Recurrence of Malignant Pleural Effusion Following Pleurodesis: Is There a Difference Between Use of Povidone-Iodine or Cyclophosphamide?

Background: Malignant pleural effusion is associated with poor quality of life. The success of pleurodesis varies with different agents, with talc being the most effective. It is however not available in Nigeria. This study aimed to determine the efficacy of povidone iodine and cyclophosphamide, the two commonly available agents for pleurodesisMethods: A prospective simple randomized enrollment of consecutive patients with malignant pleural effusion over a five year period (2008- 2012).Results: Thirty four patients were analyzed with a M:F ratio of 1:2.4. Breast cancer was responsible for almost half (47.1%) of the effusions. Although the povidone iodine group was slightly younger both groups were similar. There was no difference in the effusion recurrence for both groups. Age, duration of symptoms and cancer type were not predictors of recurrence of effusion following pleurodesis.Conclusions: Both agents are readily available and perform well with minimal side effects. However, povidone iodine being cheaper may be a more affordable alternative.Key Words: Malignant effusion, Pleurodesis, Povidone-iodine, Cyclophosphamid

A review of the management of perforated duodenal ulcers at a tertiary hospital in south western Nigeria

Background: Gastro-duodenal perforations are common and may complicate peptic ulcer disease. Management is often by surgical closure.Objective: To determine the patterns of presentation and mode of management of duodenal ulcer perforations.Methods: Retrospective review of patients with duodenal ulcer perforations seen at the Obafemi Awolowo University Teaching Hospital between June 2001 and July 2011. Patients’ records were reviewed for demography, duration of disease, probable risk factors, type of surgery and complications. Data obtained was analyzed using SPSS 15.0.Result: Forty- five patients were reviewed. There were 37 males (82.2%). Mean age was 39.7years (range 15-78years). There were 10 (22.6%) students and 8(17.8%) farmers. NSAIDs abuse (11), previous peptic ulcer disease (2), and no prior dyspeptic symptoms (20) constituted 24.4%, 4.4% and 44.4% respectively of cases. Seven (16%) patients presented less than 24 hours of onset of illness. Forty one perforations (91.1%) involved the first part of duodenum. Twenty two (49%) patients had Graham’s omental patch. We had one (2.2%) failed repair and six (13.3%) mortalities. Conclusion: Late presentation of duodenal ulcer perforation is common with high mortality. Pragmatic surgical intervention with Graham’s omentopexy with broad spectrum antibiotics is still commonly practiced.Keywords: Duodenal ulcers, perforations, management, NigeriaAfrican Health Sciences Vol 13 Issue 4 December 201