Pattern of homicide coroner's autopsies at University College Hospital, Ibadan, Nigeria: 1997-2006.

There is relatively little information regarding the pattern of homicides in developing countries such as Nigeria. This study is aimed at determining the pattern and demographic factors associated with homicide cases seen in a Nigerian Teaching Hospital. It is a descriptive autopsy study of homicide cases seen at the University College Hospital (UCH), Ibadan over a 10-year period from January 1997 to December 2006. All the coroner's autopsies for the period, of homicides or suspected homicides, were reviewed with emphasis on the following: gender, age, occupation, circumstances surrounding event, likely motive, type of weapon used, site(s) of injury and mechanism of death. Homicides accounted for 153 (3.1%) of the 4928 coroner's cases at the UCH within the study period. One hundred and thirty-seven of the 152 cases were men, and the overall age range was 4-83 years. The mechanism of death was haemorrhagic shock in 91 cases (59.9%); severe raised intracranial pressure in 58 cases (38.2%); septicaemic shock in two cases (1.3%); and asphyxia in one case (0.7%). Gunshot injuries accounted for 64.5% of the fatalities, sharp objects 21.1% and blunt force 14.5%. Most were victims of armed robbery attacks. The head, abdomen, chest and lower limbs were single sites of injuries in descending order of frequency and most of the cases sustained multiple injuries involving two or more of these sites. Gunshot deaths were the commonest form of homicides in the period under review. Young males and victims of armed robbery attacks were most susceptible.

The spectrum of malignant neoplasms in Ekiti State, south-west Nigeria.

BACKGROUND: Geographic pathology is an accepted basis for unravelling trends of disease patterns. Proper documentation at the initial stage assists in establishing a foundation data. The authors are not aware of a documented pattern of malignant neoplasm in Ekiti State. OBJECTIVE: The aim of this study is to update the available literature on malignant neoplasms and compare our findings with previous work done by other investigators. METHODS: The estimates are based on a systematic retrospective survey of cancer cases identified in the Pathology Laboratories of Federal Medical Centre, Ido-Ekiti and University Teaching Hospital, Ado-Ekiti for the period; January 2002 to December 2009. The data recorded on each case were: source of information (histology or cytology), name, age, and sex, date of diagnosis and site of tumour. Tumour site and histology were coded according to the International Classification of Diseases, ICD-10 for presentation in tabular form. RESULTS: A total of 498 cancers were recorded. There were 177 (35.5%) males with average age of 54.5 years and 321 (64.5%) females with average age of 48.6 years. The estimated Crude Incidence (CI) rates for all cancer sites are 14.7 for males and 27.4 for females, per 100,000 population. In males, the most frequent cancer is prostate cancer (37.9%) followed by cancer of the liver (10.7%) and NonHodgkin's Lymphoma, NHL (7.9%). In females, the most common cancer is that of the breast (49.3%) followed by the cervix (8.5%) and the ovary (5.32%). A total of 28 childhood cancers were registered (17 males, 11 females). The most frequent tumours were Burkitt's lymphoma (8 cases) and soft tissue sarcomas (3 cases). CONCLUSION: This study shows that malignant neoplasms are not uncommon in Ekiti State. There is underreporting of cases as the crude incidence rates are low. This study will serve as baseline to more population-based studies in future.

Pattern of death in a Nigerian teaching hospital; 3-decade analysis.

