Comparison between flutter valve drainage bag and underwater seal device for the management of non-massive malignant and paramalignant pleural effusions.

INTRODUCTION: The aim of this study is to compare the use of flutter valve drainage bag system as an alternative to conventional underwater seal drainage bottle in the management of non-massive malignant/paramalignant pleural effusion. METHODS: Forty-one patients with non-massive malignant and paramalignant pleural effusions were randomized into two groups. Group A (21patients) had their chest tubes connected to an underwater seal drainage bottle, while group B (20 patients) had their chest tubes connected to a flutter bag drainage device. Data obtained was analyzed with SPSS statistical package (version 16.0). RESULTS: Breast cancer was the malignancy present at diagnosis in 24(58%) patients. Complication rates were similar, 9.5% in the underwater seal group and 10 % in the flutter bag drainage group. The mean duration to full mobilization was 35.0±20.0 hours in the flutter bag group and 52.7±18.5 hours in the underwater seal group, p-value 0.007. The mean length of hospital was 7.9±2.2 days in the flutter bag group and 9.8±2.7 days in the underwater seal group. This was statistically significant, p-value of 0.019. There was no difference in the effectiveness of drainage between both groups, complete lung re-expansion was observed in 16(80%) of the flutter bag group and 18(85.7%) of the underwater seal drainage group, p-value 0.70. CONCLUSION: The flutter valve drainage bag is an effective and safe alternative to the standard underwater seal drainage bottle in the management of non-massive malignant and paramalignant pleural effusion.

Acceptance of elective bradypacing by patients: an African perspective.

BACKGROUND: In our practice, we noticed that patients respond differently when pacemaker insertion is recommended to them. We then saw the need to study how African patients accept elective pacemaker implantation. AIM: The study was conducted to determine African patients' responses to elective pacemaker insertion. PATIENTS AND METHODS: We recruited patients who reported at our outpatient clinic with indications for elective pacemaker insertion. The study period lasted 64 months from September 1999. The patients were counseled before insertion and we sought their consent before being recruited for the study. Five possible responses were used to grade acceptance. They were followed up for 12 months each. Patients who were brought in emergency and those who refused participation were excluded. Those who missed follow-up were also dropped. RESULTS: Ninety-two patients (n = 92) met our study criteria after dropping eight patients who missed follow-up clinic attendance. Most of the candidates (71.7%) felt they had no options but to accept pacemakers at the time of operation. The remaining candidates either accepted the procedure with hope or wholeheartedly. Most of the candidates migrated up the ladder of acceptance over the 12-month period. DISCUSSION AND CONCLUSION: We concluded that most patients would accept pacemakers wholeheartedly over time.

Etiopathology and management challenges of blunt chest trauma in Nigeria.

Blunt chest trauma had not been roundly studied in Nigeria. This study was conducted to determine the etiopathological and management challenges of chest trauma in a developing country. In a prospective multicenter hospital-based study of 10-years duration in the city of Lagos, the data of 896 patients were recorded. The male-to-female ratio was 8 : 1, and the mean age was 27.1 years. The majority of patients (76.9%) were aged 20-39 years. Road traffic accidents caused 98.1% of the injuries. Lung parenchymal injuries occurred in 66% of patients, and cardiac trauma in 0.1%. Isolated chest trauma was found in 85% of patients, and 134 had associated injuries. The incidence of blunt chest trauma could be reduced if the number of road traffic accidents in Nigeria is reduced.