Prevalence and predictors of intra-abdominal hypertension and compartment syndrome in surgical patients in critical care units at Kenyatta National Hospital.

BACKGROUND: Intra-abdominal hypertension (IAH) affects almost every organ sytem.If it is not detected early and corrected, mortality would be high. The prevalence of IAH and abdominal compartment syndrome (ACS) at Kenyatta National Hospital (KNH) critical care units is not known. The aim of this sudy was to determine the prevalence and factors associated with development of IAH/ACS among critically ill surgical patients. METHODS: This was a cross sectional descriptive study involving surgical patients in critical care units at KNH, carried out from March 2015 to October 2015. One hundred and thirteen critically ill and ventilated patients 13 years or older were recruited into the study. Krohn's intravesical method was used to measure intra- abdominal pressure (IAP). Measurements were done at first contact, then at 12 and 24 h. Additional parameters recorded included: laboratory tests such as serum bilirubin and total blood count as well as clinical parameters such as urine output, vital signs and peak airway pressure, among others. Frequency, means and standard deviation were used to describe the data. Categorical variables e.g. age, were analysed using Chi square test and continous variables using student 't' test and Mann Whitney test as appropriate RESULT: A total of 113 consecutive surgical patients admitted to the critical care units were recruited. Of our study population, 71.7% (by IAP max) and 67.3% (by IAP mean) had IAH. Abdominal compartment syndrome (ACS) developed in 4.4% of the population. The following factors were significant determinants of risk of IAH : amount of IV fluids over 24 h (3949.6 vs 2931.1, p = 0.003, adjusted OR 1.0 [1.0-1.002]), haemoglobin values at admission (9.9 vs 12.0, p = <0.012, adjusted OR 0.6 [0.4-0.9]), peak airway pressure (28.4 vs 17.3; p = 0.018, adjusted OR 1.6 [1.1-2.4]) and synchronised intermittent mandatory ventilation (SIMV) (60 vs 32; p = 0.041, adjusted OR 1.4 [0.78-2.04]). Of those who had IAH; age, amount of iv fluids over 24 h, fluid balance and ventilator mode were significant determinants of risk of progression to ACS . CONCLUSION: The prevalence of intraabdominal hypertension and abdominal compartment syndrome at KNH is high. Clinical parameters pertaining to fluids administration and ventilator mode are siginificant determinants.

Misdiagnosed adult testicular torsion: case report.

Adult testicular torsion is thought to be rare if not relatively unusual. The rarity could be an underestimation since there are many episodes of missed torsions and misdiagnosis with other conditions of acute scrotum despite the now widespread ultra sound availability that are being reported in the literature. Such a misdiagnosis is herein reported of a 41-year-old man.

Unusual bladder outflow obstruction: case report.

Hydatid disease, the parasitic infestation caused by the cestode, echinococcus granulosus involves mainly the liver and the lungs though no organ is immune. Genito urinary involvement has been found mainly in the kidneys and rarely in other structures such as, bladder and epididymis. Isolated retrovesical location of the hydatid cyst is a very rare condition whose manifestations appears after a long course of the disease and are due to compression of bladder, causing the bladder out flow obstruction. Such rare case of bladder out flow obstruction is presented.

An experience with percutaneous nephrostolithotomy.

A review of percutaneous nephrostolithotomy (PNL) done at Nottingham, City Hospital during January 1985 to April 1987 was undertaken. During this period 113 patients underwent the procedures. The study was confined to 92 patients who had complete case records. Initially 81 patients successfully had percutaneous nephrostolithotomy. Simple extraction were done in 21 (22.8%) patients, USL in 55 (56.5%) while a combination of USL and EHL was done in 8 (8.7%) patients. The overall stone clearance without further manipulations, was 70.6% but with further manipulations the clearance rate rose to 84.8%, suggesting that with increased expertise, one would expect the clearance to be near 100%.

Clinical presentation of urinary bladder cancers in Kenya.

A review of cancers of urinary bladder as seen in the Kenyatta National Hospital was undertaken. 75 cases were histologically documented between January 1977 to June 1984. The incidence was found to be 0.75% of all reported cancers in the Kenyatta National Hospital, which is lower than the 2% reported in the white populations of Europe and North America. Overall, two age peaks were observed at the 6th and 7th decades; the majority occurring between 5th and 7th decades. Males predominated over females by four times. 81.3% of patients presented with haematuria, 65.3% presented with irritative bladder symptoms while 41.3% presented with bladder out-let obstruction. The frequently seen histological variants of cancers were transitional cell carcinoma (53.3%) of all grades and/or stages, followed by anaplastic carcinomas (17.3%) and then by squamous cell carcinomas (13.3%) which were mainly confined to patients from Lake region and coast regions.