Management of malignant pleural effusion (MPE) in a Tertiary Hospital in a low-income-country: challenges and prospects

Background: In the West African sub-region, significant morbidity and mortality are known to affect patients with malignant pleural effusion (MPE) but are highly under reported unlike USA, Europe or South Africa. Aim/Objective: To review cases of MPE in our tertiary hospital in the last 13 years with a view to determining the challenges and prospects. Materials and Method: This is a retrospective study spanning over a decade from January, 2007 to December, 2019. Malignant pleural effusion from various neoplasms constitutes the commonest thoracic malignancy in our tertiary hospital. After 13 years of management of such patients, we reviewed the datafrom the hospital record's department. The data obtained were demography, aetiology, total number of pleural fluid specimens for cytology and pleural biopsies submitted for histology, pleurodesis and other treatment modalities. Result: 211 patients with MPE were admitted and managed during the period under review. Of these numbers, 135(64.0%) were confirmed cytologically positive (MPE). 76(36.0%) tested falsely negative and were initially regarded as paramalignant, later confirmed MPE. The age affected was from 7 to 81 years with a mean of 44 years. Of 211 patients with MPE, 94 were males while 117 were females, with a male to female ratio of 4:5. Aetiologically, metastatic breast cancer was the highest followed by advance lung cancer. Conclusion: Submission of insufficient samples resulted in false negative cytology. Review of recurrent pleural effusion and exophytic tumour at the sites of CTTD resulted in late diagnosis of MPE. Additionally, prolonged hospital stay awaiting CTTD and cytology results are among the challenges

Clinical Study of Trans-catheter Closure of Patent Ductus Arteriosus with Occluder Devices among Children Aged 9 Months to 18 Years.

Background and Objectives: This study was aimed at determining our experience with occluder devices over last 5 years. The objective of this study is to compare the complication rates and efficacy of different devices used for the closure of PDA. Methods: A cross-sectional retrospective study in which a review of the records of all children who had PDA surgery in a paediatric cardiac center, Innova Childrens’ Heart Hospital, Hyderabad, India over a five year period (June 2007 and July 2011) was undertaken. The hospital records showed that from June 2007 to July 2011, a total of 456 children aged 9 months to 18 years had trans-catheter closure over the study period, of these, 159 underwent trans-catheter device closure of PDA. A team of experienced paediatric cardiologist performed all the procedures. Results: Out of the 159 cases, 134 (84.2%) were successful while 25 (15.7%) were complicated. Five (5) {20.0%} cases had temporary residual leak, 3 (12.0%) had failure of the procedure that required surgical intervention, 9 (36.0%) had protrusion of the device into the aorta without significant Doppler pressure gradient. There exist a relation between success, complication and device used for the procedure.The type of occluder device used for the procedure significantly affect the outcome (χ2 = 16.37; p = 0.02) Chinese occlude devise had the highest success rate. Twenty five (25.0) {15.7%} patients had complications in all. The commonest complication (protrusion of the device into the aorta) was seen in 3 (1.8%) cases with Chinese duct occluder, 3(1.8%) with Sear Heart R and 3 (1.8%) cases with ADOs. Non died from the procedure. Conclusion: The commonest complication is (protrusion of the device into the aorta) with Chinese occludes devise showing the highest success rate. The learning curve and accumulating experience play an indispensable role in choosing the proper device and its size.

Pattern and Clinical Profile of Children with Complex Cardiac Anomaly at University of Nigeria Teaching Hospital; Ituku-Ozalla; Enugu State; Nigeria

Background: Complex congenital cardiac abnormalities are rare among children and contribute to mortality and morbidity. The prevalence and pattern of presentation vary from lace to place.Materials and Methods: The objective of this study was to determine the clinical profile and pattern of presentation of complex congenital cardiac malformations among children attending a tertiary hospital in Enugu State. A cross-sectional retrospective study in which a review of the records of children who attended the children outpatient clinic of University of Nigeria Teaching Hospital (UNTH); Ituku-Ozalla; Enugu State over a 5-year period (January 2007-June 2012) was undertaken. Results: Thirty one thousand seven hundred and ninety-five (31;795) children attended the outpatient clinic of the hospital over the study period; of these; 65 had cardiac diseases; from which 16 were found to have congenital complex cardiac abnormalities of various types; giving a prevalence of 0.05. Complex abnormalities seen in these children are Tricuspid atresia with various associations; cor triatriatum; single ventricle; and large ASD (atrio-septal defect) with complete AVCD; cor triatriatum sinistrum with cardiomyopathy; DORV (double outlet right ventricle) with left sided aorta; hypoplastic tricuspid valve with a PDA (patent ductus artriosus); TOF (tetralogy of fallot); prolapse of aortic valve; and pulmonary regurgitation. One of these complex cardiac anomalies presented with Turner's syndrome and another with VACTERAL association. Conclusions:The results of this study show that 0.05 of children who presented at cardiology clinic of a teaching hospital in Enugu State had congenital complex cardiac abnormalities and that the commonest forms seen were those with cor triatriatum and TOF

A Study of Extracranial Aneurysms at UNTH in Enugu; Nigeria

Previous studies on aneurysms in Nigeria have either been case reports or studies of peripheral aneurysms. No study has comprehensively evaluated all aspects of this disease as an entity among Nigerians. The need therefore arises to re-evaluate this lesion so as to make deductions on incidence; sex ratio; aetiology and management. This is a retrospective descriptive study of arterial aneurysms at the University of Nigeria Teaching Hospital (UNTH); Enugu. Those treated between January 1993 and December 2002 were included for the study. Datawere obtained frommedical records for all patients admittedwith aneurysms over the study period. Atotal of 26 patientswere admitted during the period; but 24 case noteswere analysed. The age rangewas 10-75 yearswithmale: female ratio of 1.4:1. Traumatic pseudo aneurysms accounted for 16 cases (67.0)while true aneurysms comprised the remaining.Of all the aneurysms; femoral artery with most of the pseudo aneurysms had 8 out of 24 (33.0).This is followed by the infra-renal abdominal aorta (5/24; 21.0) and other sites (11/24; 46.0). Diagnoses were made clinically in most cases and by abdominal ultrasonography in abdominal aortic aneurysms. Twenty-one patients had surgical interventionwith 9.5operativemortality. The incidence of aneurysm is low in our locality (2.6/year) based on the rate of diagnosis.Abdominal aorta harbours most of the true aneurysms with diameter ranging from 8.0-15.0cm without rupture. Untreated; all will eventually rupture with catastrophic consequences. Treatment involved excision with graft interposition. This is not only expensive but the graft is often not readily available. As a solution; grafts should be stocked with drug revolving fund