Spinal Malignant Peripheral Nerve Sheath Tumours in Nigerians.

BACKGROUND: Spinal Malignant peripheral nerve sheath tumours (MPNSTs) are very rare aggressive tumours with poor prognosis. Little is known about these tumours in sub-saharan Africa. OBJECTIVES: This study aims to evaluate the clinical profile and outcome of management of these tumours in a resource limited country. METHODS: We retrospectively analysed data from the records of patients who had surgery for spinal MPNSTs at our center between January 2004 and December 2018. RESULTS: There were four patients in this study (M:F= 1:1). The ages ranged from 27-53 years with a mean of 43.25 ± 11.84 years. The tumour was located in the thoracic region in 2 of the patients (50%), the lumbar region in one (25%) and thoracolumbar in the 4th patient. Three patients (75%) presented with back pain while limb weakness, sensory deficit and sphincteric dysfunction were present in all patients at presentation. The duration of symptoms were 2 months in 2 patients (50%) and 3 months in the other 2. None of the patients had neurofibromatosis. Gross total tumour excision was achieved in 2 patients (50%) and subtotal resection in the other 2. The tumours were high grade in three patients (75%) and low grade in one. Two patients had adjuvant radiotherapy. Two of the patients were dead within 6 months of the diagnosis, another one within 18 months while one patient is still alive 3 years after. CONCLUSIONS: MPNSTs are very rare in our practice. Most of the tumours were high grade tumours and ran an aggressive course.

A randomised controlled trial of three aesthetic full-coronal restorations in primary maxillary teeth.

AIM: This randomised clinical trial (RCT) compared the clinical outcomes of three aesthetic full-coronal restorations (composite strip crowns, pre-veneered stainless steel crowns (SSCs) and pre-fabricated primary zirconia crowns) in carious and traumatised primary maxillary incisors. MATERIALS AND METHODS: One hundred and twenty nine teeth in 39 children aged between 3 to 5 years were included. Children were randomly assigned to one of three treatment groups using a permuted block randomisation technique with a total of 43 teeth in each group. After trainee calibration, restorations were placed and evaluated after 6 months. Outcomes evaluated were restoration failure, tooth wear of opposing teeth and gingival health. RESULTS: The retention rate was highest for zirconia crowns (100%) followed by pre-veneered SSCs (95%). Strip crowns were the least retentive (78%). Zirconia crowns showed low grade abrasion in four opposing teeth. Teeth restored with resin composite and pre-veneered SSC showed an increase in mean gingival index score, while corresponding values decreased in zirconia crowns. CONCLUSION: Resin composite strip crown is a highly sensitive technique leading to lower retention rate. Pre-veneered stainless steel crowns showed increased incidence of facial veneer fracture. Zirconia crowns are highly retentive and biocompatible but cause low grade of abrasion of their opposing natural dentition at the 6-month follow-up.

BODY STALK ANOMALY: CLINICAL AND HISTOPATHOLOGIC FINDINGS OF THIS RARE ANOMALY IN A NIGERIAN NEWBORN.

Introduction: Body stalk anomaly (BSA) is a rare and severe congenital malformation in which the exact pathophysiology is still unknown. The possible causes of body stalk anomaly include early amnion rupture with direct mechanical pressure and amniotic bands, vascular disruption of the early embryo, or an abnormality in the germinal disk. Case presentation: We report a case of sonologically delayed diagnosis of BSA which was confirmed post-delivery following histopathological examination and we reviewed relevant literature regarding this phenomenon. Sonographic features of the foetus included a wide anterior abdominal wall defect (omphalocele) with protrusion of the liver into the amniotic cavity. The umbilical arteries show normal calibre, flow, velocimetry, and spectral waveform. Conclusion: Body stalk anomaly is accepted as a fatal anomaly, so it is important to differentiate it from other anterior abdominal wall defects prenatally and this could guide the management options.

WHO classification of meningiomas-A single institutional experience.

INTRODUCTION: Meningiomas are among the most common intracranial neoplasms worldwide. The World Health Organization (WHO) has classified the neoplasm into three grades with each grade having several histological variants. Several studies done in blacks have shown differences with Caucasian populations regarding the occurrence of histological variants. Our study sought to examine the histological variants of meningioma seen in a predominantly black population using the WHO grading system. METHODS: We conducted a retrospective study of all meningiomas seen in our hospital facility for over twenty years. An analysis of data from all the patients diagnosed with meningioma, who also had surgical biopsies taken, was done. The meningiomas were graded using the WHO grading system and also classified into different histological variants within each grade as described by the WHO study group. RESULTS: The study included a total number of 163 biopsies. There were more females diagnosed with meningiomas with a female to male ratio of 1.4. Most of the tumors were grade one, however, there were more males with malignant meningiomas. Transitional meningiomas were the most commonly seen variants among the grade one tumors while atypical and anaplastic were most common in grades two and three, respectively. CONCLUSION: A larger population-based study is needed to provide epidemiological data on the occurrence of meningiomas in blacks.

