Metastatic breast cancer in a Nigerian tertiary hospital

Background: Late presentation of breast carcinoma is common in resource-limited countries with attendant poor outcome. Objective: To describe the pattern of clinical presentation and challenges of treating patients presenting with metastatic breast carcinoma in a Nigerian hospital. Method: Clinical records of all patients who presented with metastatic breast carcinoma between January 1991 and December 2005 at the Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria were reviewed. Results: More than half of all histologically confirmed breast cancer patients seen within the study period presented with metastatic disease. Their ages ranged between 20-81years with a mean age of 45.9 years. Only 3(6 of 202) were males. Twothirds had more than one secondary site on initial evaluation and the commonest sites were liver (63); lung parenchyma (51); pleura (26) and contralateral breast in 25. On immunohistochemistry; basal like tumours were found in 46.1. Mastectomy was done in 37 patients with fungating breast masses while only one third of those referred to a nearby center for radiotherapy had it done. One year survival rate was 27. Conclusion: Metastatic disease is common in Nigeria and treatment is limited due to resource limitations. Improved awareness of the disease is advocated to reduce late presentation

Breast Fine Needle Aspiration Cytology in a Nigerian Tertiary Hospital

Objectives:Breast disease remains a major public health issue worldwide.It is the most common cancer among Nigerian women.Fine needle aspiration cytology (FNAC) is an important preoperative assessment tool along with clinical and mammography examination in both screen detected and symptomatic breast disease.This study provide opportunity to determining the accuracy of FNAC and factors affecting false negative rate in Obafemi Awolowo University Teaching Hospital complex; Ile-Ife; Osun state Nigeria Method:All patients seen in the breast clinic with lump were sent to the pathology department for FNAC from January 1997 to December 2004.The sociodemographic data; cytology result; final histology result and the clinical staging for breast cancer were analyzed.Results:Eight hundred and sixty-four patients had FNAC during the studied period; however only 632 cases had available final histological report.Of these; 20 (3.2) were male while 612 (96.8) were female; the age ranged from 15 years to 99 years; median of 36.50.We found that absolute sensitivity for malignancy to be 70.8.The false negative rate was 14.9; while the false positive rate was 1.8.The suspicious rate was 9.8while the inadequate rate was 5.4.Conclusion:FNAC remains the least invasive; the most rapid and the most cost effective method to confirm clinical and radiological suspicion of malignancy; however; the test has high false negative rate.We recommend that consultation between pathologists and the clinicians should be facilitated and encouraged to reduce the high false negative. Also; multi-disciplinary audits of difficult case should be part of the work routine

Challenges of pancreatic cancer management in a resource scarce setting

Backgrounds: Of all forms of gastrointestinal malignancy; adenocarcinoma of the pancreas is associated with the worst survival. Management of pancreatic cancer is associated with some challenges. This study is aimed at determining the hospital incidence; sociodemographic characteristics; managements and management's outcome of carcinoma of pancreas at our hospital. We also discuss the management challenges encountered with these patients. Material and methods: We reviewed 96 pancreatic cancer patients seen at Awolowo University Teaching Hospital Complex; Ile -Ife; Nigeria; from July 1989 to July 2007. Results: There were ninety six patients diagnosed with cancer of the pancreas but only 80 patients had histological proof of pancreatic cancer. This account for 2.1of all malignancies seen and 238/100000 total admissions during the study riod. The median age is 55.0. There were 62 (64.6) male and 34 (35.4) female with male to female ratio been 2:1. Duration of symptoms in the patients ranges from 4 weeks to 109 weeks. Only three (3.1) patients has mor located in a particular anatomical sub site: two head of pancreas and one tail of the pancreas. Other patients had extensive tumor involving the head and body of the pancreas. Two patients had creaticoduodenectomy; one had resection of the tumor at the tail of pancreas and 45 patients had triple bypass. Patients with low serum albumin and serum sodium and elevated transaminases at presentation; had poorer prognosis than other patients. Conclusion: Pancreatic cancer is not uncommon in our center with male preponderance. Most patients present with advanced condition only amenable to palliative measures. There are significant challenges in the area of diagnosis; screening; treatment and research

Endoscopic hemorrhoidal sclerotherapy using 50% dextrose water: A preliminary report.

Injection sclerotherapy has a prominent role in the treatment of bleeding hemorrhoids. The commonly used sclerosants are not available or very expensive in Nigeria. We prospectively evaluated 50% dextrose water, used as a nonallergenic sclerosant, in the treatment of bleeding internal hemorrhoids. Forty consenting adult patients (median age 50 years [range 35–67]; 22 women) with bleeding hemorrhoids, seen over a 2-year period, were offered injection sclerotherapy with 50% dextrose water. They were assessed for response, tolerance and complications. The duration of symptoms before presentation was 3 months to 15 years. The bleeding stopped after the injection in all patients. No patient needed a repeat procedure. No complication was recorded during follow up which ranged from 2 months to 12 months. We conclude that endoscopic hemorrhoidal sclerotherapy using 50% dextrose water offers a simple, safe and effective modality of treatment if properly utilized.

