Molecular characteristics and prognostic features of breast cancer in Nigerian compared with UK women.

Although breast cancer (BC) incidence is lower in African-American women compared with White-American, in African countries such as Nigeria, BC is a common disease. Nigerian women have a higher risk for early-onset, with a high mortality rate from BC, prompting speculation that risk factors could be genetic and the molecular portrait of these tumours are different to those of western women. In this study, 308 BC samples from Nigerian women with complete clinical history and tumour characteristics were included and compared with a large series of BC from the UK as a control group. Immunoprofile of these tumours was characterised using a panel of 11 biomarkers of known relevance to BC. The immunoprofile and patients' outcome were compared with tumour grade-matched UK control group. Nigerian women presenting with BC were more frequently premenopausal, and their tumours were characterised by large primary tumour size, high tumour grade, advanced lymph node stage, and a higher rate of vascular invasion compared with UK women. In the grade-matched groups, Nigerian BC showed over representation of triple-negative and basal phenotypes and BRCA1 deficiency BC compared with UK women, but no difference was found regarding HER2 expression between the two series. Nigerian women showed significantly poorer outcome after development of BC compared with UK women. This study demonstrates that there are possible genetic and molecular differences between an indigenous Black population and a UK-based series. The basal-like, triple negative and BRCA1 dysfunction groups of tumours identified in this study may have implications in the development of screening programs and therapies for African patients and families that are likely to have a BRCA1 dysfunction, basal like and triple negative.

Observations on early and delayed colostomy closure.

BACKGROUND: Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. AIMS AND OBJECTIVES: The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. PATIENTS AND METHODS: Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. RESULTS: Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). CONCLUSION: Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

A study of the pattern, management and outcome of penetrating colon injuries in Sagamu.

BACKGROUND: Colon injuries are increasingly being treated safely by primary repair in spite of the high risk of septic complications. OBJECTIVE: This is a retrospective study of the pattern, management and outcome in patients treated for penetrating colon injuries at Olabisi Onabanjo University Teaching Hospital, Sagamu over a 7 year period (January 1995-December 2001). PATIENTS AND METHODS: Records of thirty-two patients were studied. RESULTS: Gunshots (75 percent) and knife stabs (18.75 percent) accounted for ninety-four percent of penetrating colon injuries. Associated intra-abdominal injuries were present in 22 patients (68.8 percent). Eight (twenty-five percent) patients presented in shock. Moderate to major faecal contamination was present in 30 (93.8%) patients. Severe colon injury occurred in nine patients. The eighteen patients with right colon wounds were managed by primary repair. All the fourteen patients with left colon wounds had a diverting colostomy alongside repair or resection. Complications included wound infection (56.7 percent) and septicaemia (31.7 percent). Eleven patients died, giving an overall mortality rate of 34.4 percent. Mortality was significantly associated with shock on admission (p<0.02), degree of faecal contamination (p<0.05) and severity of colon injury (p<0.01). Colostomy did not affect mortality. (P<0.1). CONCLUSION: In this study primary repair was employed in 56% of patients with penetrating colon injuries. The routine use of diverting colostomy for all left colon injuries can no longer be justified in current surgical practice as colostomy did not affect mortality.

Pattern of presentation and management of typhoid intestinal perforation in Sagamu, South-West Nigeria: a 15 year study.

BACKGROUND: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern, mode of therapy and outcome of cases diagnosed and treated as typhoid intestinal perforation at Olabisi Onabanjo University Teaching Hospital, Sagamu, between January 1990 and December 2004. METHODS: Complete records of 105 adult patients were studied. RESULTS: The male to female ratio was 2:1. The mean age was 27 years. Prior to arrival in our hospital, all the patients were on various combinations of antibiotics. Twenty-seven (26%) patients had been hospitalized elsewhere during the current illness. Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4%) patients. Resistance to chloramphenicol was found in three (60%) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations, mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure, multiple perforations by primary resection and anastomosis. Fifty-five (52.4%) patients developed complications. Fourteen (13.3%) patients died. There was a slight drop in mortality (8.8 %) in phase 2. Deaths were due to septicaemia in 8 (57%) patients. CONCLUSION: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation.

Acute appendicitis in Olabisi Onabanjo University Teaching Hospital Sagamu, a three year review.

