Outcome of Combined Trabeculotomy-Trabeculectomy in Eyes of Nigerian Children with Primary Congenital Glaucoma.

PURPOSE: To report the outcome of combined trabeculotomy-trabeculectomy among children with primary congenital glaucoma at a child eye health tertiary facility in southwest Nigeria. METHODS: A retrospective review of children who underwent combined trabeculotomy-trabeculectomy (CTT) surgery on account of primary congenital glaucoma between 2016 and 2020 at the University College Hospital, Ibadan, Nigeria. All surgeries were performed by paediatric ophthalmologists. The main outcome measures were postoperative intraocular pressure, corneal clarity, and complications. RESULTS: A total of 21 eyes of 13 patients were included. Ten (76.9%) of the patients were males and 8 (61.5%) had bilateral disease. The mean age at presentation was 4.8 (± 3.6) months, while the mean age at surgery was 8.1 (± 5.9) months. The average waiting time between noticing symptoms and presenting to the clinic was 3.2 (±4.9) months. The mean horizontal corneal diameter was 13.2 (± 1.4) mm, while the mean pre-operative intraocular pressure (IOP) was 25.7 (± 8.6) mmHg. The surgical success (IOP<21 mmHg) rates at 3, 6, and 12 months were 86.7%, 64.3%, and 92.9% respectively. The Kaplan-Meier estimates of the probability that IOP remained below 21 mmHg up till 3, 6, and 12 months were 74%, 53%, and 53% respectively. Postoperatively, 85.7% of the eyes had complete resolution of corneal oedema. One eye had an intraoperative complication of vitreous loss. The post-operative clinic follow-up rate reduced to 52.4% by 1 year. CONCLUSION: Combined trabeculotomy-trabeculectomy is a relatively safe procedure that is associated with favorable success in Nigerian children with primary congenital glaucoma.

OBJECTIF: Présenter le résultat de la combinaison de la trabeculotomie et la trabeculectomie chez les enfants atteints de glaucome congénital primitif dans un hôpital tertiaire du sud-ouest du Nigéria. METHODES: Une revue rétrospective des enfants qui avaient subi une combinaison de trabeculotomie et trabeculectomie pour le traitement de glaucome congénital primitif entre 2016 et 2020 à l'University College Hospital,Ibadan, Nigeria. Toutes les chirurgies avaient été effectuées par des ophtalmologistes pédiatres. Les principaux résultats étaient la pression intraoculaire postopératoire, la clarté cornéenne et les complications. RESULTATS: Au total 21 yeux de 13 patients étaient étudiés. Dix (76,9%) patients étaient des garçons et 8 (61,5%) avaient une atteinte bilatérale. La moyenne d'age à la présentation était de 4,8 (± 3,6) mois, tandis que la moyenne d'age au moment de la chirurgie était de 8,1 (± 5,9) mois. Le temps d'attente moyen entre l'observation des symptômes et la présentation à la consultation était de 3,2 (± 4,9) mois. Le diamètre cornéen horizontal moyen était de 13,2 (± 1,4) mm, tandis que la pression intraoculaire (PIO) préopératoire moyen était de 25,7 (± 8,6) mmHg. Les taux de succès chirurgical (PIO <21 mmHg) à 3, 6 et 12 mois étaient respectivement de 86,7%, 64,3% et 92,9% . Les estimations de Kaplan-Meier de la probabilité que la PIO restait en dessous de 21 mmHg jusqu'à 3, 6 et 12 mois était respectivement 74%, 53% et 53%. Après l'opération, 85,7% des yeux avaient une résolution complète de l'œdème cornéen. Un œil avait une complication peropératoire de perte de vitré. Le taux de visites médicales en postopératoire était réduit à 52,4% en 1 an. CONCLUSION: La combinaison de la trabeculotomie et de la trabeculectomie est une procedure chirurgicale relativement sûre associée à un succès favorable chez les enfants Nigérians atteints de glaucome congénital primitif. Mots clés: Glaucome congenital, Trabeculotomie et Trabeculectomie, Résultat chirurgical, Pression intraoculaire.

Cardiac diastolic function after recovery from pre-eclampsia.

