Reconstruction of the chest wall after excision of a giant malignant peripheral nerve sheath tumor.

Primary chest wall tumors are uncommon and constitute 0.2-2% of all tumors. Metastatic tumors and tumors of local extension are more common. Malignant peripheral nerve sheath tumor (MPNST) of the chest wall is even rarer and its incidence on the chest wall not stated in the literature. The incidence in the general population is 0.0001% while the risk is approximately 4600 times higher in patients with type I neurofibromatosis and 3-13% of them will finally develop into MPNST, usually after latent periods of 10-20 years. Clinically, these tumors are aggressive, locally invasive, and highly metastatic. Excision of giant chest wall tumor leaves a defect that is reconstructed using musculocutaneous flaps with or without a mesh. We report the case of a 24-year-old man who presented at the surgical outpatient clinic with 7 months history of persistent left sided chest pain minimally relieved by analgesics, 5 months of cough and worsening dyspnoea, and 3 months history of anterior chest swelling on the left side of the manubrium. Following evaluation and investigations, the tumor was excised and the residual defect closed with methylmetacrylate sandwiched between two prolene meshes and overlaid with both pectoralis major muscles. The histology of the excised mass revealed MPNST He made an uneventful postoperative recovery, but died barely 3 months later from widespread pulmonary metastases. A review of the literature revealed that such tumors hardly ever reach such large-size as in our case.

Audit of cardiothoracic diseases seen at the National Cardiothoracic Centre Enugu Nigeria.

BACKGROUND: The University of Nigeria Teaching Hospital, Enugu was designated the national centre of Excellence for Cardiothoracic diseases, because of the availability of skilled manpower. This study was therefore undertaken to see the pattern of cardiothoracic diseases managed in the surgical unit of the centre and to see if the objectives of its establishment are being achieved. METHOD: A retrospective analysis of in-patient admission records managed surgically or conservatively between 2000 and 2004 was made. RESULTS: A total of 704 cases were identified; 469 (55.6%) men, 121 (17.2%) women and 114 (16.2%) children. Majority, 163 (23.25%) were between the age range of 20-29 years. Enugu, the State where the hospital is domicile had the highest admission rate of 318 patients (45.15%) while the 19 Northern States had a total of 67 patients (9.51%). Chest wall disorder constituted the majority of cases (28.69%) of which chest trauma from road traffic accident was the majority 49.6%. Most patients were hospitalised for an average of 2-4 weeks (56%). CONCLUSION: The study revealed a low admission rate with a declining trend over the years and a skewed distribution of their origin. It also identifies militating factors and draws the attention of the relevant authorities to take necessary actions to stem this trend.

Cardiac pacemaker treatment of heart block in Enugu a 5-year review.

BACKGROUND: Symptomatic heart block is a treatable cardiac cause of death which occurs globally. In Nigeria it is increasingly diagnosed and treated with permanent artificial cardiac pacemaker insertion and pulse generator implantation, sometimes after a period of misdiagnosis and inappropriate treatment. METHODS: Twenty-three patients who were diagnosed with symptomatic heart block and surgically treated with permanent artificial cardiac pacemaker in National Cardiothoracic Centre, Enugu, between April 2001 and March 2006 had their case notes retrospectively reviewed and information entered into a proforma. This was analyzed. Patients diagnosed with symptomatic heart block but not treated with artificial cardiac pacemaker insertion were excluded from the study. There were eight such patients who could not afford the cost of surgical treatment during the period under review. RESULTS: The mean age of the patients was 70 years and the commonest presentation was shortness of breath (100%). Hypertensive heart disease was present in 65% of the patients and a history of chronic chloroquine usage was positive in 73% of the patients. Predominant pretreatment pulse rate was in the range of 30-40 per minute (43%) while 21% of the patients had pulse rate below 30 per minute. These categories of patients commonly had Stoke-Adams syndrome. Sixty-seven per cent of the patients had predominantly systolic hypertension on admission and 16% had hypotension. Third degree heart block was present in 65% of the patients and 89% of all patients needed pre-pacing haemodynamic stabilization with positive inotropic/chronotropic drug(s). Treatment consisted of permanent endocardial pacing in 65% and epicardial pacing in 35% of the patients with equally good response in symptoms, haemodynamic parameters and electrocardiographic features. CONCLUSION: Permanent artificial cardiac pacing is, the reliable treatment of symptomatic heart block and should be included in the National Health Insurance Scheme list.