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Unruptured amoebic liver abscess is usually not regarded as a surgical emergency. At University College Hospital, Ibadan, in a two-year period from June 1975 to May 1977, six cases of unruptured amoebic liver abscess underwent emergency exploratory laparotomy because they presented as cases of acute abdomen. The initial diagnoses made by senior physicians included perforated duodenal ulcer, intestinal obstruction, cholecystitis and appendicitis. All patients had persistent draining sinuses after surgery for periods ranging from one to five months. Neither the trophozoites nor the cystic forms of Entamoeba histolytica were present in the "abscess" which was essentially necrotic liver tissue. The diagnosis of amoebic liver abscess was based on clinical features: typical "anchovy" or chocolate-coloured aspirate from the liver, response to anti-amoebic therapy and serological studies.

This report presents a prospective series of 12 patients with a diagnosis of purulent pericarditis who were treated between April 1978 and September 1979 by the cardiothoracic surgical unit at the University College Hospital, Ibadan, Nigeria. These patients were studied to determine the adequacy of a therapeutic protocol consisting of systemic antibiotics and pericardiostomy tube drainage. All patients were in the pediatric age group with an average age of 6¾ years. Bronchopneumonia was the antecedent focus of sepsis in eight patients, with pyomyositis in four (33 percent). Two patients expired prior to surgery.No mortality or significant morbidity occurred in the ten patients who underwent pericardiostomy.The results of this series combined with the initial experience reported in 1978 by the same authors confirm the described protocol as the treatment of choice in their environment.

Between 1969 and 1979, 20 patients under-went pneumonectomy for tuberculous destroyed lungs (TDL) at the University College Hospital (UCH), Ibadan, Nigeria. Their ages ranged from 9 to 57 years, with an average age of 24 years. The left lung was involved in 16 patients (80 percent) and the right lung in four patients (20 percent). All patients had received treatment for pulmonary tuberculosis (PTB) for over three years, and all patients had negative cultures of acid-fast bacilli (AFB) at the time of operation. Pulmonary function studies were performed in 15 patients, bronchography in 18, and pulmonary angiography in four. Ninteen patients had elective resection because of mild to moderate hemoptysis without mortality. The only death occurred in a 37-year-old man who had emergency resection because of massive hemoptysis. He died intraoperatively of cardiac arrest. One patient developed bronchopleural fistula (BPF), empyema, and wound infection. The fistula closed spontaneously following prolonged chest drainage and pleural irrigation with antibiotics and antituberculous drugs. As a result of our experience with pulmonary tuberculosis in our environment, the authors now recommend elective resection for patients with TDL in order to prevent massive hemoptysis which may prove fatal.

A retrospective study of 37 patients undergoing pulmonary resection, between 1975 and 1980, was performed to establish the incidence of wound infection and to determine contributory factors. Sixteen patients had suppurative lung disease while 11 had pulmonary tuberculosis. The majority of the patients received prophylactic antibiotic (Ampicillin and Cloxacillin) given intramuscularly or intravenously, prior to thoracotomy, and continued for several days post-operatively. Twenty of the 37 cases (54%) developed wound infection, defined as any purulent wound drainage in the post-operative period. The patients with infection (group A) did not differ from those without (group B) as regards presence of pyorrhoea or haemoptysis, the duration of operation or the quantity of blood infused during surgery. A significant difference in the duration of chest intubation was identified between group A (6 +/- 1.3 days) and group B (3 +/- 1.5 days) (P less than 0.001). The implication of the results towards the modification of post-operative management of patients is discussed.

Sixty-five patients were treated for ruptured mitral valve chordae from January, 1976, to December, 1981; 21 patients underwent valve reconstruction (group A) and 44 underwent valve replacement (group B). Both groups had a mean age of 62 years with an overall male: female ratio of 2:1. Eighty-one percent of group A and 73% of group B presented in clinical class III/IV (NYHA). Chordal rupture was spontaneous in 76% (group A) and 61% (group B) respectively, with posterior leaflet chordal involvement in most patients. The operative mortality was 6.8% (3 deaths) in group B with no early death in group A (p less than 0.001). More than 85% of both groups were in class I/II (NYHA) postoperatively. The actuarial survival at 5 years was 85% in group A and 78% in group B. No emboli occurred in group A while an actuarial incidence of freedom from emboli of 76% at 5 years was observed in group B (p less than 0.046). One patient (4.8%) in group A was reoperated for failed valve repair. The patients with repaired valves were assessed by echocardiography. The peak rates of dimension change of the left ventricular cavity were in the normal range in all but 3 patients, while the left ventricular and end-diastolic dimensions were significantly reduced (p less than 0.005). We conclude that valve reconstruction provides an improved functional result in patients with ruptured mitral chordae in addition to an increased event-free survival.

