Cervical cancer screening at Ibadan.

Over a period of 44 months, 3171 smears were performed at the University College Hospital (UCH). Ibadan, Cytology Clinic. Of these, 44.2% were in asymptomatic women. Fifty-five point three percent were normal; 15.6% of the smears were reported as non-specific inflammatory changes while 20.1% were due to specific infections. Varying degrees of cervical intra-epithelial neoplasia (CIN) were diagnosed in 8.4% of the smears. The abdominal smears were treated with chemotherapy, cryocautery, diathermy, cone biopsy and hysterectomy. A simplified management plan for a patient with an abnormal smear based on our experience is also presented.

Aetiology of status epilepticus in Ibadan: a neuropathologic study.

In this neuropathologic study of 41 cases diagnosed as status epilepticus (SE) over a 10-year period at the University College Hospital, Ibadan (UCH), we found that the commonest cause was infection of the central nervous system (17 cases). The other aetiologic factors were: metabolic derrangement/toxic (14 cases) and cerebrovascular disease which was the most frequent cause in subjects above 12 years of age. It was encountered in 6 cases. Space occupying lesions which involved the frontal lobes were found in 4 cases. The conditions associated with the disease at death were: cerebral oedema, pulmonary oedema; pulmonary consolidation and pulmonary embolism. Our findings highlight the importance of looking for treatable conditions in patients presenting with this grave condition in this environment.

The rarity of minimal change disease in Nigerian patients with the nephrotic syndrome.

Minimal change disease (MCD), mesangial proliferative glomerulonephritis (MPGN) and focal glomerulosclerosis (FGS) may be indistinguishable at some stage when examined by light microscopy, but MCD in adults has over 80% response rate to prednisolone therapy. In search of MCD, we treated 22 patients with biopsy reported MCD (1 patient), MPGN (15 patients), and FGS (6 patients), out of 84 adult patients with the nephrotic syndrome (NS) seen over 55 months, with prednisolone 60mg daily for 6 weeks (4 patients) or 8 weeks (18 patients). Two patients with MPGN showed partial remissions with proteinuria dropping to 0.8g/24 hours and 1.2g/24 hrs. All the others were non-responsive with proteinuria remaining above 2g/24 hours. Allowing that 20% of patients may not respond to prednisolone, 4 patients may have been missed. It is concluded that MCD as defined by minor glomerular changes and good response to steroids is rare in adult Nigerian patients with the NS.

Oral soft tissue malignancies in Ibadan, Nigeria.

Eighty-nine primary malignant neoplasms of the oral and oro-pharyngeal tissues excluding bone and salivary gland tissue were studied over a period of 21 years. They constituted 0.4% of the total number of neoplasms seen at the University College Hospital, Ibadan, over that period and contribute only a small proportion, in contrast to the widely held view that oral tumours are very common in Africa. Squamous cell carcinoma was the commonest type of lesion seen and the commonly affected sites were palate, gum (gingiva), tongue, lip and floor of mouth, in that order. The incidental overall male:female ratio is 2.4:1, and it varied for site and type of tumour. In general, the older male is most affected and the peak incidence of the malignancies occurred in the 51-60 years age group.

Salivary gland tumours in Ibadan, Nigeria: a study of 295 cases.

Over a period of 21 years 295 primary salivary gland epithelial tumours were collected and studied. These tumours constituted 2.8% of all head and neck tumours seen at the University College Hospital. Ibadan, over the same period. Two hundred and one (68.1%) were in the major glands and 94 (31.9%) were in the minor intra-oral glands, with the parotid and palatal glands being most frequently involved. There was no statistically significant difference in the sex ratio, and the incidence of tumour gradually increased with age to a peak during the 4th decade. Pleomorphic adenoma was the commonest benign lesion while mucoepidermoid and adenoid cystic carcinomas were the common malignant lesions seen, and were more prevalent in older males. Unlike in other African studies, adenolymphoma, acinic cell carcinoma, adenocarcinoma, and undifferentiated carcinoma types were all identified.

