Accuracy of fluid delivery devices for the neonate: Are the measures assured?

INTRODUCTION: Delivery of accurate volumes of fluid in surgical neonates and children is crucial for the good outcome of treatment. But how accurate are the calibrations on the fluid delivery devices? AIMS: This study seeks to verify the accuracy of these devices in common use in our practice. MATERIALS AND METHODS: This is a cross-sectional experimental study carried out in our center; a tertiary health facility in Southern Nigeria in May 2019. Fluid delivery devices (FDDs) used in the course of treatment of our pediatric patients were randomly included in the study. The number of drops per ml of each device was obtained by counting while the fluid dropped until a 1 ml volume was delivered. The data was then collated and analyzed. RESULTS: A total of 215 FDDs were included in this study. They comprised infusion giving set, Soluset (Burette) giving set, and blood giving set. The rate of delivery was 20 drops/ml (infusion giving sets), 60 drops/min (Burette/Soluset), and 15 drops/ml (Blood giving set). They were all in keeping with the labeled/assumed calibration in each of the types of FDDs P < 0.05. Therefore, the mean, median, and mode were the same. CONCLUSION: This study has demonstrated that the FDDs used our center are accurately calibrated and safe as they deliver volumes of fluid as labeled. The findings in this study reassure us of the dependability and accuracy of delivery of the FDDs we use in children in our center.

Pilot study on laparoscopic surgery in port-harcourt, Nigeria.

BACKGROUND: Video-laparoscopic surgery has long been practiced in western countries; however documented practice of this minimal access surgical technique are recently emanating from Nigeria. To the best of our knowledge, this is the first documented study on laparoscopic surgery from the Niger Delta region. AIM: To evaluate the feasibility of laparoscopy as a useful tool for management of common surgical abdominal conditions in our environment. PATIENTS AND METHODS: This was a prospective outcome study of all consecutive surgical patients who had laparoscopic procedures in general and pediatric surgery units of our institution from August 2011 to December 2012. Data on patient's age, gender, indication for surgery, duration of hospital stay and outcome of surgery were collected and analyzed. RESULTS: A total of 15 laparoscopic procedures were performed during this study period with age range of 2-65 years; mean: 32.27 ± 17.86 years. There were 11 males and four females. Six laparoscopic appendicectomies, one laparoscopy-assisted orchidopexy, five diagnostic laparoscopy ± biopsy, one laparoscopic trans-abdominal pre-peritoneal herniorrhaphy for bilateral indirect inguinal hernia and two laparoscopic adhesiolysis for small bowel obstruction were performed. All were successfully completed except one conversion (6.7%) for uncontrollable bleeding in an intra-abdominal tumor. CONCLUSION: The practice of laparoscopic surgery in our environment is feasible and safe despite the numerous, but surmountable challenges. There is the need for adequate training of the support staff and a dedicated theatre suite.

Anaesthetic Management for Surgical Relief of Neonatal Airway Obstruction Caused by a Cystic Hygroma

Background: Cystic hygroma is a rare congenital malformation of the lymphatic system which may cause neonatal airway obstruction. Surgical excision of this tumour is associated with high morbidity and mortality. Aim: To report the anaesthetic management for a successful excision of a cystic hygroma in a neonate. Case Report: A two-day-old female presented with history of an anterior neck swelling; tachypnoea and dyspnoea ; noticed at birth. There was associated stridor and subcostal recession. A diagnosis of cystic hygroma with upper airway obstruction was made. Tumour excision was done under endotracheal general anaesthesia. An intraoperative tracheostomy was carried out. Cyanosis occurred frequently within first 24 hours postoperatively while in the special care baby unit (SCBU) and was relieved by intermittent suction of the tracheostomy tube. Patient was weaned off the tracheostomy tube on the 30th post-operative day and discharged home two days later. She was subsequently followed up at the paediatric surgery outpatient clinic. Conclusion: Anaesthetic management for excision of a cystic hygroma in a neonate is by no means easy. It can be successful if the airway remains patent; ventilation is adequate; normothermia and optimal replacement of body fluid losses are ensured