BACKGROUND: In developing countries such as Nigeria, limited resources require that health priorities be selected wisely and death-related research is clearly warranted. The aim of this study is to provide a comprehensive report on the various causes of death in our center from 1978 to 2006. METHODS: This was a descriptive, retrospective study of all deaths recorded at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile - Ife, Osun State in Southwest Nigeria from 1978 to 2006. RESULT: A total number of 9,947 deaths were recorded during the study period and there were 6,277 male deaths (63.1%) and 3,670 female deaths (36.9%) with a female to male ratio of 1:1.5. The age ranged from birth to 100 years with a median of 25 years. Infection (2,594 patients; 26.1%) was the most common cause of death and this was followed closely by trauma death (2,028 patients; 20.4%) and neonatal death (1,074 patients; 10.8%). Death from infectious disease and trauma reduced from 1,048 and 1,441 in the first decade (1977 - 1986) to 478 and 133 in the last decade respectively. While death from neoplasia increased from 112 in the first decade to 354 in the last decade of the study period. CONCLUSION: Our study shows that death from infectious disease in the present decade has reduced to almost half that was recorded in first decade. Similarly death from trauma has also reduced compared to the first decade of the study. Death from neoplasia is however higher in the last decade.

Sudden cardiac death in Nigerians--the Ile-Ife experience.

OBJECTIVE: To determine the clinico-pathologic features, circumstances of death and related epidemiological variables in cases of sudden cardiac death among Nigerians. METHODS: A review of all cases of medico-legal autopsies performed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, on cases of sudden unexpected deaths over a ten-year period (1987-1997). RESULTS: The records of 2,529 medico-legal autopsies were reviewed, of which 79 were found to be cases of sudden cardiac deaths (SCD). The SCD cases consisted of 59 males (74.7%) and 20 females (25.3%), with age ranging from 27 to 80 years. The mean age (and standard deviation) was 53.7 (+11.2) and 52.2 (+10.9) for males and females respectively. A total of 68 cases (86.1%) were brought dead into the hospital and 38 (55.1%) of these were apparently healthy prior to death. The nature of activities associated with SCD, where such was documented, was passive in 90% of cases. Hypertensive heart disease was the cause of death in 66 cases (83.5%), of which only 20 (30.3%) were previously diagnosed. Ischaemic heart disease and cardiomyopathies ranked next as the most common cause of death with 5 cases (6.3%) each. CONCLUSION: Hypertensive heart disease is the most common cause of sudden cardiac death in Nigerians, and many of hypertensive cases were previously undiagnosed. Cases of coronary heart disease and myocardial infarction played significant roles as causes of sudden cardiac death, indicating that their incidence may not be as rare among Nigerians as previously thought.

Pattern of suicides in Ile-Ife, Nigeria.

This is a study of pattern of autopsy findings in cases of completed suicides, with respect to age, sex and methods employed over a period of 11 years and 2 months. Suicides are generally reported to be rare in the less developed countries. Yet sudden deaths of indetermined aetiology are a well-recognized entity. Besides, it has been established that depressive disorders, a major cause of suicides, hitherto thought to be rare in Africa, is now recognized to be fairly common, presenting in a rather subtle form with features of somatization. Suicides in Ife were found to be 0.4 per 100,000 population with a higher incidence in males with a ratio 3.6 to 1. The majority of the victims were in the third decade of life. The majority of suicides were committed with Gammalin 20 and the local Dane gun. Those who used the gun applied it to the head and neck region in 76% of the cases.

Sudden unexpected death from cardiac causes in Nigerians: a review of 50 autopsied cases.

Fifty cases of sudden and unexpected death from cardiac causes in individuals between the ages of 28 and 80 years are reviewed; the causes and circumstances of the deaths of these individuals are defined. 70% were males and 44% of the deaths occurred in the 41-50 years age group. Death was due to hypertensive heart disease in 82% of the cases and only 18% were previously diagnosed. Acute left ventricular failure was the commonest (68%) cause of death. Only 4% of the total died of acute myocardial infarction from coronary artery disease. The causes of sudden cardiac death in a developing country such as Nigeria, appears to be different to the pattern in Western countries.

Pattern of homicides in Nigeria--the Ile-Ife experience.

Homicide victims were studied in Ife, Nigeria, between October 1977 and December 1988. Two hundred and two cases were analysed during the period. Male to Female ratio was 4.6:1. The peak age of victims was between 20 and 40 years; 37 percent were killed with firearms, 35 percent with cutting and piercing instruments and 18% by blunt force. These findings tally favourably with observations in other places.

