Challenges and outcome of Wilms' tumour management in a resource-constrained setting.

BACKGROUND: To review the results of Wilms' tumour patients in a tertiary referral hospital in a developing country and to find ways of improving long-term survival. PATIENTS AND METHODS: Between January 1998 and May 2004, 40 patients with Wilms' tumour (WT) were admitted to Queen Elizabeth Central Hospital. Their files were reviewed and general physical condition on admission, pre-operative investigations, management and outcome were noted. RESULTS: The mean age of presentation was 4.2 years with an equal distribution between the sexes. The mean BMI was 15 kg/m2 and more than 80% of the patients were either mildly (PCV <33%) or severely anaemic (PCV <24%). All patients presented with abdominal distension. Half of them had additional complaints including abdominal pain, haematuria, dyspnoea, oedema and or weight loss. Thirty-nine out of the forty patients received pre-operative chemotherapy. Of the 36 patients that underwent surgery, 32 underwent total nephrectomy, one a partial nephrectomy, and in three the tumour was irresectable. There were no intra-operative tumour ruptures. Only 15% of the patients completed their post-operative course of chemotherapy. The 1-year survival lies between 25% and 53%. Fifteen of the 36 patients operated were known to have a recurrence. CONCLUSION: The patients presented in an advanced stage of the disease. Survival rates are disappointing and recurrence rates are high. Some improvement in outcome may be expected with the implementation of more aggressive treatment protocols but early diagnosis, completion of treatment regimens are needed. Pro-active follow-up is essential to measure outcome.

The use of tannins in the local treatment of burn wounds - a pilot study.

Twenty patients aged 3 years and above with fresh partial thickness burns of less than 20% total body surface area were randomly assigned to local treatment of the burn wound either with a solution containing tannins (tannin group), or one of the other commonly used topical agents, such as honey and ghee, silver sulfadiazine, etc (the other group). The effects on serum transaminase and alkaline phosphatase, the incidence and type of wound infection, the quality of the eschar, the formation of scar tissue, adverse effects, the alleviation of pain and possible adverse reactions were studied in both treatment groups. Surprisingly initial assessment of the burn wound depth proved more difficult than anticipated even in the hands of the more experienced health worker. Liver function tests were elevated in both the tannin (6 patients) and the other group (7 patients). Bacterial colonization of the wounds was equally distributed in both groups, although Staphylococcus aureus was found more often in the other group (9 versus 1). The quality of the eschar was better in the tannin group (6 patients had a supple eschar versus 3 in the other group). The most important observations were that no adverse reactions were encountered and that in the tannin group only one patient developed a hypertrophic scar compared to 5 patients in the other group. It proved difficult to quantify alleviation of pain especially in the children.

The establishment of a burns unit in a developing country--a collaborative venture in Malawi.

In September 1993, the recently completed 32-bedded Burns Unit in the Queen Elizabeth Central Hospital, Blantyre, Malawi, was officially opened. This represented the culmination of 3 years' planning and construction; this paper presents our experience in developing this type of project, and an analysis of the early results of treatment in the unit. The widespread neglect of this common injury in developing countries is highlighted and the importance of input from specialists in this field working in collaboration with local medical and nursing staff is emphasized. The potential for making a significant impact in reducing the morbidity and mortality in burn injuries is highlighted.

Pretreatment with [131I] metaiodobenzylguanidine and surgical resection of advanced neuroblastoma.

Pretreatment with [131I] metaiodobenzylguanidine (MIBG) followed by surgical resection in advanced neuroblastoma (stage 3 and 4) has been studied in relation to resectability, morbidity and mortality, survival rate after two years, control of distant metastasis and serum levels of LDH as prognostic factors. Twenty-one patients with advanced neuroblastoma were primarily treated with MIBG radiotherapy, followed by surgical resection. Sixteen patients had stage 4 disease. Between 2 and 6 courses of MIBG treatment were given per patient. In 17 patients gross complete resection was achieved. Two patients developed complications directly related to the operation, one died as a result of this. The overall mortality was 38%. MIBG therapy resulted in partial response in 13 patients and in stable disease in 8 patients. Two years survival in the group with partial response was 86% and in the group with stable disease 28%. Because of the resulting excellent general condition of the patients the interval between pretreatment with MIBG and surgery could be very short. Follow-up till December 1994 showed that 13 children were alive for 3 to 47 months. Seven had no evidence of disease. Preoperative MIBG de novo treatment in advanced neuroblastoma is equal to induction chemotherapy, but less toxic.

Burkitt's lymphoma: a case file study of 160 patients treated in Queen Elizabeth Central Hospital from 1988 to 1992.

From 1988 to 1992 160 children with clinically or pathologically proven Burkitt's lymphoma were seen and treated in Queen Elizabeth Central Hospital in Blantyre, Malawi. We present the epidemiologic features, the results of staging using ultrasonography, fine needle aspiration biopsy, and the different treatment regimens used. Lack of resources made it extremely difficult to provide the necessary high level of care for these children or to carry out a proper study in the management of this fascinating disease.

Childhood malignancies in Malawi

The incidence of malignancies in industrialised countries is 100 per million but this figure drops to 40 per million in Malawi. There may be under-reporting due to inadquate medical facilities; lack of parental awareness and the role that the traditional healer plays

Childhood malignancies in Malawi

This paper reviews the cases of childhood malignancy seen between January 1985 and March 1989 and compares the results with those of Molyneux

Elective cricothyroidotomy.

Cricothyroidotomies instead of tracheostomies were performed in 61 adult patients over a period of two years. The indications were as for tracheostomy. The majority of the patients had severe trauma, respiratory problems and sepsis. The procedure was to be found easy and fast. There were no severe complications during or directly after the operation. Of the 23 surviving patients 7 were lost for follow up, 16 patients were reexamined 6 months after decannulation. No serious complications had developed, although 2 patients had minor granulation tissue formation at the stoma site and 1 had a minimal anterior narrowing of the subglottic region without granulation tissue. None of these patients needed treatment.

Bile-duct cysts--diagnosis and treatment in 14 patients.

Between 1978 and 1982 14 patients were treated for bile-duct cysts. The predominant clinical signs were obstructive jaundice and hepatomegaly in the younger patients, while pain was the most common symptom in the older patients. Ultrasonography was a valuable diagnostic technic but percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiopancreatography (ERCP) were associated with septic complications; as an alternative, routine preoperative cholangiography is recommended to visualize the type of bile-duct cyst. Excision of the bile-duct cyst was considered the treatment of choice. Excision was performed in 11, and internal drainage in three patients. Cholangitis developed in four children after excision of the cyst. In our series the prognosis was good following surgical treatment, even in younger patients.