Sebaceous gland carcinoma of the eyelid: case report.

This paper reports a case of sebaceous adenocarcinoma of the meibomian gland in a 69-year-old man. The tumour was excised and histopathological examination revealed the characteristic features of sebaceous adenocarcinoma.

Unusual renal manifestations of choriocarcinoma.

The cases of two young Nigerian women, who presented with profuse haematuria and renal enlargement secondary to metastatic infiltration from choriocarcinoma in the absence of primary malignant uterine foci are reported and discussed. The rarity of this mode of presentation of choriocarcinoma is highlighted.

Diseases causing chronic renal failure in Nigerians--a prospective study of 100 cases.

There are indications that there is an increased risk of chronic renal failure (CRF) in the Negroid race, yet few studies have been carried out in the native 'black' environment. A clinico-pathological study of 100 consecutive Nigerian subjects with CRF, seen over a 3-year period, is presented. Primary chronic glomerulonephritis (CGN) accounted for 50, accelerated hypertension for 25, and various aetiological entities for a further nine; these included, chronic pyelonephritis (two), diabetic nephropathy (two), calculous nephropathy (one), toxaemia of pregnancy (one), renal dysplasia (one), tuberculosis (one) and polycystic disease in the ninth subject. In 16 cases, no definitive aetiological diagnosis could be made. Combinations of the following features, protracted hypertension, proteinuria, significant analgesic intake and gouty arthritis, were observed. CGN and accelerated hypertension still remain the leading causes of CRF, while diseases such as diabetes mellitus and chronic pyelonephritis do not contribute significantly to CRF in Nigerians. Recognition of the early features and the causes of CRF would considerably reduce the prevalence of this condition.

Fine needle aspiration cytology in the assessment of breast lumps in Ibadan.

Within the period August 1984 to January 1987, 209 needle aspirates of breast lumps were examined cytologically. One hundred and forty-four smears had histological confirmation. The diagnostic accuracy of fine needle aspiration cytology for malignancy is 79% in this study, with a specificity of 97%. The role of fine needle aspiration cytology, as a useful diagnostic tool and a necessary adjunct to clinical examination in the assessment of breast lumps is discussed.

The prevalence of Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans in the cytology clinic at Ibadan, Nigeria.

In a study of 2224 adult women from the cytology clinic of the University College Hospital, Ibadan, Nigeria, the prevalence of 'specific vaginal infection' (i.e. Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans) was 14.5%. For individual organisms, the rates were 9.76% for G. vaginalis, 2.52% for T. vaginalis and 2.20% for C. albicans. About half of the patients were asymptomatic while others were referred from other clinics with vaginal discharge, cervical erosion, post-coital bleeding, intermenstrual bleeding and various other symptoms and signs. The infections were almost uniformly distributed in all age groups studied. Increasing promiscuity either as a result of increased mobility of husbands (due to economic depression) or increased use of contraception by older women was thought to be responsible for the persistence of these infections in those aged 45 years and above. In addition, Gardnerella vaginalis, Trichomonas vaginalis and Candida albicans infections can also be easily diagnosed from cervical cytology, by identification either of the organism or of characteristic cytological cellular changes.