Histopathological analysis of carcinoma of the male breast in Ile-Ife, Nigeria.

Carcinoma of the male breast is said to be rare. A review of the records at the histopathology laboratory of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, confirms the universal assertion that carcinoma of the male breast is very rare. In over nineteen years of its existence, the laboratory recorded only 10 cases of carcinoma of the male breast. This gives an incidence rate of 1.9% of a total of 513 cases affecting both male and female breasts. All cases were infiltrating ductal carcinoma: there were two cases of papillary, one each of colloid and clear cell carcinoma while the remaining were "not otherwise specified". The age range was 40-80 years with an average of 56.9 years. There was left-sided preponderance with eight cases in the left breast and two cases in the right breast. Six cases had evidence of metastasis either at the time of initial diagnosis or some months after simple mastectomy.

Benign disease of the breast in Ile-Ife: a 10 year experience and literature review.

This study is a 10 year review of the benign diseases of the breast in Ile-Ife, Nigeria. A total of 362 cases were found. Three hundred and forty (95%) of the diseases occurred in females while 18 (5%) occurred in males giving a female-male ratio of 19:1. Fibroadenoma was the commonest lesion followed by fibrocystic disease. They accounted for 59.1% and 16.5% of benign breast diseases respectively. Acute and acute-on-chronic mastitis constituted 7.2%. These three lesions made up over 82% of the cases. Gynaecomastia was the commonest benign male breast disease and accounted for 3.8% of all the cases of benign breast disease. Apart from the atypical hyperplasia form of fibrocystic disease, benign diseases of the breast are not major predisposing lesions to malignant breast diseases.

A prospective study of coroner's autopsies in University College Hospital, Ibadan, Nigeria.

The present study reviews 876 consecutive coroner's autopsies performed in the Department of Pathology, University College Hospital, Ibadan over a two-year period (1 February 1991 to 31 January 1993). The hospital autopsy rate during the study period was 36.2%, and 62.5 per cent of these post-mortems were medico-legal cases. The most common indications for coroner's autopsies were sudden natural deaths (55.6%), followed by accidental deaths (35.3%). The proportions of maternal (4.3%), homicidal (3.1%) and suicidal (0.3%) deaths were much lower. The male to female ratio was 1.7 to 1. Ninety-one (10.4%) of the cases fell within the paediatric age group and the peak age incidence for these cases was in the 5-14 years age group. The remaining 785 (89.6%) cases were adults and the peak age incidence for these cases was in the fourth decade of life. The most common cause of sudden natural death was cardiovascular disease, of which hypertension constituted the majority of cases. Other major causes of sudden death included pneumonia, meningitis, typhoid fever and neoplastic diseases. Road traffic accidents accounted for 78 per cent of accidental deaths followed by falls (13.3%) and burns (4.6%). Abortions, post-partum haemorrhage and eclampsia were the major causes of maternal deaths in the present study. Homicidal deaths were eight times more frequent in male than female victims and the commonest mode of death was gunshot injuries. Suicidal deaths remain extremely uncommon in African patients, as confirmed by our study.

Lymphadenopathy in Nigerian children.

The histopathologic findings on 121 excised enlarged lymph nodes from 48 female and 73 male Nigerian children resident in Ife-Ijesa zone of Western Nigeria over a period of ten years (1982-1991) form the basis of this study. Patients' ages ranged from 2 months to 15 years. Most of the patients (81%) were aged 6 years and above. The cervical region was the commonest site of lymphadenopathy (48%) and localized lymphadenopathy was the rule. Chronic specific inflammation (tuberculosis, toxoplasmosis, and histoplasmosis) predominated as a cause of lymphadenopathy (44%) compared with non specific lymphadenitis (31%) and malignant tumours (24%). Tuberculosis was the commonest cause of chronic specific lymphadenitis and was commoner in girls. The cervical region was the commonest site for chronic specific lymphadenitis, as well as Hodgkin's and non-Hodgkin's lymphoma. The lymphomas were more common in males. The peak incidence for Hodgkin's disease was between the ages of 12 and 15 years.

