Autopsy as a tool in the prevention of maternal mortality

Maternal mortality rates are an index of the state of a nation's health system. Maternal autopsies help to determine these rates, provide information on avoidable/unavoidable causes of mortality, consequently leading to the development of strategies for treatment and prevention ofmaternalmortality andmorbidity. The lesson from post-mortem examinations, using the vehicle of confidential enquiries into maternal deaths, can save the lives of many; causing reduction in both maternal and perinatal mortality as well as reductions in morbidity. However for autopsies to fulfil this role they must be of a very high standard and must be subjected to quality controlmeasures.Keywords: Autopsy,prevention, maternal mortality

Morbidity and Mortality Among Road Users in Benin-City, Nigeria

Background/objective: Murray and Krug had reported that road traffic injuries are a major cause of death globally, with disproportionate number occurring in developing counties. Seventy out of 308 deaths that occurred in Benin City from August 2002-July 2003, representing 22.7% of all deaths was due to road traffic injuries. Despite this observation, there is a paucity of data on road traffic morbidity and mortality. The aim of this study was to evaluate patterns of morbidity and mortality among drivers and passengers of cars involved in road traffic accidents in Benin-City Nigeria from August 2002-July 2003 as a base line data. Methods: Eighty-seven car drivers and passengers who were studied were part of a larger study, involved in a road traffic accident and brought to the accident and emergency units of either the University of Benin Teaching Hospital or the State Specialist Hospital between August 2002-July2003.The injured ones were examined and dead patients had autopsy done on them. Results: Over all, out of 283 total accidents cases reviewed in the period of study 87 were car occupants representing 30.7% of all accident cases, and 67 patients (23.7%) sustained varying injuries, while 20 patients (7.1%) died. Commercial cars were involved in majority of cases 85%. Males were also more in number. Intracranial hemorrhage was the predominant cause of death. Conclusion: Occupants of cars accounted for the singular most common category of morbidity and mortality among all road users. The male to female ratio was 2.1:1. Windscreen injuries most commonly associated with facial and head injuries represented the commonest cause of morbidity and mortality. The commonest autopsy finding as cause of death was intra-cranial hemorrhage.Contexte/Objectif: Murray et Krug avaient rapport\ue9 cela rles dommages du trafic d'oad sont une cause importante de la mort globalement, avec le nombre disproportionn\ue9 se produisant dans les comt\ue9s se d\ue9veloppants. Soixante-dix sur les 308 d\ue9c\ue8s qui se sont produites dans la ville du B\ue9nin d'ao\ufbt 2002 \ue0 juillet 2003, repr\ue9sentant 22.7% de toutes les d\ue9c\ue8s \ue9taient dus aux dommages du trafic de route. En d\ue9pit de cette observation, il y a un manque des donn\ue9es sur la morbidit\ue9 et la mortalit\ue9 du trafic de route. Le but de cette \ue9tude est 1. Pour \ue9valuer des mod\ue8les de la morbidit\ue9 et de la mortalit\ue9 parmi des conducteurs et des passagers des voitures impliqu\ue9es dans des accidents de trafic de route dans la B\ue9nin-Ville Nig\ue9ria de Ao\ufbt 2002 \ue0 juillet 2003 comme grande ligne donn\ue9es. M\ue9thodes: Les conducteurs et les passagers de voiture d'Eighty-seven qui ont \ue9t\ue9 \ue9tudi\ue9s faisaient partie de une plus grande \ue9tude, impliqu\ue9 dans un accident de trafic de route et apport\ue9 aux unit\ue9s d'accidents et de secours de l'universit\ue9 de l'h\uf4pital de enseignement du B\ue9nin ou de l'h\uf4pital de sp\ue9cialiste en \ue9tat entre l'ao\ufbt 2002 \ue0 juillet 2003. Bless\ue9s ont \ue9t\ue9 examin\ue9s et les patients morts ont eu autopsie faite sur eux. R\ue9sultats: Au-dessus de tous, sur 283 cas totaux d'accidents pass\ue9s en revue dans la p\ue9riode de l'\ue9tude 87 \ue9taient des occupants de voiture repr\ue9sentant 30.7% de tous les cas d'accidents, et 67 patients (23.7%) ont soutenu des dommages variables, alors que 20 patients (7.1%) mouraient. Des voitures commerciales ont \ue9t\ue9 impliqu\ue9es dans la majorit\ue9 d'affaires 85%. Les m\ue2les \ue9taient \ue9galement plus en nombre. L'h\ue9morragie intra-cr\ue2nienne \ue9tait la cause pr\ue9dominante de la mort. Conclusion: Les occupants des voitures ont expliqu\ue9 le singulier la plupart de cat\ue9gorie commune de morbidit\ue9 et mortalit\ue9 parmi tous les utilisateurs de route. Le m\ue2le au rapport femelle \ue9tait 2.1:1. Dommages de pare-brise le plus g\ue9n\ue9ralement associ\ue9s aux dommages faciaux et principaux a repr\ue9sent\ue9 la cause la plus commune de la morbidit\ue9 et de la mortalit\ue9. L'autopsie la plus commune trouvant comme cause de la mort \ue9tait h\ue9morragie intra-cr\ue2nienne

