Marjolin’s ulcer arising from cutaneous lichen planus

The association between cutaneous lichen planus and Squamous cell carcinoma has been controversial. The rarity of documented cases, has led some to suggest that it may represent a chance association. Whilst there have been many reports of Marjolin’s ulcer arising from oral lichen planus, reports of Squamous cell carcinoma arising from or associated with cutaneous lichen planus in the literature remains sparse. The aim of this review is to report the case of a patient with a lesion previously diagnosed as cutaneous lichen planus, who developed Marjolin’s ulcer in the same location, in the absence of known exposure to exogenous carcinogens. The development of Marjolin’s ulcer from cutaneous lichen planus is not as rare as previously believed although the pathogenic mechanism for the transformation remains largely unknown.Keywords: Cutaneous lichen planus, Marjolin’s ulcer, Squamous cell carcinom

Lymphomas of the female genital tract in Ibadan

Context: Female genital tract cancers are second only to breast malignancies. Cervical cancer is the commonest while epithelial cancers constitute the major histologic type. Lymphoid neoplasms are extremely rare, with the Burkitt's variety accounting for majority of cases seen in the African female.Objective: This is a review of the obstetric/gynaecological patients seen at the University College Hospital, Ibadan between 1976 and 2005, predating the commencement of a nationwide research into non – Hodgkin's lymphoma funded by the Aboderin Foundation.Study Design: Records of subjects were analysed for their  sociodemographic and clinicopathological characteristics, recruiting only those who satisfy the criteria for diagnosing genital tract lymphomas according to Kosari et al1. Retrievable archival paraffin blocks of subjects were also analysed using immunophenotyping.Results: Fifteen cases were identified within the study period; the highest yearly incidence rate being 3 in 1977. In eighteen of the years studied no cases were seen. Most cases (80.0%) occurred in the ovaries. Eighty percent (12) of patients were 25 years or below and nulliparas and grandmultiparas formed 46.7 and 13.4% respectively. Unilateral orbilateral oophorectomy was the commonest surgical procedure (53.3%) while 20.0% had total abdominal hysterectomy with or without bilateral salpingoophorectomy. Data were unavailable concerning use of adjuvanttherapy and outcome of treatment. Four archival paraffin blocks were available for immunophenotyping using the affordable panel of CD20, CD10 and Bcl – 2 antibodies; all were Burkitt's lymphoma.Conclusion: Female genital lymphomas are very rare, affecting the young and nulliparous. The Burkitt's type is commonest

Non-invasive or minimally invasive autopsy compared to conventional autopsy of suspected natural deaths in adults: a systematic review

Objectives: Autopsies are used for healthcare quality control and improving medical knowledge. Because autopsy rates are declining worldwide, various non-invasive or minimally invasive autopsy methods are now being developed. To investigate whether these might replace the invasive autopsies conventionally performed in naturally deceased adults, we systematically reviewed original prospective validation studies. Materials and methods: We searched six databases. Two reviewers independently selected articles and extracted data. Methods and patient groups were too heterogeneous for meaningful meta-analysis of outcomes. Results: Sixteen of 1538 articles met our inclusion criteria. Eight studies used a blinded comparison; ten included less than 30 appropriate cases. Thirteen studies used radiological imaging (seven dealt solely with non-invasive procedures), two thoracoscopy and laparoscopy, and one sampling without imaging. Combining CT and MR was the best non-invasive method (agreement for cause of death: 70 %, 95%CI: 62.6; 76.4), but minimally invasive methods surpassed non-invasive methods. The highest sensitivity for cause of death (90.9 %, 95%CI: 74.5; 97.6, suspected duplicates excluded) was achieved in recent studies combining CT, CT-angiography and biopsies. Conclusion: Minimally invasive autopsies including biopsies performed best. To establish a feasible alternative to conventional autopsy and to increase consent to post-mortem investigations, further research in larger study groups is needed. Key points: • Health care quality control benefits from clinical feedback provided by (alternative) autopsies. • So far, sixteen studies investigated alternative autopsy methods for naturally deceased adults. • Thirteen studies used radiological imaging modalities, eight tissue biopsies, and three CT-angiography. • Combined CT, CT-angiography and biopsies were most sensitive diagnosing cause of death

Prevalence of Helicobacter pylori among Nigerian patients with dyspepsia in Ibadan

Introduction: Determination of the true prevalence of Helicobacter pylori (H. pylori) is difficult in a hyper-endemic area like Nigeria with use of serological tests because of their low discriminatory power between previous and current infections. The use of biopsy based methods will go a long way to mitigate this problem. We investigated the prevalence of H. pylori in dyspeptic patients and its relationship with gastroduodenal pathologies using gastric biopsy histology and rapid urease test. Methods: Eighty-six consecutive adult patients with dyspepsia underwent upper gastrointestinal endoscopy using forward-viewing endoscopes. Antral biopsy specimens were collected for histology and rapid urease test. Diagnosis of H. pylori infection was made if both or either of the tests was positive. Results: Of the 86 subjects, there were 39 (45.3%) males and 47(54.7%) females. The age range was 23 to 85 years with a mean of 49.19±13.75 years. Diagnosis of H. pylori was made in 55(64%) patients. Gastritis was the commonest endoscopic finding (60.5%), serious gastroduodenal pathology (gastric ulcer, duodenal ulcer and gastric cancer) were documented in only 12 (14%) patients. Thirty three (63.5%) of the 55 patients with gastritis had H. pylori infection while 7(58.3%) of the 12 patients with serious gastroduodenal lesions had the infection. Thirteen (72.2%) of the 18 patients that had normal endoscopic findings were H.pylori positive. Conclusion: The prevalence of H. pylori among dyspeptics using biopsy based methods is high in the South-Western part of Nigeria. It is therefore important to test and treat H. pylori among Nigerians with dyspepsia

Antibiotic-associated Pseudomembraneous Colitis in a Nigeria - a case report

No AbstractNigerian Journal of Clinical Practice Vol. 11 (2) 2008: pp. 172-17

HELICOBACTER PYLORI SEROLOGY AND EVALUATION OF GASTRODUODENAL DISEASE IN NIGERIANS WITH DYSPEPSIA

Helicobacter pylori (H. pylori) has been strongly associated with various gastroduodenal diseases worldwide with only a few studies emanating from developing countries. The objectives of this study were to determine the prevalence of serum Immunoglobulin G (IgG) and underlying gastroduodenal pathology in Nigerian patients with dyspepsia and ascertain the usefulness of H. pylori IgG screening in decreasing endoscopic workload in dyspeptics in Nigeria. Fifty-five patients with dyspepsia and 55 age and sex-matched apparently normal control were screened for H. pylori IgG using ImmunocombRII kits. Each of the 55 patients was also examined endoscopically with biopsies taken appropriately. Serology was positive in 94.5% and 92.7% of dyspeptic patients and controls respectively. Gastroduodenal inflammation was the commonest endoscopic finding, 43 (78.18%). Other findings were malignant gastric tumour 6(10.9%), reflux oesophagitis 3 (5.45%), gastric ulcer 2 (3.64%), and duodenal ulcer in 1 (1.82%). Chronic gastritis was the main histopathologic finding in the dyspeptic patients. It is concluded that serum H. pylori IgG cannot be used as a screening procedure to reduce endoscopic workload in Nigerian patients with dyspepsia. Key Words: dyspepsia; Helicobacter pylori serology; gastroduodenal disease African Journal Of Clinical And Experimental Microbiology Jan 2004 Vol.5 No.1 131-13