Malignant solid tumours in Nigerian children.

The subject of neoplasia in African children has received little or no attention within the past two decades. The current study retrospectively reviews malignant solid tumours in children from birth up to the age of 15 years over an 11 year period in Ile-Ife, Nigeria. During this period, 71 pc of solid tumours seen in children were malignant and boys were more often affected than girls. The peak incidence was between the ages of six and 13 years. Lymphoma was the commonest type of tumour, accounting for 72.6 pc of all malignant solid tumours and males predominated. All the rhabdomyosarcomas were seen in boys and the alveolar variant predominated. Osteogenic sarcoma and nephroblastoma were more often seen in girls. No primary brain tumour was seen.

Adolescent sexual behavior and condom use in Ile-Ife, Nigeria.

A study to identify risky sexual behaviors related to condom use was conducted in a Yoruba-speaking urban area of Nigeria. The subjects were 256 randomly selected male high school students, 15-19 years of age, who completed a self-administered questionnaire. The majority (79%, or 194) reported having had heterosexual intercourse in the previous 12 months, 9 (4.6%) with prostitutes and 107 (55.4%) with more than one sexual partner. Three subjects who had more than one sexual partner and 1 of the 9 who had sexual intercourse with a prostitute had used a condom. Condoms were reported to be used only for the prevention of unwanted pregnancy by 61.3% of the students. Implications of these findings for adolescent AIDS education in Africa are discussed.

African histoplasmosis (Duboisii) of the skull with neurological complication--a case report and review of literature.

A case of African histoplasmosis of the skull associated with neurological deficit has been reported. There was complete recovery of neurological features after excision of the lesion followed by a course of co-trimoxazole. A review of the available literature indicates the rarity of this particular mode of presentation. The reversibility of the neurological complications makes it important that clinicians increase their awareness of this treatable condition.

The surgical pathology of colorectal carcinomas in Nigerians.

This paper presents a 10-year experience on the examination of surgical specimens of colorectal carcinomas in Nigerians. Colorectal carcinomas were found to constitute about 80% of all cases of large bowel malignancy. The Male: Female ratio was 2.28:2. Most of the cases (65.9%) were 50 years or younger and the peak incidence was in the 41-50 year age group. The site distribution in order of frequency was recto-sigmoid area (57.3%), descending colon (23.2%), caecum (12.2%) ascending colon and transverse colon 3.7% each. Seventy-three percent of the tumours were well differentiated adenocarcinomas while 15.9% were poorly differentiated. Mucinous carcinoma and signet ring carcinoma were found in 7.3% and 3.7% respectively. There was colonic metastasis in 54.9% of cases and 20.8% had distant metastases at initial surgery. Associated lesions were villous adenoma, 24.4%, Tubular adenoma-17.1%, amoebiasis 6.1% and schistosomiasis, 3.7%. The above observations together with those of previous authors suggests a difference in the biology of colorectal carcinomas in the tropics. The association with chronic granulomatous diseases, in particular, may be indicative of an entirely different oncogenic mechanism in their development in the tropics.

The pathological basis of chronic renal failure in Nigerians. An autopsy study.

With the aim of determining the relative prevalence of the diseases underlying chronic renal failure (CRF) in a large homogeneous black tropical population, the autopsy records of the Obafemi Awolowo University Teaching Hospital over a four year period were studied. Out of a total of 702 cases coming to autopsy during this period, 66 (9.4%) died as a result of CRF. The highest number of cases of CRF fell within the 31-40 year age group with a male/female ratio of 1.28:1. Chronic glomerulonephritis was responsible for 40.9% of cases, malignant nephrosclerosis 16.6%, benign nephrosclerosis 7.6% while endstage renal disease (ESRD) was responsible for 15.4%. A miscellaneous group of diseases was responsible for 19.7%, about half of which was due to chronic pyelonephritis. Rarer causes of CRF were diabetic nephropathy, multiple myeloma, systemic lupus erythematosus and analgesic nephropathy.

