Omentoplasty as an effective surgical modality for managing a high risk patient with deep sternal wound infection

Poorly managed diabetes and hypertensives are risk factors for deep sternal wound infection (DSWI) following cardiac surgery; leading to increased morbidity and mortality. To reappraise the effectiveness of omental flap in the management of High risk patient with DSWI. A middle aged man with extensive mediastinitis following cardiac surgery (from outside referral). He was a known Diabetic and Hypertensive who was poorly compliant on medications. The history, physical examination, gycosylated Haemoglobin (HbA1c) and microbiological analyses showed high blood pressure, poor glycaemic control, septicaemia with staphylococcal DSWI. Resuscitation was achieved with the use of oral antihypertensives, Human insulin and antibiotics respectively. The DSWI was managed with serial debridement and subsequent wound cover with omental flap. The hospital stay was shorter and outcome was good. The management of DSWI with omental flap may be an effective surgical modality that reduces morbidity and mortality even in high risk patients

Medical students' preference for choice of clinical specialties: A multicentre survey in Nigeria

Background: The important goal of undergraduate medical training is to train doctors who would undergo further training to become specialists in various fields of clinical medicine. The admission into the specialty training programame depends largely on the pool of undergraduate medical students who have passed qualifications exams and are willing to choose and undergo training in a given clinical specialty. There are many factors considered by medical students when they make up their minds to choose a clinical specialty. This study seeks to determine the medical student preference for the clinical specialty and the factors that they consider in making such choice.Methods: This is a cross-sectional questionnaire based multicentre study in 3 accredited medical training institutions in Nigeria. Final year medical students who were willing to participate in the study filled out the questionnaires for fifteen minutes.  Information on their age, gender, specialty of preference and reason for choosing a particular clinical specialty were sought.Results: A total of 187 final year students took part in the study. Most of the students where in 21 – 30 year age range. Obstetrics and Gynaecology (24.9%), Surgery (18.9%), Internal medicine (14.1%) and Paediatics (8.1%), where the top clinical specialties preferred by the respondents. The less preferred specialties where Pathology  (2.7%), radiology (1.1%) ophthalmology (4.3%), ENT (0%). Personal liking  (51.9%), society perception (13.0%), financial reward (8.1%); where the most considered reasons for the choice of specialty.Conclusion:Medical students prefer to choose core-clinical specialty based on personal liking, financial reward and society perception.Keyword: Medical Students' Preference; Clinical Specialties; Nigeri

Surgical inpatient mortality in a Nigerian Tertiary Hospital

Background: There is paucity of literatures on audit of mortality in the surgical units of tertiary hospitals in the country. This has made the spectrum of mortality not to been known in some of the centers and therefore, there is a great disparity and dearth in apportioning health care services appropriately.Aim: The determination of the pattern of mortality in a surgical unit helps in planning, provision of quality surgical care and prioritizing of limited resources in developing countries.Methods: This is a retrospective study of all patients who died during admission into surgical wards of our hospital between 2007 and 2012. Data on demography and events leading to death were collected and analyzed from all surgical wards, the emergency unit, surgical outpatients, and theater records.Results: A total of 527 deaths occurred among the 8230 patients admitted during the 6‑year period giving a mortality rate of 6.4%. Three hundred and forty‑five (65.5%) were male, while 282 (34.5%) were females. The mortality rates in units were as follows: Burn and plastic (23.1%), general surgery (5.5%), neurosurgery (7.9%), urology (6.0%), orthopedics (3.8%), pediatric surgery (3.4%), and cardiothoracic surgery (11.9%). The yearly mortality rate were as follows, respectively: 2007 (7.1%), 2008 (6.0%), 2009 (4.5%), 2010 (6.5%), 2011 (7.2%), and 2012 (7.5%). About 84.6% of the patients died within 1 month on admission. The leading causes of mortality were trauma (41.8%) and cancer (32.4%). Most of the deaths (64.9%) occurred between 20‑ and 70‑year‑old.Conclusion: Trauma and cancer constitute a great deal of health burden in our region. Strong legislation and screenings with timely interventions are required.Keywords: Cancer, surgical mortality, traum

Recombinant-activated factor VII in the paediatric cardiac surgery: Single unit experience

