Pathology of childhood nephrotic syndrome in northern Nigeria.

Histopathology of kidney biopsies in 46 children with nephrotic syndrome in northern Nigeria showed that 15 had quartan malarial nephropathy, 14 membranoproliferative glomerulonephritis, six proliferative glomerulonephritis and four chronic glomerulonephritis. There were only two cases of minimal change lesion. No set of clinical features typify any particular histologic diagnosis. There was progression of glomerular lesion in five of the ten children who had repeat biopsy.

Surgical management of pericarditis in Zaria, Nigeria.

Over eight years, 58 rural Nigerians with pericarditis were treated surgically in Zaria using basic surgical facilities. Eighteen patients had purulent pericarditis, associated with staphylococcal pneumonia in children, or pneumococcal pneumonia in adults. Treatment with antibiotics and prompt pericardiectomy appeared to be superior to drainage, since a quarter of those initially treated with surgical drainage developed early constriction and required pericardiectomy soon after. Thirteen patients had chronic pericardial effusions, of whom one had epicardial constriction and two had cardiomyopathy. Twenty-seven patients had chronic constrictive pericarditis but tuberculosis was confirmed histologically in three only. Echocardiographic findings remained unchanged in five patients evaluated before and after pericardiectomy. Eight of the 13 patients who died had already developed myocardial or hepatic insufficiency before operation, because of late presentation or diagnosis. Greater awareness of the significance of precordial pain in this rural population where ischaemic heart disease is rare would help in making an earlier diagnosis.

Immunological aspects of nephrotic syndrome in northern Nigeria.

Immunological aspects of 40 northern Nigerian children with nephrotic syndrome of recent onset are reported. Eight our of 30 had hepatitis-associated antigen in their sera. Hypocomplementaemia was rare. Measurement of serum C3, C4, and ASOT was not of diagnostic value. Proteinuria selectivity index was poor in half of the patients, and appeared t o depend on the severity of the kidney lesion. Abnormal immunofluorescence of kidney glomeruli to immunoglobulins, complement, Plasmodium malariae, and Plasmodium falciparum was found in 26 of the 29 children. The pattern of immunofluorescence was chiefly granular and was confined to the glomeruli. IgM was predominant. It was concluded that immunological reaction is involved in the pathogenesis of nephrotic syndrome in northern Nigerian children.

The Burkitt lymphoma in the northern savanna of Nigeria.

In one area of the northern savanna of Nigeria the proportional frequency of the Burkitt lymphoma in childhood cancers was 39 percent. The age, sex and clinical expression of the tumour were similar to the well described pattern in Ibadan in the southern forest belt. The BL can therefore be regarded as "endemic" in this area, although its frequency is probably less than that recorded in the south. The possibility of a differing epidemiological pattern of P. falciparum malaria being responsible for this finding is discussed.

Teratomas in adult Nigerians.

Over a six-year period, 132 teratomas were seen at the Ahmadu Bello University Hospital in Zaria, Nigeria. Twenty-seven of these, comprising most of the extragonadal tumours were seen in infants and children. Of the 105 tumours found in adults, ninety-four were benign cystic teratomas of the ovary occurring mostly in the third and fourth decades of life. There were three instances of malignant transformation of a previously benign cystic ovarian teratoma and four cases of struma ovarii, one of which was admixed with trabecular carcinoid but none of which was associated with hyperthyroidism or carcinoma. This study confirms the rarity in adult Nigerians of the following tumours each of which occurred only once in the series: mediastinal, solid ovarian teratoma, testicular and sacrococcygeal teratoma. The latter two were malignant and the sacrococcygeal tumour has been reclassified as an endodermal sinus tumour.

Nigerian 'heart muscle disease': the late stages of untreated hypertensive heart failure?

