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Kesieme EB, Iruolagbe CO, Omoregbee BI, Inuwa IM. Basic Overview of Conventional Coronary Angiography for Planning Cardiac Surgery. Cureus 2024; 16:e52942. [PMID: 38405998 PMCID: PMC10894027 DOI: 10.7759/cureus.52942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Coronary angiography is a common procedure performed by the cardiologist to evaluate coronary atherosclerotic disease (CAD) and the result is utilized by both cardiologists and cardiac surgeons to perform catheter and surgical interventions on the coronary artery. In addition to evaluating CAD, other useful investigative modalities such as left ventriculography and aortography can be performed at the time of coronary angiography. Despite its limitations and the emergence of newer investigative modalities like coronary computed tomography angiography, intravascular ultrasound scan, and magnetic resonance coronary angiography, conventional coronary angiography has remained the gold standard for the evaluation of coronary artery disease. Hence, it remains an investigative modality that every member of the cardiothoracic team performing coronary artery bypass grafting must learn how to interpret.
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Affiliation(s)
- Emeka B Kesieme
- Cardiothoracic Surgery, Irrua Specialist Teaching Hospital, Irrua, NGA
- Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, GBR
| | - Christopher O Iruolagbe
- Cardiology, Rosalind Franklin University of Medicine and Science/Chicago Medical School, Chicago, USA
| | | | - Ismail M Inuwa
- Cardiothoracic Surgery, Aminu Kano Teaching Hospital, Kano, NGA
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Danton MHD, Kesieme EB. Modification of the Warden Procedure for Surgical Repair of Partial Anomalous Pulmonary Venous Connection. World J Pediatr Congenit Heart Surg 2023:21501351231168830. [PMID: 37186786 DOI: 10.1177/21501351231168830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Warden procedure is a popular technique for repairing partial anomalous pulmonary venous connection. We describe a modification of this technique for surgical repair of this condition by raising both a superior vena cava (SVC) flap and right atrial appendage flap to create a tension-free SVC-RA continuity (neo-SVC). The anomalous pulmonary veins are routed via the remanent of proximal SVC and baffled to the left atrium across a surgically created or enlarged atrial septal defect using autologous pericardium.
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Affiliation(s)
- Mark H D Danton
- Congenital and Adult Congenital Cardiac Surgery, Royal Hospital for Children & Golden Jubilee National Hospital, Glasgow, UK
| | - Emeka B Kesieme
- Department of Cardiothoracic Surgery, Royal Infirmary, Aberdeen, UK
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Kesieme EB, Buchan KG. Multiple Right Ventricular Haemangiomas. Cureus 2023; 15:e36570. [PMID: 37095811 PMCID: PMC10122193 DOI: 10.7759/cureus.36570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
Right ventricular haemangiomas are rare benign tumours, usually solitary and commonly located in the right heart. We report a 49-year-old female who presented with four masses in the right ventricle, three arising from the right ventricular free wall and one arising from the anterior leaflet of the tricuspid valve. She subsequently underwent total excision of the tumours and an anteroinferior commissuroplasty for severe tricuspid regurgitation complicating the excision. Histology confirmed cavernous haemangioma. Solitary haemangioma of the right ventricle has been reported severally in the literature but, to the best of our knowledge, this is the first report of multiple right ventricular haemangiomas.
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Affiliation(s)
- Emeka B Kesieme
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
| | - Keith G Buchan
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
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Kesieme EB, Tsoi E, Buchan KG. Coronary Artery Bypass Surgery in a Preoperative Total Laryngectomy Patient. Cureus 2023; 15:e36610. [PMID: 37102011 PMCID: PMC10123222 DOI: 10.7759/cureus.36610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
For patients awaiting urgent total laryngectomy who require coronary artery bypass grafting (CABG), the conventional median sternotomy should be avoided. We present a 69-year-old male who had urgent CABG as a prelude to an urgent laryngectomy for recurring laryngeal carcinoma. We recommend a manubrium-sparing T-shaped ministernotomy to preserve tissues and to avoid the disruption of the anatomy of the lower neck and superior mediastinum.
