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BACKGROUND: Globally, major chest injuries have both high morbidity and mortality. A detailed study of chest injuries in south-eastern Nigeria is here presented. AIMS: To determine the incidence, the predisposing factors, the pattern of presentation and the outcome of management of chest injuries. MATERIALS AND METHODS: This is a retrospective study spanning a period of 10 years (2002-2011). The medical records of all patients with documented chest injuries that presented to our hospital within the period under review, were retrieved and analysed, by simple arithmetic percentages. RESULT: A total of 402 patients (average of 40/year) with the age ranges in the spectrum of 0-10 and 81-90 years, with a mean of 2.2 were found. Gender-wise, 301 males (74.9%) and 101 females (25.1%) were affected. The aetiological or the predisposing factors were blunt chest injuries (61.2%) and penetrating chest injuries (38.8%). In the pattern of presentation, haemothorax (20.9%), haemopneumothorax (16.2%), pneumothorax (17.4%) including simple, open and tension types as well as multiple ribs fractures (7.7%) constituted the majority. In the management strategies, conservative methods were mainly used. The outcome ranged from very good to fair. CONCLUSION: The management of chest injuries in our sub-region like any other developing countries is very much challenging. Concerted efforts are needed to overcome the burden it imposes.

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BACKGROUND: The management of arterial aneurysm either central or peripheral has undergone evolution over the past decades. We encounter both true and pseudo aneurysm on regular basis with its complications: OBJECTIVE: To assess the challenges of managing arterial aneurysm at UNTH, Enugu in view of the health complications of the condition. METHOD: Medical records of all patients with documented arterial aneurysm over a 5-year period (2007-2011) were reviewed. Data collected and documented included patients' demographics, type of vessels involved, investigative tools used in confirming the diagnosis, type of treatment, outcome and length of hospital stay. RESULT: Atotal of 37 patients were managed for arterial aneurysm during the period under review. These consisted of 24 males (64.9%) and 13 females (35.2%). Age range was 11-78 years with a mean of 2.4 years. Central aneurysms involved ascending, arch and descending aorta as well as abdominal aorta. Peripheral ones affected femoral, axillary, brachial, and popliteal artery. The central aneurysms with the exception of abdominal aortic aneurysms were managed conservatively. Those that failed conservative management were referred to centres with expertise and facilities for on pump surgery. The peripheral ones in addition to abdominal aortic aneurysms were managed operatively with good outcome. The challenges identified in the management included non-availability of on pump expertise and prosthesis, late presentation of patients, under utilisation of CT and or MRI, poor compliance to antihypertensive drugs and poor follow up. CONCLUSION: Intervention in arterial aneurysms is the gold standard but not yet easily available and affordable at this centre. The challenges that have been identified are real and need to be addressed in order to deliver optimal care to patients within our domain. Efforts are underway in tackiling them.

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BACKGROUND: The University of Nigeria Teaching Hospital, Enugu was designated the national centre of Excellence for Cardiothoracic diseases, because of the availability of skilled manpower. This study was therefore undertaken to see the pattern of cardiothoracic diseases managed in the surgical unit of the centre and to see if the objectives of its establishment are being achieved. METHOD: A retrospective analysis of in-patient admission records managed surgically or conservatively between 2000 and 2004 was made. RESULTS: A total of 704 cases were identified; 469 (55.6%) men, 121 (17.2%) women and 114 (16.2%) children. Majority, 163 (23.25%) were between the age range of 20-29 years. Enugu, the State where the hospital is domicile had the highest admission rate of 318 patients (45.15%) while the 19 Northern States had a total of 67 patients (9.51%). Chest wall disorder constituted the majority of cases (28.69%) of which chest trauma from road traffic accident was the majority 49.6%. Most patients were hospitalised for an average of 2-4 weeks (56%). CONCLUSION: The study revealed a low admission rate with a declining trend over the years and a skewed distribution of their origin. It also identifies militating factors and draws the attention of the relevant authorities to take necessary actions to stem this trend.