Haemangioma of the Uterine Cervix in a Postmenopausal Woman – A Case Report

Haemangioma of the cervix is rare and it is often discovered incidentally. A 50-year old postmenopausal woman was being managed for postmenopausal bleeding due to endometrial hyperplasia and was discovered to have a non-friable cervical mass during vaginal examination at one of the follow-up visits. The mass was excised and  histopathological diagnosis of capillary haemangioma was made. The local excision was adequate and the patient had no new complaint at the last follow-up visit which was  about 6 months postexcision. The management approach to cervical haemangioma is conservative treatment except when it provokes life-threatening haemorrhage in which case hysterectomy may be considered. Clinicians should consider haemangioma in the differential diagnosis of cervical mass/lesion in a postmenopausal woman but unlike endometrial haemangioma, conservative approach is often successful in its  management.Keywords: Haemangioma, cervix, postmenopausal, haemorrhage

RECTAL CARCINOMA IN A NINE YEAR OLD NIGERIAN MALE CHILD: CASE REPORT

Carcinoma of the colon and rectum are rare in children and under the age of 40 years. A caseof coro-rectal carcinoma in a nine-year-old Nigerian male child is reported. Family history wassignificant in the patient, it revealed that his father died three years earlier because of chronicdiarrhoea and mucoid stool with associated on and off constipation and one of his elder brothersdied eight years ago of colonic cancer at the age of twenty years. Exploratory laparotomy was donefor the patient which revealed fixed rectosigmoid tumour with metastases to the liver, omentumand small intestine and ascites was also found. Hartmann’s procedure with sigmoid colostomy wasperformed and the tumour was resected. Histological report of the biopsy specimen was consistentwith poorly differentiated adeno-carcinoma. To the best of our knowledge, the youngest patientrecorded in the literature is seven years old, which is younger than our patient, but this is still theyoungest in our records

Morphological Pattern of Childhood Solid Tumours in Lagos University Teaching Hospital.

Background: There is a wide variation in the incidence of childhood tumors world wide. The relative incidence of childhood tumors in developing countries is increasing and might add significantly to the high childhood morbidity and mortality caused by infectious diseases. There is need to determine the incidence of childhood cancer in different centers of the country and contribute to the National cancer register Objective: The aim of this study is to determine the burden and patterns of childhood tumour in our environment. Methods: A retrospective review of histologically diagnosed cases of childhood tumours seen from January 2000 to 2007 from the records of the department of Morbid Anatomy of the Lagos University Teaching Hospital (LUTH), Nigeria was carried out. All the cases were analyzed for age and gender distribution as well as histological types Results: Malignant tumours constituted 30.50% of the tumours of which retinoblastoma is the most common. The most common benign tumour was fibroadenoma accounting for 36.2% of all benign tumours. The female to male ratio for malignant and benign tumours are 1:1 and 1:1.3 respectively. The peak age incidence was 11 – 15 years for benign and 1 – 5 for malignant tumours. . Conclusion: The study showed decrease in the annual incidence of childhood tumours in Lagos. There was however no difference in the pattern when compared with other centers in Nigeria and in other African countries.Keywords: Morphology, Pattern, Childhood, Solid tumour

Evaluation Of The Toxicity And Reversibility Profile Of The Aqueous Seed Extract Of Hunteria Umbellata (K. Schum.) Hallier F. In Rodents