BACKGROUND: Olabisi Onabanjo University Teaching Hospital is located in Sagamu, a suburban town with a population of 50,000 (1992 census). The hospital is a tertiary care facility in competition with a large number of private hospitals with different levels of competence. OBJECTIVE: The objective of the study is to review the outcome of the surgical management of acute appendicitis in our hospital. METHOD: A retrospective study of subjects who had appendectomy for the clinical diagnosis of acute appendicitis between January 2002 and December 2004 was done. RESULT: 113 subjects consisting of 52 females (46%), and 61 males (54%) were studied. The mean age was 24.1 years, 71 subjects (62.9%) were in the 10-30 years range. 57.5% of the subjects were students and 71 subjects (62.8) resided in urban area. All the subjects, had generalized in 23.9%). The mean duration of symptoms was 3.53 days with standard deviation of 3.69 days. Only 3 subjects presented on the day of onset of symptoms. Only 15 subjects (13.3%) had surgery on the day of admission. 69subjects (61.1%) had uncomplicated inflamed appendix at surgery and 2 subjects (1.8%) had clinically normal appendix. The mean duration of hospital stay was 10.6 days with standard deviation of 7.4. The commonest postoperative complication was pyrexia in 16 subjects (14.2%), followed by wound infection in 12 subjects (10.6%). One subject died (0.9%). CONCLUSION: The outcome reflects the late presentation and delay in surgical treatment.

Essential thrombocythaemia associated with priapism: a case report.

A case of priapism complicating essential thrombocythaemia in a 45-year old Nigerian gardener is described. His platelet counts ranged from 1.2-1.6 x 10(12)/L, haematocrit from 0.25-0.33 L/L and leucocytes from 23.4-30.6 x 10(9)/L. There was a splenomegaly of 5cm. He had bilateral cavernostomy but is yet to regain penile erection 3(1)-2 months after surgery.

Clinicopathological and molecular significance of Sumolyation marker (ubiquitin conjugating enzyme 9 (UBC9)) expression in breast cancer of black women.

The majority of breast cancers (BC) in Nigerian women are triple negative and show breast cancer-associated gene 1 (BRCA1) deficiency as well as the basal like phenotype, with a high mortality rate. In contrast to the well-defined predictive factors for the hormonal therapy, there is a paucity of information on the BRCA1 deficiency breast tumor biology, particularly among African women. BRCA1 Sumoylation (UBC9) has been speculated to be involved in the ER transcription activity, BRCA1 deficiency and triple negative BC. We therefore hypothesized that UBC9, a SUMOylation marker, may have contributed to the aggressive nature of BRCA1 tumor phenotype observed in Nigerian women. This study investigated the immunoprofiles of UBC9 in tissue microarray (TMA) of 199 Nigerian women and correlated their protein expression with clinical outcome, pathological responses and the expression of other biomarkers to demonstrate the functional significance in Nigerian women. The protein expression of UBC9, as compared with other biomarkers, showed an inverse correlation with steroid hormones (ER, progesterone (PgR)), BRCA1, p27, p21 and MDM4, and a positive correlation with triple negative, basal cytokeratins (CK14 and CK5/6), epidermal growth factor receptor (EGFR), basal-like breast cancer phenotype, p53, phosphoinositide-3-kinases (PI3KCA), placental cadherin, (P-cadherin) and BRCA1 regulators (metastasis tumor antigen-1 (MTA1). Survival analysis showed that those tumors positive for UBC9 expression had a significantly poorer breast cancer-specific survival (BCSS) as compared with those showing negative expression. UBC9 remained an independent predictor of outcome for BCSS. This study demonstrates that UBC9 appears to play an important role in the tumor biology of Nigerian women. Therefore, a novel UBC9 targeted therapy in black women with BC could enhance a better patient outcome.

Open burn wound dressing: a practical option in resource constrained settings.

Various types of wound care products abound for the treatment of burn injuries. Most of these products are rather expensive and beyond the means of many patients in poorer countries. This poses a challenge to burn care workers in these environments and calls for the adoption of practical solutions with the use of less expensive and readily available alternatives. The aim of this study is to review the outcome of our burn patients managed with topical silver sulphadiazine dressing in terms of time to wound healing and length of hospital stay. Consecutive burn patients admitted over a four year period were included in the study. The patients were resuscitated along standard protocols and their wounds were dressed daily with dermazin. The demographic and clinical characteristics of the patients were retrieved and analyzed using the SPSS version 16. The primary outcome measure for the study was the time to complete re-epithelialization of the wounds and discharge of the patients. 144 patients with a M: F ratio of 2.3: 1 were managed during the period. The age range was 4 months to 81.9 years with a median age of 26 years. The TBSA range was 1 to 99% with a median of 28.5%. The mean duration from time of injury to wound healing was 21.5 days with a median of 17 days. Open burn wound dressing with silver sulphadiazine offers a satisfactory outcome and should be considered for burn dressing in low resource settings.

