Diagnostic role of video-assisted thoracoscopy in the management of indeterminate pleural effusion.

Background: The management of pleural effusion usually involves the drainage of the effusion, identification, and treatment of the underlying cause (s). Studies have shown that the initial diagnostic techniques do not give conclusive diagnosis in some cases of pleural effusion. This group of patients described as patients with indeterminate or undiagnosed pleural effusion constitutes a significant proportion of patients with pleural effusion in clinical practice. In this study, we examined the role of video-assisted thoracoscopy (VAT) in the diagnostic work-up of these patients. Aim: To determine the diagnostic outcome of VAT in the management of indeterminate pleural effusion in our center. Patients and Methods: Consecutive patients who presented with pleural effusions and who met the inclusion criteria had video-assisted thoracoscopy for diagnostic purposes. Outcome measures including the diagnostic yield, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of VAT in patients with indeterminate pleural effusion, duration of the procedure, duration of hospitalization after the procedure, and complications for all the patients were documented and analyzed. Results: Of the 22 patients with indeterminate pleural effusion, conclusive diagnosis was obtained in 18 (81.8%) with a sensitivity of 91.7% [95% confidence interval (CI); 61.5-99.8%], specificity of 100% (95% CI; 69.1-100%), PPV of 100% (95% CI; 0-100%), and NPV of 90.9% (95% CI; 60.5-98.5%) for malignancy and a sensitivity of 78% (95% CI; 40-97%), a specificity of 100% (95% CI; 75.3-100%), PPV of 100% (95% CI; 0-100%), and NPV of 86.7% (95% CI; 65.7-95.7%) for tuberculosis. Conclusion: Our results show that video-assisted thoracoscopy plays a useful role in our center in obtaining diagnosis in patients with indeterminate pleural effusion.

ADVANCED BRONCHOGENIC CARCINOMA PRESENTING WITH SKIN NODULES - A CASE REPORT.

Bronchogenic cancer can metastasize to several organs of the body. Metastases to skin and subcutaneous tissue are uncommon. We present our experience with the management of a patient with an unusual presentation of bronchogenic carcinoma with multiple skin nodules. In patients with bronchogenic cancer, metastasis to the skin and subcutaneous tissues could heighten the index of suspicion of advanced disease. The nodules should be histologically assessed and if confirmed metastatic, only palliative therapies are indicated.

ADVANCED BRONCHOGENIC CARCINOMA PRESENTING WITH SKIN NODULES - A CASE REPORT.

Bronchogenic cancer can metastasize to several organs of the body. Metastases to skin and subcutaneous tissue are uncommon. We present our experience with the management of a patient with an unusual presentation of bronchogenic carcinoma with multiple skin nodules. In patients with bronchogenic cancer, metastasis to the skin and subcutaneous tissues could heighten the index of suspicion of advanced disease. The nodules should be histologically assessed and if confirmed metastatic, only palliative therapies are indicated.

Management of lower urinary retention in a limited resource setting.

BACKGROUND: There is a projected increase in lower urinary tract obstruction by 2018, especially in the developing economies of Asia and Africa. However in many of these countries, the problems encountered both by the patients and the clinicians are not well documented. Our aims are, to prospectively analyse the management of urinary retention, the associated difficulties, and complications in our setting, where access to investigative modalities such as Computerize Tomography and Magnetic Resonance Imaging are not available. PATIENTS AND METHODS: The study was approved by the University Of Calabar Teaching Hospital ethical committee. A validated Proforma was used to collect data from all patients who were clinically diagnosed with urinary retention based on history, and physical examination, from July 2009 to June 2010. Data collected from the 1st of July 2009 to the 30th of June 2010, include demographics, findings on physical examination, previous medical history and co-morbid conditions. The results of investigations done such as: urinalysis, full blood count, electrolytes, urea and creatinine, intravenous urography, trans- abdominal ultrasonography, chest X-ray and histology of trans-rectal biopsies of the prostate . The total number of new patients seen, including those with urinary retention during the study was documented. The retentions were also classified into acute and chronic. All the patients were followed up throughout the study. The data was analysed using Epi-Info statistical program version 3.4 of 2007 to analyse the data, estimating averages, mean, median and percentages. RESULTS: The total number of new patients seen, including those with urinary retention was Seventy thousand, one hundred and thirty nine (70,139).Of this number, hundred and fifty nine (0.23%), presented with urinary retention; 145 (91.2%) were acute, and14 (8.8%) were chronic. The male: female ratio was 39:1.The patients ages ranged from 4 to 94 years, with a mean of 53.7±11.2. Seventy seven [48.4%] of them were in the 6(th) and 7(th) decades of life. The common causes were; prostatic diseases [BPH and cancer of the prostate] 77.0%, infections 75.8%, trauma 12.1%, and congenital 12.1%. Urinary retention was relieved by: indwelling urethral catheterization [IUC] 120 patients (75.5%), supra- pubic cystostomy [SC] 34 (21.4%) and intermittent urethral catheterization [IC] 5 (3.1%). The most frequently encountered complications include pyuria (18.2%), pericatheter sepsis 17.5%, and haemorrhage during change of catheter 16.8% [figure 2]. Figure 2Complication after one week bladder drainage. CONCLUSION: Lower urinary retention is common in our environment. The management is appropriate and standard. The man power and facilities are inadequate, and requires urgent improvement.

