Sixteen patients with pyogenic osteomyelitis of the ribs are reported; ages ranged from 3 months to 42 years and 10 were female. Right sided ribs were affected in 10 cases and single ribs in 12. Antecedent causes included empyema thoracis (56%) and blunt chest trauma (19%). Fourteen out of 16 patients presented with discharging chest wall sinuses and five patients had associated swellings on the chest wall. The duration of symptoms ranged from two to 36 months. The most common microorganism isolated was Staphylococcus aureus (50%). Rib excision (with drainage of the empyema in two cases) was curative in all 16 cases in this study.Osteomyelitis of the ribs appears to be a rare disease in both the tropical and the temperate areas of the world.13 Adeyokunnu and Hendrickse,4 in a review of 63 cases of salmonella osteomyelitis seen in Nigerian children, found no case of rib osteomyelitis. Similarly, Dich et al1 reviewed 163 cases of osteomyelitis in infants and children over 15 years and found only one case (0.6%) affecting the ribs.Osteomyelitis of the ribs has been found in association with childhood empyema, -7 Staphylococcus aureus infection,1 sickle cell anaemia, and infection due to Salmonella and Klebsiella species and Proteus rettgeri.3 Osteomyelitis arising in ribs adjacent to sites of intubation in the chest in children with empyema has been documented by Osinowo et al.7 The present report reviews 16 cases of rib osteomyelitis treated by our cardiothoracic unit over seven and a half years. From this experience and a review of the published reports we consider the aetiology, pathogenesis, clinical presentation, and results of treatment of the disease. MethodsThe records of all patients with rib osteomyelitis admitted to the unit from January 1975 to May 1983 formed the basis of this prospective study.The data extracted from each patient's record included the age, sex, clinical presentation, radiological findings, mode and results of treatment, and the results of bacteriological and routine haeAddress for reprint requests: Dr 0 Osinowo,

BackgroundEffusive–constrictive pericarditis is a syndrome in which constriction by the visceral pericardium occurs in the presence of a dense effusion in a free pericardial space. Treatment of this disease is problematic because pericardiocentesis does not relieve the impaired filling of the heart and surgical removal of the visceral pericardium is challenging. We sought to provide further information by addressing the evolution and clinico-pathological pattern, and optimal surgical management of this disease.MethodsWe conducted a prospective review of a consecutive series of five patients managed in the cardiothoracic surgery unit of University College Hospital, Ibadan, in the previous year, along with a general overview of other cases managed over a seven-year period. This was followed by an extensive literature review with a special focus on Africa.ResultsThe diagnosis of effusive–constrictive pericarditis was established on the basis of clinical findings of features of pericardial disease with evidence of pericardial effusion, and echocardiographic finding of constrictive physiology with or without radiological evidence of pericardial calcification. A review of our surgical records over the previous seven years revealed a prevalence of 13% among patients with pericardial disease of any type (11/86), 22% of patients presenting with effusive pericardial disease (11/50) and 35% who had had pericardiectomy for constrictive pericarditis (11/31). All five cases in this series were confirmed by a clinical scenario of non-resolving cardiac impairment despite adequate open pericardial drainage. They all improved following pericardiectomy.ConclusionEffusive–constrictive pericarditis as a subset of pericardial disease deserves closer study and individualisation of treatment. Evaluating patients suspected of having the disease affords clinicians the opportunity to integrate clinical features and non-invasive investigations with or without findings at pericardiostomy, to derive a management plan tailored to each patient. The limited number of patients in this series called for caution in generalisation. Hence our aim was to increase the sensitivity of others to issues raised and help spur on further collaborative studies to lay down guidelines with an African perspective.

ABSTRACI 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 < 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.

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