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Affiliation(s)
- Emeka B Kesieme
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
| | - Erica Tsoi
- Medicine and Surgery, University of Aberdeen School of Medicine, Aberdeen, GBR
| | - Keith G Buchan
- Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, GBR
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Smood B, Spratt JR, Mehaffey JH, Luc JGY, Vinck EE, Lehtinen ML, Wallen TJ, Jenkinson CG, Kim W, Kesieme EB, Han JJ, Helmers MR, Iyengar A, Patrick WL, Kelly JJ, Watkins AA, Cevasco M, Williams ML. COVID-19 and cardiothoracic surgery: Effects on training and workforce utilization in a global pandemic. J Card Surg 2021; 36:3296-3305. [PMID: 34173279 PMCID: PMC8447436 DOI: 10.1111/jocs.15773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
Background The COVID‐19 pandemic has disrupted all aspects of healthcare, including cardiothoracic surgery (CTS). We sought to determine the pandemic's impact on CTS trainees' educational experiences. Methods A survey was developed and distributed to members of the Thoracic Surgery Residents Association and other international CTS trainees. Trainees were asked to evaluate their cumulative experiences and share their overall perceptions of how CTS training had been impacted during the earliest months of the COVID‐19 pandemic (i.e., since March 01, 2020). Surveys were distributed and responses were recorded June 25–August 05, 2020. In total, 748 surveys were distributed and 166 responses were received (overall response rate 22.2%). Of these, 126 of 166 responses (75.9%) met inclusion criteria for final analysis. Results Final responses analyzed included 45 of 126 (35.7%) United States (US) and 81 of 126 (64.3%) international trainees, including 101 of 126 (80.2%) senior and 25 of 126 (19.8%) junior trainees. Most respondents (76/126, 43.2%) lost over 1 week in the hospital due to the pandemic. Juniors (12/25, 48.0%) were more likely than seniors (20/101, 19.8%) to be reassigned to COVID‐19‐specific units (p < .01). Half of trainees (63/126) reported their case volumes were reduced by over 50%. US trainees (42/45, 93.3%) were more likely than international trainees (58/81, 71.6%) to report reduced operative case volumes (p < .01). Most trainees (104/126, 83%) believed their overall clinical acumen was not adversely impacted by the pandemic. Conclusions CTS trainees in the United States and abroad have been significantly impacted by the COVID‐19 pandemic, with time lost in the hospital, decreased operative experiences, less time on CTS services, and frequent reassignment to COVID‐19‐specific care settings.
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Affiliation(s)
- Benjamin Smood
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John R Spratt
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - J Hunter Mehaffey
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Jessica G Y Luc
- Department of Surgery, Division of Cardiovascular Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric E Vinck
- Department of Surgery, Division of Cardiovascular Surgery, Clínica Cardio VID, Pontifical Bolivarian University, Medellín, Colombia
| | - Miia L Lehtinen
- Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Tyler J Wallen
- Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Charles G Jenkinson
- St. Vincent's Hospital, Sydney, Australia.,The University of Western Australia, Western Australia, Australia.,Murdoch University, Perth, Australia.,Heart and Lung Research Institute of Western Australia, Western Australia, Australia.,The University of New South Wales, New South Wales, Australia
| | - Woojung Kim
- Department of Thoracic and Cardiovascular Surgery, National University Hospital, Seoul, Republic of Korea
| | - Emeka B Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Nigeria
| | - Jason J Han
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mark R Helmers
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Amit Iyengar
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - William L Patrick
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John J Kelly
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ammara A Watkins
- Department of Surgery, Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Marisa Cevasco
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew L Williams
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Kesieme EB, Abubakar U, Olusoji O, Inuwa IM, Kefas J, Anumenechi N. Factors affecting interest in cardiothoracic surgery among junior surgical residents in Nigeria. Cardiovasc J Afr 2017; 28:293-297. [PMID: 28252676 PMCID: PMC5730681 DOI: 10.5830/cvja-2017-004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 01/12/2017] [Indexed: 11/06/2022] Open
Abstract
Objective: A survey was undertaken to determine the factors that affect interest in cardiothoracic surgery (CTS) among junior surgical residents in Nigeria. Methods: A cross-sectional study was done using a pilottested, 56-item, semi-structured questionnaire, which was filled in by 238 junior surgical residents in accredited hospitals in Nigeria. Results: Few of the respondents (8.4%) were committed to specialising in CTS. A minority of them, 28.2 and 2.1%, had assisted in major thoracic procedures and open-heart surgeries, respectively. The relationship between the level of training, rotation in CTS in junior residency and interest in CTS were statistically significant (p < 0.05). The main important factors responsible for the low interest in CTS include the lack of equipment (92%), limited training positions (64.9%), poor or lack of exposure in CTS as a junior resident (63%) and in medical school (58.8%). Conclusion: There is a dire need to provide facilities and training opportunities to improve the cardiothoracic workforce in Nigeria.