Background: The control of excessive bleeding after paediatric cardiac surgery can be challenging. This may make the use of recombinant-activated factor VII (rFVIIa) in preventing this excessive bleeding, after adopted conventional methods have failed, desirable. Our aim is to  highlight our experience with the use of rFVIIa in preventing excessive bleeding after paediatric cardiac surgery.Patients and Methods: The data for 14 patients who had rFVIIa for excessive haemorrhage after cardiac surgery from December 2009 to November 2010 was analysed. The perioperative blood loss from the chest drain before and after the administration of rFVIIa, use of blood products, international normalized ratio (INR) and activated partial thromboplastin (aPTT), before and after administration of rFVIIa, were analysed.Results: The rFVIIa was successful in stopping bleeding in all the patients. The mean coagulation factors before rFVIIa were as follows: INR, 2.88 (1.82–4.5); aPTT, 65 seconds (33.4–95.1); after rFVIIa, the mean INRwas 1.2 (0.82–1.56), mean APTT was 38.7 seconds (25.6–54.9). No  thromboembolic events or allergic reactions or deaths were recorded. Conclusions: rFVIIa use is not only effective in stopping excessive perioperative bleeding but also safe and indirectly reduces transfusion of blood and its products. Key words: Coagulating factor, excessive bleeding, paediatric cardiac surgery, recombinant-activated factor VI

Superior repair: A useful approach for some anatomic variants of total anomalous pulmonary venous connection

Background: Total anomalous pulmonary venous connection (TAPVC) occurs when all the four pulmonary veins drain to the right atrium or to tributaries of the systemic veins. There have been various published techniques for the repair but none has been agreed on for the different anatomical variants that may be encountered during surgery.Patients and Methods: Between January 2005 and June 2010 the data of 6 of 18 patients who had surgical repair using the superior approach wereretrospectively reviewed.Three patients had long narrow venous stalk connecting the coronary sinus to venous confl uence; two had the right  pulmonary veins draining to superior vena cava (SVC) and left pulmonary veins to left lateral wall of SVC and one had an obstruction at entrance of Pulmonary Vein into venous confl uence. Results: Five patients initially had the superior approach while one had transatrial with unroofi ng of the coronary sinus. Two had a concomitant Wardens procedure. The mean aortic cross clamping was 87.5 (60-125) min, the mean cardiopulmonary bypass time should have min as unit of 127.8 (100-180), the mean Intensive Care Unit (ICU) stay of 2.5 (2-4)  days and the mean hospital stay 8.2 (7-9) days. One patient died at earlypost-operation from low cardiac outputand five had an uneventful  post-operative course and had remained stable until date.Conclusion: In our experience, the superior approach was an effective alternative approach for some anatomic variants of TAPVC that may be unexpectedly encountered during operation and also useful surgical  approach for older children.Key words: Long venous stalk, pulmonary venous obstruction, superior approach, trans-atrial approach, warden’s procedur

Multi-center survey of House officers’ choice of Medical specialties in Nigeria: preferences and determining factors

The objective of the study was to determine preferences and factors influencing the choice of medical specialties by House officers.  Questionnaires were distributed to House-officers in 4 tertiary hospitals namely: the National hospital, Abuja, the University of Port-Harcourt, the Jos University, and the University of Uyo Teaching Hospitals. The data were simultaneously collected and analyzed using SPSS 20.0 version. Of the 150 questionnaires distributed, 129(86%) were duly filled. The mean age was 22.4 years (range 21-40 years), 79(61.2 %) of the respondent were male. Fifty-nine(45.7%) chose training within the country while 32(24.8%)  preferred outside as 107(86%) chose training in Teaching Hospitals. Teachers, Resident doctors and parents influenced choices in 34(26.3%), 17(13.1%) and 16(12.4%) respectively. Thirty-four(26.3%), 28 (21.7%), 13(10.1%) and 15(11.6%) preferred obstetrics, surgery, internal medicine and paediatrics respectively. Seventy (46.7%) chose specialties for personal likeness and 17(11.3%) for role models in that specialty. House officers preferred to pursue medical specialty in teaching hospitals within the country and they are motivated by personal fulfilment, independence of practice and role models while more prefer to specialize in more Obstetrics/ Gyaenocology and surgery

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

Background: The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort. Methods: This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders. Results: Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses. Conclusions: Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes