Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility.

BACKGROUND: Trauma remains a leading cause of morbidity and mortality in resource challenged economies I. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually from road traffic accidents and are managed at the accident and emergency unit while the severe ones are admitted into the intensive care unit. METHODOLOGY: All trauma admissions to the intensive care unit (ICU) of LAUTECHTeaching Hospital Osogbo over a 5 year period (2008-2012) after ethical approval from the ethical unit of the hospital were reviewed. RESULTS: During the study period, 112 trauma patients were admitted to the ICU, representing 68% of total ICU admissions. The male:female ratio of ICU trauma cases was 3:1. Out of the trauma admissions 83 (74.1%) of the cases came as emergency from the accident and emergency unit while 2.4% and 1.6% respectively came from operating theatre-- and the general ward respectively. 83 (74.1%) of trauma cases admitted were road traffic accidents, while 20 (17.9%) were burns not related to RTA and the remaining 8(9%) were due to falls, fight/ssault. Most of the road traffic accidents related trauma patients admitted to the intensive care unit had head injuries (66.3%) while 7% and 12% had multiple fractures and chest injuries respectively. The mean patient age 35 years and the mean duration of ICU stay was 6.3 ± 8.4 days. Survivors had a longer ICU stay CONCLUSION: Trauma is a major cause of hospitalization and intensive care utilization. It also consumes a significant amount of the health care budget.In most instances it is preventtable.Trauma prevention, the most effective management strategy should include increased public education, improved security, better implementation of legislative measures to ensure safety for all road users, control of firearms, and minimizing domestic and intentional violence. Appropriate, aggressive intensive care in combination with efficient communications,rapid medical evacuation, and an organized emergency multidisciplinary trauma care team will further improve outcome in trauma patients.

Laryngeal carcinoma: experience in Ile-Ife, Nigeria.

OBJECTIVES: This study aimed to determine the prevalent age, pattern of presentation, histopathology type, and outcome of management of laryngeal carcinoma in our environment. DESIGN AND SETTING: This was a 10-year retrospective study carried out at a teaching hospital. MATERIALS AND METHODS: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age, sex, occupation, presentation, use of cigarette and alcohol, investigations, histology, outcome of management, and duration of follow-up were extracted and analyzed. RESULTS: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all, cough in 7 (53.8%), weight loss in 7 (53.8%), and otalgia in 6 (46.2%). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8%) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4%) had pharyngolaryngectomy, thyroidectomy, radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4%) patients, pharyngeal stenosis, stomal stenosis, and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. CONCLUSION: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers, ignorance, local taboo, poverty, and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

Laryngeal carcinoma: experience in Ile-Ife, Nigeria

Objectives: This study aimed to determine the prevalent age; pattern of presentation; histopathology type; and outcome of management of laryngeal carcinoma in our environment. Design and Setting: This was a 10-year retrospective study carried out at a teaching hospital. Materials and Methods: Records of patients managed for laryngeal carcinoma from January 1994 to December 2004 were reviewed. Only 13 cases with tissue diagnosis were included in this review. The age; sex; occupation; presentation; use of cigarette and alcohol; investigations; histology; outcome of management; and duration of follow-up were extracted and analyzed. Results: The patients had a mean age of 69.9 years (range 38-88 years) and a male-to-female ratio of 12:1. Histopathology was squamous cell carcinoma in all. Symptoms included hoarseness in voice and breathlessness in all; cough in 7 (53.8); weight loss in 7 (53.8); and otalgia in 6 (46.2). Two patients indulged in alcohol and two were also regular cigarette smokers. All the patients presented with stage IV disease and in respiratory distress necessitating emergency tracheostomy. Seven (53.8) patients had total laryngectomy plus postoperative radiotherapy while 2 (15.4) had pharyngolaryngectomy; thyroidectomy; radical neck dissection plus postoperative radiotherapy and thyroxine supplement. Surgical complications included pharyngocutaneous fistula in 2 (15.4) patients; pharyngeal stenosis; stomal stenosis; and hypocalcemia with hypothyroidism in 1 patient each. The fistulae were managed conservatively and prognosis was good despite late presentation. Conclusion: Laryngeal carcinoma mainly occurs in males. Presentation is late with hoarseness in voice and breathlessness in our community. Soft-tissue neck x-ray is a useful diagnostic tool. Scarce radiotherapy centers; ignorance; local taboo; poverty; and poor recognition by primary healthcare providers have a negative impact on its management. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma

Review of skull base surgery in a Nigerian teaching hospital.