BACKGROUND: Pre-eclampsia is associated with significant changes to the cardiovascular system during pregnancy. Eccentric and concentric remodelling of the left ventricle occurs, resulting in impaired contractility and diastolic dysfunction. It is unclear whether these structural and functional changes resolve completely after delivery. AIMS: The objective of the study was to determine cardiac diastolic function at delivery and one year post-partum in women with severe pre-eclampsia, and to determine possible future cardiovascular risk. METHODS: This was a descriptive study performed at Steve Biko Academic Hospital, a tertiary referral hospital in Pretoria, South Africa. Ninety-six women with severe preeclampsia and 45 normotensive women with uncomplicated pregnancies were recruited during the delivery admission. Seventy-four (77.1%) women in the pre-eclamptic group were classified as a maternal near miss. Transthoracic Doppler echocardiography was performed at delivery and one year post-partum. RESULTS: At one year post-partum, women with pre-eclampsia had a higher diastolic blood pressure (p = 0.001) and body mass index (p = 0.02) than women in the normotensive control group. Women with early onset pre-eclampsia requiring delivery prior to 34 weeks' gestation had an increased risk of diastolic dysfunction at one year post-partum (RR 3.41, 95% CI: 1.11-10.5, p = 0.04) and this was irrespective of whether the patient had chronic hypertension or not. CONCLUSION: Women who develop early-onset pre-eclampsia requiring delivery before 34 weeks are at a significant risk of developing cardiac diastolic dysfunction one year after delivery compared to normotensive women with a history of a low-risk pregnancy.

Surgical considerations in the management of giant emphysematous bullae.

Nine cases with giant emphysematous bullae causing progressive incapacitating dyspnea due to gradual but progressive compression of adjacent lung tissue are reviewed. All the patients selected for surgery had peripheral arterial oxygen saturation of not less than 92 percent at rest. A total of 13 excisions was carried out in the nine patients with resultant increase in their postoperative arterial oxygen tension and improvement in exercise tolerance. There were no deaths from the operations.

Foreign bodies in the tracheobronchial tree: management and complications.

Accidental inhalation of a foreign body into the air passages is not an uncommon occurrence in any age group, but it is more frequent in the younger age group. Thirty-seven of the 47 patients (78.7 percent) in the present study were under 16 years of age. Most of the foreign bodies were found in the right bronchus. In this series, 73.9 percent of the interbronchial foreign bodies were recovered by bronchoscopy, while 6.5 and 19.6 percent were recovered during emergency tracheotomy and bronchotomy, respectively. The mortality in this series was 6.4 percent.

Pleural empyema in infants and children: analysis of 298 cases.

Of 298 infants and children with empyema thoracis seen, 62 percent were under 2 years of age. The majority of the cases had underlying pulmonary infection, and Staphylococcus aureus was dominant among the organisms isolated. The diagnosis was made in all cases on the basis of chest x-ray films and thoracentesis. Full expansion of the lung and resolution of the underlying pneumonia occurred on administration of appropriate antibiotics and catheter drainage in all cases except in two patients who had decortication. The mortality rate was 5 percent; delayed presentation and suboptimal prehospitalization antibiotics influenced the morbidity.

Achalasia of the esophagus: reflections upon a clinical study of 33 cases.

Thirty-three patients who have suffered with dysphagia to solids and liquids for a varying number of years are reviewed. They all had a history and radiologic findings suggestive of achalasia of the esophagus. Thirty-one of the cases who had uncomplicated achalasia benefited from a transthoracic modified Heller's procedure. Lower esophageal diaphragm and carcinoma arising in the proximal half of the distal third of the esophagus occurred in association with achalasia in two patients. Over 90 percent had symptomatic relief of their symptoms. The only mortality was recorded in a patient who had palliative esophagogastrectomy for associated carcinoma. A properly performed anterior extramucosal esophagomyotomy is the safest and most effective procedure available, even in places with minimal facilities.

Intrathoracic complications of amoebic liver abscess.

Amoebiasis is a world-wide parasitic infestation but is more prevalent and virulent in warm countries. Of 33 patients with amoebic liver abscess (ALA) seen over a 5-year period, 24 had intrathoracic complications. Management consisted mainly of the administration of the antiamoebic agent metronidazole (Flagyl), repeated needle aspiration of ALA and surgical drainage when aspiration failed. Closed tube thoracostomy was the preferred management of amoebic empyema. Associated cerebral involvement in 4 cases improved with parenteral metronidazole. Pericardial amoebic abscess claimed 100% mortality in our series.

Management of oesophageal foreign bodies in children.