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Affiliation(s)
- Emeka B Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.
| | - Umar Abubakar
- Department of Surgery, Usmanu Dan Fodio University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Olugbenga Olusoji
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
| | - Ismail Mohammed Inuwa
- Department of Surgery, Aminu Kano University Teaching Hospital, Kano, Kano State, Nigeria
| | - John Kefas
- Department of Surgery, Tafawa Belawa University Teaching Hospital, Bauchi, Bauchi State, Nigeria
| | - Ndubuisi Anumenechi
- Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
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Kesieme EB, Arekhandia BJ, Inuwa IM, Akpayak IC, Ekpe EE, Olawoye OA, Umar A, Awunor NS, Amadi EC, Ofoegbu IJ. Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons. Niger J Clin Pract 2016; 19:170-4. [PMID: 26856276 DOI: 10.4103/1119-3077.175961] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. OBJECTIVES We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). MATERIALS AND METHODS Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. RESULTS The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. CONCLUSION There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.
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Affiliation(s)
- E B Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo, Nigeria
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Abstract
Background: Chest tube insertion is a simple and sometimes life-saving procedure performed mainly by surgical residents. However with inadequate knowledge and poor expertise, complications may be life threatening. Objective: We aimed to determine the level of experience and expertise of resident surgeons in performing tube thoracostomy. Methodology: Four tertiary institutions were selected by simple random sampling. A structured questionnaire was administered to 90 residents after obtaining consent. Results: The majority of respondents were between 31 and 35 years. About 10% of respondents have not observed or performed tube thoracostomy while 77.8% of respondents performed tube thoracostomy for the first time during residency training. The mean score was 6.2 ± 2.2 and 59.3% of respondents exhibited good experience and practice. Rotation through cardiothoracic surgery had an effect on the score (P = 0.034). About 80.2% always obtained consent while 50.6% always used the blunt technique of insertion. About 61.7% of respondents routinely inserted a chest drain in the Triangle of safety. Only 27.2% of respondents utilized different sizes of chest tubes for different pathologies. Most respondents removed chest drains when the output is <50 mL. Twenty-six respondents (32.1%) always monitored air leak before removal of tubes in cases of pneumothorax. Superficial surgical site infection, tube dislodgement, and tube blockage were the most common complications. Conclusion: Many of the surgical resident lack adequate expertise in this lifesaving procedure and they lose the opportunity to learn it as interns. There is a need to stress the need to acquire this skill early, to further educate and evaluate them to avoid complications.
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Affiliation(s)
- Emeka B Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
| | - Olugbenga Olusoji
- Department of Surgery, Lagos University Teaching Hospital, Lagos, Lagos State, Nigeria
| | - Ismail Mohammed Inuwa
- Department of Surgery, Aminu Kano University Teaching Hospital, Kano, Kano State, Nigeria
| | | | - Eghosa Aigbe
- Department of Surgery, Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria
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Abubakar U, Legbo JN, Opara AC, Sahabi SM, Ray B, Abubakar Y, Jacob J, Kesieme EB, Okonta EK. Excision of a giant anterior chest wall neurofibroma and chest wall reconstruction with methlymethacrylate and vertical rectus abdominis musculocutaneous flap: case report. Niger J Med 2014; 23:344-350. [PMID: 25470863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Plexiformneurofibromas (PNFs) are benign nerve tumours resulting from aberrant growth of cells of nerve sheath. PNFs are generally painless, slow growing neoplasms. Although most neoplasms are asymptomatic, they can be particularly debilitating due to their potential to grow to very large sizes. They have potential for transformation into highly malignant peripheral nerve sheath tumours which occur in approximately 5% of patients. They can affect most parts of the body. When they occur in the chest wall, they are amenable to excision. Following excision, a surgeon is faced with a large skeletal and soft tissue defects which pose functional and cosmetic challenges. CASE PRESENTATION We present a 24-year-old farmer that presented with a giant anterior chest wall plexiformneurofibroma that was noticed since childhood. He had excision of the mass and skeletal reconstruction with methylmethacrylate sandwiched in prolene mesh and softtissue coverage with vertical rectus abdominismusculocutaneous flap. CONCLUSION We conclude that the use of methylmethacrylate and myocutaneous flaps give both good functional and cosmetic outcome following excision of large chest wall tumours.