Neurofibromatosis in Children as Seen in the University of Port Harcourt Teaching Hospital

Background: Neurofibromatosis (NF) is transmitted as an autosomal dominant trait but 50of new cases appear because of mutation. The disease can be confounded by a broad spectrum of complications; such as various kinds of osseous lesions; stenosis of the renal arteries; optic glioma; and learning disabilities and disfigurement. Aim : To determine the prevalence; pattern of presentation and outcome of neurofibromatosis in children in the University of Port Harcourt Teaching Hospital. Method: This was a prospective study done from 1st June 2004 to 30th May 2009. All the children who presented with neurofibromatosis over the 5- year period were studied. Data collected included age; sex; and reasons for presentation. Definitive diagnosis was made using the National Institute of Health Diagnostic Criteria. Data was entered into excel and analyzed using SPSS. Simple statistics; frequency and percentages were used. Results: The total number of children seen over the period of study was 12;443 children. Out of these; 18(0.19) had neurofibromatosis. All (100) had the type 1 variety. None had type 2 variety. The patients' ages ranged between 5 and 16 years. There was a positive family history in 13 (72.2) of them. All the patients had cafe au- lait spots. Clinically the predominant forms of the neurofibromas were cutaneous 15(83.3); subcutaneous 10(55.6); and plexiform 5(27.8). None of the patients died. Five cases with huge masses causing pain and disfigurement had surgical intervention. Conclusion: Neurofibromatosis is not rare in this environment. This neurocutaneous inherited genetic disorder is a common cause of morbidity. Multidisciplinary management reduces the disease burden borne by affected individuals

A simple lithotomy device for children.

BACKGROUND: The position of the patient is important for good access during surgery. The aim of this paper is to present a simple lithotomy device for children. METHOD: We present a simple easy-to-construct and affordable lithotomy device utilizing locally available materials for paediatricpatients. RESULTS: A simple, cheap and easy-to-construct lithotomy device for children has been used in our centre. It is also easy to sterilize and very durable. No complication has been noticed so far that is attributable to the lithotomy device. It has been used for Swenson's procedure for Hirschsprung's disease, and rectal biopsy. CONCLUSION: The affordability of the device will save hospital administrators and the country great cost while still being effective. The device is being recommended for use in developing countries where paediatric operating tables are not available.

Pathological study of colorectal carcinoma in adult Nigerians: a study of 45 cases.

BACKGROUND: A 12-year (1st Jan. 1990-31st Dec. 2001) retrospective study of 45 colorectal carcinomas was carried out the in University of Port Harcourt Teaching Hospital (UPTH) based on age, sex, clinical presentation, anatomical sites, histological types and clinical stages. METHODS: All the histological slides from surgical specimen obtained from the large intestine and diagnosed as colorectal carcinoma were reviewed in Anatomical Pathology Department of UPTH, Port Harcourt. The age, sex, sites and histological types were extracted from the request forms and reports while the clinical presentation and staging were obtained from the case notes. RESULTS: A total of 34 (75.6%) and 11 (24.4%) occurred in males and females respectively, giving a sex ratio of 3:1. The least age of occurrence was a 22 year old male and the oldest was a 82 year old male. The highest frequency (28.9%) occurred in the age group 50-59 years which is a decade earlier than the Caucasians. Majority of our patients (33.3%) presented with either diarrhoea or constipation (altered bowel habit). The commonest site of this cancer is the rectum and the least occurred in the transverse colon. Most of our patients presented with advanced cancer of stage IV & III of TNM classification (D and C of Astler-Coller System). The tumours were also histologicially graded into well moderately and undifferentiated type. CONCLUSION: Colorectal carcinoma is one of commonest malignancies that occurs in young and middle aged in this environment. Patients present when the tumour is in an advanced stage hence poorer prognosis and the ages of the patents is about 10 years earlier than that of Caucasians.