Des produits différents de soins pour le traitement des brûlures des plaies abondent. La plupart de ces produits sont assez coûteux et au-delà des moyens de beaucoup de patients dans les pays pauvres. Cela pose un défi pour les agents de santé qui s'occupent des victimes des brûlures dans ces environnements. Pour cette raison il faut adopter des solutions pratiques, moins coûteuses et facilement disponibles. Le but de cette étude est d'examiner les résultats de nos patients brûlés gérés avec des pansements topique à la crème de sulphadiazine d'argent en termes de temps de la cicatrisation et de la durée du séjour à l'hôpital. Patients brûlés consécutifs admis sur une période de quatre ans ont été inclus dans l'étude. Les patients ont été réanimés selon des protocoles standards et les pansements avec dermazin étaient changés quotidiennement. Les caractéristiques démographiques et cliniques des patients ont été récupérées et analysées en utilisant la version 16 de SPSS. Le critère d'évaluation primaire de l'étude était le temps pour la réépithélialisation totale des plaies et le congé des patients. 144 patients avec un sex-ratio de M 2,3: F 1 ont été gérés au cours de la période. La tranche d'âge était de 4 mois à 81,9 ans, avec un âge médian de 26 ans. La gamme de la surface corporelle totale brûlée était de 1 à 99% avec une médiane de 28,5%. La durée moyenne de temps pour la guérison des plaies était de 21,5 jours, avec une médiane de 17 jours. Les pansements avec sulphadiazine d'argent sur les plaies de brûlures ouvertes donnent des résultats satisfaisants et devraient être considerés pour traiter des brûlures dans les milieux à faibles ressources.

Obesity and response to neoadjuvant chemotherapy in breast cancer

The prevalence of obesity is rising worldwide including Sub-Saharan Africa just as the incidence of breast cancer is rising in same region with increasing morbidity and mortality. Obesity or overweight has been identified as a risk factor for breast cancer and both have been associated with poor outcome of breast cancer treatment. The objective of this study was to assess the effect of obesity /overweight on clinical response to Adriamycin Cyclophosphamide-Paclitaxel (AC-P) regimen neoadjuvant chemotherapy in patients with breast cancer. A prospective observational of 39 female patients with breast cancer. A prospective observational study of newly diagnosed breast cancer patients with palpable breast lumps on neoadjuvant chemotherapy of AC-P regime. Age of the patients, tumour size, stage, estrogen, progestogen and HER2 receptor status were noted. Height measured in metres and weight measured in Kilograms were recorded and Body Mass Index (BMI) calculated .Tumour size measured at presentation, then after first, third, sixth and eighth doses to determine response as defined by the UICC method such as complete clinical response, partial clinical response, stable disease and progressive disease. BMI was then categorized into Normal weight 25kg/m2 and Overweight 25-30kg/m2 and Obese 30kg/m2. 43.6% were obese, 33.3% were overweight and 23.1% were normal weight. Thirty percent of overweight /obese patients had complete clinical response 2 compared with 77% of low/normal weight patients and this was statistically significant (X2 =6.53, p 0.015). 76.7% of the overweight/obese were premenopausal compared with 23.3% who were post menopausal, and this is statistically significant.(X2 =5.84, p 0.024). Obesity/ overweight is associated with poorer clinical response to neoadjuvant chemotherapy in the cohort of patients studied

