Major limb amputation in adults, Zaria, Nigeria.

Over a period of 10 years, a total of 320 limb amputations were performed on adults at the Ahmadu Bello University Hospital, Nigeria. The major indication for upper limb amputation was trauma and post-fracture splintage gangrene (57%). In the lower limb the most common indication for amputation was advanced squamous cell carcinoma of the skin involving the bone. There was no case of peripheral vascular disease in these patients other than diabetic ulcers. The fitting of prosthesis was uncommon. Most of these amputations were certainly preventable. The need is for early and effective management of fractures, and the excision and grafting of non-healing leg ulcers before they become chronic.

Skin cancer in Zaria, Nigeria.

Skin cancer from 775 patients in the savannah showed a preponderance of squamous cell carcinoma (SCC) of the leg related to neglected, poorly managed and chronic ulcers or scars from burns or injuries. SCC of the head and neck had no predisposing factor. Malignant melanoma overwhelmingly affected the feet, dermatofibrosarcoma affected the trunk and Kaposi sarcoma affected the limbs. Basal cell carcinoma (BCC) comprised only 2% of all skin cancers. The 18 albino patients had a higher frequency of both SCC and BCC mostly on the head and neck. Excisional surgery was generally effective, the wounds being closed primarily or by means of flaps and skin grafts. However, 98 patients required amputation below the knee for tibial involvement by SCC. The prognosis and health care costs of skin cancer will only be improved if burns and injuries are adequately treated.

Squamous cell carcinoma of the skin in Africans.

Over a period of 12 years, 524 cases of squamous cell carcinoma were seen at the Ahmadu Bello University Hospital, Zaria, Nigeria. The common site affected was the lower limb (54%) followed by the head and neck region. Long standing chronic leg ulcer was the most common predisposing factor. Most tumours arose from post-burn scars, with no previous hospital treatment of the burns.

Parathyroid adenoma in northern Nigeria.

A middle-aged farmer and a female student presented with osteitis fibrosa cystica with nephrocalcinosis in the former and nephrolithiasis in the latter due to primary hyperparathyroidism. Hypercalcaemia was present in both cases and neck exploration revealed a large solitary parathyroid adenoma which was excised. Because primary hyperparathyroidism is less common in tropical countries doctors may be less familiar with the early manifestations of the disease. The number of patients thus undiagnosed and untreated is unknown.

Skin cancer in African albinos.

A review of 775 normally pigmented Africans and 18 African albinos with malignant skin tumours showed that squamous cell carcinoma was the most common tumour type, in contrast to Caucasians, in whom basal cell carcinoma is most frequent. In African albinos squamous cell carcinoma of the head and neck region was most frequent. However, the proportion of basal cell carcinomas was low also among albinos but higher than among normally pigmented patients. In contrast to the normally pigmented patients, there were no squamous cell carcinomas on the limbs in albino patients. We suggest that this difference was due to environmental factors, such as chronic leg ulcers, which might have been less influential in the albinos, who seldom lived more than 30 years. No cases of cutaneous melanoma or Kaposi sarcoma were found in the albino group.

Urinary stones in children in Zaria.

In a period of 16 years, 22 boys whose ages ranged from 10 months to 15 years were treated for stones occurring predominantly in the lower urinary tract. These boys represented 9.6/100,000 paediatric admissions, indicating the rarity of urinary stones in children in Zaria. Congenital obstructing lesions were present in 13 (59%) and the urine was infected in eight cases, most frequently by Klebsiella spp.

Gastric teratoma: a case report.

Gastric teratoma is a very rare, usually benign, tumour of childhood. In industrialized countries, the diagnosis is facilitated by advanced technology when the infant is still in utero or soon after birth, and surgery is performed quite early in life, long before symptoms appear. This tumour was seen in our hospital in a 4-month-old boy. A mass had been noted at birth, but the infant remained symptomless. He was brought to hospital only on account of its rapid growth. The teratoma was successfully excised and the child was not seen again after discharge from hospital. We presume he remains well.

Breast cancer in Zaria, Nigeria.

A retrospective analysis of the clinical records of 129 women with breast cancer seen at the Ahmadu Bello University Teaching Hospital, Zaria has been carried out. The patients were young (median age 38 years), 64% were premenopausal and 89% were parous and had practised prolonged breastfeeding. Patients typically presented with massive breast tumour (median diameter 10 cm) with matted axillary lymph nodes in 57%. Eighty-eight per cent of patients had stage III or IV disease, and in 85% the histological tumour type was infiltrating ductal carcinoma. Mastectomy was the main mode of treatment and the default rate both before and after treatment was high. The median crude survival period for our patients was only 1.5 years. The survival disadvantage is probably the result of the combined effect of delayed presentation by the patients, the preponderance of biologically very aggressive tumours and our grossly limited therapeutic modalities.

The risk of cancer in endemic multinodular goitre.

From 1971 to 1985 at the Ahmadu Bello University Hospital, Zaria, 245 patients with multinodular goitre were operated upon mostly for cosmesis. Clinically unsuspected malignancy was present in 50 (20 pc) of the resected specimens of which 26 were follicular and 20 papillary. This pattern conforms with the reports from other African Zones of endemic goitre where the frequency of cancer is lower in the clinically solitary nodular goitre. Thus, the management strategy ought to regard the multinodular goitre as pre-malignant and operations should be performed earlier on this account.

Burn injuries during pregnancy: an African series.

Seven pregnant women aged 20 to 30 years were among the burn patients treated at Ahmadu Bello University Hospital in Zaria, Nigeria. Five suffered flame burns and two were scalded. The burned surface area ranged from 4% to 80%. One patient was in the first trimester, two in the second, and four in the third. Six (86%) of the mothers and five (71%) of the fetuses survived.

Ritual hot baths (wankan-jego) in Zaria, Nigeria.

PIP: Among the Hausa-Fulani women of Zaria, Nigeria, "cold" or "sanyi" is thought to be a common cause of illnesses, and especially edema (swelling) during pregnancy. The traditional treatment for these illnesses is a hot bath. The new mother or mother-to-be sleeps in an overheated room and must take baths in very hot water, called "wankan- jego," to keep out the cold. The birth attendant uses a bundle of leafy twigs from tamarind or neem trees to splash hot water over the women's body. This splashing hides the real temperature of the hot water over the women's body. This splashing hides the real temperature of the hot water so that she does not feel it, but it may actually be 82 degrees centigrade. Severe scalds often result from, such baths. Women confined during childbirth in the hospital and then discharged are still often subjected to the "wakan-jego" after they return home. Their thighs, buttocks and breasts are the most susceptible areas where these hot-water scald burns are the worst, sometimes even resulting in their nipples being sloughed off, thus making the mother unable to lactate. Since most deliveries in the Zaria region still take place at home and most patients with childbirth complications come to the hospital only as a last resort, it is possible that scald injuries are underreported and the total morbidity and mortality rate may be much higher, both of mothers and babies. Understanding this cultural ritual is necessary to devise effective countermeasures, like encouraging hand testing the bath water for its safety before commencing the baths. Better still, since all the scalded patients in the groups studied were illiterate housewives, formal education could disprove the need for these traditional and harmful hot baths to chase away the "cold" that has been falsely believed to be the cause of childbirth illnesses. [full text]^ieng

Spina bifida cystica in northern Nigeria.

At the Ahmadu Bello University Hospitals in northern Nigeria 152 boys and 160 girls with spina bifida cystica were registered from 1971 to 1985. Only 21% of the patients were registered at the hospital within 24 h of birth; 90% had been delivered at home and without antenatal care. The malformation occurred in the lumbar or lumbosacral region in 75% of cases. Meningomyeloceles comprised 81%. Surgical closure was performed by general surgeons in 112 (36%) of the patients mainly for nursing care and social reasons. Of the children, 56 died in the hospital, 33 moved and 166 were lost to follow-up at 1 month. Only 8 were seen up to 1 year but 4 have lived beyond 4 years. This series serves as a baseline for comparison with future experience in this part of the world.

Cranium bifidum in northern Nigeria.

At the Ahmadu Bello University Hospitals in northern Nigeria, 35 girls and 29 boys with cranium bifidum were registered between 1971 and 1985. Only 25% of the patients were brought to the hospital within 24 h of life; 57 had been delivered at home without the mothers having received formal prenatal care. The majority (69%) of the lesions occurred in the occipital region; 52 (81%) were encephaloceles while the others were cranial meningoceles. Resection and repair were performed in 35 patients by general surgeons who had no facilities for vertriculoperitoneal shunts in infants with hydrocephalus. Thirteen children died in the hospital, 3 moved away, and 34 were lost to follow-up at 1 month. Only 3 were seen up to 1 year. Improvement in the care of such patients is expected since a neurosurgical unit has now been established.

Surgery for chronic pancreatitis in Zaria, Nigeria.

Fifteen children and 23 adults with complications of chronic pancreatitis were managed in Zaria, Nigeria from 1971 to 1987. They comprised 26 patients with chronic pseudocysts, 9 with chronic abdominal pain, and 3 with obstructive jaundice. Internal drainage was performed for 22 (85%) of the pseudocysts, with resection and external drainage, respectively, in 2 each. A longitudinal pancreaticojejunostomy was performed in a child with juvenile tropical pancreatitis syndrome and biliary bypass was performed in the jaundiced patients. The cause of chronic pancreatitis was known only in 8 (31%) of the patients.

Conservation of the ruptured spleen in children: an African series.

In the Zaria region of northern Nigeria, which is endemic for malaria and schistosomiasis, laparotomy was performed for traumatic rupture of the spleen in 27 children, 10 of whom had splenomegaly. Eleven of the children were pedestrians knocked down by motor vehicles while crossing the road and six were boys who fell off mango or guava trees. Using suture techniques, 17 ruptured spleens were repaired and one was partially resected: eight of them were enlarged. Total splenectomy was performed in nine cases. Five of the children in the splenic conservation group died within 4 days of surgery owing to severe associated injuries. It is concluded that splenorrhaphy is quite feasible in both normal-sized and enlarged spleens and should be encouraged in similar tropical countries where splenomegaly is a common response to endemic malaria and schistosoma.

Burn injuries during the puerperium in Zaria, Nigeria.

Of the 35 women who sustained burn injuries during the puerperium in Zaria, 31 had practised ritual hot baths or "Wankan-jego" which caused severe scalds. Five of the women also developed peripartum cardiac failure. Two died. Three of the newborns also died partly as a result of the mothers' illness. Formal education and general economic development would help in eliminating this preventable source of maternal and infant morbidity and mortality.

Pseudocysts of the pancreas in children: an African series.

Ten children ranging in age from 15 months to 16 years were operated on for pancreatic pseudocysts in Zaria. Four of the cysts were traumatic in origin but the cause of the others was obscure: perhaps some of the patients had juvenile tropical pancreatitis syndrome (JTPS). Since these were all chronic pseudocysts with thick walls, internal drainage was performed in eight and resection in one; the inadvertent opening into an anterior pseudocyst was converted into an external drainage porta. In the absence of modern abdominal imaging facilities, it is possible that pancreatic pseudocysts are under-reported in most parts of Africa.

Bladder and urethral injuries associated with fractures of the pelvis in Zaria, Nigeria.

Among 3540 trauma patients received at the A.B.U. Hospital, Zaria between 1972 and 1982, 350 had fractures of the pelvis, and 127 of these had associated injuries of the urinary bladder and urethra. They comprised 90 men and 37 women. Bladder and urethral contusion were the commonest injuries in 56 patients who required only catheter drainage. Surgical explorations and repairs were necessary in 71. Of the anatomical categories, pelvic posterior fractures occurred in 55 patients and were associated with a larger proportion of major non-urinary injuries, ruptured bladder and a greater fatality rate.