BACKGROUND AND OBJECTIVES: There is dearth of information on skull base surgery in Nigerians. This study was conducted to determine types of skull base lesions describe surgical approaches to the lesions and determine outcome of surgical management of the lesions over the study period. METHODS: We retrospectively reviewed the case notes of the patients who underwent skull base neurosurgical procedures between January 2001 and June 2007 in our centre. We obtained information on demography, clinical presentation, diagnosis, cranial computerised tomography findings, type of surgery, intraoperative findings and outcome of surgical management at the time of discharge from the hospital. RESULTS: Brain tumours were diagnosed in 28 patients, head injuries in 9 patients and one patient each had anterior encephalocele and frontal sinus mucocele. Eighteen patients had frontal craniotomy, three patients had temporal craniotomy and two patients had lateral rhinotomy in addition to bifrontal craniotomy. Two patients had frontoorbitotomy while retrosigmoid craniectomy was performed in one patient. Thirty three patients showed significant postoperative improvement at discharge. CONCLUSION: Brain tumour was the most common indication for skull base surgery in our centre. These tumours were mainly located in the anterior cranial fossa. Frontal craniotomy was the most common surgical approach. Non-availability of modern neurosurgical facilities confined us to the use of mainly traditional approaches. The availability of these facilities will assist in improving our management outcome in the future.

Laryngeal carcinoma: our experience at Obafemi Awolowo University Teaching Hospital complex, Ile-Ife, Nigeria.

OBJECTIVES: To determine the prevalent age, frequency, pattern ofpresentation, investigations and outcome of management of laryngeal carcinoma in our environment. DESIGN: 10 year retrospective study (January 1994 to December 2003). SETTING: Teaching hospital. SUBJECTS: 13 patients with tissue diagnosis managed for laryngeal carcinoma. MAIN OUTCOME MEASURES: The age, sex, occupation, presentation, use of cigarettes and alcohol, investigations, tissue diagnosis, outcome of management and duration of follow up were extracted from hospital records and analysed. RESULTS: The age of patients ranged 38 to 88 years (median 69, male: female ratio=12:1). The histopathology was squamous cell carcinoma in all. Common symptoms included hoarseness of voice and breathlessness in all the patients, cough and weight loss in seven patients and otalgia in six. Only one patient indulged in alcohol while two were regular cigarette smokers. All the patients presented in stage IV with respiratory distress necessitating emergency tracheostomy in all. Seven patients had total laryngectomy plus post-operative radiotherapy while two patients had pharyngo-laryngectomy, thyroidectomy and radical neck dissection plus post-operative radiotherapy and thyroxine supplement. Post operative complications included pharyngocutaneous fistula in two patients, pharyngeal stenosis, stoma stenosis, and hypocalcaemia with hypothyroidism in one patient each. The fistulae were management conservatively. Prognosis was good despite late presentation. CONCLUSION: Laryngeal carcinoma occurs predominantly in males. Presentation is late with hoarseness of voice and breathlessness in our community. Soft tissue neck X-ray is a useful diagnostic tool. Scarcity of radiotherapy centres, ignorance, local taboos, poverty and poor recognition by general medical practitioners negatively affected management of the patients. Laryngeal carcinoma should be excluded when managing elderly patients for bronchial asthma.

Malignant renal tumors in adults: a ten-year review in a Nigerian hospital.

This study was undertaken to determine the age, sex, pattern of presentation, histopathology and outcome of management of adult patients with malignant renal tumors (MRT) in Nigeria. Using hospital records, a retrospective study was performed covering the period between January 1997 and December 2006. A total of 18 adult patients had been diagnosed to have MRT during this period. Information extracted and analyzed included the age of the patient, sex, presentation, investigations, type of histopathology, management and duration of follow-up. The mean age of the study patients was 47.5 years (range 16-80 yrs). The male: female ratio was 13 : 5 and the mean duration of symptoms was 43.6 weeks (range 2-104 wks). Sixteen patients (88.9%) presented in advanced stage. Symptoms included loin pain in 17 (94.4%), abdominal swelling in 15 (83.3%), weight-loss in 13 (72.2%) and hematuria in nine (50.0%). Ultrasound and intravenous urography assisted greatly in making the diagnosis. Thirteen patients (72.2%) underwent radical nephrectomy, tumors were not resectable in two (11.1%) and three others (16.7%) were deemed unfit to undergo surgery. The average tumor mass removed at surgery was 1.884 Kg (range 0.48-3.82 Kg). Renal cell carcinoma (RCC) accounted for 13 of the tumors (72.2%). Surgical complications include primary-hemorrhage, septicemia and tumor recurrence in one patient each (7.6%). Morbidity and mortality rates were 7.6% each. The average post-operative hospital stay and follow-up duration were 9.3 days and 37.5 months respectively. Our study suggests that RCC is the major MRT in our community. Most cases still present late with loin pain and swelling, weight loss and hematuria. This late presentation and sarcomatous type of tumor have negative influence on prognosis. Radical nephrectomy is beneficial in operable, locally advanced, non-metastatic MRT.