BILATERAL GANGLIONIC HAEMORRHAGIC STROKE COMPLICATING SUSPECTED MENINGOCOCCAEMIA: A CASE REPORT.

Haemorrhagic stroke in pyogenic meningitis is a rare complication accounting for about 2% of all complications1,2. It often results from disseminated intravascular coagulation, which is a complication of bacterial meningitis and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patient presenting with altered levels of consciousness to detect cerebrovascular complications.

Differential effects of total and partial sleep deprivation on salivary factors in Wistar rats.

OBJECTIVE: Aim of this study was to investigate the effects of sleep deprivation on salivary factors in rats. DESIGN: Animals were randomly assigned into three groups of 6 animals each as control, total sleep deprivation (TSD) and partial sleep deprivation (PSD) groups. The multiple platform method was used to induce partial and total sleep deprivation for 7days. On the 8th day, stimulated saliva samples were collected for the analysis of salivary lag time, flow rate, salivary amylase activity, immunoglobulin A secretion rate and corticosterone levels using ELISA and standard kinetic enzyme assay. Data were analyzed using ANOVA with Dunnett T3 post hoc tests. RESULTS: Salivary flow rate reduced significantly in the TSD group compared with the PSD group as well as the control group (p=0.01). The secretion rate of salivary IgA was significantly reduced in the TSD group compared with the control group (p=0.04). Salivary amylase activity was significantly elevated in the TSD group compared with the PSD group as well as control group (p<0.001). However, there were no significant changes in the salivary lag time and levels of corticosterone among the groups. CONCLUSIONS: These findings suggest that total sleep deprivation is associated with reduced salivary flow rate and secretion rate of IgA as well as elevated levels of salivary amylase activity in rats. However, sleep recovery of four hours in the PSD group produced ameliorative effects on the impaired functions of salivary glands.

Features and Outcome of Surgical Management of Spinal Tumors in a Cohort of Nigerian Patients.

OBJECTIVE: There is a dearth of information on operated cases of spinal tumors in patients in sub-Saharan Africa. The objective of this study was to evaluate the histologic pattern, anatomic distribution, and extent and outcome of surgery of Nigerian patients with spinal tumors. METHODS: This retrospective study comprised a cohort of Nigerians who underwent surgery for spinal tumors. Data obtained included patient demographics, duration of symptoms, anatomic location, imaging findings, Frankel grading before and after surgery, and type and outcome of surgery. Univariate analysis was performed, and results were compared with results from other parts of the world. RESULTS: There were 59 patients (male-to-female ratio 1:1.1) with a bimodal age distribution. The highest (20.34%) incidence was seen in the 20-29 age group. More than half (58.06%) of the patients presented with a duration of symptoms of at least 6 months (duration of symptoms was >12 months in 35.48%). Motor deficit was present in 97.73% of patients at presentation. Functional grading was Frankel A in 38.10% of patients, Frankel C in 26.19%, Frankel B in 16.67%, Frankel D in 16.67%, and Frankel E in 2.38%. The tumors were mostly in the thoracic region (65.45%), and 58% were extradural in location. Gross total tumor excision was performed in 50.88% of the cases, and subtotal resection was performed in 24.56%. Spinal stabilization was performed in 17.86% with spinous process wiring and vertical strut being the most common method of stabilization (80%) among this group. Metastasis was the most common histologic tumor type (23.21%). Meningioma accounted for 12.50% of tumors, and ependymoma, astrocytoma, and hemangioma each accounted for 7.14%. The most common source of metastasis was the prostate (38.46%). Postoperatively, 45% of patients improved neurologically, 52.5% remained the same, and 2.5% deteriorated. There was no perioperative mortality. CONCLUSIONS: Metastasis was the most common histologic type of spinal tumor in this study, and the most common location was extradural. The outcome was satisfactory in most cases with neurologic function remaining the same or improving after surgery in most patients.

Enhanced wound contraction in fresh wounds dressed with honey in Wistar rats (Rattus Novergicus).

