Two decades of recipient and donor referrals for heart transplantation to Groote Schuur Hospital, Cape Town, South Africa: A retrospective study.

BACKGROUND: Heart transplantation in South Africa faces numerous challenges related to organ scarcity and unequal access to advanced heart therapy. There is an urgent need to analyse the current transplant referral pathway to optimise equitable access to transplantation. OBJECTIVES: To provide an audit of heart transplant referrals to Groote Schuur Hospital, Cape Town, over a 23-year period, focusing on patient demographics, indications for referral, waiting-list dynamics, and transplant referral outcomes. METHODS: The study utilised a retrospective patient folder review for the period 1 January 1997 - 31 December 2019 and audited the trends in heart transplant referrals and associated outcomes of the referral at a tertiary academic hospital. RESULTS: A total of 625 recipients were referred for heart transplantation, with the majority being male (n=412; 65.9%), while gender was undocumented for 69 cases (11.0%). The mean age was 38.1 (14.6) years, and 153 (24.5%) were listed for transplant, while 215 (34.4%) were deemed ineligible for listing. Contraindications for listing included social (n=106; 49.3%), medical (n=83; 38.6%) and psychological (n=26; 12.0%) factors, while 134 patients (21.4%) were considered too well. Poor social circumstances (n=38; 39.6%), poor insight (n=28; 29.2%) and poor compliance (n=21; 21.9%) were the most common non-medical reasons for not listing recipients, while obesity (n=30; 31.3%) and smoking (n=23; 24.0%) were notable medical contraindications. Forty-nine patients (7.8%) died during work-up, while 130 (85.0%) of the listed patients received a heart transplant. Of the 429 donor referrals, 139 (32.4%) were accepted for organ procurement. Reasons for declining donors included unsuitability for transplantation (30.3%), lack of capacity (1.8%), and recipient-donor mismatch (66.9%). CONCLUSION: Three-quarters of the referred patients were deemed unsuitable for heart transplantation for medical and/or social reasons. The ratio of referral to listing has decreased over time. However, once listed, the likelihood of receiving a transplant was high.

Mediastinoscopy as a diagnostic tool in a South African tertiary hospital.

BACKGROUND: Mediastinoscopy is an effective and safe diagnostic tool for anterior mediastinal lesions. The study was done to assess the usefulness of mediastinoscopy as a diagnostic modality for mediastinal lesions. METHODS: A retrospective study of patients who had mediastinoscopy over 12 years at the Groote Schuur Hospital, Cape Town. Preoperative data, intraoperative and postoperative data were collected. RESULTS: The records of 115 patients were reviewed. Male to female ratio was 1.4:1 with a mean age of 48.5 (± 16.8) years. Preoperative computerised tomography (CT) scan was done in 98.3%. The most common indications for mediastinoscopy were mediastinal lymphadenopathy (87.8%) and anterior mediastinal mass (12.2%). Prior endobronchial ultrasound (EBUS) biopsy was done in 11.3%. All the patients had conventional cervical mediastinoscopy. Lung cancer staging accounted for 16.5% of the procedures. A biopsy was successfully done in 103 patients (89.6%). The most common lymph node station biopsied was 2R (55.7% of 76 patients), though the information on stations biopsied could not be ascertained in 25.2% of patients. The complication rate was 1.7 % (suprasternal haematoma and brachiocephalic artery injury). Histopathologic diagnoses were obtained in 89.5% (103/115 patients). Benign diagnoses accounted for 72.8% (75), while malignant diagnoses were 27.2% (28). Intensive care unit (ICU) stay and mechanical ventilation were required in 5% and 2.5% of patients, respectively. The median postoperative hospital stay was 2 days. There were no postoperative deaths. The median follow-up period was 14 days. CONCLUSION: Mediastinoscopy's diagnostic role is assured, still required and is safe with minimal morbidity and no mortality.

Clinicopathological Pattern and Management of Primary Lung Cancer in Ilorin, Nigeria.