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Dongo AE, Kesieme EB, Iyamu CE, Okokhere PO, Akhuemokhan OC, Akpede GO. Lassa fever presenting as acute abdomen: a case series. Virol J 2013; 10:123. [PMID: 23597024 PMCID: PMC3639802 DOI: 10.1186/1743-422x-10-123] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.
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Affiliation(s)
- Andrew E Dongo
- Department of Surgery, Irrua Specialist Teaching Hospital, PMB 08, Irrua, Edo State, Nigeria.
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Okonta KE, Kesieme EB, Agarwal V. eComment. The vraisemblance of haemostatic therapy for excessive bleeding after cardiac surgery. Interact Cardiovasc Thorac Surg 2012; 15:389. [PMID: 22908177 DOI: 10.1093/icvts/ivs307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kelechi E Okonta
- Cardiovascular and Thoracic Surgery, University College Hospital, PMB 5116, Ibadan, Nigeria
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Okonta KE, Abubakar U, Kesieme EB, Adeoye PO. eComment. Re: Is heparin needed for patients with an intra-aortic balloon pump? Interact Cardiovasc Thorac Surg 2012; 15:140. [PMID: 22723545 DOI: 10.1093/icvts/ivs197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kelechi E Okonta
- Division of Cardiothoracic Surgery, University College Hospital Ibadan, Ibadan, Nigeria
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Abstract
We conducted a 16-year retrospective review of 31 cases of tracheobronchial carcinoid tumors treated in our institution between 1995 and 2011, to determine their characteristic features and outcome of management. There were 12 men and 19 women. The most common presenting symptoms were cough and hemoptysis (71%) with a mean duration of 4 years. Preoperative bronchoscopy confirmed the diagnosis in 80% of patients. Right-sided tumors accounted for 60% of cases. Most tumors arose from the mainstem bronchi. Histologic analysis revealed typical carcinoids in 28 cases and atypical carcinoids in 3. Surgical treatment was mainly radical resection (pneumonectomy in 19 patients). A parenchymal-preserving surgery (sleeve resection of left main bronchus and end-to-end anastomosis) was only possible in 2 cases. Mediastinal lymph nodes were involved in 30% of cases. Most patients had widespread extraluminal extension. Follow-up revealed recurrence in one patient. No deaths were recorded, and complications were mainly atelectasis and air leak. Radical resection remains the mainstay of surgical management of bronchial carcinoids in cases of late presentation with destroyed and bronchiectatic distal pulmonary parenchyma. Parenchymal-preserving surgery should only be carried out when indicated.
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Affiliation(s)
- Ravindra K Dewan
- Department of Thoracic Surgery, LRS Institute of Tuberculosis and Respiratory Disease, New Delhi, India.
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Okonta KE, Kesieme EB. Is oesophagectomy or conservative treatment for delayed benign oesophageal perforation the better option? Interact Cardiovasc Thorac Surg 2012; 15:509-11. [PMID: 22695516 DOI: 10.1093/icvts/ivs190] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was, 'Is oesophagectomy or conservative treatment for delayed benign oesophageal perforation the better option?' Seven papers were identified that provided the best evidence to answer the question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these studies were tabulated. A total of 147 patients from the studies had oesophageal perforation, while 86 had oesophagectomies for delayed oesophageal perforation (DOP; defined as a perforation diagnosed after 24 h) and 57 had conservative procedures. The mortality rate ranged from 0 to 18% for patients with oesophagectomies, increasing to 50% with double exclusion and reaching as high as 68% in primary repair. In one report, it was found that conservative procedures inflicted higher morbidity than oesophagectomy, which eliminated the perforation, the source of sepsis and the underlying oesophageal disease; another study came to the same conclusion. One study concurred that oesophageal perforation was a surgical disease and only a few cases qualified for conservative procedures. In a review of 34 patients who had DOP, 19 were treated with conservative procedures and 15 oesophagectomy; the mortality rate for patients treated by conservative procedures was 68%, whereas it was 13.3% for patients treated by oesophagectomy. In another study, among the patients treated with conservative procedures, at least one required an additional operation and about 33.3% of patients who survived had continued difficulty with swallowing. In four of the studies, the authors observed that oesophagectomy for DOP was a better surgical option, which decreased mortality, and one study compared the treatment outcome between conservative procedures and oesophagectomy. The primary end-point in all the studies was elimination of the source of sepsis by extirpating the perforated oesophagus in comparison with conservative procedures. However, the consensus of opinion in all the presented evidence was in support of the theory that oesophagectomy was safer and better than conservative procedures. In conclusion, oesophagectomy for DOP was superior to conservative procedures. The limitation of the present review was the lack of many randomized controlled trials.
