Intestinal obstruction in Nigerian children.

A 10-yr review of acute intestinal obstruction in 280 Nigerian children reveals that the condition is the major cause of surgical emergencies in Nigerian children, as in children of other developing countries. These are significant differences of pediatric intestinal obstruction in developing countries, as compared with the pattern in other parts of the world. Intussuscaption was the leading cause followed by incarcerated or strangulated hernia. Lateness in presentation was common, with a resulting high morbidity and prolonged hospital stay. The overall mortality was 16%, but mortality of 33% was recorded in the neonatal group.     

Management of pleural sepsis in Nigerian children.

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.     

Cardiovascular response during severe acute asthma and its treatment in children.

Heart rate, blood pressure, pulsus paradoxus, and cardiac output measured by means of transthoracic electrical impedance cardiography have been recorded in 29 children mean age 10 years +/- 2 SD during status asthmaticus. Changes were recorded over the first two hours of treatment during which all patients received oxygen, intravenous fluid, and hydrocortisone, and were randomly assigned to receive aminophylline, salbutamol, or both. Admission values showed significant correlation of pulsus paradoxus with PaCO2 (r = 0.66). Pulsus paradoxus was greater than 20 mmHg for all patients with PaCO2 above 5.5 kPa. Mean stroke volume and cardiac output were 89% and 131% of the resting convalescent values in the same children. Stroke volume cardiac output and heart rate did not correlate with peak expiratory flow rate or blood gas measurements. Aminophylline and salbutamol together were associated with significantly greater increase in PEF than aminophylline alone (P less than 0.05). Nebulised salbutamol was just as effective as intravenous salbutamol. Heart rate and systolic blood pressure declined significantly after nebulised salbutamol and aminophylline, but not after intravenous salbutamol and aminophylline. Stroke volume and cardiac output did not change significantly in any treatment group.     

Recurrent accident and emergency department attendance for acute asthma in children.

Asthmatic children aged over 5 years making repeated visits to the accident and emergency department of a children's hospital were compared prospectively, on the basis of a clinical questionnaire and pulmonary function tests, with a control group of outpatients with asthma to find the reasons for their repeated attendance. Recurrent attenders (n = 145) had more severe asthma than control subjects (n = 118), with greater airway obstruction at rest (FEV1 79% v 85% predicted) and bronchial lability (47% v 38%). Significantly more of the "emergency" group used pressurised aerosols and fewer dry powder inhalers to administer bronchodilators. There were no differences in prophylactic treatment. Seventy one per cent of parents in the emergency group had feared that their child would die during an attack, compared with 56% of control subjects. Eighty one per cent of children were self referred to the accident and emergency department. Most parents had found hospital to be the quickest means of obtaining treatment in an emergency. There were no differences between the two groups in parents' knowledge about asthma, home conditions, or social disadvantage. Although children who repeatedly attend hospital accident and emergency departments for treatment of acute attacks have more severe asthma than controls and show some deficiencies in treatment, the major determinant of attendance appeared to be the parents' conviction that appropriate treatment could not be obtained elsewhere.     

Cough receptor sensitivity in children with acute and non-acute asthma

BACKGROUND: Cough is a major symptom in some children with asthma. The relationship between cough and the severity of asthma is ill defined. A study was undertaken to test the hypotheses that, in children with asthma who cough as a major part of their asthma symptoms, cough receptor sensitivity (CRS) is heightened during an acute severe exacerbation of asthma but not in the non-acute phase and airway calibre or its change correlates with CRS. METHODS: Spirometric measurements and the capsaicin CRS test were performed on children admitted to hospital for an acute severe exacerbation of asthma. Nasal secretions were tested for viruses. The children were grouped into those who usually cough with asthma episodes and those who do not. The tests were repeated 7-10 days and 4-6 weeks later. The CRS outcome measure used was the concentration of capsaicin required to stimulate two (Cth) and five coughs (C5). RESULTS: The CRS of the group who coughed (n = 15) was significantly higher than those who did not cough (n = 16) (mean difference log Cth 0.77 mumol (95% CI 0.35 to 1.18), C5 0.72 mumol (95% CI 0.26 to 1.18)) during acute asthma but not after the exacerbation. CRS was not significantly different between groups based on the presence of a viral infection. Neither forced expiratory volume in one second (FEV1) nor its change correlated with CRS nor its change. CONCLUSIONS: In children with asthma CRS is heightened in acute severe asthma in the subgroup of children who have cough as a significant symptom with their asthma episodes. In acute and non-acute asthma CRS does not correlate with FEV1.


     

Pneumothorax complicating acute asthma.

The association of asthma and pneumothorax in hospital practice is examined. The association varies from 1:300 to 1:1 000 acute asthmatics admitted to either a specialized or general unit. The clinical details of 18 patients with further reference to associated parenchymal lung diseases are discussed.     