BACKGROUND: Due to reports that honey accelerates wound healing, an investigation on its role in wound contraction in fresh wounds inflicted on wistar rats was carried out. METHOD: Twenty adult male wistar rats had 2cm by 2cm square wound inflicted on their right dorsolateral trunk. They were divided into two groups. The experimental group had their wounds dressed with honey while the control group had normal saline dressing. Wound dressing was done every five days and measurements taken at each dressing. Wound morphology was also assessed. RESULTS: Dressing with honey significantly enhanced percentage wound contraction on day 10 with value of 79.20+/-2.94 compared to control value of 53.50+/-4.32. p=0.0. The mean wound measurement on day 10 reduced significantly in honey group, 1.15+/-0.18 compared to control group 2.38+/-0.28. p=0.002. However, there was no significant difference in fibroblast count per high power field in honey group 68.0+/-2.59 compared to control 90.2+/-17.40, p=0.242. Honey dressing increased mean blood vessel count per high power field, 18.8+/-3.77 albeit non significantly when compared to control value of 13.4+/-2.44, p=0.264. Also honey dressing caused increased granulation tissue formation in wounds dressed with honey compared to control group. CONCLUSION: Our study suggests that honey dressing enhances wound contraction in fresh wounds which is one of the key features of wound healing.

Radiation nephritis: anti-inflammatory effect of dexamethasone in adult Wistar rats (Rattus norvegicus) / Nefritis por radiación: efecto anti-inflamatorio de la dexametasona en ratas Wistar adultas (Rattus norvegicus)

The anti-inflammatory effect of dexamethasone on the irradiated kidneys of adult Wistar rats (Rattus norvegicus) was studied. Eighteen adult Wistar rats were, after acclimatization, randomly divided into 3 groups of 6 animals per group. The control group had normal saline, receiving neither drugs nor radiation. The second group received normal saline and radiation. The third group received pretreatment with dexamethasone at 1mg/kg body weight/day for 2 days followed by radiation. Radiation was delivered to the animals as a single fraction of 2.5 Gy of gamma rays from Cobalt-60 source, using an AECL Theatron 780-C Teletherapy machine. After exposure to the different interventions, the animals were sacrificed on the 14th post-irradiation day and the kidneys dissected out from each animal. The renal tissues were subjected to histological processing, and then studied using an eyepiece objective ruler calibrated with a 2mm stage micrometer for histomorphometric studies. The result of the study showed that all irradiated animals suffered weight loss by the 14th day post-irradiation (p<0.05) irrespective of the additional treatment with dexamethasone and this was statistically significant. Histomorphometry showed that the maximum width of the glomerular capsule was significantly greater in the radiation groups than in the control at p<0.05. The maximal glomerular diameter was significantly greater in irradiated animals compared with the control animals at p<0.05. The outcome of this study showed that the intraperitoneal administration of dexamethasone at 1mg/kg body weight/day for 2 days prior to treatment with irradiation did not prevent weight loss nor ameliorate the swelling of the nephrons resulting from the effect of radiation injury to the Wistar rat.

Fue estudiado el efecto anti-inflamatorio de la dexametasona en riñones irradiados de 18 ratas Wistar adultas (Rattus norvegicus). Luego de la aclimatización, aleatoriamente se dividieron en 3 grupos de 6 animales por grupo. El grupo control recibió una solución salina normal, sin recibir drogas ni radiación. El segundo grupo recibió solución salina normal y radiación. El tercer grupo recibió tratamiento previo con dexametasona con 1 mg / kg de peso corporal / día, durante 2 días, seguido de radiación. Los animales fueron expuestos a radiación con una fracción independiente de 2.5 Gy de rayos gamma por una fuente de Cobalto-60, usando una máquina de teleterapia AECL Theatron 780-C. Después de la exposición a las diferentes intervenciones, los animales fueron sacrificados el día 14 post-irradiación y los riñones de cada uno de los animales fueron disecados. Los tejidos renales fueron sometidos a procesamiento histológico, y luego se estudiaron utilizando un objetivo ocular milimetrado calibrado a 2mm para el estudio histomorfométrico. Se demostró que todos los animales irradiados sufrieron pérdida de peso 14 días después de ésta (p <0.05), independientemente de los tratamientos adicionales con dexametasona , siendo estadísticamente significativo. La histomorfometría mostró que el ancho máximo de la cápsula glomerular fue significativamente mayor en los grupos irradiados que en el control en p <0.05. El diámetro máximo del glomérulo fue significativamente mayor en los animales irradiados en comparación con los animales control p <0.05. Los resultados de este estudio mostraron que la administración intraperitoneal, de 1 mg / kg de peso corporal / día durante 2 días, de dexametasona antes de comenzar el tratamiento con irradiación, no impide la pérdida de peso ni permite aliviar el edema de los nefrones, injuria producto de la radiación a las Ratas Wistar.