Gunshot injuries in Calabar, Nigeria: an indication of increasing societal violence and police brutality.

BACKGROUND: Gunshot injuries were rare in Calabar before the Nigerian civil war. This has changed in subsequent years and has reached a near epidemic proportion in the last three years. These are caused by civil violence, police brutality and armed robberies. OBJECTIVE: To evaluate the incidence, pattern and causes of gunshot injuries in this region and draw the attention of Nigerians and the Government to the above problems for a possible solution. METHODOLOGY: Records of patients admitted into the University of Calabar Teaching Hospital (UCTH) with gunshot wounds between April 2002 and May 2004 were extracted. Parameters analyzed included patients' biodata, sources of injury, anatomical site (s) of injury, modalities of treatment and the outcome RESULT: There were 51 injuries in 49 patients as follows: The lower limbs 25 (51'), upper limbs 6 (12.4'), upper limbs/ chest 2 (4.1'), chest 4 (8.2'), abdomen 7(14.1') and head/neck 5(10.2'). Male/female ratio was 48:1. Twenty-four (49') sustained their injuries from either accidental discharge or deliberate shooting by the police while armed robbers wounded 10 (20.4') and cultists, 2 (4.1'). Two patients had amputations and mortality was 8.2'. CONCLUSION/RECOMMENDATIONS: The police should be cautious with guns;they and the Government should be alert to the menace of robbery, political violence, cultism and communal clashes. Good Governance, creation of employment, eradication of corruption and political violence may help.

Pregnancy heartburn in Nigerians and Caucasians with theories about aetiology based on manometric recordings from the oesophagus and stomach.

A study by questionnaire of the incidence of pregnancy heartburn in two groups of Nigerians and one group of Caucasians showed an incidence of 9-8 per cent in all Nigerians as against 78-8 per cent in Caucasians. The difference was highly significant (chi 2 = 102-75; P less than 0-0001). An oesophageal manometric study of the lower esophageal sphincter in 12 non-pregnant women and in 12 pregnant Nigerians (10 without heartburn and 2 with heartburn) showed that the mean lower oesophageal sphincter pressure (+/- SD) in the pregnant patients without heartburn was 20-1 +/- 7-0 mm Hg as against 17-9 +/- 7-0 in the non-pregnant women. While one pregnant subject without heartburn had a lower oesophageal sphincter which was partially displaced into the thorax, none of the non-pregnant women had such sphincter displacement. The two pregnant women with heartburn had low resting sphincter pressures and in both of them the sphincters were partially in the thorax. It is argued that pregnancy heartburn is due to the displacement of the lower oesophageal sphincter into the negative pressure environment of the thorax where the sphincter is less capable of resisting reflux. It is also argued that pregnancy heartburn is commoner in Caucasians that in Nigerians because the spincter in non-pregnant Caucasians is often partly intrathoracic and is thus more easily displaced completely into the thorax by the pregnant uterus.

Incidence of hiatus hernia and gastro-oesophageal reflux in 1030 prospective barium meal examinations in adult Nigerians.

A prospective study to determine the incidence of hiatus hernia and gastro-oesophageal reflux in 1030 consecutive symptomatic adult Nigerian patients undergoing barium meal examination is reported. The results show a very low incidence of hiatus hernia (0-39%) and an equally low incidence of gastro-oesophageal reflux (2-2%) when compared with similar studies in Europe and America. There was a high incidence of duodenal ulcer (23-3%) and a low incidence of gastric ulcer (1-8%), the duodenal/gastric ulcer ratio of 12-1:1 being much higher than in Europe.