Evidence for the hypertensive origin of Nigerian 'heart muscle disease' is presented. Epidemiologically, clinically and pathologically it is similar to hypertensive failure and it is associated with hypertension. It is more severe than hypertensive failure as judged by its prognosis and the myocardial damage at necropsy. The radiographic aortic width and renal histology, but not the retinal arteries have evidence of chronic hypertension in some. Using renal histology and scores on a discriminant analysis it was estimated that 34/62 cases in the necropsy series had been hypertensive . Up to 28 cases had not suffered from chronic hypertension but this figure (3%) of cardiac necropsies does not justify the identification of a highly prevalent myocardial disease in Nigeria. The arguments could apply to South African cryptogenic 'heart disease' and 'Jamaican cardiomyopathy'. The study presents data on the natural history of hypertensive failure.

Primary liver cell carcinoma (PLCC) in the Northern Guinea Savanna of Nigeria.

There is a high prevalence of primary liver cell carcinoma in the Guinea Savanna country of Nigeria, one of the highest frequencies in the world. The highest frequency of the tumour was among males aged 20 to 49 years. The clinical and laboratory findings are similar to those found in other series in Africa. Alpha1-foeto-protein occurred in 85% of cases while HBsAg was noted in 49% of cases.

Post mortem coronary arteriography in Nigerians: a radiological review.

The findings in 147 unselected consecutive post mortem coronary arteriograms carried out at the University College Hospital, Ibadan, are analysed. The so-called third primary division of the left coronary artery was noted in 35% of cases which is much less than the 74% quoted for the South African Bantu. In atrial blood supply, there was a definite predominance of one coronary artery. The predominant artery to both atria originated in one-third of cases from the right coronary, in another third from the left coronary and in the remaining third from both coronary artery systems respectively. Only in eight instances was atherosclerotic disease noted and even then, this was of the mildest degree with only minimal and slight intimal irregularity. This further explains the known rarity of myocardial infarction as a cause of death in the Nigerian. The study forms a useful basis for the baseline anatomy of the coronary arteries in Nigerians as a prelude to in vivo studies in the cardiomyopathies.

Splenomegaly in Northern Nigeria.

Seventy five patients with large spleens were investigated in order to establish the causes of splenomegaly in Northern Nigeria, to define further the diagnostic criteria of tropical splenomegaly syndrome (TSS), and to study its pathogenesis. Investigations included examination of liver biopsy, bone marrow cytology, lymphocyte response to phytohaemagglutinin (PHA), serum immunoglobulins and complement, and the presence of immunoglobulin and complement fixed in Kupffer cells. Thirty patients had TSS, five chronic lymphatic leukaemia (CLL), four a syndrome of gross lymphoid hyperplasia (GLH) distinct from TSS, CLL and the lymphomas, and twenty three miscellaneous conventional diseases. In thirteen cases no definite diagnosis could be established. TSS was found to be predominantly a disease of female Fulani cattle herders. Its essential characteristics were splenomegaly in the presence of acquired immunity to malaria, a grossly raised serum IgM, a lowered serum complement, and the presence of IgM fixed in Kupffer cells. There was lymphoid hyperplasia in bone marrow, hepatic sinusoids and often blood which may be indistinguishable from that in CLL. Lymphocytes undergo normal blastogenesis to PHA. There was clinical and haematological response to proguanil therapy. Reticuloendothelial phagocytosis of IgM, probably as a complex, seems to be the essential feature of the condition. As it was impossible to identify early cases of TSS it is unclear whether IgM overproduction or phagocytosis of IgM complexes is the first stage of the disease. The precise nature of the association with malaria remains obscure. The diagnosis of CLL demanded the demonstration of an abnormally low immunoglobulin level and impaired lymphocyte responsiveness to PHA by blast transformation or 3H-thymidine incorporation, in addition to the usual haematological findings. The syndrome GLH occurred in multiparous Hausa women. It was characterised by intense lymphocytosis with active, PHA-responsive cells, and normal immunoglobulin levels. Patients responded to proguanil therapy. It is suggested that these patients have a depressed immune response to malaria, perhaps through repeated pregnancies, and to a leukaemogenic agent, both of which stimulate lymphocytosis. Antimalarial treatment at this stage may prevent the development of frank leukaemia or lymphoma. The usefulness of the various investigative procedures and the problem of managing the large number of undiagnosed cases are discussed.