Eighty-five patients underwent mitral valve reconstruction by the Carpentier method from January 1976 to December 1981. Concomitant procedures were performed in 30 patients (aortic valve replacement in 23, coronary revascularisation in six, and tricuspid valve repair in seven). Before operation 76 patients (89%) were in clinical class II or III (New York Heart Association) and atrial fibrillation was present in 50. Thirty-six patients had valvular incompetence, while 26 had pure stenosis. The aetiology was rheumatic in 57 cases and dysplastic in 21. The patients were assessed for clinical improvement, durability of valve repair, thromboembolism, and survival. There was one death, an operative mortality rate of 1.2%, and 63 of 74 patients followed for one to six years were in clinical class I after operation. The actuarial survival was 92% with a 93% incidence of freedom from thromboemboli at five years. Six patients had embolic episodes, four of whom had aortic valve replacement. Three patients had a repeat operation 16-20 months later, a valve failure rate of 6.7%. Nineteen patients with ruptured chordae had postoperative echocardiographic assessment of myocardial and mitral valve functions; the peak rates of dimension changes of the left ventricular cavity (indicative of flow across the mitral valve) fell to normal in most patients, and the left ventricular end-diastolic dimensions decreased significantly from 6.4 (1.53) to 5.09 (1.31) cm (mean and SD)--p less than 0.05. Our results confirm that reconstructive mitral surgery is able to restore and maintain normal valve function in addition to providing satisfactory relief of symptoms.

A 6-year study was carried out in our hospital practice to determine the prevalence of spontaneous pneumothorax. Thirty patients with 32 episodes of pneumothorax were diagnosed. Tuberculosis was encountered in 9(30%) patients while no specific cause was found in 12(40%) patients. This study indicates that spontaneous pneumothorax is uncommon in the Nigerian, while the tuberculosis aetiology may be a pointer to the overall high prevalence of the disease in the community.

Eighty consecutive patients undergoing pulmonary resection at the University College Hospital, Ibadan were studied to determine the factors predictive of postoperative morbidity and mortality. The operative mortality was 10% while complications occurred in 66% of the patients. Complications were significantly more frequent (p less than 0.01) in those with benign disease (73%) than with malignant conditions (31%). Benign disease and pneumonectomy were predictors of wound infection (p less than 0.05 & p less than 0.02 respectively); haemoptysis and pneumonectomy, predictors of bronchopleural fistula (p less than 0.02 and p less than 0.05 respectively); benign disease predictor of empyema (p less than 0.02); and age over 50 years predictor of mortality (p less than 0.01). It is concluded that improved care of patients with these predictive factors would result in reduction of morbidity and mortality.

A retrospective study of 1,150 consecutive patients with thoracic and cardiovascular diseases seen at the University College Hospital, Ibadan, Nigeria, over a five-year period (January, 1975, to December, 1979) showed that 42% (481 patients) were treated for suppurative diseases of the lung and pleura, notably empyema thoracis, lung abscess, and bronchiectasis. Of these, 336 or 70% were treated for empyema thoracis, most of whom were less than 2 years old. Seventy-five patients (16%) had lung abscess, 53 of whom were treated medically with 8 deaths, while 22 had emergency resection for massive hemoptysis with 9 deaths. Of the 70 patients with bronchiectasis, 37 were treated medically with 2 deaths, while 33 were treated surgically with 5 deaths. These data demonstrate that infectious diseases of the lung and pleura remain the greatest challenge to the thoracic surgeons in tropical, developing countries who are often handicapped by inadequate facilities, lack of drugs, illiteracy, poverty, superstitious beliefs, and poor environmental hygiene.

A Nigerian infant with symptoms of moderate respiratory dysfunction since birth is described. The diagnosis of the scimitar syndrome was made intraoperatively. The clinical and roentgenographic features with which the patient presented are outlined together with anatomical observations. The presence of an associated foramen of Morgagni hernia has not been reported previously.The relevant literature is reviewed, with emphasis on the preoperative diagnostic investigations essential in planning and executing appropriate surgical therapy.

Between 1968 and 1977, 87 patients underwent pneumonectomy at Rhode Island Hospital. Postoperatively, 25 patients developed arrhythmia (29 percent), giving rise to hemodynamic deterioration necessitating aggressive treatment. There were nine hospital deaths (10 percent). The effect of preoperative digitalis was analyzed in 68 patients over age 50 years.In Group 1, digoxin was not used until the onset of arrhythmia. There were 40 patients in this group; 18 developed arrhythmia (45 percent) with four deaths (22 percent).In Group 2, patients were given digitalis preoperatively. There were 28 patients; six developed arrhythmia (21 percent) with no deaths.Thus, the high incidence (45 percent in Group 1 and 21 percent in Group 2), as well as risk of mortality (4/18 patients) from arrhythmia following pneumonectomy, in patients over 50 years of age without digitalization, is a strong indication for preoperative digitalis.

This report reviews the authors' experience with 35 pneumonectomies over a ten-year period at the University College Hospital, Ibadan, Nigeria. The most common indications for pneumonectomy were TB-destroyed lung and life threatening pulmonary hemorrhage due to suppurative lung disease. Malignant tumors of the lung were featured twice as the cause for pneumonectomies in this study.Results show that until 1973, when most pneumonectomies were performed for TB-destroyed lungs, the mortality rate was nine percent, but after 1973, when more pneumonectomies were performed for life threatening hemoptysis, the mortality rose to 29 percent.From this study, it will appear that penumonectomy carries a grave prognosis when performed for suppurative lung disease, when there is active and massive hemorrhage, and when performed under emergency conditions.

A case is presented of a five-year-old girl with history of intermittent episodes of cough and vomiting exacerbated by eating. A diagnosis of broncho-esophageal fistula was made on barium esophagography after she failed to improve on therapy for bronchiectasis and tuberculosis over a one-year period.The diagnostic considerations and management of broncho-esophageal fistula in the Nigerian child with bronchiectasis are described.