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Affiliation(s)
- Kelechi E Okonta
- Division of Cardiothoracic Surgery, Department of Surgery, University College Hospital, PMB 5116, Ibadan, Nigeria.
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Welcker K, Kesieme EB, Internullo E, Kranenburg van Koppen LJC. Ergonomics in thoracoscopic surgery: results of a survey among thoracic surgeons. Interact Cardiovasc Thorac Surg 2012; 15:197-200. [PMID: 22586071 DOI: 10.1093/icvts/ivs173] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The frequent and prolonged use of thoracoscopic equipment raises ergonomic risks which may cause physical distress. We aimed to determine the relationship between ergonomic problems encountered in thoracoscopic surgery and physical distress among thoracic surgeons. METHODS An online questionnaire which investigated personal factors, product factors, interaction factors and physical discomfort was sent to all members of the European Society of Thoracic Surgeons (ESTS). RESULTS Of the respondents, 2.4% indicated that a one arm's length should be the optimal distance between the surgeon and the monitor. Only 2.4% indicated that the monitor should be positioned below the eye level of the surgeon. Most of the respondents agreed, partially to fully, that they experienced neck discomfort because of inappropriate monitor height, bad monitor position and bad table height. Most respondents experienced numb fingers and shoulder discomfort due to instrument manipulation. Most of the respondents (77.1%) experienced muscle fatigue to some extent due to a static posture during thoracoscopic surgery. The majority of respondents (81.9, 76.3 and 83.2% respectively) indicated that they had varying degrees of discomfort mainly in the neck, shoulder and back. Some 94.4% of respondents were unaware of any guidelines concerning table height, monitor and instrument placement for endoscopic surgery. CONCLUSIONS Most thoracic surgeons in Europe are unaware of ergonomic guidelines and do not practise them, hence they suffer varying degrees of physical discomfort arising from ergonomic issues.
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Affiliation(s)
- Katrin Welcker
- Department of Thoracic Surgery, Klinikum Bremen-Ost, Bremen, Germany.
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Dewan RK, Kesieme EB, Sisodia A, Ramchandani R, Kesieme CN. Congenital malformation of lung parenchyma: 15 years experience in a thoracic surgical unit. Indian J Chest Dis Allied Sci 2012; 54:105-109. [PMID: 22973779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To review the surgical management of congenital malformations of lung parenchyma in a thoracic surgery unit over a period of 15 years. METHODS We carried out a retrospective analysis of records of all patients who had surgery for congenital malformations of lung parenchyma between 1995 and 2010. RESULTS Forty-five patients underwent surgery for congenital lung lesions out of 3735 thoracotomies performed during the study period. The lesions included 29 lung sequestrations, 12 bronchogenic cysts, 3 congenital lobar emphysema and one congenital cystic adenomatoid malformation. Only 26 (26%) cases were diagnosed preoperatively. Twenty-eight (62.2%) patients underwent lobectomy, 5 (11.1%) patients had pneumonectomy, and 10 (22.2%) patients had removal of cyst while 2 (0.45%) patients had lung resection with repair of the oesophageal connection. No mortality was recorded. One patient had post-operative complication of oesophageal fistula which was successfully managed conservatively. The follow-up was between 8 months to 14 years. All patients were asymptomatic and had no physical limitations during the follow-up. CONCLUSIONS Surgery is curative and produces good long-term result in patients with congenital malformations of lung parenchyma. It should be offered to patients as a therapeutic option where indicated and feasible.