Attitude of general public to risks associated with anaesthesia.

OBJECTIVE: To identify specific fears being entertained about general anaesthesia. METHODS: People who do work in any medical facility were targeted in this prospective questionnaire-based study. All respondents were literate. The questionnaire was divided into two sections; (a) The baseline information, which included age, sex, marital status, occupation, previous exposure to anaesthesia and patient preference for anaesthesia technique. (b) Fear about risks associated with general anaesthesia; respondents were expected to pick one of four options (very concerned, somewhat concerned, not concerned and not sure), to indicate how they feel about each of the eight risks listed in the questionnaire. The data obtained was analyzed using SSPS version 10 for Windows. RESULTS: In a bivariate analysis, marital status, occupation and previous exposure to anaesthesia are not associated with the expressed fear by the respondents. Respondents had the highest concern for the fear of death (82%), followed by fear of postoperative pain (75.4%). Least concern was for awareness during anaesthesia (37.7%). The mean age of those who expressed concern about being aware during operation is 37.0 +/- 8.6 years while those not concerned is 31.8 +/- 8.5 years (p=0.034). More of those who are concerned with nakedness preferred general anaesthesia (p = 0.023). Also, more females (95.7%) than males (70.6%) expressed fear about pain during general anaesthesia (p = 0.019). CONCLUSION: Fear of death is a great concern for our patients coming for general anaesthesia and it is followed closely by fear of postoperative pain, the later was of greater concern to females. Finally, more of those who were concerned about nakedness preferred general anaesthesia.

Cardiorespiratory changes during upper gastrointestinal endoscopy.

OBJECTIVES: To determine the changes in oxygen saturation, blood pressure and heart rate during various endoscopic procedures and to find out the risk factors for these changes. METHODS: Forty patients without cardiorespiratory disorders were recruited. Oxygen saturation, blood pressure and pulse rate were monitored during endoscopy using pulse oximeter and automated blood pressure monitor. These were recorded from baseline until 5 minutes after the procedure. The important variables, which were evaluated in relation to these changes, included age, gender, duration of the procedure and drug/dosages. RESULTS: Baseline mean oxygen saturation was 96.8 +/- 1.55%. It decreased significantly to 94.53 +/- 3.30%(p= 0.002) during insertion of probe. Mild to moderate hypoxia was found in 19 (47.5%) patients. Severe hypoxia was found in 5 (12.5%) patients. The variables that reached statistical significance for desaturation were age greater than 50 years and duration longer than 27 minutes. Changes in pulse rate were significant post-sedation, during probe insertion, during scoping, at removal of probe and immediately post-procedure (p < 0.02). The mean change in systolic blood pressure was not significant throughout the procedure when compared to baseline, however 14 (35%) patients developed transient hypertension. CONCLUSIONS: Mild to moderate hypoxia is common during endoscopic procedures and of no serious consequence. However severe hypoxia is less common. We recommend a non-invasive monitoring in patients with age greater than 50 years and procedure longer than 27 minutes.

Kidney transplantation in a developing economy: challenges and initial report of three cases at Ile Ife.

BACKGROUND: Kidney transplantation (KT) is globally adjudged the best alternative treatment for end stage renal disease (ESRD) in preference to life-long dialysis. This form of therapy was hitherto unavailable in Nigeria until our hospital and a private hospital embarked on a KT programme despite our depressed economy, and inadequate facilities. We present the initial report of KT performed in our hospital and the challenges of KT in our developing society. CASE REPORTS: Three patients with ESRD had living related KT between June 2002 and April 2003. The first patient died with functioning graft six and a half months post transplantation from complications of Diabetes mellitus and sepsis, while the remaining two still enjoy a good quality of life 35 months post transplantation. There were problems with procurement and monitoring of immunosuppressive drugs in the three patients. This report also illustrates the common causes of ESRD in Nigeria and some of the complications of KT. To our knowledge, these are the first reported cases of KT in Nigeria. CONCLUSION: Kidney transplantation is cost effective and offers a good quality of life for ESRD patients. Poverty, inadequate facilities and lack of donors are major problems facing KT in our society. Although KT requires high technical and material resources, with proper training, commitment and adequate funding, it is feasible, safe and cheaper on a long term basis for the management of patients with ESRD in a developing economy like ours. There is a need for government funding of KT programmes in developing countries.