Empyema Thoracis in Zaria; a Preliminary Report

Aims and ObjectiveTo study the nature and pattern of presentation of empyema thoracis (and the association between duration or time of presentation and educational level and level of income respectively), the aetiology, and different treatment outcomes.                                                                Materials and MethodsA prospective study of all patients who presented with Empyema Thoracis between January 2008 to May 2010 was carried out at ABUTH Zaria. Thediagnosis of empyema thoracis was entertained from either the presence of pus in the pleural space or the culture of actively multiplying bacteria in a serous Data was analysed with SPSS 15.ResultsA total of 26 patients were managed, 19(73.1%) men, 7(26.9%) women. There were 4(15.4%) acute and 22(84.6%) chronic empyema. One male had bilateral chronic empyema giving 13 right-sided, and 14 left-sided empyema. Tuberculosis was responsible for 26.9% of the cases, 38.4% were postpneumonic, while postoperative, and AIDS were each responsible for 11.5% and trauma 7.7%. Five patients had decortication, 2 had rib resection and open drainage, and the remainder were managed on tube thoracostomy. Two patients were discharged against medical advice, 6 were lost during follow-up. Fourteen (53.8%) were educated (1 acute and 13 chronic). Twelve (46.2 %) were uneducated (3 acute and 9 chronic). Fourteen patients (2 acute and 12 chronic) earned average or above average income while 12 (46.2%) earned below average income (2 acute and 10 chronic). There was no association between duration of presenting complaints and level of education or level of income (Fisher's exact test was, 0.306 and 1.000, respectively) at a P value of 0.05.                          ConclusionEmpyema thoracis is persistent and prevalent in our environment despite improvements in diagnosis, treatment and prevention. Most patients present late and this is not related to income or level of education. The commonest organism isolated from empyema fluid in developing countries is Staphylococcus aureus but most empyema fluid are sterile due to prolong antibiotic use. The factors responsible for delayed presentation, the pattern of presentation and the pathology and outcome of treatment is part of an ongoing study.Key Words: Empyema Thoracis, Presentation, Aetiology, Treatmen

Indications and Complications of Tube Thoracostomy with Improvised Underwater Seal Bottles

Background: Tube thoracostomy is a lifesaving and frequently performed procedure in hospitals where the expertise and necessary tools are available. Where the ideal drainage receptacle is unavailable, the underwater seal device can be improvised with bottled water plastic can especially in emergency situations. Aims and Objectives: To determine the frequencies of the various indications and complications of tube thoracostomy with improvised underwater seal. Materials and Methods: A cross‑sectional study with a structured proforma was used for assessment over a 3‑year period (May 2010‑April 2013). The proforma was filled at the time of the procedure by the performing surgeon and patients were followed up with serial chest X‑rays until certified cured. A 1.5 L bottled water container was used as the underwater seal receptacle. The data was analysed with SPSS 15 software program. Results: A total of 167 patients were managed. There were 106 (63.5%) males and 61 (36.5%) females. The mean age was 34.85 ± 16.72 with a range of 1‑80 years. The most frequent indication was for malignant/paramalignant effusion, 46 (27.5%). Others were trauma, 44 (26.3%), Parapneumonic effusion, 20 (12%), postthoracotomy 14 (8.4%), empyema thoracis 12 (7.2%), heart disease and tuberculous effusion 11 (6.6%) each, pneumothorax 8 (4.8%) and misdiagnosis 1 (0.6%). A hundred and one (60.5%) of the procedures were performed by registrars, 41 (24.6%) by consultants, house officers 15 (9%) and senior registrars 10 (6%). The overall complication rate was 16.8% with the more frequent complications been empyema (5.6%) and pneumothorax (3.6%). The average duration of tube placement was 13.02 ± 12.362 days and range of 1‑110 days. Conclusion: Tube thoracostomy can be a relatively safe procedure with acceptable complication rates even with improvised underwater seal drainage bottles.Keywords: Complications, indications, improvisation, tube thoracostom

Empyema thoracis in Zaria; A preliminary report

Aims and Objective To study the nature and pattern of presentation of empyema thoracis (and the association between duration or time of presentation and educational level and level of income respectively), the aetiology, and different treatment outcomes. Materials and Methods A prospective study of all patients who presented with Empyema Thoracis between January 2008 to May 2010 was carried out at ABUTH Zaria. The diagnosis of empyema thoracis was entertained from either the presence of pus in the pleural space or the culture of actively multiplying bacteria in a serous Data was analysed with SPSS 15. Results A total of 26 patients were managed, 19(73.1%) men, 7(26.9%) women. There were 4(15.4%) acute and 22(84.6%) chronic empyema. One male had bilateral chronic empyema giving 13 right-sided, and 14 left-sided empyema. Tuberculosis was responsible for 26.9% of the cases, 38.4% were post-pneumonic, while postoperative, and AIDS were each responsible for 11.5% and trauma 7.7%. Five patients had decortication, 2 had rib resection and open drainage, and the remainder were managed on tube thoracostomy. Two patients were discharged against medical advice, 6 were lost during follow-up. Fourteen (53.8%) were educated (1 acute and 13 chronic). Twelve (46.2 %) were uneducated (3 acute and 9 chronic). Fourteen patients (2 acute and 12 chronic) earned average or above average income while 12 (46.2%) earned below average income (2 acute and 10 chronic). There was no association between duration of presenting complaints and level of education or level of income (Fisher′s exact test was, 0.306 and 1.000, respectively) at a P value of 0.05 Conclusion Empyema thoracis is persistent and prevalent in our environment despite improvements in diagnosis, treatment and prevention. Most patients present late and this is not related to income or level of education. The commonest organism isolated from empyema fluid in developing countries is staphylococcus aureus but most empyema fluid are sterile due to prolong antibiotic use. The factors responsible for delayed presentation, the pattern of presentation and the pathology and outcome of treatment is part of an ongoing study