Pattern of congenital malformations in Nigerian children

A series of 252 abortuses, stillbirths and neonates at the University of Ilorin Teaching Hospital and ECWA Hospital, Egbe, in Nigeria, were examined by autopsy dissection between 1983 and 1985. Their clinical cohorts in the nurseries, pediatric wards and those subjected to operations were also reviewed. Primary school children volunteers in two Ilorin schools were also examined in 1987 for cardiopulmonary malformations and umbilical hernia. Incident rates for congenital malformations ranged from 0.08 to 38.27% for congenital groin hernia, 2.39 to 8.73% for umbilical hernia, and 0.21 to 21.05% for the entire gastrointestinal tract. Other incident rates are 0.10 to 7.14% for genitourinary tract, 0.33 to 6.69% for CNS, 0.16 to 5.55% for musculoskeletal system, 0.26 to 4.76% for cardiovascular and 0.06 to 3.9% for bronchopulmonary malformations. The scope of the study is expected to make it adaptable in other developing countries.     

Patient self care in acute asthma.

Psychosocial and other factors that may affect patient self care in acute asthma were investigated in 210 asthmatic adults recruited from general practice and hospital clinics. Interviews and self complete questionnaires were used to assess patients' management of a hypothetical slow onset and rapid onset attack of asthma, attitudes to asthma, family support, psychiatric morbidity, recent asthma morbidity, and knowledge of drug treatment. The patients with the highest morbidity from asthma delayed longest before taking appropriate action in the hypothetical acute attack. One in four patients expressed strong feelings of stigma and pessimism about being asthmatic, but attitudes were only weakly associated with behaviour. Other factors showed no significant relation to self care. The results suggest that there is no single important factor or group of factors governing patients' management of acute asthma. Health education might therefore prove more effective if it paid less attention to the possible cause or causes of poor self care and instead offered pragmatic advice on changing behaviour.     

Assisted ventilation in severe acute asthma.

During the period 1973-85 assisted ventilation was used for the treatment of severe asthma on 48 occasions in 18 patients (one patient was ventilated 29 times). On each occasion arterial blood gas abnormalities were restored to normal as quickly as possible irrespective of peak inflation pressures. One patient was thought to be brain dead on transfer from another hospital but was ventilated for 48 hours while this diagnosis was confirmed. There was one episode of mediastinal emphysema. There were no other complications apart from transient hypotension (blood pressure less than 100/60 mm Hg), which occurred on 17 occasions but did not have any sequelae. There was no relationship between hypotension and inflation pressure but there was an association between hypotension and rate of fall of arterial carbon dioxide tension. It is concluded that the risks of barotrauma during the ventilation of patients with severe asthma are theoretical or extremely small. Rapid correction of respiratory acidosis abolishes hypercapnic respiratory drive, allowing ventilation without use of muscle relaxants. It may also enable a shorter duration of ventilation, thus decreasing the likelihood of complications.     

Vitamin D receptor polymorphisms and nutritional rickets in Nigerian children.

Nutritional rickets is common in Nigeria where vitamin D deficiency is rare and dietary insufficiency of calcium is common. It occurs more commonly in siblings of affected children than of unaffected children. Postulating that vitamin D receptor (VDR) polymorphisms might relate to the susceptibility of some Nigerian children to develop rickets in the setting of low calcium intake, we compared the VDR genotypes, as determined by the presence or absence of Bsm I, Apa I, Taq I, and Fok I restriction enzyme cleavage sites, between 105 children with active nutritional rickets and 94 subjects representative of the community from which the rachitic children came. In the rickets group, the ff genotype was less common than in the community group, and the FF genotype was relatively increased (f allele frequency, 17% in rachitic children and 26% in the community group, p = 0.03). Neither individual allele frequencies for the other polymorphisms nor combinations of genotypes at different sites were different between the rachitic and community groups. Although it is not clear why a presumed better-functioning VDR variant (F allele) is associated with an increased risk of developing rickets, this study raises the possibility that VDR alleles might be important in determining an individual's susceptibility to developing rickets when faced with dietary calcium deficiency.     

Omental and mesenteric cysts in Nigerian children

Omental and mesenteric cysts are rare intra-abdominal lesions which may be congenital, traumatic, neoplastic or infectious in origin. They give rise to non-specific clinical features and may be a cause of the surgical acute abdomen, especially in children. Correct preoperative diagnosis is infrequent but a high index of suspicion and use of ultrasonography when available would improve clinical diagnosis. Six omental and mesenteric cysts encountered in five children over a 10-year period (1978-87) are reported. All the cysts were congenital. Three patients presented with non-specific symptoms and two presented with acute abdomen. Correct preoperative diagnosis was made in two patients. All five patients had surgery. Two had enucleation of the cysts, two had excision of the cysts with adjacent bowel segment and one patient with two cysts had partial excision of the wall of the cysts with free internal drainage into the peritoneal cavity. All patients survived.