With an increasing annual incidence, lung cancer remains the second most common cancer after breast cancer and the most common cause of cancer death worldwide. The distinctive features of its histological subtypes and the multifactorial etiologies ranging from tobacco smoking to genetic predisposition contribute to the associated poor clinical outcomes. Nonsmall-cell lung cancer (NSCLC) which constitutes most of the cases is a molecularly heterogeneous disease associated with poorer prognosis and risk of recurrence. However, this tumoral heterogeneity, which is disadvantageous to traditional chemotherapy, has been shown to be advantageous to immunotherapy in this review. Hence, the application of immune checkpoint inhibitors (ICIs) such as antiprogrammed cell death-1 antibodies has brought a change in thinking in the management of NSCLC, with future combination therapies looking promising in reducing the lung cancer burden. This review focuses on lung cancer background and treatment setbacks, exploring ICIs and antiprogrammed cell death-1 antibody mechanisms, the clinical trials leading to Food and Drug Administration approvals and future advancements.

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Background: Image-guided tru-cut lung biopsy is a surgical procedure done to obtain a sample of lung tissue for histological analysis or for other analyses. However, when image-guided facilities are not readily available, a nonimage-guided lung biopsy may be desirable. Methods: This was a prospective case series of all patients seen in the cardiothoracic surgery unit of a teaching hospital for a 2-year period with clinical and radiologic features suspicious of a malignancy or other lung pathologies, and with evidence of advanced disease. The biodata, clinical features, volume of the specimen, the presence or absence of contaminants or complications, and the histological diagnosis were also collected and descriptively studied. Results: Baseline characteristics – Sixteen patients were seen with a mean age of 49.4 ± 13.7 years (28–67 years). There were 11 (68.8%) females in the sample. With regards to presenting symptoms: 14 patients had predominantly cough, 8 had predominantly dyspnea, and 5 had a combination of various other symptoms. Seven patients (43.8%) had pleural effusion which was drained before the biopsy. Biopsy results – The mean volume of the samples obtained was 1.72 ± 3.8 cm³ (0.02–15.00 cm³). The biopsy sample was contaminated by skeletal muscles in two patients (12.5%). Eleven (68.8%) samples were malignant whereas five (31.2%) were nonmalignant pathologies. There were no major complications such as subcutaneous emphysema or pneumothorax or hemothorax recorded after the procedure in any of the patients. Conclusion: It is possible to do a nonimage-guided tru-cut lung biopsy and yet achieved some level of safety, minimal or no complication, and less cost, even in advanced disease with pleural effusion.

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Objective: The study's aim was to categorize patients' risk profiles, management options, and strategies to mitigate clinical practice challenges in a limited resource setting. Materials and Methods: We retrospectively reviewed the medical records of patients with acute venous thromboembolism (VTE) entered in a prospective database at our center from August 2014 to July 2021. Results: Twenty-two of 708 admitted patients were diagnosed with VTE for an incidence of 3.1%. The mean age was 63.7 ΁ 14.7, range 30-89, mean body mass index 31.5 ΁ 6.7 and 54.5% were female. Six (27.3%) patients had deep-vein thrombosis (DVT), 14 (63.6%) pulmonary embolism (PE) and 2 (9.1%) DVT/ PE. Dyspnea (68.2%) and leg swelling (63.6%) were the most frequent presenting symptoms. Hypoxemia with oxygen saturation <90 and cardiogenic shock was present in 27.3% and 13.6%, respectively. Due to limited access to computer tomography pulmonary angiogram (CTPA), transthoracic echocardiogram (TTE) was utilized to aide diagnosis and was performed in 14 (87.5%) patients with PE. All 14 patients showed evidence of right ventricular dysfunction, 78.5% had moderate-to-severe pulmonary hypertension and 57.1% right heart thrombus. 4 patients with DVT were treated as outpatients. All inpatients were anticoagulated with either unfractionated heparin or low-molecular-weight heparin and transitioned to Vitamin K antagonist or direct oral anticoagulant. The primary treatment duration was 3-6 months. The mean duration of follow-up was 17.5 ΁ 14.7 months. Hospital mortality was 16.7% (3/18), 30 days mortality 18.2% (4/22) and 6 months all-cause mortality 31.8% (7/22). All patients with late deaths had moderate-to-severe pulmonary hypertension. Conclusion: TTE in the absence of CTPA is a useful alternative diagnostic tool in the management of acute PE in limited-resource settings. It may also aid prognostication through estimation of pulmonary artery pressure.