The surgical pathology of colorectal carcinomas in Nigerians.

This paper presents a 10-year experience on the examination of surgical specimens of colorectal carcinomas in Nigerians. Colorectal carcinomas were found to constitute about 80 per cent of all cases of large bowel malignancy. The male:female ratio was 2.28:1. Most of the cases (65.9%) were below 50 years and the peak incidence was in the 41-50 year age group. The site distribution in order of frequency was recto-sigmoid area (57.3%), descending colon (23.2%), caecum (12.2%), ascending colon and transverse colon 3.7 per cent each. Seventy-three per cent of the tumours were well differentiated adenocarcinoma while 15.9 per cent were poorly differentiated. Mucinous carcinoma and signet ring carcinoma were found in 7.3 per cent and 3.7 per cent respectively. There were colonic metastasis in 54.9 per cent of cases and 20.8 per cent had distant metastasis at initial surgery. Associated lesions were villous adenoma, 24.4 per cent tubular adenoma 17.1 percent, amoebiasis 6.1 per cent and Schistosomiasis 3.7 per cent. The above observations together with those of previous authors suggest a difference in the biology of colorectal carcinomas in the tropics. The association with chronic granulomatous diseases, in particular, may be indicative of entirely different oncogenic mechanisms in their development in the tropics.

Review of the histopathological findings in appendices removed for acute appendicitis in Nigerians.

The vermiform appendix is a frequent surgical specimen in most routine histopathology laboratories. This is because acute appendicitis is one of the commonest reasons for undertaking emergency laparotomy in most hospitals, even in developing countries. Three hundred and sixteen appendices removed for acute appendix in our hospital over a 10-year period were analysed, of which 37 (11.7%) were found to be normal while 221 (69.9%) showed histopathological evidence of acute inflammation. There were 25 cases of chronic appendicitis, four (1.3%) of which were granulomatous. Of these, schistosomal appendicitis was observed in three cases (0.95%) and tuberculous appendicitis was seen in one case. Of the 33 cases classified as miscellaneous, intraluminal ova of parasites with phlegmonous eosinophilic infiltration of the appendix was observed in 17 cases (5.4%) and Toxoplasma appendicitis was observed in five cases. Carcinoid tumour was diagnosed in three cases (0.95%), and in two of these the tumour had spread beyond the appendix.

Adenomyosis uteri in Ile-Ife, Nigeria. A prospective clinicopathologic study.

A 12-month prospective study of 120 consecutive hysterectomy and 12 myomectomy specimens received at the histopathology laboratory of the Obafemi Awolowo University Teaching Hospitals was undertaken to determine the occurrence of adenomyosis. The observed incidence was 9.8%. Adenomyosis was commonest in multiparous women in the fifth decade of life. The principal presenting complaint was abnormal uterine bleeding. The average dimension of a typical affected uterus was 10 x 7 x 6 cm weighing an average of 175 g. Diagnosis was mostly post-operative. This study shows that adenomyosis uteri is not uncommon in Nigerians.

Secondary amyloidosis in chronic osteomyelitis.

We report a longitudinal study to detect amyloidosis in 51 patients with chronic osteomyelitis which was carried out between 1986 and 1989 at our University Hospital in Nigeria. Biopsies of the sinus edge and rectal mucosa were carried out and stained specifically for amyloid deposits with Congo Red. Positive microscopic findings at one or other, but not at both sites were present in 5 cases (9.8%). Secondary amyloidosis is not common among patients with long standing suppurating osteomyelitis. When the suppuration is controlled or removed the amyloid deposits are absorbed.