BACKGROUND: Lung cancer incidence and mortality rates have increased in some low and medium-resourced countries. OBJECTIVES: This study aimed to describe the clinicopathological pattern and management of lung cancer seen in our setting. METHODS: We reviewed cases of pulmonary neoplasm diagnosed and managed at the University of Ilorin teaching hospital over eight years. Cases with tissue diagnosis were enrolled in the study and relevant clinical data were collected from the medical record using a proforma. DESIGN: Hospital-based retrospective study. RESULTS: Out of the 71 cases of primary lung cancer reviewed, 44(62%) were males and the male to female ratio was 2:1. The mean age was 62±14 years and the occurrence was highest in aged 50-69 years. Thirty (42.3%) with histories of tobacco smoking were males. Adenocarcinoma accounted for 34(54.9%), 23(32.4%) were squamous cell carcinoma, 2(2.8%) were large cell carcinoma and 6(8.5%) were other histological variants. The majority (82.7%) presented at stage III-IV lung cancers, 56.3% had malignant pleural effusion and 74.6% received palliative care. Thirty-eight (53.3%) had chest tube drainage, 19(26.7%) underwent chemical pleurodesis and 22(31.0%) received Cisplatin-based systemic chemotherapy. One patient had curative surgery and none received radiotherapy. At 12 months, 4 (5.6%) were still alive, 14(19.7%) cases had medical records of their death and 53(74.7%) were lost to follow up. CONCLUSION: This study has highlighted the clinicopathological trend, high rate of mortality and late presentation of lung cancer in our setting. There is a need to increase the awareness of the warning signs and risk factors to ensure early detection and facilitate curative therapy.

CONTEXTE: L'incidence du cancer du poumon et les taux de mortalité ont augmenté dans certains pays à faibles et moyennes ressources. OBJECTIFS: Cette étude visait à décrire le modèle clinicopathologique et la prise en charge du cancer du poumon observé dans notre milieu. MÉTHODES: Nous avons passé en revue les cas de néoplasme pulmonaire diagnostiqués et pris en charge à l'hôpital universitaire de l'Université d'Ilorin pendant huit ans. Les cas avec diagnostic tissulaire ont été inclus dans l'étude et les données cliniques pertinentes ont été collectées à partir du dossier médical à l'aide d'un formulaire. CONCEPTION: étude rétrospective en milieu hospitalier. RÉSULTATS: Sur les 71 cas de cancer du poumon primitif examinés, 44 (62%) étaient des hommes et le ratio homme / femme était de 2:1. L'âge moyen était de 62 ± 14 ans et la fréquence était la plus élevée chez les 50 à 69 ans. Trente (42,3%) ayant des antécédents de tabagisme étaient des hommes. L'adénocarcinome représentait 34 (54,9%), 23 (32,4%) étaient des carcinomes épidermoïdes, 2 (2,8%) étaient des carcinomes à grandes cellules et 6 (8,5%) étaient d'autres variantes histologiques. La majorité (82,7%) des cancers du poumon de stade III-IV, 56,3% ont eu un épanchement pleural malin et 74,6% ont reçu des soins palliatifs. Trente-huit (53,3%) ont eu un drainage par sonde thoracique, 19 (26,7%) ont subi une pleurodèse chimique et 22 (31,0%) ont reçu une chimiothérapie systémique à base de cisplatine. Un patient a subi une chirurgie curative et aucun n'a reçu de radiothérapie. À 12 mois, 4 (5,6%) étaient encore en vie, 14 (19,7%) cas avaient un médical de leur décès et 53 (74,7%) étaient perdus de vue. CONCLUSION: Cette étude a mis en évidence la tendance clinicopathologique, le taux élevé de mortalité, et la présentation tardive du cancer du poumon dans notre milieu. Il est nécessaire d'accroître la sensibilisation aux signes avant-coureurs et aux facteurs de risque pour assurer une détection précoce et faciliter la thérapie curative. MOTS CLÉS: Clinico-pathologique, modèle, prise en charge, cancer du poumon, néoplasme, Nigéria.

Haemoptysis secondary to a complicated hydatid cyst of the lung: A case report.

Pulmonary hydatid disease is almost exclusively caused by the infestation of the larval stage of Echinococcus granulosus. Humans are infected, accidentally, through the faeco-oral route by the ingestion of food and milk, contaminated by dog faeces containing the ova of parasites or direct contact with dogs. We describe an unusual cause of massive haemoptysis in a young male who had bilateral lung hydatid cysts as well as a large splenic hydatic cyst. He underwent bilateral thoracotomies for cyst excision for relief of haemoptysis.

Neck trauma: a red-herring to diagnosis of chemodectoma.

Chemodectoma, a neuroendocrine tumour of the paraganglionic cells in the carotid body remains an uncommon tumour. We report the first case from University of Ilorin Teaching Hospital, Ilorin, Nigeria. Though with a red herring history of trauma induced swelling, clinical and radiologic features were characteristic of chemodectoma. Histologic features of the excised lesion are presented.

Pre-hospital care in Nigeria: a country without emergency medical services.