OBJECTIVE: To evaluate the pattern and outcome of management of retained oesophageal foreign bodies in children. DESIGN: Retrospective study. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, January 1991 to December 2000. SUBJECTS: One hundred and eight paediatric patients, aged 0-14 years managed for retained oesophageal foreign bodies. INTERVENTION: The foreign bodies were removed endoscopically, using either a larynoscope or a rigid oesophagoscope, under general anaesthesia. RESULTS: There were 108 patients, with a mean age of 3.0 +/- 0.8 years and age range of 23 days to 14 years. The male to female ratio was 1.5: 1. Sixty four (59.3%) patients were within 1-5 year age group. Coins constituted 79.6% of the retained foreign bodies. Over 90% of patients presented within the first four days of the incidence. The dominant complaints were drooling of saliva in 37 (40.2%) and difficulty in swallowing in 35 (38.1%) patients. The commonest sites of the foreign body retention were the upper third of oesophagus 52(48.2%) and the hypopharynx 36(33.3%). The main complications following the foreign body removal were oesophageal perforations 4(3.7%) and lacerations 16(15%). CONCLUSION: Retained oesophageal foreign body is a common childhood health hazard. Early diagnosis and prompt skillful removal are necessary for a satisfactory outcome.

Lower lungfield tuberculosis in a rural African population.

An analysis of 500 consecutive pulmonary tuberculosis cases shows that lower lungfield tuberculosis occurs in 6.8 percent of the negroid population studied and therefore shows no racial predelection. The ratio of female to male involvement was 3:1. A clear association with young women and with pregnancy with or without other infections was demonstrated. Affected men were in the much older age group. Some association with diabetes and heart failure were also observed. The initial diagnosis of most of these patients was basal pneumonia or lung abscess. Therefore, the most useful clinical pointers were productive cough with or without haemoptysis unresponsive to various conventional antibiotics. The right base was most favoured and cavitation with fluid levels were frequent. We believe that the aetiological factors would include stress as could occur with pregnancies and poor basal tissue oxygenation due to diminished basal expansion in abdominal distension or cardiac failure.

Oesophago-pleural fistula complicating a case of tuberculous pyopneumothorax.

The case of a 3-year-old girl who developed an oesophago-pleural fistula following tuberculous pyopneumothorax is described. She was successful managed followed by surgical closure of the fistula.

Thoracic injuries in road traffic accidents: analysis of 148 cases.

A series of 148 cases of chest injuries is presented and their treatment and results are described. The study covered a period of 5 1/2 years and the significance of associated injuries is stressed.

Lower oesophageal diaphragm and achalasia in an adult. An unusual association.

An unusual case of congenital lower oesophageal diaphragm (web) associated with achalasia is described. An 18-year-old nulliparous girl presented with severe cachexia and aphagia following progressive dysphagia. A barium swallow demonstrated the achalasia, and the oesophageal diaphragm with a central pinhole opening was seen at endoscopy. Parenteral hyperalimentation was required for ten weeks prior to surgery. Circumferential excision of the oesophageal diaphragm in conjunction with Y-V advancement oesophagoplasty gave a good result.

Management of pulmonary aspergilloma in the presence of active tuberculosis.

Eleven cases of pulmonary aspergilloma complicating active cavitating pulmonary tuberculosis are reviewed. Nine of the 10 patients who had combined medical (antituberculosis drugs) and surgical treatment were cured of their disease; one patient, who had bilateral multiple aspergillomas, died from massive haemoptysis after resection of one of the affected lobes. The only medically treated patient who refused surgery had fatal haemoptysis at home. Pulmonary resection is recommended for patients who are fit for operation whenever the diagnosis of aspergilloma is made because most published reports indicate that only a few patients benefit from drug treatment alone.

Congenital lobar emphysema of left upper lobe. A case report.

In a 2 1/2-year-old boy chest X-ray examination because of dyspnoea revealed hyperlucency of the left upper lobe with herniation of the hyperinflated lobe into the right hemithorax. Surgical exploration showed the upper lobe of the trilobed lung to be the site of congenital lobar emphysema, while the lingula and left lower lobe were collapsed. Left upper lobectomy was successfully performed.

Host-guest-like thiamine-anion complexation in thiaminium bis(tetrafluoroborate).

In the title compound, 3-[(4-amino-2-methyl-5-pyrimidin-1-io)methyl]-5-(2-hydroxyethyl)-4-methylthiazolium(2+) bis(tetrafluoroborate), C(12)H(18)N(4)OS(2+).2BF(4)(-), the divalent thiamine cation (in the F conformation) is associated with BF(4)(-) anions via two characteristic bridging interactions between the thiazolium and pyrimidinium rings, i.e. C-H...BF(4)(-)...pyrimidinium and N-H...BF(4)(-)...thiazolium interactions. Thiamine molecules are linked by N-H...O hydrogen bonds to form a helical chain structure.