Antibiotic resistance of helicobacter pylori from patients in Ile-Ife, South-west, Nigeria

Background: Helicobacter pylori has become recognized as a major cause of gastroduodenal diseases in man. Evidence indicates that once acquired; H. pylori persists; usually for life unless eradicated by antimicrobial therapy. Over the past few years; we have accumulated some knowledge of the epidemiology of H. pylori in Ile-Ife; South-West Nigeria. In one collaborative study; we detected H. pylori in 195 (73) patients referred for endoscopy at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). Furthermore we have observed a variegated gastric inflammatory response and atrophy including atrophic pangastritis but are yet to demonstrate MALToma in any of our patients. In addition we have demonstrated that dental plaque is a possible source of gastric H. pylori infection and such an endogenous source could account for difficulty in eradication leading to re-infection. Presently; infected patients are treated with standard combination therapy made up of amoxycilin and ciprofloxacin with a proton pump inhibitor /bismuth. Reports however have shown that the incidence of antimicrobial resistance in Helicobacter pylori is a growing problem and which has been linked with failures in treatment and eradication. Given this situation it has become necessary to have information about the susceptibility of isolates to particular antimicrobial agents before the selection of an appropriate treatment regimen. Objectives: More recently; we sought to study antimicrobial susceptibility of locally isolated H. pylori strains. Methods: We subjected 32 isolates to antimicrobial susceptibility testing against seven agents. Results: All the isolates showed multiple acquired antimicrobial resistance as they were all resistant to amoxicillin; clarithromycin; metronidazole; while 29/31; 27/31 showed resistance to rifampicin and tetracycline respectively. Five (15.6) of these isolates showed resistance to ciprofloxacin. Conclusions: Our findings suggest that H. pylori strains isolated within our study environment have acquired resistance to all the commonly pres-cribed antibiotics. On the basis of the findings it would be necessary to re-evaluate the eradication treatment regime in our setting

Antimicrobial susceptibility of Helicobacter pylori isolates of dyspeptic Nigerian patients.

The resistance of Helicobacter pylori to antibiotic treatment is a growing global concern, but this has not been well studied in our environment. This study sought to determine: the susceptibility of the organism to common antimicrobial agents used in its eradication therapy. Twenty H. pylori isolates from dyspeptic patients were subjected to standard procedures for sensitivity testing and the determination of minimum inhibitory concentration against amoxycillin, ciprofloxacin, clarithromycin, erythromycin, metronidazole, rifampicin and tetracycline. The study showed marked in vitro multiple antimicrobial resistance to the commonly used eradication agents. All twenty isolates were however sensitive to ciprofloxacin. The findings of marked antimicrobial resistance may affect the effectiveness of currently recommended eradication regimes. In our environment, incorporating ciprofloxacin into the existing H. pylori antimicrobial therapy may improve the outcome of eradication.

Spectrum of causes of intestinal obstruction in adult Nigerian patients : general surgery

Objective. To present changes in the cause of intestinal obstruction in an African setting. Design. Consecutive cases of acute intestinal obstruction from 1985 to 1994. Setting. Obafemi Awolowo University Teaching Hospitals Complex; Ile-Ife; Nigeria. Subjects. Adult patients with clinical and radiological evidence of intestinal obstruction. Results. There were 99 patients (60 males) aged 15 - 101 years (mean age 45 years). The majority of patients were young and middle-aged adults. Main causes of obstruction included adhesion (N = 44); volvulus (N =15); external hernias (N = 11); colorectal carcinoma (N = 10) and intussusception (N = 8). Approximately twothirds of patients (28/44) with adhesion had had previous abdominal operations. The overall mortality was 14; mainly owing to strangulation obstruction and colonic malignancy. Conclusions. The increasing role of adhesions as a cause of acute intestinal obstruction demands greater need for routine preventive measures against adhesion formation

Helicobacter pylori in the dental plaque and gastric mucosa of dyspeptic Nigerian patients.

BACKGROUND: Presence of helicobacter pylori (H.Pylori) in the dental plaques may be associated with the presence of the same organism in gastric mucosa. OBJECTIVES: To assess and compare the prevalence of H. pylori in dental plaques and gastric mucosa of dyspeptic Nigerians. METHODS: Sixty-six consecutive patients undergoing endoscopy for investigation of dyspepsia were included in the study. A predesigned questionnaire was used to collect information on socio-demographic and other factors. Each patient also had clinical dental examination. Dental plaque scrapping was collected before endoscopy for helicobacter pylori culture, and at endoscopy, two gastric biopsy specimens were taken for culture and histology. RESULTS: The mean age (+/- SD) of the patients was 44.8 (+/- 17.4) years (range 5 to 80 years). The positivity rate of helicobacter pylori in gastric biopsy was 35 of 66 (53.0%) while the same for dental plaque was 46 of 66 (69.7%). The correlation (Spearman's) between gastric mucosa and dental plaque colonization with helicobactor pylori was significant (R = 0.30, P = 0.01). When concordant positivity of gastric biopsy culture and histology was taken as diagnostic, the sensitivity of dental plaque culture was found to be 82.9% and the specificity was 45.2%. CONCLUSIONS: This study revealed that helicobactor pylori has a high prevalence in the dental plaque of the population that we have studied and may therefore be of potential relevance in screening for such infection.