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Affiliation(s)
- R K Dewan
- Department of Thoracic Surgery, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi, India.
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Kesieme EB, Kesieme CN. Congenital diaphragmatic hernia: review of current concept in surgical management. ISRN Surg 2011; 2011:974041. [PMID: 22229104 PMCID: PMC3251163 DOI: 10.5402/2011/974041] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/26/2011] [Indexed: 11/23/2022]
Abstract
Congenital diaphragmatic hernias (CDHs) occur mainly in two locations: the foramen of Morgagni and the more common type involving the foramen of Bochdalek. Hiatal hernia and paraesophageal hernia have also been described as other forms of CDH. Pulmonary hypertension and pulmonary hypoplasia have been recognized as the two most important factors in the pathophysiology of congenital diaphragmatic hernia. Advances in surgical management include delayed surgical approach that enables preoperative stabilization, introduction of fetal intervention due to improved prenatal diagnosis, the introduction of minimal invasive surgery, in addition to the standard open repair, and the use of improved prosthetic devices for closure.
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Affiliation(s)
- Emeka B Kesieme
- Department of Surgery, Irrua Specialist Teaching Hospital, PMB 8, Edo State, Irrua, Nigeria
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Dongo AE, Kesieme EB, Irabor DO, Ladipo JK. A review of posttraumatic bowel injuries in ibadan. ISRN Surg 2011; 2011:478042. [PMID: 22084759 PMCID: PMC3200064 DOI: 10.5402/2011/478042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 05/31/2011] [Indexed: 11/23/2022]
Abstract
Background. Bowel injuries are a leading cause of morbidity and mortality following trauma. Evaluating patients who sustained abdominal trauma with bowel injury may pose a significant diagnostic challenge to the surgeon. Prompt recognition and timely intervention is necessary to improve outcome. Aim. This study was undertaken to evaluate treatment and outcome of patients with bowel trauma. Methods. A 5-year retrospective study of all patients presenting with abdominal trauma requiring surgical intervention seen in the UCH Ibadan, Nigeria was undertaken. Results. There were 71 patients (59 males and 12 females). The majority of cases (70%) occurred between the 3rd and 5th decades of life. Some 37 patients (52%) sustained blunt abdominal injury, while 34 patients (48%) sustained penetrating abdominal injury. There were 27 patients with bowel injuries (38%). Isolated bowel injuries occurred in 19 patients (27%). The most common surgical operation performed was simple closure. There were 3 deaths in patients with bowel injuries. Conclusion. Most cases of bowel injury can be managed by simple closure, a technique that is not so technically demanding for surgeons in less-developed countries. This study has also incidentally identified a “rule of six” for patients with bowel injuries and abdominal trauma.
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Affiliation(s)
- A E Dongo
- Department of Surgery, Irrua Specialist Teaching Hospital, PMB 8, Irrua, Edo State, Nigeria
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Abubakar U, Adeoye PO, Adebo OA, Adegboye VO, Kesieme EB, Okonta EK. Pattern of pericardial diseases in HIV-positive patients at University College Hospital, Ibadan, Nigeria. South Afr J HIV Med 2011. [DOI: 10.4102/sajhivmed.v12i2.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Rationale. Pericarditis has been reported as the most common cardiac complication of HIV disease, followed by pericardial effusion.
Methods. A retrospective review was conducted of all 68 patients treated for pericardial diseases between August 2003 and July 2008 at University College Hospital, Ibadan, Nigeria. HIV-positive patients (N=42) were compared with those who were HIV negative (N=26).
Results. More male than female patients presented with pericardial disease, and the HIV-positive patients were younger than those who were HIV negative. Pericardial effusion was the commonest mode of presentation, accounting for 20 HIV-positive patients (47.7%) and 13 HIV-negative patients (50%). Pericardiostomy was the commonest surgical intervention performed in HIV-positive patients (N=15), while the majority of HIV-negative patients had pericardiocentesis.
Conclusion. Pericardial effusion was the commonest cardiac presentation in HIV-positive patients in our setting. We recommend that patients with pericardial effusion be investigated for HIV infection.
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