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Background: Persistent ductus arteriosus (PDA) is one of the most common congenital heart diseases, and its management ranges from pharmacologic, surgical, or catheter-based therapy. Advances in cardiac surgery have made ligation of PDAs a safe surgical procedure. Objective: The objective of this study is to evaluate the experience in the surgical management of PDA at the University of Ilorin Teaching Hospital. Subjects and Methods: Retrospective data of patients who had open ligation of PDA at the Thoracic and Cardiovascular Surgery division University of Ilorin Teaching Hospital from 2006 to 2021 were reviewed. Results: Of the 27 patients (10 males and 17 females), 25 had left posterolateral thoracotomy for PDA ligation. Their median age was 1 year. The mean weight was 7.75 kg with a range of 3.9–20 kg. The mean preoperative PDA size by echocardiography was 5.06 mm and a range of 3–8 mm. Krichenko type B was the most common morphology seen in eight of the patients. The majority (18) had no other comorbidities, whereas two had cardiac and seven had extracardiac comorbidities. Two patients developed pulmonary complications (pneumonia and pulmonary edema), one patient developed surgical site infection and one patient postoperative pyrexia and seizures which resulted in the only observed mortality. Conclusions: We report our experience with surgical ligation of PDA the only treatment modality at our institution currently as we lack the capacity for transcatheter closure.

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Aneurysms of the radial artery are fairly common considering the rise in radial artery catheterization and other forms of trauma. The majority of these are, however, pseudoaneurysms. True aneurysms involving the radial artery are, however, very rare. Here, we report a true saccular aneurysm involving the distal right radial artery in a female with ulnar artery dominance managed by ligation and excision. A 35-year-old woman who presented with a right distal forearm swelling of 6-year duration and 8-month history of pain, with no prior history of trauma to the forearm, and no comorbidities. She was found to have a 2 cm × 2 cm mass in her right lateral distal forearm, 8 cm from the wrist joint. It was nontender with expansile pulsation. Allen's test revealed ulnar artery dominance. A duplex ultrasound scan revealed aneurysm of the right radial artery. The patient subsequently had ligation of the radial artery and excision of the aneurysm sac under local anesthesia. Histology revealed true aneurysm of the radial artery. Idiopathic true aneurysm of the radial artery is rare and can remain asymptomatic for a long time, and arterial ligation and aneurysm excision are safe in the presence of ulnar artery dominance.

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A 55-year-old male status postinsertion of a dual-chamber implantable cardioverter-defibrillator for ischemic cardiomyopathy 11 years earlier presented with right ventricular lead malfunction. While undergoing a transvenous laser lead extraction procedure, the patient developed sudden circulatory collapse from suspected injury to the superior vena cava (SVC). A prophylactically inserted bridge balloon stationed in the inferior vena cava was rapidly deployed in the SVC, temporarily controlling hemorrhage until emergency sternotomy and repair of the laceration with cardiopulmonary bypass support.

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Middle aortic syndrome (MAS) is a rare clinical condition generated by segmental narrowing of the abdominal or distal descending thoracic aorta. Although rarely diagnosed and reported, it is a cause of hypertension in the middle aged. Its coexistence with rheumatic mitral valve disease is yet to be documented in the English literature. A 25-year-old female who had previously been managed as a hypertensive presented with difficulty with breathing, NYHA class II, and generalized body weakness, more in the lower limbs. General examination was normal. Her vitals were as follows: temperature- 98.5°F, pulse rate - 100/min, blood pressure (BP) - 160/100 mmHg (left upper limb), respiratory rate - 20/min, saturation - 100% on room air. Echocardiography revealed a thickened aortic valve, concentric left ventricular hypertrophy, thickened and prolapsed anterior mitral leaflet, thickened and fixed posterior mitral leaflet, severe mitral regurgitation, dilated left chambers, severe tricuspid regurgitation, and severe pulmonary artery hypertension (PAH, RVSP = 82 mmHg). She was scheduled for mitral valve replacement (MVR) and tricuspid valve repair. The diagnosis of surgical hypertension was missed. As a routine protocol in our institution, radial and femoral cannulation was done for invasive BP monitoring. Following such cannulation, radio-femoral pressure gradient was noted, with a suspicion of aortic coarctation, necessitating the need to defer the surgery. On further evaluation, computed tomography (CT) chest and CT angiography were suggestive of MAS extending from T8 to T11 thoracic vertebrae, with narrow-lumen proximal abdominal aorta. She subsequently had aorto-aortic bypass + MVR + tricuspid valve sutural annuloplasty via median sternotomy + laparotomy for definitive treatment. MAS is a rare vascular disorder. Of more rarity is its coexistence with rheumatic valvular disease complicated by severe PAH. With standard institutional protocols of evaluation, and a high index of suspicion, a missed diagnosis can be forestalled.

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