Aetiological considerations in 96 consecutive cases of ascites

Background: Ascites is always a feature of an underlying disease; whose cause is unknown at presentation most of the time. Its initial treatment therefore will be empirical and dependent on the most frequent and common causes in the environment. Aim: To evaluate a cohort of patients with ascites to determine the common causes in the University of Port Harcourt Teaching Hospital (UPTH). Methods: We undertook a clinical evaluation of 96 consecutive cases seen at the UPTH; over a three-year period; using a combination of diagnostic modalities which included biochemical; serological and cytological examination of the ascitic fluid; as well as radiology and ultrasonography; and histological examinations of liver biopsy specimens in cases suggestive of liver disease. Results: The three most common causes of ascites in this series were liver diseases-36.5(chronic liver disease 27.1; hepatocellular carcinoma 9.4); renal diseases 30.2(chronic renal failure 23.9; nephrotic syndrome 6.3); and cardiac diseases 23.9(congestive cardiac failure 22.9; Endomyocardial fibrosis 1). The clinical conditions associated with portal hypertension (liver and cardiac diseases) accounted for 60of cases. Localized intra-abdominal disease; such as tuberculosis was rare (3.1); and chronic alcohol consumption was very common amongst all aetiological groups. Peripheral oedema was a frequent accompaniment of the renal and cardiac cases more than the liver diseases; whereas pleural effusion was very rare. Conclusion: Patients presenting with ascites can be commenced on diuretics and salt restriction pending the establishment of a definitive diagnosis

Adult tetanus at the University of Port Harcourt Teaching Hospital: An analysis of 42 cases

Background: Adult tetanus is still common in Nigeria as in other developing countries where immunization programmes are poor. Recently; fee for service was introduced in tertiary medical institutions. Type of Study: Retrospective. Aim: To define the characteristics of cases of tetanus in adults admitted to the University of Port Harcourt Teaching Hospital (UPTH) from 1991 to 1995. Methods: Patients with features of tetanus were identified from ward records and the Medical Records Department. The case note were examined and analysed. The management was carried out in the general medical wards and consisted of anti-tetanus serum (ATS); crystalline penicillin; dextrose infusion; diazepam and metho carbarmol provided for by patients. Results: There were 42 patients: 26 males and 16 females. The ages ranged from 15 to 60 years (mean 29 years). The immunization history was poor. The commonest portal of entry was the lower limb (47.6). The predominant social groups were students and fishermen. There was delay in the treatment of some of the patients as a result of which 25 cases had complications such as tachycardia; pneumonia and hypertension. Nine patients had multiple complications. Twenty-one patients died on admission. Eighteen deaths occurred within the first week of admission. Conclusion: The high mortality may reflect treatment delays and lack of intensive care unit facilities. Adequate campaign for anti-tetanus immunization should be embarked upon especially for the high risk students and fishermen

Management of fulminant hepatic failure with Mannitol. [short communication]

Eight patients with fulminant hepatic were managed conservatively using intermittent infusion of 20 percent mannitol. All but one case regained consciousness within seven days of commencement of the mannitol infusion. All have maintained normal hepatic function over a period of twelve to eighteen months. Mannitol still remains an effective treatment modality in centres where newer and sophisticated methods of therapy are now available