Experience with Lichtenstein Hernioplasty in Sagamu

Background: Newer methods have evolved to address the major drawback of the traditional methods of hernia repair. These emphasize the use of prosthetic materials to strengthen the posterior wall of the inguinal canal without tension. Although Lichtenstein hernioplasty, like other newer methods, is associated with low recurrence rates, it is not commonly used in our clinical setting.Objective: To review the outcome of Lichtenstein hernioplasty using polypropylene mesh in a resource-poor setting.Methods: The hospital records of patients who had Lichtenstein hernioplasty between the year 2004 and 2013 in a six-bed private surgical clinic and who were followed up over a two- to ten-year period, were studied. Demographic data, clinical features, operative findings and outcome measures like post-operative complications and recurrence rates, were recorded.Results: There were 62 patients (with 69 hernias) of which 2 were females with the age range of 12-84years. 50 hernias (72.5%) were of the inguinoscrotal type, 39 patients (63.0%) had right inguinal hernias, 5 (7.2%) hernias were obstructed and 8 (11.2%) hernias were recurrent. Six (9.7%) had emergency surgery, 46 (74.2%) had surgery under local infiltrations and 15 (24.2%) had spinal anaesthesia. Scrotal oedema (4.3%), haematoma (1.4%), and hydrocoele (1.4%) were the early complications recorded. One recurrence of hernia occurred in a patient who had repair of twice recurrent hernia. The mean duration of follow-up in years was 5 (S.D 2.5) years.Conclusion: Lichtenstein repair of inguinal hernia was a safe and effective procedure in the private clinical setting

Pattern of Presentation and Management of Typhoid Intestinal Perforation in Sagamu; South-West Nigeria: a 15 year Study

Background: Mortality from typhoid intestinal perforation remains high in the West African sub-region. The aim of this retrospective analysis was to assess the presentation pattern; mode of therapy and outcome of cases diagnosed and treated as typhoid intestina perforation at Olabisi Onabanjo University Teaching Hospital; Sagamu; between January 1990 and December 2004. Methods: Complete records of 105 adult patients were studied. Results: The male to female ratio was 2:1. The mean age was 27years. Prior to arrival in our hospital; all the patients were on various combinations of antibiotics. Twenty-seven (26) patients had been hospitalized elsewhere during the current illness Chloramphenicol was the drug of first choice in the first ten years (phase 1). It was replaced with ciprofloxacin in the subsequent five years (phase 2). Blood culture was positive for salmonella organisms in 5(4) patients. Resistance to chloramphenicol was found in three (60) out of these five positive cultures. All patients had laparotomy after resuscitation. There were 112 perforations; mostly in the ileum and jejunum. Perforations were single in one hundred and one patients and multiple in four patients. Single perforations were treated by two-layered closure; multiple perforations by primary resection and anastomosis. Fifty-five (52.4) patients developed complications. Fourteen (13.3) patients died. There was a slight drop in mortality (8.8) in phase 2. Deaths were due to septicaemia in 8(57) patients. Conclusion: The pattern of presentation and outcome of management of typhoid intestinal perforation are similar to what is observed in other centres in our local environment. However the drop in mortality rate in the last 5 years of the study and the finding of strains of salmonella typhi resistant to chloramphenicol require further evaluation

Abdominal injuries in olabisi onabanjo university teaching Hospital Sagamu, Nigeria: Pattern and outcome

Objective: The aim was to study the pattern and outcome of abdominal trauma managed by Laparotomy in Olabisi Onabanjo University teaching Hospital Sagamu (OOUTH), South Western Nigeria.Method: This is a retrospective study. The records of the patients were retrieved and relevant data extracted such as age, sex, occupation, address, cause of injury, vital signs on admission, abdominal signs, other injuries, number of units of blood transfused, investigations, indications for surgery, operative findings, procedure carried out, complications and outcome.Results: Seventy seven subjects were reviewed. There were 23 females (29.9%), and 54 males (70.1%). The age range was 3years to 68years, 32 patients (41.6%) were in 20-30 years age group. The mechanism of injury was blunt trauma in 61 (79.2%) and penetrating injury in 16 patients (20.8%). Road traffic accident was the commonest cause of injury, in 53 patients (68.8%). 42 patients (54.5%) had extra abdominal injuries. Positive paracentesis abdominis was the commonest indication for surgery, in 53 patients (68.8%). The spleen was the most commonly injured organ, in 31 patients (40.2%) while the organs were normal in 4 patients (5.2%). The complication observed includes acute renal failure, in 5 patients (6.5%), multiple organ failure in 5 patients, and wound infection in 8 patients (10.4%). Ten patients died. (13%)Conclusion: Splenic rupture is the most common abdominal injury treated by Laparotomy in OOUTH Sagamu and the commonest cause is road traffic accident. Mortality was due mainly to acute renal failure and multiple organ failure