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Clinical observation shows that most of the patients with pleural effusion of undetermined aetiology in a Nigerian teaching hospital receive antiTB drug trials. This observation prompted the authors to evaluate the role of percutaneous needle pleural biopsy as a diagnostic tool in effusions of uncertain aetiology. Thirty-seven patients with pleural effusion of uncertain aetiology were investigated by percutaneous pleural biopsies using Abrams pleural biopsy needle over an 18-month period. In 34, the aetiology was established giving a sensitivity of 92%. Non-specific pleurisy/empyema remains the commonest cause of effusion (41%), followed closely by malignancies (29.4%) and TB pleurisy (22%), respectively. Percutaneous needle pleural biopsies establish diagnosis of malignancy in 91% of the cases with 72% of the malignancies originating from the lung. There is a significant association between malignancy and pleural effusion of uncertain aetiology in patients above 40 years of age (P = 0.022). The empirical use of antiTB drugs in the absence of investigative results suggestive of the diagnoses should be discouraged. Instead concerted effort should be made to establish the cause of such effusion.

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We report a case of fractured internal jugular catheter, a rare but life threatening complication of the use of intravascular catheter in a 73 year-old man. He had an internal jugular catheter in-situ for nine months, much longer than the manufacturer's recommended duration.

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A study of pericarditis treated surgically over a period of 14.5 years was conducted to evaluate the current pattern and management of this disease in a tropical environment. The series comprised 86 patients (58 males and 28 females) aged from 5 months to 60 years (mean 21.1 years). Pericarditis was effusive in 41 patients, calcific in 33 and fibrous in 12. Aetiological or associated factors were non-specific, pyogenic infection, rheumatic heart disease, endomyocardial fibrosis, tuberculosis and amoebiasis in 36, 21, eight, eight, six and four patients, respectively. All the patients were in New York Heart Association (NYHA) functional class III or IV. Operative treatment involved pericardiotomy with tube drainage in 32 patients, pericardiectomy in 49, and pericardiotomy with subsequent pericardiectomy in five. The total hospital mortality rate was 8.0%, and was largely a result of severe pre-operative cardiac decompensation and multiple organ failure. Of the 79 early survivors, 91% reverted to NYHA functional class I or II. Surgical treatment remains the most effective management of chronic pericarditis which still constitutes a major clinical problem in some countries.

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Ventilatory pulmonary function was studied in 108 healthy young Nigerian adults using an electronic spirometer, with a view to determining the normal values of function for healthy Nigerians. The measured values of forced vital capacity, forced expiratory volume in 1 sec, maximum voluntary ventilation, and peak flow rate were compared with those obtained from similar studies on Nigerians and the predicted values for Caucasians. Higher values of function were obtained in Nigerian males than in the females. Nigerian males, however, showed lower values when compared with Caucasians of similar anthropometric measurements; there was no difference between the females in this study and their Caucasian counterparts. There were also some similarities and differences between the values obtained in this study and those of similar studies in Nigerians of different socio-ethnic backgrounds. The results emphasize the necessity for a ventilatory normogram for each socio-economic or ethnic grouping of individuals.

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This study investigated the effects of clavulanate-potentiated amoxycillin in the management of moderate to severe respiratory tract infections. A total of 34 patients aged 10-70 years were studied to establish the clinical and bacterial efficacy of treatment and screened for unwanted effects and abnormal laboratory findings. Clavulanate-potentiated amoxycillin was given in dosages of 375 or 750 mg twice daily, orally, for a mean of 13 days (range 3-30 days). Patients were assessed at the end of 2 weeks and again on discharge from hospital (if later) for up to 6 months. Overall diminution in the number of symptoms was recorded at the end of the study; 78% of symptoms had disappeared after 2 weeks. The treatment proved highly effective in controlling respiratory tract infections in 94% of patients. The necessity for multiple drug therapy and parenteral administration was also avoided.

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Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25.6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.

