Occupational asthma caused by peracetic acid-hydrogen peroxide mixture.

BACKGROUND: Healthcare practice in the UK has moved away from using aldehyde disinfectants for the decontamination of endoscopes, in part due to the risk of respiratory sensitization. Peracetic acid (PAA) in combination with hydrogen peroxide (HP) is a commonly used alternative. AIM: We describe a case of occupational asthma (OA) diagnosed at our specialist occupational lung disease clinic and caused by occupational exposure to PAA-HP mixture, used as a disinfectant in an endoscope washer-disinfector machine. CASE REPORT: A 48-year-old man employed as a mycologist and environmental microbiologist at a Birmingham city hospital, UK, presented following an acute exposure to PAA-HP mixture causing lacrimation, burning optic pain and headache. He had also experienced symptoms suggestive of OA for the preceding 10 months, and the diagnosis was confirmed through OASYS analysis of serial peak expiratory flow measurements. He had been exposed to PAA-HP mixture whilst working in the endoscopy department for 12 months prior to the acute episode, and a subsequent specific inhalation challenge test was positive with a late asthmatic response to PAA-HP mixture. CONCLUSION: This case provides evidence for a sensitization mechanism in OA caused by PAA-HP mixture.

A Pilot Study of Target Weight Guided Treatment in Acute Heart Failure Using Ultrafiltration or Usual Care: Effect on Sodium Removal

BACKGROUND AND OBJECTIVES: In the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial, ultrafiltration (UF) removed volume more effectively than usual care (UC). Hypothetically, UF may be superior to UC due to increased sodium (Na) removal and less neurohormonal activation. We compared UF and UC in a randomized pilot trial of target weight guided therapy for acute decompensated heart failure (ADHF). SUBJECTS AND METHODS: Sixteen patients with ADHF were enrolled and target weights established prospectively, prior to randomization to UC or UF. UF patients did not receive diuretics and UC patients were all treated with a continuous furosemide drip. All urine and ultrafiltrate were collected and Na concentrations measured. RESULTS: Similar volumes were removed in UC and UF groups (110105 mL and 107415 mL, respectively) and the UF group also produced 45325 mL of urine. Na concentration was 138+/-6 meq/L in the ultrafiltrate, 85+/-73 meq/L in the UC group's urine, and 26+/-23 meq/L in the UF group's urine. Given the relevant associated volumes, total meq of the Na removed was similar (1168 in UC vs. 1216 in UF). The UF group produced isotonic ultrafiltrate and a higher volume of dilute urine than anticipated. CONCLUSION: In a randomized pilot study of target weight guided therapy with UC or UF for ADHF, there were no differences in total volumes or Na removed, and lengths of hospital stays were similar. Isotonic fluid loss by UF was accompanied by the production of very dilute urine.

Congenital lobar emphysema in a Nigerian neonate: a rare cause of neonatal respiratory distress.

Congenital lobar emphysema (CLE) is a notable cause of respiratory distress in neonates, however it remains a diagnostic challenge due to inadequate facilities and low level of experience. The management of this condition also is a bigger challenge due to paucity of expertise and relatively non-existent well-equiped neonatal intensive care unit in this part of the world. Here we present the case of a 5- day old baby who presented at Lagoon Hospital, Apapa with history of severe respiratory distress since birth. CT scan of the chest confirmed an emphysematous left upper lobe with contralateral mediastinal shift. The baby had a left posterolateral thoracotomy with left upper lobectomy and thereafter was electively ventillated for forty eight hours in the neonatal intensive unit. He had an uneventful postoperative course and was discharged from the hospital within one week forfollow-up in the clinic.

Eventration of the diaphragm--case reports and review of the literature.

Eventration of the diaphragm can have varied symptomatology. We present three cases that presented with features suggestive of gastric outlet obstruction, productive cough of acute onset, and traumatic diaphragmatic rupture respectively. They were successfully treated with plication of affected hemidiaphragm. We also reviewed existing literature on the subject with presentation of our findings.

Congenital cystic adenomatoid malformation of the lung: a case report and diagnostic challenges in a typical African setting.

Congenital cystic adenomatoid malformation (CCAM) of the lung an entity which results from a harmatomatous proliferation of the bronchioles constitutes 25% of the all congenital lung anomalies. Majority of cases of CCAM usually present with respiratory distress from birth, while others may present with recurrent chest infections in childhood or in adulthood. Most reports on CCAM have been on caucasian children and the diagnosis of the condition appears to be challenging unless there is a high index of suspicion. This report describes the case of a child who presented in late infancy and was initially managed as a case of hydropneumothorax, however a Computed Tomography (CT) of the chest confirmed CCAM. The diagnostic challenges is also addressed.

Bradypacing: indications and management challenges in Nigeria.

