Early experience with outpatient tube drainage for management of pleural collections

BACKGROUND: Increasing cases of pleural effusion leads to pressure on bed spaces and a stretch of the limited facilities available for intervention in our centre. This therefore prompted a search for acceptable alternative way of treatment. OBJECTIVE: To evaluate the use of ambulatory drainage system for chronic infectious and malignant pleural effusion on outpatient basis. METHODS: Eight of 113 routinely performed closed tube thoracostomies drainage were converted to ambulatory drainage system at the time of patients' discharge to follow-up clinic. This was after the catheter care had been thoroughly explained to the patients and their relatives. RESULTS: Eight patients (seven males and one female) had ambulatory outpatient tube management. Their mean age was 44.9 ± 18years with a range of 22­70 years. Histologically confirmed causes of the effusion were; metastatic adenocarcinoma in two(25%) of the cases; chronic non-specific inflammation in another two(25%) and tuberculous empyema thoracis in three(37.5%) one of whom had TB/HIV co-infection and one(12.5%) of chronic bacterial parapneumonic empyema. One case each of metastatic adenocarcinoma and chronic nonspecific suppuration had failed chemical pleurodesis before the outpatient drainage procedure. Half of the cases (including tuberculous and non-tuberculous) were successfully weaned off their catheters. Minor complications such as pain, discomfort, minimal stoma bleeding, and peri-catheter leak were recorded. Rapid fluid re-accumulation prevented weaning in two (25%) of the cases. CONCLUSION: Out-patient chest tube drainage is effective for the management of both malignant and suppurative pleural effusion. This approach would reduce the ever increasing cost of hospital care for this group of patients. WAJM 2009; 28(6): 364­367

Sickle Cell Chronic Lung Disease among Young Adult Nigerians

BACKGROUND: Sickle cell chronic lung disease (SCLD) is often underappreciated by health care providers because its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA). METHODS: Ninety (43 males and 47 females) patients with SCA who were selected by balloting and 90 (54 males and 36 females) healthy subjects with normal adult haemoglobin were studied. Their ventilatory function test (spirometry and peak expiratory flow rates); radiological and electocardiographic parameters were obtained and analyzed for SCLD. RESULTS: Seventeen (18.9) of the patients had SCLD. Majority (94.1) of them were in stage1 disease; 5.9in stage two; and none in the more advanced stages3 and 4. The number of patients with SCLD increased with increasing age. SCLD was associated with more than five previous hospital admissions (82.4; OR=10.02; CI=4.51-22.22) and presence of symptoms suggesting previous acute chest syndrome (dyspnoea in 58.8; OR=33.33; CI=7.39-150.30; chest pain in 94.1; OR=81.33; CI= 9.83-672.85; cough in 47.1; OR=64.00; CI=7.15-572.60). CONCLUSION: SCLD may not be a rare event in Nigeria. Therefore efforts should be made to diagnose it in the early asymptomatic stage so as to offer effective intervention therapy to halt progression to the more disabling advanced stages