OBJECTIVES: Efficient pre-hospital transport (emergency medical services, EMS) is associated with improved outcomes in road traffic injuries (RTI). This study aims to discover possible interventions in the existing mode of transport. METHODS: Persons bringing all RTI victims to the Emergency room (ER) over a 4-year period and the injury arrival intervals were noted prospectively. FINDINGS: There were 2,624 patients (1,886 males and 738 females); only 2,046 (78%) had clear documentations of three categories of persons bringing victims to ER: Relatives (REL, 1,081, 52.83%); Police/Federal Road Safety Corps (P/F, 827, 40.42%) and Bystanders (BS, 138, 6.74%). No intervention was provided during transport: Within 1 hour, 986 victims (48.2% of 2,046) arrived ERbrought by P/F (448, 21.9%), REL (439, 21.5% of 2,046), and BS (99, 4.8%). These figures, in each instance, represent 40.6 % of total victims brought by REL; 54.2% by P/F and 71.7% by BS. However, after 6 hours, REL were the main active group as they brought 94.5% (359 of 380) patients of this period. In 91 victims (4.4%) the injury arrival time was not captured. CONCLUSION: This study has identified three groups of persons involved in pre-hospital transport with nearly 50% getting to ER within 1 hour without any intervention or prior notification of ER. Absence of EMS obscures pre-hospital death records. The P/F responsible for only 40% of transport should be trained and equipped to offer basic trauma life support (BTLS). The REL and BS (both responsible for 60% of transport) represent a pool of volunteers for BTLS to be trained.

Physicochemical studies on Uburu Salt Lake Ebonyi State-Nigeria.

Physicochemical properties of soil (sediment) and water from Uburu salt lake were evaluated and compared with control soil and surface water from the same community. Results showed significant (p < 0.05) higher values for the heavy metals cadmium, chromium, copper, lead and zinc in the lake water relative to the control. The values of these metals in the lake soil (sediments) however, were significantly (p < 0.05) lower than the control soil. Similar significant (p < 0.05) elevations were observed in the lake water temperature, salinity, pH, calcium, magnesium, sodium, potassium, nitrate, carbonate, sulphate and phosphate levels compared to the control. Significant (p < 0.05) changes were also noted in the lake soil's pH, exchangeable acidity, nitrogen, organic carbon, calcium and magnesium levels. Also the soil texture was affected relative to the control. In a number of cases, the values of the studied parameters were higher than the permissible WHO standards. In view of these findings, cautious use of the salt lake soil and water is advocated.

Motorcycle injuries in a developing country and the vulnerability of riders, passengers, and pedestrians.

At a Nigerian university hospital, none of the motorcyclists who presented over a 12 month period had been wearing a helmet, and of the eight patients who died, seven had head injuries. Of the five collision types described, the rate of motorcycle-other vehicle collisions was highest at 40.6%, while the motorcycle-pedestrian rate was 23.4%. Measures to prevent these collisions might reduce overall crashes by 64%; in addition, helmet law should be enforced.

Surgical emergencies in a Nigerian university hospital.

An audit of surgical emergencies was carried out to monitor acute trauma care and determine areas needing clinical improvement. This is essential for the development of institutional and national health policies on trauma and non-trauma diseases. All patients attending the surgical Accident and Emergency were studied prospectively from September 1999 to August 2000 to obtain their age, sex and diagnosis and to determine causes and injury-arrival time for trauma cases and the outcome of care for all cases. Out of 2,455 patients comprising 1,696 males and 759 females (M:F = 2.2:1) age range two weeks to 95 years, trauma accounted for 1,679 (68.4%). The median age (and the mode) of presentation overall and in males was in the third decade. Females had a 'plateau' age of presentation for the first four decades before the gradual fall to zero. Superficial skin trauma (lacerations, abrasions and bruises) represents the commonest presentation (16.1%) followed by fractures (13.9%), acute abdominal conditions (7.6%), head injury, HI (5.5%), multiple injury (4.1%), urinary retention (3.3%), burns and scalds (3.3%) and others. Eight-one patients died, comprising 54 males and 27 females, out of which 64 were trauma related deaths. Most common causes of death were HI (35 patients, 43.2%) and septicaemia (13 patients, 16.0%). Late presentation and poor finances contributed to the deaths in patients with septicaemia. Trauma is an important entity in our emergency practice. Prompt access to surgical care should reduce the morbidity and mortality from acute abdominal conditions and HI. The high incidence of urinary retention requires further analysis. Statistics of this nature can aid planning of care delivery and study of preventable deaths.

Epidemiology of trauma deaths.

