Complications of tube thoracostomy using Advanced Trauma Life Support technique in chest trauma.

BACKGROUND: Tube thoracostomy (TT) is central in the management of chest trauma sufficing in over 80% of cases. As a result the procedure is commonly performed in most emergency departments. OBJECTIVE: The aim of this study was to assess the efficacy and complications of TT using Advanced Trauma Life Support (ATLS) technique in chest trauma. METHODS: This prospective study was done at the Trauma Unit of the University of Benin Teaching Hospital in Nigeria. All patients with chest trauma who needed tube thoracostomy between February 2006 and February 2009 were studied. Data recorded for each patient included injury, mechanism of injury, Glasgow Coma score, revised trauma score, and indications for tube thoracostomy. Chest radiographs were obtained preinsertion, post insertion and post extubation for all the cases. Patients were monitored for tube thoracostomy complications. RESULTS: Of 9415 trauma patients seen during the period 105 patients had tube thoracostomy but only 70 (56 male, 14 female) had adequate data for analysis. Seventy-four tubes were passed in the 70 patients with unilateral tubes in 66 (94.3%) and bilateral tubes in 4 (5.7%). Blunt chest trauma occurred in 32 (45.7%) and penetrating chest trauma in 38 (54.3%) of the patients. Simple haemothorax and haemopneumothorax were the commonest indications for tube thoracostomy. Complications recorded include four cases of kinked tubes, four of superficial wound infection and 10 cases of residual haemothorax. CONCLUSION: Tube thoracostomy in the emergency department using advanced trauma life support principles is effective in chest trauma and associated with few complications.

Management of splenic injuries in a university teaching hospital in Nigeria.

BACKGROUND: Management of spleen injuries has undergone evolution over the past few decades. OBJECTIVE: To assess the challenges of managing splenic injuries in Nigeria. METHODS: The medical records of all adult trauma patients with documented injury of the spleen over a two-year period (2006-2008) were reviewed. Data collected included patient demographics, mechanism of injury, injury-arrival time, Revised Trauma Score, abdominocentesis, abdominal ultrasound and CT findings. Treatment received, outcome and length of hospital stay were also documented. RESULTS: Twenty-three patients were managed for splenic injuries during the period under review. These consisted of 21 (91.3%) males and two (8.7%) females. The age range was 16 to 58 years [mean of 29.6(12.2 years)]. The mechanism of injury was blunt in 21 cases and penetrating in two cases with motor vehicle accident being the most common cause of injury. The mean injury-arrival time was 25.2(26.5) hours. Eight patients successfully underwent non-operative management, while 15 had operative intervention. Splenectomy was the most frequently performed procedure. Challenges identified in the management of patients with splenic injuries in Nigeria include delayed presentation, underutilization of CT, unavailability of interventional radiology, inadequate ICUs, limited vaccination, discharge against medical advice and poor follow up. CONCLUSION: Non-operative management of injuries to the spleen in adults appears promising. The challenges identified need to be addressed in order to deliver optimal care for the victims of spleen trauma.

Haemorheological changes in African breast cancer patients.

Several studies have indicated the existence of thrombo-embolic complications in cancer patients and that this could be associated with changes in heamorheological parameters. Packed cell volume (PCV), heamoglobin (Hb), relative plasma viscosity (RPV) and plasma Fibrinogen concentration (PFC) were measured in 50 healthy control women, 50 age-matched women with breast cancer, and 10 women with histophathologically proven benign breast tumour. There were significant differences between the controls and breast cancer patients in all the parameters measured (p < 0.05). However, patients with cancer have significantly higher RPV and PFC (P < 0.001) respectively than controls. There was significant mean difference between pre and post mastectomy in fibrinogen concentration (p < 0.05) and this was observed over the 5-week study period. Since increased fibrinogen may give rise to increase fibrin formation which has been asserted as an independent cardiovascular risk factor for thromb-oembolic complications, African patients with breast cancer may well be predisposed to thrombotic complications during illness. The theological assessment may offer valuable benefit for the management and early diagnosis of breast cancer in African women.

Haemorheological changes in African breast cancer patients

Several Studies have indicated the existence of thrombo-embolic complications in cancer patients and that this could be associated with changes in heamorheological para- meters. Packed cell volume (PCV); heamoglobin (Hb); relative plasma viscosity (RPV) and plasma Fibrinogen concentration (PFC) were measured in 50 healthy control women; 50 age-matched women with breast cancer; and 10 women with histophathologically proven benign breast tumour. There were significant differences between the controls and breast cancer patients in all the parameters measured (p0.05). However; patients with cancer have significantly higher RPV and PFC (P0.001) respectively than controls. There was significant mean difference between pre and post mastectomy in fibrinogen concentration (p0.05) and this was observed over the 5-week study period. Since increased fibrinogen may give rise to increase fibrin formation which has been asserted as an independent cardiovascular risk factor for thromb-oembolic complications; African patients with breast cancer may well be predisposed to thrombotic complications during illness. The rheological assessment may offer valuable benefit for the management and early diagnosis of breast cancer in African women

Risk of transfusion-transmitted hepatitis C virus in a tertiary hospital in Nigeria.

OBJECTIVES: To evaluate the risk of probable iatrogenic hepatitis C virus (HCV) infection following transfusion of donor blood that has not been screened for HCV. STUDY DESIGN: Prospective study. METHODS: Screening for human immunodeficiency virus and hepatitis B virus is routine in the University of Benin Teaching Hospital. HCV screening was performed on transfused bags of donor blood selected at random. The detection of anti-HCV was based on the principle of double antigen sandwich immunoassay, in which purified recombinant antigens are employed sufficiently to identify anti-HCV. The outcomes of interest included the proportion of HCV-positive units of transfused donor blood, the source of blood and the total number of units of blood processed in the hospital blood bank. RESULTS: A total of 4532 units of donor blood were procured in the blood bank. Of these, 4132 units were certified as fit for transfusion following the hospital protocols. The sources of the transfused blood samples were commercial blood donors [89.2% (n = 3687)] and targeted donation [10.8% (n = 445)]. One hundred and ninety-two transfused blood samples were randomly screened for HCV, and 3% (n = 6) were found to be positive (95% confidence intervals 0.007-0.06). The likely risk of iatrogenic transfusion-related HCV infection was estimated to be 129 cases/year at the present rate of utilization of donor blood at the University of Benin Teaching Hospital. CONCLUSION: There is a risk of iatrogenic transfusion-transmitted HCV in the study hospital. Hospitals in Nigeria should screen for HCV prior to allogeneic transfusion, which may help in avoiding transfusion-related HCV and its probable long-term effects.