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.

Coronary artery pathology of 111 consecutive Nigerians.

A detailed study of the coronary arteries of 111 consecutive necropsies at Ile-Ife, Nigeria is reported. Coronary occlusive disease occurred in eight (7.2%) subjects and involved less than 50% of luminal size in five, and greater than 50% of luminal size in three subjects. Previous medical history was available in four of eight subjects and all four had hypertension. All three subjects with greater than 50% luminal occlusion were hypertensive patients and professionals, one was additionally diabetic and a heavy smoker and serum cholesterol (available in one) was 250 mg/ml. The mean age of the subjects with moderate and severe disease was 54 (range 35 to 71) years. Thus coronary occlusive disease among Nigerians occurred in elderly, affluent and hypertensive patients exposed to Western diets and habits.

Peripheral lymphadenopathy in Nigeria.

An analysis of 294 enlarged peripheral lymph node biopsies in Ife, Nigeria, revealed that the underlying disease in 51.7% was chronic inflammation while malignant diseases accounted for 48.3%. The order of frequency of the lesions was reactive hyperplasia (29.3%), metastatic cancer (24.5%), malignant lymphoma (23.8%), tuberculosis (15.6%) and toxoplasmosis (3.7%). One-third of the metastases were of undetermined origin. The neck which accounted for 53% of the biopsies, was the most frequent site for tuberculous adenitis, toxoplasmic lymphadenitis, and malignancies. The axilla was involved in 15% of the cases and was the most common site for metastatic breast carcinoma. The inguinal lymph nodes were also involved in 24% of the cases and had the highest occurrence of melanoma, reactive hyperplasia and parasitic granuloma. The habit of bare-foot walking leading to repeated trauma and infection is implicated in the high incidence of inguinal node reactive hyperplasia. This study demonstrates that lymph node malignancies and chronic granulomatous infections present a problem of increasing diagnostic and therapeutic importance and furthermore, it emphasizes that physicians in Nigeria should consider toxoplasmosis in the differential diagnosis of peripheral lymphadenopathy.

Loasis as a possible trigger of African endomyocardial fibrosis: a case report from Nigeria.

A Nigerian boy, previously in good health, presented with a two-day history of fever with chills; followed on the third day by periorbital swelling, urticarial rash and itching; and on the sixth day by dyspneoa, abdominal swelling and leg swelling. There was clinical, radiological and electrocardiographic evidence of dominant right-sided heart failure. Loa-loa was isolated from the blood and eosinophilia was marked but both were cured by diethylcarbamazine therapy. Heart failure, however, persisted and ended fatally 25 1/2 months later. Endomyocardial fibrosis, more severe on the right sided chambers, but affecting both ventricles was diagnosed. Evidence is presented from the literature to indicate loasis as the trigger of endomyocardial damage in this patient.

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.

Intrauterine intussusception causing intestinal atresia.

The patient presented at the age of 2 days with persistent bilious vomiting, failure to pass meconium and urine, and progressive abdominal distension dating from birth, and a clinical diagnosis of intestinal obstruction was made. This was confirmed by plain abdominal radiographs. At laparotomy atresia of the terminal ileum was found. The proximal and distal segments of the bowel ended blindly and there was a V-shaped defect in the adjoining mesentery. The blind ends were resected and an end-to-back anastomosis was performed. The lumen of the resected distal segment contained an intussusceptum.

Ovarian pregnancy causing obstructed labor at term in a heterotopic gestation.

A case of advanced heterotopic pregnancy in which an ovarian pregnancy caused obstructed labour with incomplete uterine rupture is presented. A live baby that weighed 3.25 kg was delivered at caesarean section. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The left ovarian mass contained a fetus papyraceus of about 24 weeks gestation.

Ectopic pregnancy associated with tubal schistosomiasis in a Nigerian woman.

A case of ruptured tubal ectopic pregnancy is presented. On histological examination of the fallopian tube involved, ova of Schistosoma haematobium were found in the submucosal and intramural parts of the tube. The case illustrates a rare preventable cause of ectopic pregnancy in this population.

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.

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 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.

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.

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.

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.

Cervical teratoma in Nigeria children.

Cervical teratomas are uncommon tumours. Over an eight-year period, four cases of cervical teratomas were seen in children at the University Teaching Hospital, Ile-Ife, Nigeria. The children ranged in age from two weeks to nine years. In two patients the tumours were noticed at birth but in only one was it symptomatic to be the cause of hospitalization at the age of two weeks. The other two had the tumours for three and six years respectively and presented because of cosmetic embarrassment. All the tumours were easily resected at surgery and two showed an anatomical relationship to the thyroid gland. The post-operative course was uneventful in the four patients. The histopathology of the tumours have shown tissues from the three germ layers with neurological elements predominating in two and thyroid tissue present in the other two. Over a follow-up period varying from one to four years none of the children have demonstrated any abnormality of thyroid functions.

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.

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.

Primary tuberculous mastitis in a Nigerian woman.

Tubercolous mastitis is an uncommon lesion even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is still very high. At the Ife University Teaching Hospital only one case of tuberculous mastitis has been seen over a ten-year period during which 671 breast biopsies were examined. This was in a 36-year old Nigerian woman who developed a left breast mass during pregnancy. She was seen after her delivery and was initially diagnosed as a case of carcinoma of the breast. Subsequent excisional biopsy and pathological examination of the mass confirmed tuberculosis of the breast. She has responded favourably to anti-tuberculous therapy.

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.