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Postpneumonic pleural suppuration is a common condition seen in paediatric practice in Nigeria. One hundred and twenty cases seen at the University of Nigeria Teaching Hospital, Enugu, over a 4-year period were reviewed. The patients were aged between 1 1/2 months and 16 years. History of antecedent measles was elicited in 27 of the children, and 70% of the patients presented to the hospital later than 7 days after the onset of symptoms of pleura suppuration. From the pleural aspirates of 106 cases (88.3%) Staphylococcus aureus was cultured in 31.2%, but there were no organisms cultured in 39.4%. Twenty-nine children were treated by chemotherapy only; 11 of them (37.9%) died. Sixty-eight cases had tube drainage of the pleural collections, with 6 deaths (8.8%). Twenty-three patients had thoracotomy, evacuation of the suppurative lesion and decortication of the lung, with no mortality. There was overall hospital mortality of 14.2%, the highest mortality being in children who had associated measles, gastroenteritis, anaemia or malnutrition. Early surgical drainage by tube thoracostomy or by thoracotomy and decortication in addition to appropriate and adequate antibiotic therapy is the treatment of choice.

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Two cases of pulmonary aspergilloma confirmed histologically are reported fron Nigeria; they constitute the first cases reported from this country. We advise that a high index of suspicion is necessary to detect more cases of pulmonary aspergilloma in Nigeria.

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Accidents and trauma are the most common causes of death in the young Nigerian male. Due to inadequate facilities for recovering the injured, patients with major vascular injuries fail to reach the hospital alive. The incidence of vascular injury in the Nigerian population should be higher than is reflected in this study. Late presentation to the hospital results in the greater number of patients with traumatic aneurysms. Improvement in ambulance and hospital services for the injured will facilitate earlier detection and treatment of vascular injuries, improve the mortality rate, and limit the late sequelae of vascular injuries.

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Twenty-one children, all suffering from thoracic empyema, were treated with a combination of antibiotic therapy (Suprapen) and tube thoracostomy. A satisfactory clinical response with radiological and laboratory confirmation was seen in all but one patient, thus obviating the need for major surgery. Suprapen may be considered as a first line antibiotic in such cases of pleural sepsis in the absence of bacteriological confirmation of infection.

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Pleural sepsis in children is common in most developing countries. It may present as total pyothorax, pyopneumothorax, or localised thoracic empyema. In most cases, it follows an attack of bronchopneumonia, but other debilitating conditions such as measles, malnutrition, and sickle cell anaemia form part of the clinical syndrome. In a review of 60 cases of pleural sepsis in children aged between 1.5 months and 16 years, there were 40 cases of pyothorax, 15 of pyopneumothorax, and five of localised empyema. Treatment with chemotherapy only was given in 22 cases of whom eight died. Twenty-three patients had chemotherapy and tube drainage of the pleural contents; five died. Fifteen children had excision of the pleural disease, and decortication of the lung; none died. In view of the chronicity of the pleural sepsis by the time the child is seen in the hospital, and also the low mortality and shorter period in hospital, thoracotomy and decortication is recommended as the treatment of choice.

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In a developing country with inadequate clinical facilities a conservative method of management of a major clinical problem is often the only rational approach. This policy was adopted in the management of 145 patients with chest trauma in a teaching hospital in Nigeria. Automobile accidents were the cause of the thoracic injuries in 73.1% of the patients; 71.7% of the patients were managed as in-patients. The management of the patients was essentially aimed at correction of hypovolaemia, tube drainage of pleural collections, and relief of pain by intercostal nerve block. Major operative procedures were adopted in 11 cases (7.6%) for persistent haemothorax or for pyothorax, ruptured diaphragm, ruptured abdominal viscus, and subdural haematona. No operative reduction of rib fractures was performed and only 1 of the 12 patients with flail chest was mechanically ventilated. The hospital mortality was 9.7% and, despite a high rate of default at follow-up attendances, no late death or serious complication was recorded. Th aspects peculiar to chest trauma in Nigeria are discussed.

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Sixty-six Nigerian children with rheumatic fever were studied between 1975 and 1979. Equal numbers of patients had acute and chronic disease. Carditis was the most common major manifestation, being present in 98% of the cases, whereas subcutaneous nodules, erythema marginatum, and chorea were relatively rare. Twelve patients died within two years of the disease's appearance and eight have become unavailable for follow-up. Our findings resemble those from other tropical countries, in contrast with results from temperate countries: rheumatic fever manifests differently and rheumatic carditis runs a more fulminant course in a person from a tropical area.

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