pyogenic thyroiditis and HIV infection.

Infective thyroiditis remain rare disease entity. Six patients were seen in Jos, Nigeria in the last five years. All of them were HIV positive. The presentation and management of these patients are high-lighted. The clinical features and bacteriology were similar to those previously documented for infective thyroiditis.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Acute colonic pseudo-obstruction (Ogilvie's syndrome). A case presentation and review of literature.

The syndrome of acute colonic pseudo-obstruction popularly known as Ogilvie's syndrome is an infrequent pathology and has been the subject of numerous medical communications in the past two decades. Its aetiology and pathophysiology remains poorly understood and patients are still treated inappropriately. In this report, a patient with acute colonic pseudo-obstruction managed surgically is presented. The pathogenesis and surgical management of this condition is also reviewed.

Acute Disease↗
PubMedDate not supplied

The acute scrotum: aetiology, management and early outcome-preliminary report.

BACKGROUND: Most patients with acute scrotal pain may require urgent exploration. We determined the aetiological factors, treatment and early complications in such patients. METHODS: This was a prospective study of consecutive patients presenting with the acute scrotum at Jos University Teaching Hospital, Nigeria from January 2001 to December 2002. RESULTS: Twenty-nine patients were studied with a mean age of 29.4 years (range 12 days to 80 years). Seventeen (58.6%) were 11 to 30 years old. The clinical diagnostic accuracy for testicular torsion was 75% because out of the 24 patients initially thought to have testicular torsion, 18 (62.1%), four (14.8%) and two (6.9%) had testicular torsion, epididymoorchitis and torsion of appendix testis respectively at exploration. The diagnosis in other patients was intrascrotral abscess in two (6.9%), Fournier's gangrene in one (3.4%) and haematocoele in one (3.4%). Only four (13.9%) patients presented within the first 24 hours of illness (all explored within 6 hours) and 14 (48.3%) in one to five days. Thirteen (44.6%) patients had orchidopexy while seven (24.2%) had orchidectomy as a result of testicular torsion (five) and intrascrotal abscesses (two). Testicular exploration only, with antibiotics was the treatment for patients eventually found to have epididymoorchitis, with good response. Testicular salvage rate was 72% in patients with testicular torsion. Postoperative complications observed in three patients were wound infection (two) and wound dehiscence (two). CONCLUSION: We conclude that testicular torsion is the most common cause of acute scrotum in our environment. Majority of our patients with acute scrotum present to hospital late. Health education of the public and attending physicians is required in order to reduce delay in presentation, improve diagnostic skills, testicular salvage rate and prognosis.

Acute Disease↗
PubMedDate not supplied

Experience in managing splenic trauma on the Jos Plateau.

We studied retrospectively, fifty eight (58) patients with splenic injury admitted to Jos University Teaching Hospital between October 1988 and September, 1995. Forty-nine were males while nine were females (M:F = 5.4:1). The age ranged from 5 to 50 years with a mean of 24.5 years. The highest incidence was recorded in the third decade of life. Road Traffic Accident (RTA) was the commonest (75.8%) cause of splenic injury; others were fall from heights 7 (12.1%), blows to the abdomen 5 (8.6%) and stab wounds to the abdomen 2 (3.5%). Of the 58 cases, 56 (96.5%) were blunt abdominal injuries while 2 (3.5%) were penetrating stab injuries. All had laparotomy. 13 (22.4%) sustained Upadhyaya and Simpson's type 1 injury, 18 (31.0%) type II, 12 (20.7%) type III and 15 (25.9%) type IV injuries. Of the 58 patients, 29 (50%) had total splenectomy without heterotopic autotransplantation (HAT); 21 (36.2%) had splenectomy with HAT, while 8 (13.8%) had splenorrhaphy with omentoplasty. The average number of units of blood transfused was 2.3 units per patient. There were four (6.9%) deaths--two as a result of shock and multiple organ failure and another two died as a result of pulmonary embolism. However the commonest post operative complications were chest and wound infections. The rate of splenic salvage in this study was low despite the fact that most of these patients sustained types I and II injuries. We believe a greater salvage rate could be achieved and the trend in our centre now is toward splenic conservation.

Adolescent↗