BACKGROUND: Permanent pacemaker implantation is a life-saving procedure that is performed worldwide. There is paucity of reports on pacemaker surgery in Nigeria. The aims of the study were to determine the indications for pacemaker insertion, the demographic distribution of the patients requiring it, the electrocardiographic (ECG) changes, and the management challenges in Nigeria. MATERIALS AND METHOD: One hundred consecutive patients who had pacemaker insertion done by our team from 1999 were included in the study. The patients' biodata, indications for pacemaker insertion, ECG changes, and the treatment profile were recorded. RESULTS: There was female preponderance (93.0%) among the patients studied. Third-degree heart block was the indication in 86.0% of the patients and most patients did well with single lead ventricular pacing which is generally cheaper than the dual chamber pacing. CONCLUSION: The majority of bradyarrhythmia patients in this environment can be maintained on single lead ventricular pacemaker.

Otolaryngologic manifestations of gastro-oesophageal reflux disease in Lagos.

BACKGROUND/AIM: Gastro-oesophageal reflux disease(GERD) is not an uncommon disease in Nigeria. The otolaryngologic (ORL) symptoms associated with GERD are varied. In the management of patients with ORL symptoms and disease, GERD is often not considered as a differential diagnosis The aim of this study is to identify patients with ORL complications of GERD from patients with ORL disease who have symptoms that mimic GERD using defined criteria in the light of limited diagnostic facilities. MATERIALS/METHODS: A prospective study was conducted over a two year period at Lagos University Teaching Hospital Lagos and two private Otolaryngology clinics,within Lagos, among patients who presented primarily with laryngeal and pharyngeal symptoms . They were evaluated using structured questionnaire for duration of regurgitation, heartburn ,symptoms of peptic ulcer disease, clinical examination, esophagogastro - duodenoscopy findings and outcome of laryngopharyngeal symptoms following anti-reflux therapy. RESULTS: A total of 92 patients were evaluated over a two year period .ORL diseases and symptoms at presentation were chronic laryngitis, chronic pharyngitis, globus pharyngeus, globus and chronic laryngitis, laryngeal carcinoma, cricopharyngeal spasm and throat hawking. History of symptoms of peptic ulcer disease and regurgitation was obtained in 47.8% and 65.2% respectively. Endoscopic findings revealed oesophageal reflux with gastroduodenits in 4.3%, Non specific gastritis in 17.4%, duodenal ulcer in 56.4%, and normal findings in 21.7%. Patients were treated medically with antacids, H2 antagonists, proton pump inhibitors and were followed up for 9-12 months. GERD was diagnosed in 4 (4.34%), 68 (73.9%) were diagnosed as non erosive reflux disease (NERD) and 20 (21.74%) with probable acid related problem that will need further evaluation . Following anti-reflux therapy 68 (73.9%) had disappearance of their laryngopharygeal symptoms for up to a year. ORL complications of GERD/NERD was seen in 72 (78.3%). CONCLUSION: GERD should be a differential diagnosis in patient with pharyngeal and laryngeal symptoms not associated with sinus disease in the presence or absence of positive peptic ulcer disease or regurgitation and the management should be multidisciplinary.

Idiopathic interstitial pneumonias in LUTH--A morphologic study of three cases.

OBJECTIVE: Idiopathic interstitial pneumonias are rarely diagnosed in our environment. However in in the year 2000 a group of new cases were histologically diagnosed in the Department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH). This study aims to review the clinical and morphologic features of the three cases or Idiopathic Interstitial Pneumonias seen at surgicals and autopsy over a 10 year period (March 1995 to March 2005) in LUTH; as well as discuss some clinicopathologic features of interstitial pneumonias. MATERIALS AND METHODS: A review of the cases seen at surgicals and autopsy from March 1995 to March 2005 was done by retrieving the relevant reports. Cases described with interstitial pneumonitis were re-evaluated and their respective paraffin blocks re-cut for special staining to better demonstrate the changes in morphology. RESULTS: A total of 3 cases were retrieved from the ten year period reviewed. Incidentally, all occurred in the year 2000. Their mean age was 57 years and the male to female ratio was 2:1. The 'Usual Interstitial Pneumonitis' pattern was more common. CONCLUSION: Interstitial pneumonias are rare in our environment; the apparent emergence of three cases in the year 2000 alone is a curiosity as a search over a ten year period (March 1995 to March 2005) yielded no other histologically convincing case. An increased index of clinical suspicion on the part of our clinicians and pathologists as well as collaborative research involving several specialists and Medical Institutions will be required to determine the true frequency of this disease in our environment and its peculiar clinicopathological features.

Zygomatic arch reconstruction with autogenous rib bone graft in a post irradiated patient -- a case report.

Reconstruction of zygomatic arch using an autogenous free non-vascularised bone graft is presented. The zygomatic arch was resected along with the masseter and part of temporalis muscle following a histologically diagnosed case of chondrosarcoma. She received radiotherapy 3 weeks post-operatively to the site. The resultant facial asymmetry was unacceptable to the patient. She was therefore rescheduled for reconstruction of the zygomatic arch despite the anticipated attendant risk of avascular bed for the graft. Bone grafting was done 44 months post irradiation and the patient had been followed up for 38 months without evidence of rejection. We evaluated other sites of possible bone of similar contour and thickness to the zygomatic arch; we found the rib most suitable, despite the poor quality of rib as graft material, because it is a dense, thick bicortical bone with low proportion of cancellous bone, although it is the second most favoured donor site for free bone graft. The advantages of the rib as a graft are that it presents a contour that could be shaped to fit many defects, it is available in sufficient length up to 12-18 cm to fit large defects, the donor site regenerates when the periosteum is preserved.

