Analysis of Gleason grade and scores in 90 Nigerian Africans with prostate cancer during the period 1994 to 2004.

OBJECTIVES: To determine the relative frequency of prostate cancer among surgical specimens, and among prostate specimens received at the pathology department ,University Hospital Calabar. METHODS: Histology records were reviewed for the following: total number of histology specimens received; total number of prostate specimens; total number of prostate cancer; and the total number of cancers in males during the study period. Histology sections 4-5microns thick were cut from paraffin blocks and stained by Haematoxylin and Eosin (H&E). Histopathologic specimens were classified using the grading system of tumour differentiation described by Gleason and associates. RESULTS: One hundred and twenty three cancers of the prostate were received, constituting 2% of the total surgical specimens and 31% of prostate specimens. Thirty three cases (27%) could not be analyzed; therefore the study is based on 90 prostate cancer specimens. Eighty nine (99%) cases were epithelial tumours (adenocarcinoma.) There was a single mesenchymal tumour (rhabdomyosarcoma) (1%). The commonest grade in this study was the high grade (Gleason grade IV). CONCLUSIONS: We observed that prostate cancer is a common among males (all sites) diagnosed at the University Hospital Calabar, with a peak incidence between the ages of 61 - 70 years (seventh decade).

Justification rate for non-obstetric hysterectomies: a study of cases in University of Calabar Teaching Hospital, Calabar.

BACKGROUND: Hysterectomy is a commonly performed major, non obstetric operation. It is often the definitive treatment for several pelvic pathologies like uterine myoma, utero-vaginal prolapsed, dysfunctional uterine bleeding, cervical malignancy and uncontrollable post partum haemorhage. The use of the hysterectomy in women sometimes without disease has led to the perception that some of the indications for hysterectomy are unjustified. The aim of this study is to determine the justification rate for the procedure in the University of Calabar Teaching Hospital, Calabar. METHODS: This was a retrospective study of hysterectomies done at the University of Calabar Teaching Hospital between January 2001 and December 2005. The preoperative indication was compared with the pathologist's report after surgery. Hysterectomy was considered justified if the pathology report verified the indication for surgery or showed a significant alternative pathology. RESULTS: The indication for hysterectomy corresponded with the histopathological diagnosis in 76.7% of cases, while in 23.3% cases the indication and histopathological diagnosis did not correspond, out of these 3.3% of cases had significant alternative pathology. In this study 80% of all hysterectomies were justified while it was not justified in 20% of cases. CONCLUSION: It is suggested that guidelines aimed at reducing unnecessary hysterctomies should be put in place and implemented. This will go a long way in improving the justification rate for hysterectomies at our centre, save clients resources, improve client satisfaction and quality of care.

Endometrial pathology associated with infertility among Nigerian women.

SUMMARY: One hundred and forty endometrial specimens of women with infertility were examined with oil immersion at X100 magnification for evidence of secretory activity, presence of any inflammatory cells and characteristic features suggestive of specific pathogens. Twenty-three (16.4%) had evidence of chronic endometritis the majority being non-specific. Only two (1.4%) were granulomatous. There was a significant eosinophilic infiltrate in nine cases (6.4%) some numbering up to 55 eosinophils per 5 high power fields (5 hpf). Sensitive immunohistochemical techniques would be needed to correlate findings with specific pathogens for effective treatment.

Oil doom and AIDS boom in the Niger Delta Region of Nigeria.

CONTEXT: There has been a steady rise in Nigeria's HIV/AIDS burden since the first sero-prevalence survey in 1991. Nigeria's economy is mainly dependent on oil that comes from the Niger Delta Region. The majority of the people of the Niger delta region depend on fishing and farming for livelihood. Years of oil exploration activities with frequent oil spillages have led to severe environmental degradation with resultant destruction of farmlands and aquatic flora and fauna. The situation of the people of Niger Delta is characterised by poverty, high fertility and disease. ISSUE: Oil has become, to the people of the Niger Delta region a doom that has contributed in no small measure to the AIDS boom in the region. The relationship between such a burden and poverty has been forged by years of official neglect, and the presence of foreign workers. In addition, young Nigerians are drawn to the Niger Delta region by the oil economy, searching for non-existent jobs. Within Nigeria, the states of the Niger Delta region bear the burden of the spread of HIV/AIDS, and the region's poverty amidst plenty, has a negative impact on the population. LESSONS: The article concludes that the HIV/AIDS burden of the region deserves urgent and special attention because it has far-reaching implications, not only for control efforts in Nigeria, but also for the rest of the world, as nationals of various countries find employment in its oil fields. A number of recommendations are made.

Transvaginal ultrasound scan versus laparoscopy in the diagnosis of suspected ectopic pregnancy.

This is a prospective study comparing the performance of transvaginal ultrasound scan with laparoscopy as the last diagnostic tool in a clinically suspected ectopic pregnancy. Both diagnostic methods have the same sensitivity of 100%. Transvaginal ultrasound scan had a specificity of 73.7% and a positive predictive value of 89.8%. Laparoscopy had a specificity of 84.8% and a positive predictive value of 94.6%. The use of laparoscopy could avoid laparotomy in only 3.4% of patients. Since transvaginal ultrasound scan is easier, safer and cheaper than laparoscopy, more emphasis should be laid on its use in our environment than laparoscopy.

Prevalence of hepatitis B surface antigen among patients suspected of liver diseases in a Nigerian hospital.