OBJECTIVES: This study was done to highlight the pattern and distribution of trauma deaths in a Nigerian teaching hospital in order to enhance trauma research, improve treatment strategies and prevent trauma deaths. PATIENTS AND METHODS: a prospective data collection was done for 24 months beginning September 1999 detailing the age, sex, occupation, diagnosis, mechanism of trauma, injury-arrival time, and circumstances of death and determining retrospectively the severity of trauma using Revised Trauma Score (RTS), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). RESULTS: There were 129 deaths but 84 (65.1%) had sufficient data for trauma scoring. Male:Female ratio was 60:24 = 2.5:1. The age range was 2.95 years, mean 36.8 +/- 15.2 years for males and 45.5 +/- 23.0 years for females. Two thirds (66.7%) of the deaths occurred among traders/business 27.4%, artisans 20.2%, drivers and students 9.5% each. Three quarters of the deaths (75.0%, 63) were in patients involved in road traffic accidents (RTA) followed by violent trauma (10.7%), falls 9.5% and burns 4.8%. The trauma deaths include head injury (26 deaths, 31.0%), multiple injuries (30.0%), fractures (13.1%), cervical spine injury (10.7), gunshot injuries (8.3%), burns (4.8%) and others (5.0%). Sixty-two patients (73.8%) reached the hospital within 6 hours of the injury. The patients were brought by the Police, Good Samaritans or relatives in nearly equal proportions. The mean RTS, ISS and TRISS probability of survival scores were 5.16, 25 and 67% for males but 6.0, 22 and 75% for females, respectively. CONCLUSIONS: The pattern and distribution of trauma revealed a typical trauma death is a male aged below 40 years, who is a trader/businessman involved in RTA or violent trauma. Despite a probability of survival above 60% and majority of the patients getting to hospital within 6 hours, the inadequate A and E care has thrown up possibilities for prevention of trauma death, improving treatment strategies and enhancing trauma research.

Factors affecting outcome of emergency paediatric abdominal surgery

Background: Paediatric surgical abdominal emergencies are important causes of morbidity and mortality in children. None of the previous studies on abdominal surgical emergencies specifically addressed the problem as it affects children. Methods: An eight-year retrospective review of all children aged 0-15 years who presented with acute abdominal emergency. Results: Two-hundred and fifty one (251) children; male to female ratio of 1.5:1 and median age of presentation of 78 months (range 1 day-15 years). The median duration of symptoms before presentation to hospital was 96 hours. The median duration between admission and surgical intervention was 24 hours. Intestinal obstruction accounted for 87 (34.7) of acute abdominal emergency. This was the commonest emergency encountered overall. Typhoid perforation (TP) was responsible for 71 (28.3) of all acute abdominal emergencies and was the commonest condition encountered in children above the age of one year. Others included 55 (21.9) cases of appendicitis; 18 (7.2) of abdominal trauma; 6 (2.4) anterior abdominal wall defects and 5 (2.0) each of infantile hypertrophic pyloric stenosis and primary peritonitis. Postoperative complications were observed in 85 (33.9) of patients. The commonest complications were wound infection 31 (12.4) and wound dehiscence 23 (9.2); while mortality rate was 16 overall; and 31.8 in the neonatal period. Overwhelming sepsis was responsible for 26 (63.4) of all deaths recorded. Multiple congenital anomalies were the cause of death in 5 (12.2). Other causes of death were prolonged ileus with malnutrition in 4 patients; respiratory insufficiency in 2 patients and a patient each died from necrotising enterocolitis; acute renal failure; enterocutaneous fistula and over hydration. Conclusion: intestinal obstruction was the commonest acute abdominal emergency in children. The high rates of postoperative morbidity observed could be attributed to delayed presentation to hospital

Surgical morbidity and mortality pattern in the accident and emergency room--a preliminary report.

BACKGROUND AND PURPOSE: A prospective review of surgical patients attending the Accident and Emergency room was carried out to determine the pattern of morbidity and mortality in order to guide planning and provision of surgical services and improve on the quality of care available. METHODS: Patients were entered into a data sheet from September 1999; a preliminary report of the first six months is presented. RESULTS: There were 1,209 patients (850 males and 359 females, M:F = 2.2:1) with 46 different presentations. Age range was 2 weeks to 95 years. The mode and median age was in the third decade. Morbidity from trauma was 70.5%, 44.5% from Road Traffic Accident while mortality from trauma was 2.6% (32 patients). Nearly half of the mortality (47.2%) was head injury related. CONCLUSION: The commonest presentation was lacerations (19.4%) from which there was no mortality while head injury, multiple injury and multiple fractures that accounted for 14.7% morbidity had 61.1% mortality. These figures are helpful in planning services delivery and in focusing and improving on the mortality-prone presentations.