Neuroblastoma occurring in a 38-year old Nigerian man: a rare finding

Neuroblastoma (NB) is a common malignancy in children, but rarely occurs in adults. Accepted unfavorable prognostic factors include age over one year, low histological grade and advanced stage, MYCN amplification, chromosomal aberrations, elevations of neuron specific enolase and lactate dehydrogenase, and increased catecholamine metabolites in urine or serum. In adults, abdomen/retroperitoneum are the primary sites and in children the adrenal gland. We report a 38-year old civil servant who presented at our urology clinic on the 21st of December 2007 with a six month history of right flank dull pain which was worse on walking and relieved by rest, hypertension and a large right retroperitoneal mass. Tumor resection revealed a grade III NB. Chemotherapy using a combination of vincristine, adriamycin and cyclophosphamide was started. Follow-up showed regression of the mass initially with a relapse after patient absconded for three months. He resurfaced with new masses and he had a repeat chemotherapy with disappearance of the masses and is currently undergoing further treatment. To our knowledge this is the only report of NB in an adult registered so far in Nigeria and perhaps the whole of Africa. Currently, there are no standard treatment guidelines for patients with NB in adulthood. This study emphasizes the need for a standard treatment regime for adult onset neuroblastoma and its recognition as a possible differential in intra-abdominal mass in adults

Death patterns among Nigerian leaders

BACKGROUND:The aim of this study is to establish the patterns of death amongst Nigerian leaders since independence, thus providing a feasible avenue to avoid their recurrence if possible especially amongst the political elite who currently hold power. METHODS: Using available unclassified authentic public information, all leaders who had ruled Nigeria since her independence on 1 October, 1960 until her 45th birthday on 1 October 2005, irrespective of whether they are dead or alive were included. Data was extracted and analyzed. RESULTS: On 1 October 2005, Nigeria celebrated 45 years as a sovereign nation. Within this period, the country has had eleven leaders, all of whom were men. Only three (27.3%) were civilians, while eight (72.7%) were army generals. Of the eleven leaders, four (36.4%) had died before Nigeria reached its 45th birthday and all of these four (100%) died while still in office. Three of the dead leaders (75%) were assassinated, while one (25%) died suddenly in mysterious circumstances, believed to be the result of poisoning by unknown external powerful interest groups. Three of the deaths (75%) occurred during violent periods of Nigeria’s checkered history (1966-1970 and 1993-1999), showing that periods of national and international strife appeared to be the weakest link in chains of events that led to their death while in office. Autopsies were neither requested nor performed on any of the dead leaders, signifying an entrenched culture of nonchalance, a lack of a coordinated national coroner’s law and contempt for accurate and detailed death records. Worse still, no valid tenable death certificate has ever been issued. In other words, no attempt has been made to determine the cause of death of four of the nation’s former leaders. Only hurried national burials were accorded two (50%) of them while the other two (50%), who died in the coup and revenge coup of 1966, were completely neglected, and not even given a decent national burial. CONCLUSIONS: The facts identified above will serve as a landmark to highlight an existing problem, and thus bring the issue to the attention of policy-makers and the political elite. The overall expected benefit is that nations like Nigeria can focus on the issue of orderly succession and the peaceful handing-over of government to duly transparently elected national leaders and all efforts should be made to avoid holding on to power unnecessarily. The tenets of democracy shall be upheld and transparent elections take place so as to reduce national tension and strife to the barest minimum. We also strongly recommend a review and improvement of Nigeria’s national coroner’s laws

Enclosure asphyxia as a cause of death in 3 Nigerian children trapped at the boot of car-Case reports and review of literature

The paper reviews enclosure asphyxia as a cause of death of three Nigerian children aged three years, five years and seven years respectively, who were found dead and locked in the boot of a Mercedes Benz 200E Sedan car a day after they were declared missing. The first two were siblings of the same parent whose fathers actually owned the car, while the older child was a neighbour kid all of whom were well known to each other as friends and playmates. They had gone missing for a few hours prior to being seen playing together. Search parties were raised and they were never found until the following day when they were found dead in the boot of the car parked a few meters away from the house under a tree. Incidentally the same car was driven round the neighbourhood for 3 hours during the search the previous day with no inkling that they were in the boot of the car. Autopsy was ordered by the coroner to determine the cause of death

Cerebellar liponeurocytoma: a novel report from Nigeria in a 6-year-old girl, and review of literature

Liponeurocytoma is a newly defined clinical entity predominantly seen in the cerebellum as a slow-growing tumor. In this report, we present the case of a 6-year-old Nigerian girl with a liponeurocytoma, and review of literature

The Challenges of Management of High-grade Gliomas in Nigeria

Background: High-grade gliomas (HGG) are among the most challenging brain tumors despite many research efforts worldwide. Aim: The aim of this study was to evaluate the local challenges that may influence outcome of HGG managed in a neurosurgical center in Nigeria. Methodology: Retrospective analysis of prospectively recorded data of patients managed for intracranial HGG at Memfys Hospital for Neurosurgery, Enugu, Nigeria, between the year 2006 and 2015. Only cases with conclusive histology following surgery were analyzed. Results: Glioma was 60 (23.8%) of 252 histology confirmed brain tumors. HGG represented 53.8% of gliomas with male:female ratio of 2.2:1.0 and peaked from fifth decade of life. Glioblastoma multiforme accounted for 69% of HGG. At 1-year postsurgery, 53% of HGGs were dead and 88% of these deaths were in the World Health Organization Grade IV group. Only 40% of cases could receive adjuvant treatment with only 15% mortality at 1 year in this subgroup that received adjuvant therapy. In addition, 19% of cases had surgery at Karnofsky score (Ks) of ≤70%. However, 94% of mortality at 1 year was related to surgery at Ks of ≤60%. Only four patients had a tumor volume of ≤50 cm3, and among these cases, three patients were independent at 1 year. Patients with tumor volume above 50 cm3 accounted for 94% of mortality. Conclusion: The peak age incidence for HGG seems to be lower than in Caucasians. Most cases present late with poor Ks and big tumor volume. The proportion with access to adjuvant treatment is still poor. Preoperative Karnofsky, extent of resection, duration of hospital, and Intensive Care Unit stay have impact on outcome