Hepatitis B virus (HBV) infection has been reported to be the aetiological factor for hepatocellular carcinoma (HCC), hepatitis and liver cirrhosis. This study was therefore carried out to determine the seroprevalence of hepatitis B surface antigen (HBsAg), a specific marker of HBV infection in patients with suspected liver diseases. The investigation was carried out among patients attending the University of Maiduguri Teaching Hospital (UMTH), Nigeria with clinical symptoms suggestive of liver diseases and others with non-specific clinical features during the period from 1990-1995. A total of 197 (38%) of 517 patients tested positive for HBsAg, 81 (49%) out of 144 with symptoms suggestive of hepatitis, 75 (50%) of 149 HCC and 10 (56%) of 18 liver cirrhosis were HBsAg positive. Comparison of the yearly total prevalence values of HBsAg for the six years under study showed no significant difference. Similarly, yearly prevalence values amongst patients with suspected liver diseases showed no significant differences. Nevertheless, significant difference, (P < 0.05) between the prevalence of HBsAg among suspected cases of liver diseases and others with non-specific signs and symptoms was observed. Similarly, HBsAg was statistically significantly higher among males than females. The high prevalence rate of HBsAg in our environment may be associated with the suspected cases of liver diseases, which are equally prevalent in our locality. Health education to prohibit traditional practices that could predispose individuals to HBV infections is emphasised. The incorporation of HBV vaccination in the national programme on immunization currently in use in Nigeria is highly recommended. This would be an effective method of preventing HBV infection from childhood.

Helminth associated hypereosinophilia and tropical endomyocardial fibrosis (EMF) in Nigeria.

There should be a recognisable trend between the incidence of hypereosinophilia and the duration of tropical endomyocardial fibrosis (EMF), if the hypothesis, that EMF is the burnt out phase of eosinophil associated heart disease, is correct. We tested this hypothesis in a prospective study of 89 consecutive EMF cases over an 18 year period at two Nigerian locations (Ife in South West and Calabar in South East). We carefully dated the duration of EMF symptoms at first presentation and screened for hypereosinophilia (eosinophilia > or = 1500/mm3), and their causes. When no cause was identified for hypereosinophilia we gave a therapeutic trial with diethylcarbamazine to the patients. An eosinophil count > or = 1000/mm3 was recorded in 80% of 24 cases seen within 6 months; 55% of 46 cases seen 0-24 months; 54% of 18 cases seen 25-48 months and 21% of 25 cases seen more than 49 months of onset of symptoms: while the respective distribution of eosinophil count > or = 1500/mm3 for similar periods were 66, 44, 27 and 21%. This reflects a highly significant (P < 0.001) inverse relationship between hypereosinophilia and the duration of EMF and strengthens the concept that EMF (without eosinophilia) represents the late stage of eosinophilic heart disease. The localisation of endemic EMF to the low-lying tropical rain forest Zone and its predominant occurrence among rural dwellers and farmers suggest a vector borne etiologic agent. Microfilaria was the most likely cause of hypereosinophilia in the cases presented.

Malignant childhood tumours in Calabar, Nigeria.

Children suspected with cancers seen during a 5-year period (Jan 1983-Dec 1987) in the University of Calabar Teaching Hospital (UCTH) Calabar, Nigeria were prospectively studied. A total of 60 cases were confirmed in those aged below 15 years with a majority (38.3%) of the children under 3 years. The pattern shows a preponderance of Burkitt's lymphoma followed by nephroblastoma and soft tissue sarcoma as the commonest malignancies. A low relative frequency of leukaemias (8.3%) and no intracranial tumours were encountered. This pattern closely resembles that of other Nigerian reports but contrasts with the situation in Britain and America, with their high leukaemia and intracranial tumour frequency ratios. Generally, there appears to be a low prevalence of malignancies among children in Calabar and presumably the south-eastern part of Nigeria. Difficulties in their management are attributable to late presentation, high patient default rate, complete lack of radiotherapy, and shortage of chemotherapeutic agents.

Painless peripheral lymphadenopathy in Nigerian children.

We conducted a diagnostic biopsy during a period of 8 years (January 1981 - December 1988) on 74 consecutive children (aged under 16 years) who attended the University of Calabar Teaching Hospital, Calabar, for chronic enlarged painless lymphadenopathy, with a view to determining the diseases that commonly present with this symptom in our environment. Histological diagnoses returned were predominantly tuberculosis, neoplasms and nonspecific reactive changes. Each of these conditions was evenly distributed among the entire age group. Neoplasms were mainly Hodgkins and non-Hodgkins lymphoma, with Burkitt's tumour the commonest childhood tumour in Nigeria not contributing significantly to the neoplastic lymphadenopathy. Regional enlargement rather than generalised lymphadenopathy seems to be dominant, the commonest sites of involvement being the cervical followed by the inguinal regions. Chronic lymph node enlargement appears to be rare in our environment and only a few disease conditions manifest with peripheral nodes despite the large number of infections and other inflammatory diseases in Nigerian children.

Preliminary observations on cerebral malaria in Nigerian children.

Seventy-five cases of childhood cerebral malaria (CM) seen within a 30-month period (January 1986 to June 1988) in the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria were prospectively studied. Fifty-five percent of the victims were aged 1-5 years while 39% were between 6 and 10 years. Eight percent of the cases were postmortem surprises, their condition having been masked by other complications of malaria. At variance with the accepted definition of CM, 20% of the patients neither convulsed nor lost consciousness. In searching for any delineating premortem features of the disease, a combination of fever, multiple seizures, coma with severe anaemia did appear impressive and also a co-existence of tonic-clonic with pure tonic seizures was highly suspicious. The need to heighten the index of suspicion and encourage extensive research into this lethal aspect of malaria is stressed.