Diagnostic utility of fine-needle aspiration cytology in the management of liver disease in a district hospital.

BACKGROUND: Fine needle aspiration (FNA) cytology is a cost effective technique of obtaining cellular specimens for diagnoses. It has many advantages over large needle core biopsies that makes it quite suitable for outpatient department and institutions without facilities for histopathology diagnosis. Any site of the body can be sampled with FNA technique. OBJECTIVE: To assess the diagnostic utility of fine needle aspiration cytology technique in management of patients with liver disease in resource limited settings. DESIGN: Prospective cross sectional study. SETTING: Patient evaluation and FNA aspiration were done in Murang'a and Machakos district hospitals and specimen staining and microscopy were done in Centre for Clinical Research, Kenya Medical Research Institute. SUBJECTS: Patients who were suspected to have liver disease were referred to the medical outpatient clinics in Murang'a and Machakos district hospitals for evaluation. In addition those on the medical wards in the two hospitals who were suspected to have liver disease were also evaluated. INTERVENTIONS: The patients with liver disease were identified after physical and abdominal ultrasound examination. Those with hepatomegaly were selected for the study. Liver fine needle aspiration was done using 21 gauge fine needle attached to a 10 ml syringe. Focal lesions were targeted as much as possible. Thin smears of specimens obtained were spread onto microscope slides which were then dropped into 95% ethanol and left for 30 min in order to fix the material. The slides were then removed, dried and transported to KEMRI where they were stained with Papanicolaou stain then evaluated on the light microscope. RESULTS: One hundred and twenty patients with suspected liver disease were evaluated in the two hospitals; 70 in Machakos and 50 in Murang'a. Fifty patients were identified to have liver disease and fine needle aspiration done aseptically. Twenty one (42%) of the 50 patients had malignant cells; 15(30%) of the 50 patients had necrotic material aspirates 2 (4%) shoved fatty changes later showed to be liver cirrhosis; 11 (22%) showed normal hepatocytes. CONCLUSION: The results support the diagnostic utility of FNA cytology in the management of liver disease, especially in rural setting.

Visceral leishmaniasis with concomittant post kala-azar dermal leishmaniasis responds to oral sitamaquine: case report.

We report a rare case of visceral leishmanisis with concomitant post kala-azar dermal leishmaniasis as the initial presentation in a female patient from Baringo district, Rift valley province, Kenya.

Hepatitis B and C virus infections and liver function in AIDS patients at Chris Hani Baragwanath Hospital, Johannesburg.

BACKGROUND: Impaired liver function tests and co-infection with hepatitis viruses in AIDS patients are common in western countries. OBJECTIVE: To assess liver function and prevalence of co-infection with hepatitis B and hepatitis C viruses in AIDS patients at Chris Hani Baragwanath Hospital. DESIGN: A prospective study. SETTING: Chris Hani Baragwanath Hospital, Johannesburg, South Africa. PATIENTS: One hundred consecutive patients with AIDS admitted to Chris Hani Baragwanath Hospital. RESULTS: There were 52 males and 48 females aged 16 to 54 years (mean + SD: 34.6 + 7.5 years). The results of laboratory test were as follows: LFTs: bilirubin 11.8 (+15.6) mumol/l; AST: 79.6 (+/- 116.6) iu/L; alkaline phosphatase: 204.3 (+/- 237.4) i mu/L; albumin: 23.9 (+/- 6.2) g/l; CD4+ lymphocytes: 141.5 (+/- 168.6) microliters; CD8+: 666.9 (+/- 618.3) microliters; HBV - HbsAg: 6 (6%); HbsAg + eAg: 3 (3%); previous disease (Anti HBs and/or anti HBc): 35%, HCV: 1(1%). CONCLUSION: Liver function tests were impaired in the majority of patients with AIDS (93%) in our setting. Evidence of previous and present HBV infection was present in 41%. This is different from what is observed in western countries (90-95%). The results also suggest that patients here acquired HBV infection while still immuno competent. HCV infection was rare.

Cardiovascular disease in elderly in-patients at the Kenyatta National Hospital, Nairobi-Kenya.

A prospective study to determine the prevalence and profile of cardiovascular disease in elderly patients admitted into the medical wards, Kenyatta National Hospital, was carried out between July 1991 and January 1992. Two hundred and two patients over 60 years of age were admitted into the medical wards over this period. This formed seven per cent of the total medical admissions. Two of these refused to take part in the study. Of the 200 elderly patients evaluated for cardiovascular disease, 146 (73%) were between 60 and 75 years of age with only 26 (13%) being over 85 years. Fifty seven per cent were males. Clinical evidence of cardiovascular disease was present in 79 (39.5%) of the patients evaluated. There was no sex difference in the prevalence of cardiovascular disease as judged from clinical evaluation (37.7% males versus 41.9% females, p > 0.05). Cardiovascular diseases in our medical in-patients at Kenyatta National Hospital are common and especially so with hypertension which plays an important role in the aetiology of congestive heart failure and cerebravascular accidents. Cardiac arrhythmias are also common though not necessarily symptomatic. Rheumatic heart disease and cardiomyopathies were uncommon in our study population. A community-based survey is needed to determine the true prevalence of cardiovascular diseases in the elderly and their contribution to morbidity in this sector of the population.