Arterial injuries in civilian practice in Lagos, Nigeria.

OBJECTIVE: This is a retrospective study of patients managed at the Lagos University Teaching Hospital for peripheral arterial injuries from January 1995 to April 2003. The aim was to study the pattern of peripheral arterial injuries in Lagos. Nigeria and to look at the outcome of management and see what improvements could be made in future. METHOD: Data was collated from case notes of patients, operation register in theatre and admission and discharge books from the surgical wards and the data bank of consultants involved in patients' management. RESULT: Forty-one patients. 37 males and 4 females. were treated within the study period (M:F ratio of 9:1). Twenty three patients (56.1%) suffered gunshot injuries during armed robbery attacks while 9 patients (22.0%) had stab injuries in civilian violence. Twenty-one patients (3 with gunshot injuries and 18 non gunshot penetrating injuries) were managed by direct suturing of vessels. Eight patients had prosthetic graft interposition while 2 patients had reversed saphenous vein grafts. Two patients had the superficial branches of their radial arteries tied up at the wrist. CONCLUSION: Gun shot injuries from armed robbery attack was the commonest cause of peripheral arterial injuries in this environment during the period of study.

Experience in oesophageal substitution in Lagos, Nigeria.

This is an audit of five years work (1996 - 2001), in oesophageal substitution at the Cardiothoracic Surgery Unit of Lagos University Teaching Hospital, Nigeria. The study aimed at highlighting the current trends in indication and methods of oesophageal substitution in the context of our experience. We did a retrospective study of all who required oesophageal substitution during the period of study. We studied the various aspects of the patients' care including the indications for oesophageal substitution, the substituting organs and the results of surgery. We saw fifty-nine patients comprising 19 patients oesophageal carcinoma, 31 corrosive strictures of the oesophagus, 4 peptic strictures and 3 achalasia cases. Two patients had oesophageal substitution because of mediastinitis. Fifty-five patients underwent oesophageal substitution. The substituting organs were stomachs in 36 patients and colon in 19 patients. There were three anastomotic strictures, two grafts failed, and five cases of anastomotic leaks. In all, operative mortality was 9.1% . We concluded that oesophageal substitution was done more for benign reasons in our centre. We also emphasised the positive aspects of colon interposition and the prospects of doing more of it in the near future.

Modified Allen's Test in radiocephalic arterio-venous fistula creation: how relevant?

The significance of the Modified Allen's Test has not been determined in Nigerians who need forearm arterio-venous fistulae. We sought to determine this in thirty-four patients who needed forearm arterio-venous fistulae for haemodialysis. Side-to-end radio-cephalic arterio-venous fistulae were successfully created on their forearms notwithstanding the result of Modified Allen's test. Modified Allen's test was negative in 12 (35.3% ) of the patients and side-to-end radio-cephalic fistulae were created on the forearm of all of them without any untoward effects. We concluded that preoperative Modified Allen's test is not necessary for side-to-end radio-cephalic arterio-venous fistulae of the forearm.

Efficacy and safety of repeated samarium-153 lexidronam treatment in a patient with prostate cancer and metastatic bone pain.

A patient with stage D3 prostate cancer was given 11 separate doses of samarium-153 lexidronam (Sm-153 ethylenediaminetetramethylene phosphonate) of 1 mCi/kg (37 MBq/kg) in a period of 28 months for bone pain from metastases. With the first five doses, Sm-153 lexidronam clearly reduced his bone pain and improved his quality of life, as determined by pain-assessment scores and the patient's self-assessment of its effect on his ability to perform activities of daily living. With doses 6 through 11, pain at baseline was on average less, and as a result beneficial effects after treatment were not as apparent. Samarium-153 lexidronam produced transient decreases in the leukocyte and platelet counts, but these never became low enough to cause clinical concern. This case shows both the efficacy and the safety of Sm-153 lexidronam in repeated treatments for metastatic bone pain in patients with prostate cancer.

Hypothesis of leprosy, tuberculosis and urbanization in Africa.

Leprosy today is a problem of global magnitude affecting possibly up to 15 million people. Its rise and fall in medieval Europe is an historically fascinating enigma. Partial cross-immunization by epidemic tuberculosis, reinforced by the growth of cities, has been proposed as a mechanism in leprosy's European disappearance, but evidence is lacking. In the case of Africa in recent decades, analysis of leprosy and tuberculosis rates, and of levels of urbanization, albeit with imperfect data, suggests a possible environmental health for leprosy, the existence of some cross-interference between tuberculosis and the milder, paucibacillary form of leprosy, and a negative correlation between leprosy and urbanization. It is argued that the rise of the city in Africa, acting through a combination of influences, including tuberculosis, is leading to a decline of leprosy.