PIP: Between October 1, 1986-April 30, 1989, laboratory staff at the University College Hospital in Ibadan, Nigeria tested the cervical smears of 2224 women (20 years old). 50.3% of the women underwent a smear for routine reasons and 49.7% did due to indications such as cervical erosion, cervicitis, vaginal discharge, postcoital bleeding, and intermenstrual bleeding. 14.5% of the smears revealed specific vaginal infections. Overall prevalence for Gardnerella vaginalis was 9.76%, 2.52% for Trichomonas vaginalis, and 2.2% for Candida albicans. The staff detected G. vaginalis in 63.4% of the 322 women who had a vaginal infection. 17.4% had syphilis and 15.2% candidiasis. 30.44 year old women comprised the largest group of women (46.8%) with these sexually transmitted diseases (STDs). Yet there was a sizable percentage of women 45 years old with an STD (22.1%), especially the uneducated women. This could be due to the economic necessity of husbands leaving wives to find work and who consequently have several sexual partners. It may also be a result of increased contraceptive use among older women which fosters multiple sexual relationships. 43.13% of women with a vaginal infection had a discharge. 24.51% of all women who presented with vaginal discharge tested positive for G. vaginalis while only 8.86% of the asymptomatic controls did. All women with abnormal smears other than those with cervical intraepithelial neoplasia were treated with oral metronidazole and vaginal clotrimazole. Only 8.9% of the women still had abnormal smears after 3 months. In conclusion, the researchers believed that cervical cytology, both identification of the organism or of characteristics cellular changes, can easily diagnose these 3 STDs.

Flexible fibre optic bronchoscopy in Ibadan: report of 6 years' experience.

This study describes 6 years' experience of flexible fibre optic bronchoscopy (FFB) at the University College Hospital, Ibadan. Ninety-three bronchoscopies were carried out in 83 patients. The study revealed 22 patients with primary lung malignancies, four with tuberculosis, three with secondary malignancies, three with sarcoidosis, and two with interstitial fibrosis. The yield from FFB was 44% and complications were encountered in only three patients, with no mortality.

Burkitts lymphoma of the ovary in Nigerian adults--a 27-year review.

Ten cases of adult Burkitts lymphoma managed over a 27-year period at the University College Hospital, Ibadan were reviewed. The incidence of adult ovarian Burkitts over the period was 1.3%. Menstrual abnormalities and abdominal masses were the most common symptoms while bilateral multinodular ovarian masses were the most constant findings at laparotomy. Diagnosis was mainly by histopathology. Surgery and chemotherapy were the main modalities of treatment. Mortality was high with cerebral metastases being the most common cause of death.

Hodgkin's disease in siblings: a case report.

Two male siblings (ages 12 and 16 years) presenting with Hodgkin's disease are reported. They were both diagnosed as stage IVB with identical histological type--lymphocyte depleted. The presence of identical sex, shared environment and the closeness of the time of onset suggested a combination of both environmental and genetic factors in the aetiology of the disease in these siblings.

Anaplastic ganglioglioma of the brainstem in an adult.

Gangliogliomas are neoplasms with neuronal and glial components. The most common location is the temporal lobe and for that reason those patients have seizures as the major complaint. Gangliogliomas with anaplastic features are uncommon. A 33-year-old man presented with a two-year history of progressively worsening right-sided weakness and contractures. Physical examination demonstrated right-sided weakness and contractures involving the upper and lower extremities. Magnetic resonance demonstrated multiple nodules involving the tegmental pons with a small projection into the prepontine cistern on the left, midbrain tegmentum on the left in the subthalamic region. The patient was studied by MRI on T1WI, T2WI, FLAIR, DWI, and magnetic resonance spectroscopy. He underwent a craniotomy and biopsy of the mass. Histological examination of the specimen revealed glial proliferation. Based on these findings the pathologic diagnosis was anaplastic ganglioglioma. Only one previous report of an anaplastic astrocytoma in the cerebello-pontine angle in an adult has been published. In children three cases were reported, only one with magnetic resonance. Our case showed multiple nodular structures hypointense on T1 and hyperintense on T2 and FLAIR with enhancement on T1 after injection of paramagnetic contrast. Only in this contribution T2 value were diffusion-weighted and ADC characteristics and (1)H spectroscopy analyzed.

Congenital benign extracranial teratoma in a Nigerian neonate.

The clinical, operative, and pathological findings associated with a huge extracranial teratoma in a Nigerian neonate are described. Especially noteworthy are the site and size of the tumor, the surgical treatment and the good prognosis. The child has remained well and developed normally 4 years after surgery.