Hunteria umbellata (K. Schum.) Hallier f. (family: Apocynaceae) is reputed for the folkloric management of labour, pain and swellings, stomach ulcers, diabetes, obesity, and anaemia, with no scientific report of its toxicity and reversibility profile. The present study was, therefore, aimed at investigating the in vivo toxicity and reversibility profile of the aqueous seed extract of Hunteria umbellata (HU). The acute oral and intraperitoneal toxicity studies of HU were determined in Swiss albino mice while its 90-day oral toxicity and toxicity reversibility profile on anthropometric, biochemical, haematological and histopathological parameters were also assessed using standard procedures. Results showed that the LD50 values for the acute oral and intraperitoneal toxicity studies for HU were estimated to be 1000 mg/kg and 459.3 mg/kg, respectively. Visible signs of immediate and delayed toxicities including starry hair coat, respiratory distress, and dyskinesia were observed. For the chronic oral toxicity study, HU administered for 90 days produced significant (p<0.001) reductions in the weight gain pattern and significant (p<0.001) and dose related increases in the relative weights of liver, stomach, spleen, testis, lungs and heart, at the 100 and 500 mg/kg of HU. Chronic HU treatment also produced significant (p<0.05, p<0.001) dose related reductions in the serum levels of fasting blood glucose, bicarbonate, urea and creatinine while causing non-significant (p>0.05) alterations in the serum levels of sodium, potassium, alaninine transaminase, aspartate transaminase, alkaline phosphatase, total and conjugated bilirubin, total protein and albumin. Also, chronic oral treatment with HU produced significant (p<0.05, p<0.01, p<0.001) and dose-related increases in the red cell count, packed cell volume, haemoglobin concentration, platelet count, total leucocyte count and lymphocyte differential while producing significant (p<0.05) reductions in neutrophil and granulocyte differentials. HU also produced histological features of proliferations of the stomach epithelia, lung tissues, splenic white and red pulps, and testicular spermatogenic series. Following 14 days of oral toxicity reversibility test, there was no significant (p>0.05) reversal in the serum levels of the biochemical and haematological parameters investigated, including the HU-induced histological lesions. Overall, results of this study showed that HU has a relatively low oral toxicity profile but its prolonged use, particularly, at high doses should be with great caution

SURGICAL COMPLICATIONS FROM LOCAL HERBAL PRACTITIONERS: REPORT OF FIVE CASES

SUMMARYOver a 12-month period, five patients (out of a total of 72) with serious complications resulting fromuse of herbs by traditional healers were seen at the surgical unit of Olabisi Onabanjo UniversityTeaching Hospital, Sagamu, Nigeria. The age range was one and a half to five years with a meanage of 23.4 ± SD years and a male to female ratio of 3:2. All the cases were misdiagnosed andmismanaged and ended up with various complications. Such as penile amputations, digital necrosis,upper and lower limb gangrene as well a severe sepsis among others. Ignorance, cultural beliefsand attitudes, delusion, poverty and inaccessibility to orthodox medical practice were some of thefactors responsible for the patronage of traditional healers

Histopathological study of soft tissue malignancies in a teaching hospital, Sagamu, South-West Nigeria.

No Abstract

Female malignant breast lesions: the Lagos University Teaching Hospital experience (1999–2013)

Background: Breast cancer is the most common cancer in women worldwide and its incidence has been on the increase. Nigeria is no exception to this trend.Objectives: The aim of this study is to review malignant breast lesions seen in the Lagos University Teaching Hospital over a 15yr period (1999-2013) with a view to determining the variety of histopathologic types seen, as well as to determine the molecular characteristics of a smaller cohort of these lesions with immunohistochemistry using a panel of 5 antibodies on tissue microarray.Methods: The histopathology reports of breast lesions seen in the Anatomic and Molecular Pathology department of LUTH between 1999 and 2013 were retrieved, reviewed and analysed to determine the frequency of malignant breast lesions seen over the past 15yrs. Representative tumour slides and paraffin blocks of a smaller cohort of 115 consecutive cases seen in the last three years of the study were retrieved, reviewed and jointly scored by a Nigerian pathologist (AOD) and a UK specialist breast pathologist (AM) following the RCPath guidelines. Representative tumour areas were selected on the slides and marked on the corresponding paraffin block for tissue microarray (TMA) construction. TMA sections were stained for ER, PR, HER2, CK5 and E-cadherin.Results: A total of 4450 breast biopsies were studied; 22.3% of these neoplasms were malignant; 97.9% of all malignant breast lesions were epithelial in origin. Invasive ductal carcinoma of no specific type (IDC, NST) was the predominant histologic type accounting for 86.6%. Ductal carcinoma in situ (DCIS) and lobular carcinoma were seen in 3.2% and 1.5% respectively. A mixed ductal and lobular pattern was seen in 1.4%. Mucoepidermoid carcinoma, carcinoid tumour, and papillary carcinoma were rarely recorded, accounting for 0.1%, 0.2% and 0.4% respectively. In the smaller cohort of 115 breast cancer cases with immunopheno typing carried out , immunohistochemical staining revealed 24.4% oestrogen receptor (ER) positivity, 13.9% progesterone receptor (PR) positivity and 5.2%, human epidermal growth factor receptor-2 (HER2) positivity (score of 3+), 4.3% were equivocal ( 2+). Thirty-five percent of tumours were triple negative breast cancers (TNBC)and 52.5% of these were CK5 positive suggesting a basaloid phenotype.Conclusion: Malignant breast lesions, form about a quarter of all breast lesions seen in our laboratory, Majority (86.6%) are IDC, NST. A relatively high proportion (35%) of the immunophenotyped cohort consisted of TNBCs and about half of these had a basal phenotype (CK5+). More markers of the basal phenotype will be required to make a definitive statement on the proportion of TNBCs that have a basal phenotype.Keywords: Breast cancer, histopathologic pattern, immunohistochemistry, basal phenotyp