Retroperitoneal and Genital Lymphangioma Therapeutic Challenges in a Developing Country

Background: Lymphangiomas occur most commonly in the head and neck region, while other sites are rarely affected. A combination of retroperitoneal and genital lymphangioma is very rare indeed. Though congenital, it may persist into adulthood due to missed diagnosis and inadequate or total lack of treatment. Materials and methods: A report of a 22-year-old male student who presented with recurrent multiloculated genital, thigh, groin and retroperitneal lymphangioma. He underwent surgical excision and adjuvant sclerotherapy using ethylene-diamine tetra acetic acid. Results and Conclusions: There was an initial recurrence after surgery which responded satisfactorily to sclerotherapy. Complete surgical excision of lymphangioma may be precluded by vital structures but sclerotherapy produces satisfactory resolution. The difficulties in management with limited facilities for diagnosis and treatment are highlighted

Successful Separation Of Two Pairs Of Conjoined Twins In Ile Ife, Nigeria: Case Reports

Conjoined twins are rare phenomena occurring in one in 1 in 50,000 live births. Successful surgical separation of conjoined twins is a major undertaking requiring careful planning by a multidisciplinary team. Reports of seperation of joined twins in developing countries like Nigeria are rare. Ten cases of conjoined twins were separated between 1936 and January 2003 (including the authors two new cases). There were five omphalopagus, two pygopagus, two heterpagus and one ishiopagus twins. Three underwent emergency separation with 83.3% mortality while seven underwent elective seperation with 64.3% survival. The overall mortality rate was 50%. Despite the absence of advanced technological resource selected group of conjoined twins can be successfully separated in a developing country like Nigeria. An improvement in facilities and availability of trained personnel in likely to be associated with improved outcome. East African Medical Journal Vol.82(1) 2005: 50-5

Case Report: Hepatocelluar Carcinoma In Pregnancy And Postpartum Period: A Study Of 6 Cases In Nigerian Women.

Six Nigerians women with hepatcocelluar carcinoma (HCC) in pregnancy and the postpartum period were studied. Their ages ranged from 22 to 37 year with a mean of 28.2 years. Five (83.3%) of the women presented in the postpartum while 1 (16.7 %) presented during pregnancy.There was co – existing cirrhosis in 5 (83.3%) of them. All the 4 women tested for HBsAg were positive. Rapid tumour growth was observed in 2 women who were breastfeeding their babies while on admission. One of the 6 women had a fresh stillbirth at 32 weeks gestation but the other 5 had normal deliveries. Five out of 6 patients died on admission (after an average of 20 weeks of illness) while 1 patient discharged herself against medical advice. The major causes of death were hepatic failure and intra – peritoneal haemorrhage. This study shows that the pregnant Nigeria with women with HCC may carry her pregnancy to term and have normal delivery. Those women who do not present pregnancy may do so in the postpartum period. It is suggested that breastfeeding may ad rapid HCC growth and rupture. Key Words: Hepatocellular Carcinoma, pregnancy, postpartum period, Breastfeeding Nigerian Journal of Clinical Practice Vol.7(1) 2004: 46-4

Aetiology of vertigo in a Nigerian tertiary health facility, a multidisciplinary approach

Background: Vertigo is one of the most challenging problems faced by the otolaryngologist in every day practice. The aim of this study is to investigate the aetiology, and the clinical course of vertigo in our setting. Materials and methods: Forty-six consecutive patients attending the ENT Clinic of a Nigerian tertiary health institution with the chief complaints of vertigo were prospectively studied. The patients' history, clinical examination, the results of the laboratory investigations as well as the diagnostic imaging findings and the treatment modalities were reviewed. The patients were followed up for a minimum of 24 months.Results: There were 27(58.7%) males and 19(41.3%) females. The incidence of Vertigo was found to increase with age with a peak incidence in the 6th decade of life. The aetiologies of vertigo were found to be: Infectious diseases of the ear in 9(19.6%), Neoplasm 8(17.4%), Menieres 8(17.4.3%), Metabolic diseases 5(10.9%), while vascular disorders were found in 4(8.7%). Trauma occurred in 4(8.7%), Ocular pathology in 3(6.5%), while Vestibulotoxicity was found in 2(4.3%). Others include, Psychogenic causes in 2(4.3%) and vestibular neuronitis was the least found in 1(2.2%) of the patients. Laboratory investigations were unremarkable in all of the cases. Fasting blood sugar was found to be elevated in one of the patients with Diabetes and VDRL tests was found to be positive in the only patients with Otosyphilis. Electrocardiography (ECG), Vanyl Mandelic Acid (VMA), and thyroid function tests were normal in those patients where these investigations were indicated. Radiological investigations were helpful in detecting Temporal bone and cerebello-pontine angle tumours. Treatment consisted of labyrinthine sedative, the treatments of the primary cause and physiotherapy. Mortality was found in 2.2% of the patients. Conclusion: Infective ear diseases, Menieres' and neoplasms were found to be common. Vertigo in our centre represents an extremely broad spectrum of diagnosis. A thorough and a multidisciplinary evaluation of a vertiginous patient in a tertiary centre is hereby advocated.Keywords: vertigo, tertiary health institution, Nigeria Nigerian Journal of Otorhinolaryngology Vol. 2(2) 2005: 54-5

The World Health Organization ACTION-I (Antenatal CorTicosteroids for Improving Outcomes in preterm Newborns) Trial: a multi-country, multi-centre, two-arm, parallel, double-blind, placebo-controlled, individually randomized trial of antenatal corticosteroids for women at risk of imminent birth in the early preterm period in hospitals in low-resource countries

BACKGROUND: Antenatal corticosteroids (ACS) have long been regarded as a cornerstone intervention in mitigating the adverse effects of a preterm birth. However, the safety and efficacy of ACS in hospitals in low-resource countries has not been established in an efficacy trial despite their widespread use. Findings of a large cluster-randomized trial in six low- and middle-income countries showed that efforts to scale up ACS use in low-resource settings can lead to harm. There is equipoise regarding the benefits and harms of ACS use in hospitals in low-resource countries. This randomized controlled trial aims to determine whether ACS are safe and efficacious when given to women at risk of imminent birth in the early preterm period, in hospitals in low-resource countries. METHODS/DESIGN: The trial design is a parallel, two-arm, double-blind, individually randomized, placebo-controlled trial of ACS (dexamethasone) for women at risk of imminent preterm birth. The trial will recruit 6018 women in participating hospitals across five low-resource countries (Bangladesh, India, Kenya, Nigeria and Pakistan). The primary objectives are to compare the efficacy of dexamethasone with placebo on survival of the baby and maternal infectious morbidity. The primary outcomes are: 1) neonatal death (to 28 completed days of life); 2) any baby death (any stillbirth postrandomization or neonatal death); and 3) a composite outcome to assess possible maternal bacterial infections. The trial will recruit eligible, consenting pregnant women from 26 weeks 0 days to 33 weeks 6 days gestation with confirmed live fetuses, in whom birth is planned or expected within 48 h. The intervention comprises a regimen of intramuscular dexamethasone sodium phosphate. The comparison is an identical placebo regimen (normal saline). A total of 6018 women will be recruited to detect a reduction of 15% or more in neonatal deaths in a two-sided 5% significance test with 90% power (including 10% loss to follow-up). DISCUSSION: Findings of this trial will guide clinicians, programme managers and policymakers on the safety and efficacy of ACS in hospitals in low-resource countries. The trial findings will inform updating of the World Health Organization's global recommendations on ACS use. TRIAL REGISTRATION: ACTRN12617000476336 . Registered on 31 March 2017